Analyzing Features and Social Determinants of the Incidence of Class A and B Notifiable Infectious Diseases in China From 2004 to 2018 (preprint)

ABSTRACT

Background: The social order of the whole world has been disrupted since the COVID-19 outbreak. In China, we added novel coronavirus pneumonia to the list of Class B notifiable infectious diseases, and we placed Class A notifiable infectious diseases under strict monitoring. Therefore, it is significant that we study the features and social determinants of the incidence of both Class A and B infectious diseases.Methods: We analyzed the annual percentage change in the incidence of overall infectious diseases and the four main diseases by descriptive statistics analysis, estimated the differences in the incidence of infections in seven regions over 15 years by using a generalized estimation equation (GEE), and then determined social determinants affecting these infectious diseases by using a panel data model.Results: The incidence of overall Class A and B infectious diseases has been declining since January 2004. The infectious diseases with the highest yearly incidence were hepatitis, tuberculosis, syphilis, and bacterial and amoebic dysentery, with an incidence rate that has remained stable over the past 15 years. The locations of disease incidence in ascending order from low to high was East China, Northeast China, North China, Southwest China, Central China, South China, and Northwest China (c2=68.60 p<0.001). The changes in the characteristics of yearly incidence varied (c2=44.84 p<0.001). We found that two determinants, namely, percentage of people with illiteracy in the total population aged 15 years and older (p=0.01) and number of family health service people per capita (p<0.001), were positive for infectious diseases. Three determinants, including public green areas per capita (p<0.001), number of public transportation vehicles per 10 000 people (p=0.02) and area of paved roads per capita (p<0.001), were negative for infectious diseases.Conclusions: We successfully prevented and controlled Class A and B infectious diseases after the outbreak of severe acute respiratory syndrome (SARS) in 2003. Over the years, hepatitis and tuberculosis have had the highest incidence among infectious diseases and thus more attention needs to be given to these diseases. Social determinants had a significant influence on infectious diseases. Some strategies related to social determinants are needed to prevent infectious diseases.