Changing trend of sickness absenteeism among students during 2010-2017 academic years and its correlation with the incidence of acute infectious diseases in Jiading District, Shanghai
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摘要:
目的 探讨上海嘉定区2010—2017学年中小学生因病缺课变化趋势，分析因病缺课与社区急性传染病发病之间的相关性和提前/滞后期，为卫生和教育部门采取相应措施提供依据。 方法 分析2010—2017学年上海嘉定区中小学生因病缺课症状构成，使用Joinpoint回归分析学年缺课率变化趋势，通过时间序列图定性比较因病缺课率与7种急性传染病发病率的关系，并采用互相关函数和格兰杰因果检验定量分析相关性大小及提前/滞后模式。 结果 2010—2017学年上海嘉定区中小学生平均因病缺课率为0.27%，自2012学年后学年因病缺课率明显上升。缺课症状以发热最多(占47.49%)。因病缺课率的变化趋势主要与流感发病率相似，存在单向格兰杰因果关系。在2017学年第2学期，滞后3 d的全症状因病缺课率和流感发病率有最大互相关系数0.43 (95%CI=0.25~0.58)，滞后3 d的发热和呼吸系统症状因病缺课率与流感发病率取到最大互相关系数0.50 (95%CI=0.33~0.65)。 结论 中小学生因病缺课率与流感发病率存在相关性，在预测社区流感流行方面具有潜在应用价值。 Abstract:Objective To describe the sickness absenteeism among primary and secondary school students in Jiading District and to analyze its correlation with the incidence of infectious diseases and associated lead or lag times, so as, to provide a scientific basis for the health and education departments to take measures. Methods The regularity and symptom composition of school sickness absenteeism among primary and secondary school students in Jiading District from the 2010-2017 were described. The Joinpoint model was applied to analyze the changing trend of absenteeism. And the rate of school sickness absenteeism and incidences of 7 acute infectious diseases were compared through visual analysis. The time-lagged correlation coefficients and Granger causality tests were applied to quantitatively analyze the correlation and lead/lag patterns. Results The average rate of school sickness absenteeism among primary and secondary school students in Jiading District, Shanghai was 0.27%. Since the 2012 academic year, the overall rate of sickness absenteeism has been on the rise. Fever was the most common symptom of absenteeism (47.49%). The trend of sickness absenteeism rate was mainly consistent with the incidence of influenza, and showed a one-way Granger causality. The maximum time-lagged correlation coefficient was obtained in the second semester of the 2017 academic year with a value of 0.43 (95%CI=0.25-0.58). The maximum time-lagged correlation coefficient between the rate of sickness absenteeism with fever and other respiratory symptoms and the incidence of influenza was also obtained in the second semester of the 2017 academic year and the maximum correlation coefficient was 0.50(95%CI=0.33-0.65). Conclusion The sickness absenteeism rate in primary and secondary school students is correlated to influenza incidence, and it has potential application value in supplementing early warning of influenza activities in the community. -
Key words:
- Disease /
- Absenteeism /
- Communicable diseases /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。2) 王正中与于宏杰为共同第一作者。 -
图 1 上海市嘉定区2010—2017学年中小学生季节性流感因病缺课率与发病率趋势比较
Figure 1. Comparison between the trend of sickness absence rate and seasonal influenza incidence among primary and secondary students in Jiading District of Shanghai from 2010 to 2017
图 2 上海市嘉定区2010—2017学年中小学生水痘因病缺课率与发病率趋势比较
Figure 2. Comparison between the trend of sickness absence rate and the incidence of chickenpox among primary and secondary students in Jiading District of Shanghai from 2010 to 2017
图 3 上海市嘉定区2010—2017学年中小学生手足口病因病缺课率与发病率趋势比较
Figure 3. Comparison between the trend of sickness absence rate and incidence of hand-foot-mouth disease among primary and secondary students in Jiading District of Shanghai from 2010 to 2017
图 4 上海市嘉定区2010—2017学年中小学生流行性腮腺炎因病缺课率与发病率趋势比较
Figure 4. Comparison between the trend of sickness absence rate and the incidence of mumps among primary and secondary students in Jiading District of Shanghai from 2010 to 2017
表 1 上海市嘉定区不同学年中小学生因病缺课情况
Table 1. Sickness absenteeism of primary and secondary school students in different academic years in Jiading District, Shanghai
学年 学校数 新发因病缺课例数 因病缺课人天数 次均缺课/d 学年因病缺课率/% 2010 69 12 700 25 819.0 2.03 0.20 2011 71 14 881 26 731.5 1.80 0.20 2012 75 14 853 27 168.5 1.83 0.18 2013 77 23 402 38 508.5 1.65 0.25 2014 77 23 065 40 469.5 1.75 0.27 2015 80 25 354 45 181.5 1.78 0.31 2016 84 29 279 52 875.0 1.81 0.37 2017 88 31 988 57 452.5 1.80 0.42 平均 - 21 940 39 275.8 1.79 0.27 注：次均缺课天数和学年因病缺课率的平均数分别按历年因病缺课人次和教学日人天数加权计算。 
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表 2 中小学生因病缺课率与流感、水痘发病率的最大互相关性
Table 2. Cross correlation between sickness absenteeism rates and incidences of influenza and chickenpox among students
学年 学期 全症状因病缺课率与流感发病率 全症状因病缺课率与水痘发病率 发热和呼吸系统症状因病缺课率与流感发病率 CCFmax值(95%CI) k值 CCFmax值(95%CI) k值 CCFmax值(95%CI) k值 2010 1 0.11(-0.07~0.28) -7 -0.08(-0.25~0.10) -10 0.13(-0.05~0.30) -4 2 0.10(-0.09~0.27) -12 0.06(-0.12~0.24) 14 0.24(0.05~0.41)* 13 2011 1 0.42(0.25~0.57)** -3 0.13(-0.06~0.31) -14 0.36(0.18~0.51)** 4 2 0.22(0.05~0.38)** 5 -0.11(-0.28~0.07) -1 0.23(0.06~0.39)** -2 2012 1 0.35(0.17~0.50)** 14 0.41(0.24~0.55)** -12 0.38(0.21~0.53)** 14 2 0.24(0.06~0.41)** -9 0.28(0.10~0.44)** -8 0.30(0.12~0.46)** -9 2013 1 0.27(0.10~0.44)** -7 0.54(0.39~0.66)** -11 0.29(0.11~0.45)** -9 2 0.21(0.03~0.38)** 14 0.04(-0.14~0.22) -1 0.26(0.09~0.42)** -8 2014 1 0.26(0.09~0.41)** 4 0.37(0.21~0.52)** -14 0.27(0.10~0.42)** 1 2 0.20(0.01~0.38)* 14 -0.10(-0.28~0.09) 1 0.22(0.02~0.4)** 11 2015 1 0.29(0.12~0.45)** 10 0.48(0.32~0.61)** -1 0.32(0.14~0.47)** 4 2 0.25(0.07~0.42)* 1 0.13(-0.06~0.30) 9 0.28(0.10~0.44)** 8 2016 1 0.22(0.04~0.38)** -7 0.47(0.31~0.61)** -11 0.23(0.05~0.39)** -7 2 0.24(0.06~0.41)** -14 0.17(-0.02~0.34) -14 0.31(0.13~0.47)** 4 2017 1 0.21(0.03~0.37)** 14 0.32(0.15~0.48)** -14 0.25(0.07~0.41)** 14 2 0.43(0.25~0.58)** 3 0.13(-0.07~0.32) -7 0.50(0.33~0.65)** 3 注：*P < 0.05, **P < 0.01。
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