Li Xin-Xu, Ren Zhou-Peng, Wang Li-Xia, Zhang Hui, Jiang Shi-Wen, Chen Jia-Xu, Wang Jin-Feng, Zhou Xiao-Nong
National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China.
Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China.
PLoS Negl Trop Dis. 2016 Apr 18;10(3):e0004580. doi: 10.1371/journal.pntd.0004580. eCollection 2016 Mar.
Both pulmonary tuberculosis (PTB) and intestinal helminth infection (IHI) affect millions of individuals every year in China. However, the national-scale estimation of prevalence predictors and prevalence maps for these diseases, as well as co-endemic relative risk (RR) maps of both diseases' prevalence are not well developed. There are co-endemic, high prevalence areas of both diseases, whose delimitation is essential for devising effective control strategies. Bayesian geostatistical logistic regression models including socio-economic, climatic, geographical and environmental predictors were fitted separately for active PTB and IHI based on data from the national surveys for PTB and major human parasitic diseases that were completed in 2010 and 2004, respectively. Prevalence maps and co-endemic RR maps were constructed for both diseases by means of Bayesian Kriging model and Bayesian shared component model capable of appraising the fraction of variance of spatial RRs shared by both diseases, and those specific for each one, under an assumption that there are unobserved covariates common to both diseases. Our results indicate that gross domestic product (GDP) per capita had a negative association, while rural regions, the arid and polar zones and elevation had positive association with active PTB prevalence; for the IHI prevalence, GDP per capita and distance to water bodies had a negative association, the equatorial and warm zones and the normalized difference vegetation index had a positive association. Moderate to high prevalence of active PTB and low prevalence of IHI were predicted in western regions, low to moderate prevalence of active PTB and low prevalence of IHI were predicted in north-central regions and the southeast coastal regions, and moderate to high prevalence of active PTB and high prevalence of IHI were predicted in the south-western regions. Thus, co-endemic areas of active PTB and IHI were located in the south-western regions of China, which might be determined by socio-economic factors, such as GDP per capita.
在中国，肺结核（PTB）和肠道蠕虫感染（IHI）每年都影响着数百万人。然而，针对这些疾病的全国范围患病率预测因素及患病率地图，以及两种疾病患病率的共流行相对风险（RR）地图都尚未完善。存在两种疾病共流行的高患病率地区，确定这些地区对于制定有效的控制策略至关重要。基于分别于2010年和2004年完成的全国肺结核调查及主要人体寄生虫病调查数据，针对活动性肺结核和肠道蠕虫感染，分别拟合了包含社会经济、气候、地理和环境预测因素的贝叶斯地理统计逻辑回归模型。通过贝叶斯克里金模型和贝叶斯共享成分模型构建了两种疾病的患病率地图和共流行RR地图，这两个模型能够在假设存在两种疾病共有的未观察协变量的情况下，评估两种疾病共享的空间RR方差比例以及每种疾病特有的方差比例。我们的结果表明，人均国内生产总值（GDP）与活动性肺结核患病率呈负相关，而农村地区、干旱和极地地区以及海拔与活动性肺结核患病率呈正相关；对于肠道蠕虫感染患病率，人均GDP和与水体的距离呈负相关，赤道和温暖地区以及归一化植被指数呈正相关。预计西部地区活动性肺结核患病率为中到高，肠道蠕虫感染患病率为低；中北部地区和东南沿海地区活动性肺结核患病率为低到中，肠道蠕虫感染患病率为低；西南部地区活动性肺结核患病率为中到高，肠道蠕虫感染患病率为高。因此，活动性肺结核和肠道蠕虫感染的共流行地区位于中国西南部，这可能由社会经济因素如人均GDP决定。
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