中国1990-2017年乙型肝炎疫情的变化趋势研究

目的 分析1990-2017年我国乙型肝炎（乙肝）发病和死亡的变化情况，为制定防控乙肝疫情的策略提供合理依据。方法 利用中国公共卫生科学数据中心的乙肝发病和死亡数据及国家统计局的人口学资料，采用Excel 2016软件分别建立乙肝报告发病和死亡的数据库。利用Joinpoint 4.8.0.1软件进行Joinpoint回归模型分析，估计1990-2017年我国乙肝不同年龄组、不同省份年报告发病率和年报告死亡率的平均年度变化百分比，进一步分析乙肝疫情的变化趋势。采用R 3.6.2软件进行统计学分析和数据的可视化。结果 从1990年1月至2017年12月共报告20 793 233例乙肝病例（年平均报告发病率为58.19/10万）。年平均报告发病率最高的年龄组是25~29岁（119.67/10万），≥45岁年龄组年报告发病率均呈上升趋势，≥85岁年龄组的报告病死率达最高值（2.26/1 000）。有23个省份的报告发病率呈增长趋势（P<0.05），7个省份的报告发病率呈平稳趋势（P>0.05），2个省份的报告发病率呈下降趋势（P<0.05）。结论 1990-2017年中国乙肝主要发病人群已后移至成年人群，且该人群的报告发病率呈上升趋势；东部地区的部分省份防控措施落实到位，治疗水平较高，乙肝疫情已趋于平稳；西部地区大部分省份仍处上升趋势。应进一步针对不同省份的疫情现况，因地制宜地制定合适的防治策略。

Study on changes in hepatitis B incidence in China, 1990-2017

Objective To analyze the changes in the morbidity and mortality of hepatitis B in China from 1990 to 2017, and provide evidence for prevention and control of hepatitis B.Methods The reported incidence and death data of hepatitis B from the Data-Center of China Public Health Science and demographic data from the National Bureau of Statistics were used, Excel 2016 was used to establish the databases of reported hepatitis B cases and deaths, respectively. The Joinpoint regression model was used through Joinpoint software 4.8.0.1 to estimate the average annual percent change of annual reported incidence and mortality of hepatitis B in different age groups and provinces in China from 1990 to 2017 in order to further explore the trend of hepatitis B incidence. Software R 3.6.2 was used for statistical analysis and data visualization. Results A total of 20 793 233 hepatitis B cases were reported from January 1990 to December 2017 in China with average annual reported incidence of 58.19/100 000. The average annual reported incidence appeared highest in age group 25-29 years (119.67/100 000) and the annual reported incidence increased in group aged 45 years and above. Besides, the reported case fatality rate reached the highest in group aged 85 years and above (2.26/1 000). The reported incidence showed increasing trends in 23 provinces (P<0.05), stable in 7 provinces (P>0.05), and decreasing in 2 provinces (P<0.05). Conclusions The report of hepatitis B was mainly from adult population in China, and the reported incidence of hepatitis B in this population was in increase. In some provinces of the eastern China where immunization measures have been in place and the treatment level is relatively high, the incidence of hepatitis B has been leveled off; the incidences in most provinces in western China are still in increase. Therefore, more targeted prevention and control strategies should be taken in different provinces.