流动人口结核病时空传播模型及环境变化对其发病影响研究

Tuberculosis is "moving" with more than 200 millions people swarming into cities every year, which leads changes in the spatial distribution and prevalent trend of tuberculosis. In China, most migrants are labor age and generally suppposed to prevent tuberculosis to which the old or vulnerable people are most susceptible,but the fact is they are becoming the population at high risk of TB. Epigenetic epidemiology indicate that environmental changes can cause various diseases. Because it is difficult to trace and detect the risk factors related with tuberculosis among the migrants, the transmission mechanism has remained open. This study intends to investigate temporal-spatial transmission model of, and investigate effect of environmental changes on, tuberculosis in migrants by combinig clinical and theoretical epidemiology. The goals are to: detect the spatial distribution of migrant tuberculosis and evaluate the contribution of the migant to TB variance spatially; evaluate the impact of environmental changes on TB in migrants by comparing the places where the migrants are living and come from; build Markov Chain Model and predict the conditional probability that the migrants will be infectious by Monte Carlo simulation; evaluate the disease burden both for epidemic and economy. To our knowledge, few study in this field has been reported internationally so far. The results rising from the study will provide evidences to TB policy making related with tuberculosis in migrants, improve the methodology and theoretical framework of tuberculosis models in China and promote the interdisciplinary collaboration and cooperation.

随着每年2亿多流动人口涌入城市，我国结核病流行趋势发生了明显改变：结核病在流动。但我国流动人口大多是疾病防御能力较强的青壮年，"他们如何成为城市结核病主要感染者"？表观遗传流行病学研究提示环境变化可导致疾病发生。由于流动人口结核病人管理难度大，影响因素复杂，流动人口结核病发病规律一直缺乏系统研究。本课题拟结合临床和理论流行病学，开展流动人口结核病时空传播模型及环境变化对其发病影响研究。研究确定我国流动人口结核病时空分布模式，评估流动人口对结核病空间差异的贡献；对照流动人口居住地和来源地环境指标，评估环境变化对流动人口结核病发病影响；在典型样区建立马尔可夫随机模型，利用蒙特卡罗模拟不同环境下流动人口结核病发病概率；预测流动人口影响下我国结核病的流行趋势和经济负担。本课题研究的内容在国内外少有涉及，研究成果将进一步完善结核病传播模型的理论与方法，并为制定我国流动人口结核病防控策略提供理论依据。

本课题利用2010年全国结核病监测数据和全国流动人口监测数据，开展流动人口结核病时空传播模型及环境变化对其发病影响研究。研究结果确定了我国流动人口结核病时空分布模式，评估了流动人口对结核病空间差异的贡献；户籍人口和流动人口的差异；及环境变化对流动人口结核病发病影响。同时在典型样区建立马尔可夫随机模型，利用蒙特卡罗模拟不同环境下流动人口结核病发病概率；预测流动人口影响下我国结核病的流行趋势和经济负担。本课题研究的内容在国内外少有涉及，研究成果进一步完善了结核病传播模型的理论与方法，为制定我国流动人口结核病防控策略提供理论依据。