Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China.
Department of Public Health Emergency Treatment, Hunan Center for Disease Control and Prevention (CDC), Changsha, Hunan Province, 410005, China.
Public Health. 2019 May;170:49-56. doi: 10.1016/j.puhe.2019.01.014. Epub 2019 Mar 28.
Hepatitis C virus (HCV) infection continues to be a major public health concern in China. There is little information available in the literature about age- and sex-specific HCV incidence trends. The goal of this study was to examine recent trends in HCV incidence rates in Hunan, China, according to age and gender.
A descriptive study was implemented with a joinpoint analysis.
Based on the annual reported incidence data of hepatitis C in Hunan, China, from 2004 to 2017, we performed a joinpoint regression analysis to examine trends in the annual percentage change (APC) and the average annual percentage change (AAPC) in the incidence of HCV infection throughout the study period; we stratified the analysis by gender and age. The software calculates the APC, AAPC and the 95% confidence intervals for each trend segment and tests whether the slope for each segment has a significant difference from the prior segment using a Z test.
From 2004 to 2017, the overall incidence rate of HCV infection rose from 0.93 per 100,000 to 20.88 per 100,000 (AAPC, 25.2%). In particular, women aged ≥65 years had the fastest increasing rate (AAPC, 29.9%). The incidence of different demographic groups showed no significant difference in increasing trends before 2013. However, new patterns emerged after 2013: the incidence of people aged 0-14 years was no longer significantly elevated; a significant yearly decline occurred in the incidence of HCV in people aged 15-29 years; the incidence of HCV in people aged ≥30 years continued to increase, with significantly slower increasing rates than before; and women aged ≥65 years showed a significantly higher yearly increase in incidence than that in men in the same age group (APC, 11.1% in women versus 5.3% in men).
The overall increasing rate of HCV infection significantly slowed after 2007 and 2013. The differences in incidence trends among demographic groups have obviously increased in the last 5 years, and the reasons underlying these different trends urgently require further study. People in older age groups, especially women aged ≥65 years, still experienced increases in incidence rates in the last 5 years. This finding indicates that programmes for the prevention and control of HCV infection in older people require continued strengthening.
在中国，丙型肝炎病毒（HCV）感染仍然是一个主要的公共卫生问题。关于年龄和性别特异性 HCV 发病率趋势的文献资料很少。本研究的目的是根据年龄和性别，研究湖南省 HCV 发病率的近期趋势。
采用描述性研究和 joinpoint 分析。
基于 2004 年至 2017 年中国湖南丙型肝炎年度报告发病率数据，我们进行了 joinpoint 回归分析，以检查整个研究期间 HCV 感染发病率的年度百分比变化（APC）和平均年度百分比变化（AAPC）的趋势；我们按性别和年龄对分析进行分层。该软件计算每个趋势段的 APC、AAPC 和 95%置信区间，并使用 Z 检验测试每个段的斜率是否与前一段有显著差异。
2004 年至 2017 年，HCV 感染总发病率从 0.93/100000 上升至 20.88/100000（AAPC，25.2%）。特别是，≥65 岁的女性增长率最快（AAPC，29.9%）。在 2013 年之前，不同人群的发病率增长趋势没有明显差异。然而，2013 年之后出现了新的模式：0-14 岁人群的发病率不再显著升高；15-29 岁人群的 HCV 发病率呈显著下降趋势；≥30 岁人群的 HCV 发病率持续上升，增长率明显低于之前；≥65 岁的女性发病率年增长率明显高于同年龄组的男性（APC，女性为 11.1%，男性为 5.3%）。
2007 年和 2013 年后，HCV 感染的总体增长率显著放缓。过去 5 年，不同人群发病率趋势的差异明显增加，这些不同趋势的原因迫切需要进一步研究。年龄较大的人群，尤其是≥65 岁的女性，在过去 5 年中仍有发病率上升的趋势。这一发现表明，需要继续加强针对老年人 HCV 感染的预防和控制计划。
