2018-2023 年江苏省 0∼3 岁婴幼儿肠套叠发病的流行病学特征

Epidemiological characteristics of intussusception in children aged 0-3 years in Jiangsu Province from 2018 to 2023

摘要

目的：描述2018—2023年江苏省0~3岁常住儿童肠套叠的发病密度及其在不同年龄、性别和时间维度的分布特征，为该地区卫生行政部门制定 0∼3 岁儿童肠套叠防治策略和措施提供科学依据。方法：基于江苏省区域健康信息平台数据开展回顾性队列研究，纳人 2018 年 1 月 1 日至 2023 年 12 月 31 日出生且常住于江苏省的 $0 \sim$3岁儿童，通过正则表达式匹配算法，在信息平台中检索疾病和有关健康问题的国际统计分类（第10版）（Interna-tional Statistical Classification of Diseases and Related Health Problems， 10 revision，ICD-10）编码＂K56.1＂及与＂肠套叠＂语义相关的关键词汇，识别疑似病例，定义研究期间首次发病者为新发病例。采用精确人时法计算随访人年，应用泊松（Poisson）分布估算总体及各亚组的发病密度及其 95% 置信区间（confidence interval，CI）。构建泊松回归模型，计算发病率比（incidence rate ratio，IRR），检验发病密度的月龄效应与季节性差异。结果：构建了一个包含2252691 名 0∼3 岁儿童的出生队列，总随访5 316389.55 人年。研究期间共识别出 2650 例 0∼3 岁新发肠套叠病例，其中男童 1600 例（60.4%），女童 1050 例（39.6%）。总体发病密度为 $49.8\text{ }(95\mathrm{\%}\mathit{C}\mathit{I}:47.9\sim 51.7)/10$ 万人年，男童发病密度为 $57.8\text{ }(95\mathrm{\%}\mathit{C}\mathit{I}:54.9\sim 60.6)\text{ }/10$ 万人年，女童为 $41.2\text{ }(95\mathrm{\%}\mathit{C}\mathit{I}:38.7\sim 43.7)\text{ }/10$ 万人年，男女比较差异有统计学意义；城乡间发病密度差异无统计学意义。发病存在季节性，高峰集中在夏季和冬季。发病密度随月龄变化呈单峰模式，在8月龄达到顶峰（98.5/10万人年），发病年龄的中位数为19.2个月[四分位距（inter-quartile range，IQR）：11.4~26.6个月]。结论：基于江苏省区域健康信息平台的大数据回顾性队列研究，明确了2018—2023年本地 0~3 岁儿童肠套叠的流行病学特征。男童、8月龄至3岁的婴幼儿是肠套叠的高危人群，夏季和冬季为高发季节，此结果为卫生行政部门制定针对性的早期监测、预防和医疗资源调配策略提供了循证依据。

Abstract

Objective：To describe the incidence density of intussusception and its distribution charac-teristics across different ages，genders，and time periods among resident children aged 0-3 years in Jiangsu Province from 2018 to 2023，providing a scientific basis for health administrative departments in the region to formulate prevention and control strategies and measures for intussusception in children aged 0-3 years. Methods：A retrospective cohort study was conducted using data from the Jiangsu Regional Health Information Platform（RHIP）.Resident children aged 0-3 years born between January 1，2018， and December 31，2023，were included.Suspected cases were identified by retrieving the International Statistical Classification of Diseases and Related Health Problems， 10 revision（ICD-10）code＂K56.1＂ and semantically related keywords for＂intussusception＂from the original text using a regular expression matching algorithm.An incident case was defined as the first occurrence of the disease during the study period.Follow-up person-years were calculated using the exact person-time method.The Poisson distri- bution was applied to estimate the overall and subgroup incidence densities and their 95％confidence intervals（CI）.Poisson regression models were constructed to calculate incidence rate ratio（IRR）and examine the effects of age（in months）and seasonal differences on incidence density. Results：A birth cohort comprising 2252691 children aged 0-3 years was established，accumulating a total follow-up of 5316389.55 person-years.During the study period， 2650 incident cases of intussusception were identi-fied，including 1600 boys（60.4%）and 1050 girls（39.6%）.The overall incidence density was 49.8 （95％CI:47.9-51.7）per 100000 person-years.The incidence density was 57.8 （95%CI:54.9- 60.6）per 100000 person-years for boys and 41.2 （95%CI:38.7-43.7）per 100000 person-years for girls，with a statistically significant difference between the sexes.Seasonal variations were observed，with peaks occurring in summer and winter.The incidence density exhibited a unimodal pattern，peaking at 8 months（98.5 per 100000 person-years）.The median age of onset was 19.2 months[interquartile range （IQR）：11.4-26.6 months]. Conclusion：This large retrospective cohort study based on the Jiangsu RHIP clarified the epidemiological characteristics of intussusception among local children aged 0-3 years from 2018 to 2023.Boys and children aged 8 months to 3 years were identified as high-risk populations for intussusception，with peak incidence occurring in summer and winter.These findings provide evi-dence-based support for health authorities to formulate targeted strategies for early surveillance，preven-tion，and healthcare resource allocation.

