Shu Jun-Tao, Jiang Ting, Li Chen-Yu, Zou Mei-Yin, Zhou Xiao-Yi, Zhuang Xun, Zhang Bin, Jiang Yin-Hua, Qin Gang
Joint Division of Clinical Epidemiology, Affiliated Hospital of Nantong University, School of Public Health of Nantong University, Nantong, JS, China.
Department of Infectious Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, JS, China.
BMC Public Health. 2025 Jul 2;25(1):2194. doi: 10.1186/s12889-025-22515-8.
Sexually transmitted infections (STIs), including HIV, gonorrhea, and syphilis, pose significant public health challenges globally. In China, rising STI incidences are associated with rapid urbanization and changing sexual behaviors. This study aims to analyze the trends and socioeconomic factors of these three STIs in China.
Incidence data for HIV, gonorrhea, and syphilis from 31 provinces (2002-2021) were obtained from the China Hygiene and Health Statistics Yearbook. JoinPoint regression was used to assess trends, hotspot analysis to identify spatial clusters, global principal component analysis (GPCA) to reduce data dimensionality, and a panel fixed-effects model (FEM) to identify influential factors.
The annual average percentage changes (AAPCs) in incidence were 20.68% for HIV, - 2.37% for gonorrhea, and 11.55% for syphilis. Hotspot analysis revealed persistent HIV clusters in western provinces, gonorrhea clusters in the eastern coastal and parts of central provinces, and expanding syphilis clusters from western and central provinces to the entire country. GPCA extracted three components, explaining 83% of the overall variance. PA1 includes factors such as nighttime light data (NLD) and population density (PD). PA2 includes passenger volume (PAX), the working-age population aged 15-64 (P) and the number of healthcare institutions (HCIs). PA3 encompasses GDP per capita (pGDP) and the sex ratio (SR). FEM analysis showed that socioeconomic factors had varying impacts on the three STIs. HIV was negatively associated with PA1 (β = - 1.049, P < 0.05) and positively associated with PA2 (β = 0.614, P < 0.001), and negatively associated with PA3 (β = - 0.721, P < 0.001). Gonorrhea was positively associated with PA1 (β = 16.005, P < 0.001) and PA2 had strong positive correlations in most regions, while PA3 was not significant nationally. Syphilis had a negative association with PA3 at the national level (β = - 5.517, P < 0.001).
This study demonstrates temporal and spatial variations in STI epidemiology in China from 2002 to 2021, reflecting socioeconomic development disparities. The findings highlight the need for geographically and socioeconomically tailored interventions to improve STI control strategies.
包括艾滋病毒、淋病和梅毒在内的性传播感染在全球范围内构成了重大的公共卫生挑战。在中国，性传播感染发病率的上升与快速城市化和性行为的改变有关。本研究旨在分析中国这三种性传播感染的趋势和社会经济因素。
从《中国卫生健康统计年鉴》获取了31个省份2002 - 2021年的艾滋病毒、淋病和梅毒发病率数据。采用JoinPoint回归评估趋势，热点分析识别空间聚集区，全局主成分分析（GPCA）降低数据维度，并使用面板固定效应模型（FEM）识别影响因素。
艾滋病毒发病率的年平均变化百分比（AAPCs）为20.68%，淋病为 - 2.37%，梅毒为11.55%。热点分析显示，西部省份存在持续的艾滋病毒聚集区，东部沿海地区和部分中部省份存在淋病聚集区，梅毒聚集区则从西部和中部省份扩展至全国。GPCA提取了三个成分，解释了总体方差的83%。主成分1（PA1）包括诸如夜间灯光数据（NLD）和人口密度（PD）等因素。主成分2（PA2）包括客运量（PAX）、15 - 64岁劳动年龄人口（P）和医疗机构数量（HCIs）。主成分3（PA3）包括人均国内生产总值（pGDP）和性别比（SR）。FEM分析表明，社会经济因素对这三种性传播感染有不同影响。艾滋病毒与PA1呈负相关（β = - 1.·049，P < 0.05），与PA2呈正相关（β = 0.614，P < 0.001），与PA3呈负相关（β = - 0.721，P < 0.001）。淋病与PA1呈正相关（β = 16.005，P < 0.001），且在大多数地区与PA2有很强的正相关性，而PA3在全国范围内不显著。梅毒在国家层面与PA3呈负相关（β = - 5.517，P < 0.001）。
本研究展示了2002年至2021年中国性传播感染流行病学的时空变化，反映了社会经济发展差异。研究结果凸显了需要采取因地制宜、符合社会经济情况的干预措施来改进性传播感染控制策略。
