應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座

應(yīng)用Workbook法對我國梅毒疫情預(yù)計(jì)分析中國疾病預(yù)防控制中心性病控制中心.5.16南京應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第1頁研究背景我國梅毒匯報(bào)病例數(shù)快速上升，主要公共衛(wèi)生問題之一梅毒存在無癥狀感染、漏查漏診、患者不就醫(yī)等原因，實(shí)際患病數(shù)和發(fā)病數(shù)遠(yuǎn)高于匯報(bào)數(shù)WHO屢次組織開展全球STI疾病負(fù)擔(dān)預(yù)計(jì)（梅毒）我國連續(xù)5次應(yīng)用Workbook法開展全國艾滋病疫情預(yù)計(jì)成功經(jīng)驗(yàn)應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第2頁研究目標(biāo)了解梅毒流行情況評定梅毒疾病負(fù)擔(dān)制訂梅毒防治策略分配梅毒防治資源評價(jià)梅毒防治效果應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第3頁資料與方法

利用性病艾滋病監(jiān)測系統(tǒng)已經(jīng)有人群規(guī)模和梅毒感染率數(shù)據(jù)含有感染梅毒危險(xiǎn)行為性活躍人群（15-49歲年紀(jì)組）-女性性工作者（FSW）-男男性行為者(MSM)-性病就診者-吸毒者-孕產(chǎn)婦-15-49歲年紀(jì)組普通人群人群定義和起源見《全國艾滋病哨點(diǎn)監(jiān)測實(shí)施方案操作手冊》（年3月版）應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第4頁資料與方法

人群規(guī)模，各省采取統(tǒng)一方法預(yù)計(jì)和匯總地市級各類人群-暗娼：普查法；乘數(shù)法；成人男性商業(yè)性性行為百分比或女性成人人口數(shù)推算-吸毒者：“滾雪球”、提名法、乘數(shù)法，或公安部門在冊登記數(shù)和多部門教授預(yù)計(jì)等-男男性行為者：提名法或乘數(shù)法，或按照城鎮(zhèn)或農(nóng)村成年男性人口一定百分比推算-性病就診者：人數(shù)來自醫(yī)療機(jī)構(gòu)門診統(tǒng)計(jì)及推算。-孕產(chǎn)婦：中國疾病預(yù)防控制中心婦幼保健中心年度報(bào)表統(tǒng)計(jì)數(shù)-15-49歲年紀(jì)組普通人群：各省15-49歲年紀(jì)組常住總?cè)丝跀?shù)減去前5類人群規(guī)模數(shù)所得《年全國HIV/AIDS疫情預(yù)計(jì)數(shù)據(jù)搜集和使用指南》應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第5頁資料與方法

梅毒感染率，判定標(biāo)準(zhǔn)-非梅毒螺旋體抗原血清學(xué)試驗(yàn)陽性-梅毒螺旋體抗原血清學(xué)試驗(yàn)陽性數(shù)據(jù)起源-HIV哨點(diǎn)監(jiān)測數(shù)據(jù)-性病監(jiān)測點(diǎn)調(diào)查數(shù)據(jù)15-49歲年紀(jì)組普通人群（除孕產(chǎn)婦外）以當(dāng)?shù)鼗闄z人群梅毒感染率數(shù)據(jù)代替應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第6頁資料與方法

梅毒感染率合并各省同一人群有多個(gè)梅毒感染率數(shù)據(jù)，差異較大Meta分析法異質(zhì)性檢驗(yàn)應(yīng)用隨機(jī)效應(yīng)模型計(jì)算各監(jiān)測點(diǎn)感染率數(shù)據(jù)加權(quán)平均值（合并效應(yīng)值）及95%可信區(qū)間統(tǒng)計(jì)學(xué)分析均采取Stata12.0軟件應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第7頁資料與方法

Meta分析法異質(zhì)性檢驗(yàn)：若有異質(zhì)性，隨機(jī)效應(yīng)模型倒方差法，可用于無對照數(shù)據(jù)若np、n(1-p)大于5者，數(shù)據(jù)近似正態(tài)分布，采取百分比Meta分析方法若np、n(1-p)中任一值或均小于5，應(yīng)用比數(shù)（odds）Meta分析方法在應(yīng)用比數(shù)法時(shí)，假如某個(gè)地域梅毒感染人數(shù)為0，則以0.5代替JonathanA.C.Sterne.Meta-AnalysisinStata:AnUpdatedCollectionfromtheStataJournal.Statapress,.應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第8頁資料與方法

