关键词: 结核,肺, 发病率, 模型,统计学, 评价研究, 合成控制法

Abstract:

Objective: To evaluate the impact of the “Southern Xinjiang Model” policy on the epidemic situation of pulmonary tuberculosis (PTB) in Xinjiang Uygur Autonomous Region (referred to as “Xinjiang”) and the effect of prevention and control, to provide reference for promoting the implementation and optimization of PTB prevention and control measures in Xinjiang. Methods: Using the panel data of the reported incidence of PTB in 94 districts and counties of Xinjiang from 2011 to 2021 in the Infectious Disease Report Information Management System, the temporal trends of reported incidence of PTB in four regions of South Xinjiang (Hetian, Aksu, Kashgar, Kizilsu Kirgiz Autonomous Prefecture), other regions and the whole regions in Xinjiang were described, the correlation between them and the included influencing factors was analyzed. The “South Xinjiang Model” policy effect was evaluated using the synthetic control method, and the robustness of the results was verified with the aid of the placebo test. Results: The reported incidence rate of PTB in the four regions in southern Xinjiang from 2011 to 2021 was 316.19/100000 (337071/106601200), which was significantly higher than that in the other regions in Xinjiang (81.44/100000 (116950/143600500), χ²=186152.083, P<0.001). The results of correlation analysis showed that, from 2011 to 2021, the average reported incidence rate of PTB in 94 districts and counties in Xinjiang was 181.46/100000 (454023/250201700), which was correlated with the average proportion of agricultural population (0.436, 43.522/94) and per capita gross domestic product (GDP)(RMB 53578.10 yuan, 5036341/94)(Spearman rank correlation coefficient: 0.934 and -0.930, respectively; both Ps<0.001). Taking agricultural population proportion, GDP per capita, and number of medical beds per 1000 people, etc. as control variables, the synthetic control method was used for fitting analysis. The results showed that, from 2018 to 2021, the average annual reported incidence rate of PTB increased by 159.60/100000 (3667/2297600), 102.80/100000 (1678/1632300) and 185.22/100000 (4964/2680100), respectively, in Aksu, Hetian, and Kashgar with the policy effect of “South Xinjiang Model”. And the placebo test supported the results (all probabilities <0.05), which had a strong effect in the short term of policy intervention. Aksu and Hetian had the largest policy effect in 2019 (259.05/100000 and 165.47/100000), and Kashgar had the largest effect in 2018 (482.59/100000). Conclusion: The “South Xinjiang Model” for PTB prevention and control was conducive to discovery of PTB, and the short-term effect was particularly significant. It had a positive effect on reducing the overall transmission risk of PTB and the prevention and control of PTB epidemic in southern Xinjiang.

Key words: Tuberculosis, pulmonary, Incidence, Models, statistical, Evaluation studies, Synthetic control method