1、1疾病分布Distribution of Disease2疾病的分布是指疾病的人群現(xiàn)象 是描述疾病事件（發(fā)病、患病、死亡等） Time （時(shí)間） Place （空間） Person（人間） 在流行病學(xué)中簡稱“三間分布”3ExampleYou have been asked to investigate an event in which 2,220 people were exposed and 1,520 of them died. Your role as an epidemiologist is to ask questions about person, place and time.

2、4Contents第一節(jié)疾病頻率測量指標(biāo)第二節(jié) 疾病流行強(qiáng)度第三節(jié) 疾病分布形式Frequency of Disease Measurement Intensity of EpidemicDistributions Pattern of disease5Directions: This chapter describes the basic measures of disease frequency used in epidemiologic research Frequency of Disease Measurement 第一節(jié) 疾病頻率測量指標(biāo)6發(fā)病頻率測量指標(biāo)患病頻率測量指標(biāo)死亡頻率測

3、量指標(biāo)預(yù)期壽命及相關(guān)指標(biāo)Morbidity frequency measuresPrevalence related measuresMortality frequency measuresLife expectancy related measures7一、發(fā)病指標(biāo)發(fā)病率（incidence）罹患率（attack rate）續(xù)發(fā)率（secondary attack rate）8發(fā)病率（incidence） 定義 在一定期間內(nèi)，一定人群中某病新發(fā)生的病例出現(xiàn)的頻率。 Definition the rate of new cases of a disease in a specified pop

4、ulation over a defined period 發(fā)病率= K K=100%,1000/千，或10000/萬 一定期間內(nèi)某人群中某病新病例數(shù)同時(shí)期暴露人口數(shù) 9Incidence rateNumeratorNew (incident) cases appearing during a time period (usually one year)DenominatorAverage population during the time periodMidpoint population estimate Cases per 10X per year Example: 234 per 1

5、00,000 per year12罹患率（attack rate）定義 在某一局限范圍，短時(shí)間內(nèi)的發(fā)病率。觀察時(shí)間可以日、周、旬、月為單位。 Definition the proportion of a population affected by the disease during a prescribed, usually short, period of time.13Incidence rate and attack rates An outbreak of hepatitis A in Ajloon from March 1 to march 14 2000 had an atta

6、ck rate of 25 per 1000 The yearly incidence rate of hepatitis A . in Ajloon is 238 per 100,000 per year How do you compare these rates?14Is there an outbreak?Incidence and attack rates compared 1. Adjust population to make rates comparable Divide 238 per 100,000 by 100 2.38 per 1000 per year 2. Adju

7、st time period 2 weeks = 2/52 year 2.38 (2/52) = 0.11 0.11 per 1000 per 2 weeks 南方Schistosomiasis is limited in some provinces in the southHIV infection in Yunnan ProvinceNasopharyngeal carcinoma in GuangdongEsophageal cancer in Henan Jiangsu Qidong Liver CancerHypertension north South 90 Fig18. Chi

8、nas cumulative reported HIV infection distribution by province (1985-2001) 91疾病的城鄉(xiāng)分布 The disease city and countryside distribution 城市 City人口多，密度大 Population is many , density is big 交通擁擠，人口流動性大 Traffic congestion, population mobility較少經(jīng)水傳播傳染病流行 Less water-borne epidemics 蟲媒傳染病農(nóng)村 Insect intermediary

9、infectious disease 城市Insect intermediary infectious disease City某些地方病發(fā)病率The incidence of certain endemic diseases呼吸道傳染病不易流行Respiratory tract infectious disease not easy popular 疾病的城鄉(xiāng)分布 The disease city and countryside distribution 93 疾病的地區(qū)聚集性 （endemic clustering） 定義疾病頻率高于周圍地區(qū)的情況 Disease frequency is

10、 higher than the surrounding area 94 地方性疾?。ê喎Q地方病） 定義指局限于某些特定地區(qū)內(nèi)相對穩(wěn)定并經(jīng)常發(fā)生的疾病。在我國地方病指與當(dāng)?shù)厮烈蛩?、生物學(xué)因素有密切關(guān)系的疾病，其病因存在于發(fā)病地區(qū)的水、土壤、糧食中 。 Present in a community at all times but in relatively low frequency. Something that is endemic is typically restricted or peculiar to a locality or region. 95判斷依據(jù)該地區(qū)的各類居民、任何

11、民族的發(fā)病率均高在其他地區(qū)居住的相似的人群中該病的發(fā)病頻率均低，甚至不發(fā)病。incidence of the disease in any ethnic may increase in the residents in the area similar residents lived in other areas have the lower incidence, or even not occur the disease criteria of endemic diseases96criteria of endemic diseaseswho immigrate the area over

12、a period of time, its incidence approaches that in local population; the people emigrate the area, the incidence would reduce, or symptoms alleviate or self-healing.in addition, the local animals are also susceptible to the same disease遷入該地區(qū)的人經(jīng)一段時(shí)間后，其發(fā)病率和當(dāng)?shù)鼐用褚恢氯巳哼w出該地區(qū)后，發(fā)病率下降或患病癥狀減輕或自愈當(dāng)?shù)氐囊赘袆游镆部砂l(fā)生同樣的疾

13、病判斷依據(jù)97移民流行病學(xué) （migrant epidemiology） 定義 對移民人群的疾病分布進(jìn)行研究，以探討病因。它是通過觀察疾病在移民、移民移入國當(dāng)?shù)鼐用窦霸拥厝巳洪g的發(fā)病率、死亡率的差異，從其差異中探討病因線索，區(qū)分遺傳因素或環(huán)境因素作用的大小。 98若環(huán)境因素是主要因素 移民原居住地人群發(fā)病率或死亡率 移民移居地當(dāng)?shù)鼐用袢暨z傳因素是主要因素 移民原居住地人群發(fā)病率或死亡率 移民移居地當(dāng)?shù)鼐用?9Local residents in Japan, the United States white and third generation, second-generation Japanese immigrants age specific death rate of gastric cancer Fig19100分析結(jié)果注意 移民移居他地的原因及移民本身的人口學(xué)特征。 如：年齡、職業(yè)、文化水平、社會經(jīng)濟(jì)狀況、種族和其他人口學(xué)因素及其工作條件、生活環(huán)境的變化是否和非移民相同。101表6.日本人在美國的日本移民及美國白人一些疾病 的標(biāo)化死亡率比（1959-1962） 日本移民 疾病 日本人 非美國出生 美國出生 美國白人 食管癌（男） 100 132 51 47 胃癌（女） 100 55 48 18腸癌（男） 100 374 288 489乳腺癌（女） 100