Workbook法,組分法原理梅毒感染總?cè)藬?shù)=∑（某人群規(guī)模數(shù)×該人群梅毒感染率）以省為分析單位-分別計(jì)算各省各類人群梅毒感染人數(shù)-各省累加得到全國梅毒感染總?cè)藬?shù)梅毒感染人數(shù)匯總：Excel軟件應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第9頁結(jié)果Meta分析法異質(zhì)性檢驗(yàn)各省不一樣監(jiān)測點(diǎn)同一人群多個(gè)梅毒感染率數(shù)據(jù)確實(shí)存在變異（異質(zhì)性）各省五類人群梅毒感染率預(yù)計(jì)值和95%可信區(qū)間應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第10頁省份FSW人群MSM人群性病就診者人群合并效應(yīng)值（%）95%下限（%）95%上限（%）合并效應(yīng)值（%）95%下限（%）95%上限（%）合并效應(yīng)值（%）95%下限（%）95%上限（%）北京1.46580.73702.897312.43359.984015.38137.67754.261513.4587天津1.89840.60665.775824.619720.652529.069717.66812.154167.6339河北0.76680.49871.17744.16861.589110.49870.87490.46651.6351山西1.09650.73701.62867.06333.254614.64150.94520.33582.6314內(nèi)蒙1.04880.56241.945521.332517.990425.12422.86091.58285.1174遼寧1.22610.84171.78106.15144.46178.43246.69824.265610.3772吉林1.66591.18442.33622.58060.66469.48333.42241.60167.1691黑龍江1.53530.90402.593211.11558.196114.90595.18582.86659.2122上海3.16462.31124.31902.49891.35064.58266.15724.77437.9147江蘇3.26732.27324.675310.11067.755813.07895.30003.96587.0502浙江2.95692.01344.323110.34936.667015.73606.42244.66198.7864安徽3.34072.06545.35559.60426.003015.00777.15584.997310.1379福建2.96841.62075.37585.60414.36057.17584.15672.83056.0597江西0.84510.53361.33473.54000.491821.39971.12730.62122.0352山東1.17160.56522.41273.86052.18396.72953.44902.00955.8525河南1.13070.76601.66437.15583.232715.09722.31351.53833.4656應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第11頁省份吸毒者人群孕婦人群合并效應(yīng)值（%）95%下限（%）95%上限（%）合并效應(yīng)值（%）95%下限（%）95%上限（%）北京3.73972.25786.14030.12500.02520.6169天津10.24797.634913.62260.12500.01760.8819河北6.63024.63489.40630.24550.13210.4559山西4.62662.98897.10290.35330.20290.6139內(nèi)蒙2.32751.02545.0.31320.14080.6943遼寧4.28612.37527.62120.53730.33050.8723吉林3.90913.59164.25330.35230.14830.8343黑龍江5.95231.590319.86090.69300.40621.1797上海7.51623.872014.10040.40300.22020.7362江蘇7.85625.524911.05660.56020.40580.7721浙江5.87443.90538.74660.44740.28490.7027安徽7.18224.479011.31450.61810.40500.9424福建2.57020.82327.74140.74280.43681.2617江西1.42050.90182.22920.33180.22270.4947山東8.46354.039016.89590.28150.15000.5272河南1.85011.34662.53790.42440.28320.6356應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第12頁省份FSW人群MSM人群性病就診者人群合并效應(yīng)值（%）95%下限（%）95%上限（%）合并效應(yīng)值（%）95%下限（%）95%上限（%）合并效應(yīng)值（%）95%下限（%）95%上限（%）湖北1.69901.23462.33394.91263.21087.44681.54130.84682.7895湖南1.18910.80581.75331.63830.053933.98424.90793.14627.5788廣東2.02331.45142.81418.41694.556415.03323.84202.38696.1284廣西7.02415.88568.36316.46465.04988.24133.28312.48194.3314海南1.97051.79692.15849.87677.069913.63434.39821.694010.9389重慶1.60641.12952.27767.87832.631421.31575.15642.521010.2569四川3.73632.91994.76986.41644.25339.56092.83881.51575.2550貴州1.92091.29962.82786.30912.649414.28281.98400.87934.4193云南1.49941.05092.13731.21520.24835.72701.74810.83013.6404西藏4.08562.08987.8349---16.465411.537322.9524陜西1.30480.77522.18813.62642.53085.17100.85600.38761.8817甘肅1.03640.65871.62545.39110.609034.63780.63880.34911.1658青海1.37080.23487.59289.92137.364513.25045.70011.561218.7095寧夏2.22261.30993.74356.99804.87539.94813.17990.920310.4144新疆4.41502.89736.67327.30332.911417.13634.62652.31809.0134應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第13頁省份吸毒者人群孕婦人群合并效應(yīng)值（%）95%下限（%）95%上限（%）合并效應(yīng)值（%）95%下限（%）95%上限（%）湖北3.19272.39904.23290.49770.27430.9022湖南1.22250.75921.96280.40140.21140.7607廣東3.40262.83054.08560.51330.35790.7355廣西8.06166.83709.47470.80820.56411.1567海南2.11651.33343.34720.67130.34461.3048重慶4.11702.21617.52300.16000.04630.5514四川4.97374.06996.07110.57830.14302.3067貴州4.20882.95125.96360.49470.32890.7436云南2.22051.42453.44560.66270.34161.2818西藏2.21610.81065.91341.45140.20609.5005陜西3.20461.90965.32520.47680.21421.0592甘肅1.73270.70834.17260.54210.19311.5127青海2.21610.81065.91340.94620.26463.3246寧夏3.77242.26216.23270.41270.15101.1229新疆6.56204.93608.67480.58760.16972.0114應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第14頁年全國15-49歲年紀(jì)組梅毒感染人數(shù)預(yù)計(jì)結(jié)果類別預(yù)計(jì)數(shù)95%下限95%上限FSW人群546243842278875MSM人群265453162586506520性病就診者535553125698057吸毒者9424466475139349孕產(chǎn)婦700623994213658415-49歲普通人群244148411653195103924合計(jì)297942215040006063309應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第15頁年全國15-49歲年紀(jì)組人群梅毒感染率為0.40%依據(jù)發(fā)病率=患病率/病程，梅毒病程以2年計(jì)，預(yù)計(jì)年全國15-49歲年紀(jì)組梅毒發(fā)病人數(shù)為1489711人年全國15-49歲年紀(jì)組梅毒病例匯報(bào)數(shù)為287031人，本研究預(yù)計(jì)梅毒發(fā)病人數(shù)為匯報(bào)病例數(shù)5.2倍年艾滋病疫情預(yù)計(jì)新發(fā)感染4.8萬人，為當(dāng)年匯報(bào)HIV/AIDS5.4萬例89%對梅毒感染率和梅毒發(fā)病人數(shù)預(yù)計(jì)應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第16頁全國各省15-49歲年紀(jì)組梅毒預(yù)計(jì)數(shù)和匯報(bào)病例數(shù)相關(guān)分析二者之間相關(guān)系數(shù)為0.544，P<0.01應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第17頁討論-研究方法和結(jié)果科學(xué)性工作簿（Workbook）法