关键词

肠套叠 / 发病密度 / 流行病学 / 队列研究

Key words

Intussusception / Incidence density / Epidemiology / Cohort study

参考文献

[1] Li Y, Zhou Q, Liu C, et al. Epidemiology,clinical characteris- tics,and treatment of children with acute intussusception:A case series[J]. BMC Pediatr, 2023, 23(1): 143.

[2] Bines JE, Kohl KS, Forster J, et al. Acute intussusception in in- fants and children as an adverse event following immunization: Case definition and guidelines of data collection,analysis,and presentation[J]. Vaccine, 2004, 22(5/6):569-574.

[3] Clark AD, Hasso-Agopsowicz M, Kraus MW, et al. Update on the global epidemiology of intussusception:A systematic review of in- cidence rates,age distributions and case-fatality ratios among chil- dren aged<5 years,before the introduction of rotavirus vaccina- tion[J]. Int J Epidemiol, 2019, 48(4):1316-1326.

[4] 郭宏溪, 杨俊, 卞红强, 等. 2016-2022年武汉儿童原发性肠套叠流行病学特征及变化趋势[J]. 陆军军医大学学报, 2023, 45(19):2085-2091.

[5] Green LA, Fryer GE Jr, Yawn BP, et al. The ecology of medical care revisited[J]. N Engl J Med, 2001, 344 (26): 2021 - 2025.

[6] Pilkington M, Theivendram A, Brogly SB, et al. Rising incidence of childhood intussusception in Ontario:A population-based study from 1997-2016[J].Am Surg, 2023, 89 (1):129-136.

[7] Kramarz P, France EK, Destefano F, et al. Population-based study of rotavirus vaccination and intussusception[J]. Pediatr Infect Dis J, 2001, 20(4):410-416.

[8] Lei J, Wen D, Zhang X, et al. Enabling health reform through re- gional health information exchange:A model study from China[J]. J Healthc Eng, 2017, 2017: 1053403.

[9] 陆家发, 赵群, 唐凯, 等. 江苏省全民健康信息平台数据治理实践研究[J]. 中国卫生质量管理, 2023, 30(8):63-67.

[10] Liu Z, Li N, Liu G, et al. No increased risk of intussusception af-ter pentavalent rotavirus vaccination in China:A retrospective birth cohort using electronic health records of Ningbo City[J]. Emerg Microbes Infect, 2023, 12(2): 2270062.

[11] Liu N, Yen C, Huang T, et al. Incidence and epidemiology of in- tussusception among children under 2 years of age in Chenzhou and Kaifeng,China,2009-2013[J]. Vaccine, 2018, 36 (51): 7862-7867.

[12] Zhang T, Cui L, Geng X, et al. Epidemiology study of pediatric primary intussusception aged ⩽24 months in pre-rotavirus vaccine era of Jinan,China[J]. Vaccine, 2019, 37(11):1436-1442.

