Economic-related inequalities in hepatitis B virus infection among 115.8 million pregnant women in China from 2013 to 2020.
Economic-related inequalities in hepatitis B virus infection among 115.8 million pregnant women in China from 2013 to 2020.
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2013 - 2020年中国1.158亿孕妇中与经济相关的B型肝炎病毒感染不平等
DOI：
10.1016/j.eclinm.2022.101465
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发表时间：
2022-07
影响因子：
15.1
通讯作者：
中科院分区：
文献类型：
--
作者：
B型肝炎病毒（HBV）感染是一个严重的全球性健康问题，中国是最大的疾病负担。关注孕妇HBV感染中与经济相关的不平等的文献很少。我们的目的是量化2013年至2020年中国大陆孕妇中与经济相关的不平等和HBV感染随时间的变化，为考虑经济相关不平等的战略提供信息。我们使用了2013 - 2020年全国预防艾滋病、梅毒和B型肝炎母婴传播综合规划（iPMTCT规划）中30个省份孕产妇的全国横断面二级数据。在调整其他风险因素后，通过计算集中度指数和调整多变量广义估计方程（GEE）模型中的贫富差距来衡量与经济相关的不平等。本研究共纳入2013 - 2020年中国大陆孕妇115，789，148例，B表面抗原（HBsAg）总患病率为6.27%（95%CI：6.26%-6.28%）。曲线位于均等线上方，集中指数为负值，为-0.027，表明HBV感染分布中存在经济相关的健康不平等和不利于穷人（亲穷人）的不平等。集中指数呈波动下降趋势，表明经济相关的HBsAg流行不平等正在缩小。在多变量GEE模型中，在控制其他混杂因素后，经济水平最低县与经济水平最高县（参照组）之间HBsAg患病率的调整差异为46.3%（均P<0.05）。低经济水平与高HBsAg流行率之间存在明显的剂量-反应关系，调整差从15.6%增加到10.6%与最高经济组相比，最低经济组的死亡率为46.3%（aOR =1.463，95%CI：1.294-1.824）。敏感性分析显示，经济水平低与HBsAg高流行率之间的关系稳定。HBV感染主要集中在经济状况较差的人群中。在过去十年中，HBV感染中与经济相关的不平等有所减少。我们的研究结果强调了制定以公平为导向的政策和有针对性的干预措施的重要性，以减少贫困和难以接触的人群中的HBV感染，从而按时实现2030年消除HBV的目标。
Hepatitis B virus (HBV) infection is a serious global health problem and China has the largest disease burden. Literatures focusing on economic-related inequalities in HBV infection among pregnant women are scarce. We aimed to quantify the economic-related inequalities and the change over time in HBV infection among pregnant women in mainland China from 2013 to 2020 to inform strategies considering economic-related inequalities. We used national cross-sectional secondary data of pregnant women in 30 provinces from the National Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B Programme (iPMTCT Programme) from 2013 to 2020. We calculated concentration index and adjusted difference between the rich and the poor in the multivariable generalized estimating equation (GEE) model to measure economic-related inequality, after adjusted other risk factors. In this study, a total of 115,789,148 pregnant women of mainland China from 2013 to 2020 were included, the overall hepatitis B surface antigen (HBsAg) prevalence was 6.27% (95%CI: 6.26%-6.28%). The curve lay above the equality line, with the negative value of the concentration index of -0.027, which indicated that economic-related health disparities exist in the distribution of HBV infection and the inequality disadvantageous to the poor (pro-poor). The concentration index showed a trend of fluctuating decline, indicating that economic-related inequalities in HBsAg prevalence were narrowing. The adjust difference between counties with lowest economic level and counties with highest economic level (reference group) were 46.3% in HBsAg prevalence (all p<0.05) in the multivariable GEE model, after controlling other confounders. A significant dose-response relationship was observed between low economic level and high HBsAg prevalence that the adjust difference increased from 15.6% (aOR=1.156, 95% CI: 1.064–1.257) in the high-economic group to 46.3% (aOR=1.463, 95% CI: 1.294–1.824) in the lowest-economic group, compared with the highest-economic group. The association between low economic level and high HBsAg prevalence was stable in the sensitivity analysis. HBV infection was more concentrated among population with lower economic status. Economic-related inequalities in HBV infection decreased in the past decade. Our findings highlight the importance of developing equity-oriented policies and targeted interventions to reduce HBV infection among the poor and hard-to-reach populations to achieve the 2030 HBV elimination goals on time.
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影响因子：
4.8
作者：
Lopez-Feldman, Alejandro
通讯作者：
Lopez-Feldman, Alejandro
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