-組分法原理-適合用于聚集性或低流行國家和地域-直接測算出HIV/AIDS感染人群點(diǎn)預(yù)計(jì)值實(shí)踐上，我國連續(xù)5次應(yīng)用Workbook法開展全國艾滋病疫情預(yù)計(jì)，歷次預(yù)計(jì)結(jié)果也取得UNAIDS和WHO認(rèn)可數(shù)據(jù)質(zhì)量，年起艾滋病綜合監(jiān)測納入了梅毒感染率調(diào)查，各地各類人群梅毒數(shù)據(jù)積累比較全方面借鑒應(yīng)用艾滋病疫情預(yù)計(jì)方法，方法學(xué)含有科學(xué)性和可行性，利用數(shù)據(jù)質(zhì)量亦是可靠全國梅毒疫情預(yù)計(jì)教授組認(rèn)可了本研究預(yù)計(jì)方法和結(jié)果應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第18頁討論-Meta分析法各類人群梅毒感染率數(shù)據(jù)對預(yù)計(jì)結(jié)果很關(guān)鍵應(yīng)用Meta分析法合并梅毒感染率-識別和處理異質(zhì)性-提升估算可信區(qū)間精度-增大檢驗(yàn)效能魏麗娟,董惠娟.Meta分析中異質(zhì)性識別與處理.第二軍醫(yī)大學(xué)學(xué)報(bào),,27(4):449-450.應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第19頁討論-梅毒疫情預(yù)計(jì)數(shù)和匯報(bào)病例數(shù)關(guān)系各省梅毒感染預(yù)計(jì)數(shù)與梅毒匯報(bào)病例數(shù)之間存在正相關(guān)提醒梅毒疫情預(yù)計(jì)數(shù)對于梅毒報(bào)病數(shù)據(jù)有輔助參考意義梅毒疫情預(yù)計(jì)是對全國梅毒匯報(bào)病例數(shù)據(jù)主要補(bǔ)充，但不能代替報(bào)病數(shù)據(jù)應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第20頁研究局限1未考慮50歲及以上年紀(jì)組高年紀(jì)組人群梅毒感染全國50歲及以上年紀(jì)組HIV和梅毒匯報(bào)病例數(shù)逐年增加，提醒高年紀(jì)組人群值得關(guān)注當(dāng)前各地均缺乏高年紀(jì)組人群梅毒感染率數(shù)據(jù)本研究未單獨(dú)對該類人群進(jìn)行分組計(jì)算，會低估梅毒感染人數(shù)處理方法：開展專題調(diào)查，或監(jiān)測系統(tǒng)增加50歲以上年紀(jì)組人群，系統(tǒng)搜集該人群梅毒感染率數(shù)據(jù)應(yīng)用Workbo法對我國梅毒疫情的估計(jì)分析專家講座第21頁研究局限2采取婚檢人群梅毒感染率數(shù)據(jù)來代表15-49歲年紀(jì)組普通人群數(shù)據(jù)，代表性不足婚檢人群與15-49歲年紀(jì)組普通人群不完全重合婚檢為非強(qiáng)制性，婚檢率低對當(dāng)前可取得各類人群梅毒感