Long-term variations of urban–Rural disparities in infectious disease burden of over 8.44 million children, adolescents, and youth in China from 2013 to 2021: An observational study

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-04-01 DOI:10.1371/journal.pmed.1004374
Li Chen, Yi Xing, Yi Zhang, Junqing Xie, Binbin Su, Jianuo Jiang, M. Geng, Xiang Ren, Tongjun Guo, W. Yuan, Qi Ma, Manman Chen, M. Cui, Jieyu Liu, Yi Song, Liping Wang, Yanhui Dong, Jun Ma
{"title":"Long-term variations of urban–Rural disparities in infectious disease burden of over 8.44 million children, adolescents, and youth in China from 2013 to 2021: An observational study","authors":"Li Chen, Yi Xing, Yi Zhang, Junqing Xie, Binbin Su, Jianuo Jiang, M. Geng, Xiang Ren, Tongjun Guo, W. Yuan, Qi Ma, Manman Chen, M. Cui, Jieyu Liu, Yi Song, Liping Wang, Yanhui Dong, Jun Ma","doi":"10.1371/journal.pmed.1004374","DOIUrl":null,"url":null,"abstract":"Background An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban–rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities. Methods and findings This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China’s Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban–rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban–rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban–rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility. Conclusions A significant urban–rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban–rural disparity.","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":null,"pages":null},"PeriodicalIF":15.8000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PLoS Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1371/journal.pmed.1004374","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Background An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban–rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities. Methods and findings This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China’s Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban–rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban–rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban–rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility. Conclusions A significant urban–rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban–rural disparity.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
2013-2021年中国超过844万儿童、青少年传染病负担城乡差异的长期变化:一项观察性研究
背景 在经济发展和城市化的推动下,流行病学加速转型,导致疾病谱迅速变化。然而,这种转型也导致了城乡之间传染病负担的不同变化。我们的研究旨在评估中国儿童、少年和青年传染病的长期城乡差异,同时研究造成这些差异的特定疾病。方法和结果 本观察性研究从 8,442,956 例 4 至 24 岁人群中收集了 43 种应报告传染病的数据,其中城市地区 4,487,043 例,农村地区 3,955,913 例。2013 年至 2021 年的数据来自中国应报传染病监测系统。43 种传染病分为 7 类:疫苗可预防疾病、细菌性疾病、胃肠道和肠道病毒性疾病、性传播和血液传播疾病、病媒性疾病、人畜共患病和检疫性疾病。传染病发病率的计算按城市和农村地区进行分层。我们使用发病率比指数(IRR)来评估城乡差异,该指数是用每类疾病的城市发病率除以农村发病率计算得出的。在九年的研究期间,城市和农村地区的大多数应报告传染病都呈现出下降或稳定的模式。但是,在应报告的传染病中,城乡差异明显且逐渐扩大。城市儿童、少年和青年的年平均发病率高于农村儿童、少年和青年,分别为每 10 万人 439 例和每 10 万人 211 例(IRR:2.078,95% CI [2.075,2.081];P <0.001)。从 2013 年到 2021 年,这种差异主要是由于百日咳(IRR:1.782,95% CI [1.705,1.862];p <0.001)和季节性流感(IRR:3.213,95% CI [3.205,3.220];p <0.001)发病率较高造成的。在疫苗可预防疾病中,结核病(IRR:1.011,95% CI [1.006,1.015];P < 0.001)和猩红热(IRR:2.942,95% CI [2.918,2.966];P < 0.001)、细菌性疾病中的感染性腹泻(IRR:1.932,95% CI [1.924,1.939];P < 0.001)和手足口病(IRR:2.501,95% CI [2.491,2.510];P < 0.001)、病媒传播疾病中的登革热(IRR:11.952,95% CI [11.313,12.628];P < 0.001)以及 4 种性传播和血液传播疾病(梅毒:梅毒:IRR 1.743,95% CI [1.731,1.755],P <0.001;淋病:IRR 2.658,95% CI [2.635,2.682],P <0.001;艾滋病毒/艾滋病:IRR为2.269,95% CI [2.239,2.299],P <0.001;丙型肝炎IRR为1.540,95% CI [1.506,1.575],p <0.001),但城市地区大多数人畜共患病和检疫性疾病发病率较低部分抵消了这一影响(例如,人畜共患病中的布鲁氏菌病:IRR为0.516,95% CI [0.498,0.534],p <0.001;检疫性疾病中的出血热:IRR为0.930,95% CI [0.498,0.534],p <0.001):IRR为0.930,95% CI [0.881,0.981],p = 0.008)。此外,中国中部地区(IRR:1.704,95% CI [1.699,1.708];P <0.001)和东北地区(IRR:1.713,95% CI [1.700,1.726];P <0.001)的总体城乡差异尤为明显。我们研究的一个主要局限是,发病率是根据年平均人口数据计算的,没有考虑人口流动性。结论 我们的研究表明,在儿童、青少年中,应报告传染病的发病率存在明显的城乡差异。城市地区的负担比农村地区高出 2 倍多,而且这种差距似乎还在扩大,尤其是受结核病、猩红热、感染性腹泻和斑疹伤寒的影响。这些研究结果突出表明,迫切需要采取干预措施来减轻传染病的负担,并解决城乡差距日益扩大的问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
期刊最新文献
Impact of active case finding for tuberculosis with mass chest X-ray screening in Glasgow, Scotland, 1950-1963: An epidemiological analysis of historical data. Safety and tolerability of tegoprubart in patients with amyotrophic lateral sclerosis: A Phase 2A clinical trial. Incidence rates of hepatocellular carcinoma based on risk stratification in steatotic liver disease for precision medicine: A real-world longitudinal nationwide study. Leveraging behavioral economics strategies to close gaps in biomedical HIV prevention. The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1