Evaluation of implementation effect of pulmonary tuberculosis prevention and control strategy in southern Xinjiang based on synthetic control method

doi:10.19982/j.issn.1000-6621.20220509

Abstract

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

CLC Number:

R521

Mao Hongkai, Zhang Yan, Liang Zhichao, Xia Wenjun, Bao Liangliang, Mayisha·Daken , Wang Xiaomin, Cao Mingqin. Evaluation of implementation effect of pulmonary tuberculosis prevention and control strategy in southern Xinjiang based on synthetic control method[J]. Chinese Journal of Antituberculosis, 2023, 45(4): 383-390. doi: 10.19982/j.issn.1000-6621.20220509

Figures/Tables 9

年份	全疆			南疆四地州			其他地州			χ²值	P值^a
年份	人口数 (万)	发病例数	发病率 (/10万)	人口数 (万)	发病例数	发病率 (/10万)	人口数 (万)	发病例数	发病率 (/10万)	χ²值	P值^a
基本防控策略阶段	10805.61	199550	184.67	4756.68	141400	297.26	6048.92	58150	96.13	58438.770	<0.001
2011	2095.97	34583	165.00	912.18	23702	259.84	1183.78	10880	91.91
2012	2120.35	40249	189.82	923.22	28243	305.92	1197.13	12006	100.30
2013	2157.54	38964	180.59	938.94	27093	288.55	1218.60	11871	97.42
2014	2216.99	41690	188.05	987.33	29648	300.29	1229.66	12041	97.93
2015	2214.75	44066	198.97	995.00	32714	328.78	1219.75	11352	93.07
$χ 趋势 2$ 值			509.643			562.146			0.006
P值			<0.001			<0.001			0.941
主动发现开展阶段	4591.23	91169	198.57	1897.40	67136	353.83	2693.82	24033	89.21	39334.466	<0.001
2016	2277.15	43217	189.79	943.89	31550	334.25	1333.26	11667	87.51
2017	2314.07	47952	207.22	953.52	35586	373.21	1360.56	12366	90.89
$χ 趋势 2$ 值			176.023			204.134			8.642
P值			<0.001			<0.001			0.003
“南疆模式” 实施阶段	9623.33	163302	169.69	4006.02	128535	320.85	5617.30	34767	61.89	92567.420	<0.001
2018	2354.05	73931	314.06	971.05	59266	610.33	1383.00	14665	106.04
2019	2398.40	41167	171.64	996.54	32127	322.39	1401.86	9040	64.49
2020	2408.76	27166	112.78	1004.67	21379	212.80	1404.09	5787	41.22
2021	2462.12	21038	85.45	1033.77	15763	152.48	1428.34	5275	36.93
$χ 趋势 2$ 值			39006.599			33979.161			5993.518
P值			<0.001			<0.001			<0.001
合计	25020.17	454023	181.46	10660.12	337071	316.19	14360.05	116950	81.44	186152.083	<0.001
$χ 总趋势 2$ 值			3139.138			151.845			5497.865
P值			<0.001			<0.001			<0.001

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处理组区县	对照组权重分配
阿克苏市	额敏县(0.807)、托里县(0.058)、头屯河区(0.135)
和田市	轮台县(0.077)、伊吾县(0.127)、沙湾县(0.013)、托克逊县(0.782)
喀什市	吉木乃县(0.550)、额敏县(0.450)

控制变量	阿克苏市		和田市		喀什市
控制变量	真实值(平均值)	合成值(平均值)	真实值(平均值)	合成值(平均值)	真实值(平均值)	合成值(平均值)
人均国内生产总值	0.058	0.006	0.061	0.076	0.065	0.050
每千人口床位数	0.004	0.032	0.080	0.058	0.046	0.009
农业人口比例	0.387	0.378	0.456	0.623	0.472	0.534

年份	阿克苏市			和田市			喀什市
年份	真实值	合成值	处理效应	真实值	合成值	处理效应	真实值	合成值	处理效应
2018	411.54	220.68	190.85	226.92	209.25	17.66	662.27	179.68	482.59
2019	405.38	146.32	259.05	249.69	84.22	165.47	255.34	113.33	142.01
2020	247.94	86.73	161.21	195.47	42.86	152.61	165.90	70.99	94.91
2021	113.33	85.21	28.12	111.44	44.77	66.67	160.14	70.31	89.83

处理组区县	人口数 (万)	累计多发现患者例数	政策干预后的平均处理效应(/10万)	比例^a	概率值
阿克苏市	229.76	3667	159.60	1/59	0.017
和田市	163.23	1678	102.80	1/35	0.029
喀什市	268.01	4964	185.22	1/62	0.016