[13] 崔朋伟, 刘娜, 李静欣, 等. 苏州市 2007-2013年2岁以下儿童住院肠套叠流行特征[J]. 中华流行病学杂志, 2016, 37 (3):410-414.

[14] Van Trang N, Le Nguyen NT, Dao HT, et al. Incidence and epi- demiology of intussusception among infants in Ho Chi Minh City, Vietnam[J]. J Pediatr, 2014, 164(2):366-371.

[15] Takeuchi M, Osamura T, Yasunaga H, et al. Intussusception among Japanese children:An epidemiologic study using an ad- ministrative database[J]. BMC Pediatr, 2012, 12: 36.

[16] Fotso Kamdem A, Vidal C, Pazart L, et al. Incidence of acute intussusception among infants in eastern France:Results of the EPIstudy trial[J]. Eur J Pediatr, 2017, 176(3):301-309.

[17] Jenke AC, Klaassen-Mielke R, Zilbauer M, et al. Intussuscep- tion:Incidence and treatment-insights from the nationwide German surveillance[J]. J Pediatr Gastroenterol Nutr, 2011, 52(4): 446-451.

[18] Gadroen K, Kemmeren JM, Bruijning-Verhagen PC, et al. Base- line incidence of intussusception in early childhood before rotavirus vaccine introduction,the Netherlands,January 2008 to December 2012

[19] [ J . Euro Surveill, 2017, 22(25): 30556.]

[20] Jiang J, Jiang B, Parashar U, et al. Childhood intussusception:A literature review[J]. PLoS One, 2013, 8 (7):e68482.

[21] Johnson B, Gargiullo P, Murphy TV, et al. Sociodemographic and dietary risk factors for natural infant intussusception in the United States[J]. J Pediatr Gastroenterol Nutr, 2010, 51 (4): 458 - 463.

[22] World Health Organization. Acute intussusception in infants and children:Incidence,clinical representation and management:A global perspective[R]. Geneva: World Health Organization, 2002.

[23] Chang CY, Chen YY, Lin CH, et al. Recurrence of pediatric in- tussusception:A nationwide population-based descriptive study in Taiwan[J]. Medicine, 2023, 102(35):e34727.

[24] Hwang S, Kim J, Jung JY, et al. The epidemiology of childhood intussusception in South Korea:An observational study[J]. PLoS One, 2019, 14(12):e0219286.

[25] Trotta F, Da Cas R, Bella A, et al. Intussusception hospitaliza- tions incidence in the pediatric population in Italy:A nationwide cross-sectional study[J]. Ital J Pediatr, 2016, 42(1): 89.

[26] Panzera F, Di Venere B, Rizzi M, et al. Bowel intussusception in adult:Prevalence,diagnostic tools and therapy[J]. World J Methodol, 2021, 11(3):81-87.

[27] 国家统计局. 中国统计年鉴2024[M]. 北京: 中国统计出版社, 2024.

[28] Althubaiti A. Information bias in health research:Definition,pit- falls,and adjustment methods[J]. J Multidiscip Healthc, 2016, 9:211-217.

[29] Liang J, Zheng X, Chen Z, et al. The experience and challenges of healthcare-reform-driven medical consortia and Regional Health Information Technologies in China:A longitudinal study[J]. Int J Med Inform, 2019, 131: 103954.

[30] Li C, Xu X, Zhou G, et al. Implementation of national health in- formatization in China:Survey about the status quo[J]. JMIR Med Inform, 2019, 7(1):e12238.

[31] 江苏省统计局. 江苏统计年鉴2024[M]. 南京: 江苏省统计局, 2024.

[32] Burnett E, Kabir F, van Trang N, et al. Infectious etiologies of intussusception among children<2 years old in 4 Asian countries[J]. J Infect Dis, 2020, 211(9):1499-1505.

基金资助

盖茨基金会(INV-035024)

国家自然科学基金(82204175)

国家自然科学基金(72361127500)

国家自然科学基金(82330107)