Dataset Information

Modelling input-output flows of severe acute respiratory syndrome in mainland China.

ABSTRACT:

Background

Severe acute respiratory syndrome (SARS) originated in China in 2002, and it spread to 26 provinces in mainland China and 32 countries across five continents in a matter of months. This outbreak resulted in 774 deaths. However, the spatial features and potential determinants of SARS input-output flows remain unclear.

Methods

We used an adjusted spatial interaction model to examine the spatial effects and potential factors associated with SARS input-output flows.

Results

The presence of origin-based spatial dependence positively affected SARS input-output flows from the neighbours of the origin regions. Two components of the input-output flows, migrant and hospitalization flows, exhibited distinctive features. The origin-based and destination-based spatial dependence positively affected migrant flows (i.e., due to those seeking jobs) from the neighbours of origin and destination locations. Similarly, the destination-based spatial dependence also positively affected hospitalization flows (i.e., due to those seeking treatment) from the neighbours of destination regions. However, the origin-to-destination based spatial dependence negatively affected hospitalisation flows from the neighbours of origin-to-destination regions. The direct effects accounted for 78% of the SARS input-output flows, which was 3.56-fold greater than the indirect effects. Differences in regional income drove the SARS input-output flows. Therefore, urban income had a positive effect, whereas rural income had a negative effect. Total interregional flows increased by 3.54% with a 1% increase in urban income, and intraregional flows increased by 8.35%. In contrast, the total interregional flows decreased by 3.38% with a 1% increase in rural income, and intraregional flows declined by 2.29%. Railway capacity, per person gross domestic product (PGDP), urban rate and the law of distance decay also affected the input-output flows.

Conclusions

Our results confirm that the SARS input-output flows presented significant geographic spatial heterogeneity and spatial effects. Income differences were the major cause of the flows between pairs of regions. Railway capacity, PGDP, and urban rate also played important roles. These findings provide valuable information for the Chinese government to control the future spread of nationwide epidemics.

SUBMITTER: Wang L

PROVIDER: S-EPMC4770707 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Publications

Modelling input-output flows of severe acute respiratory syndrome in mainland China.

Wang Li L Wang Jinfeng J Xu Chengdong C Liu Tiejun T

BMC public health 20160229

<h4>Background</h4>Severe acute respiratory syndrome (SARS) originated in China in 2002, and it spread to 26 provinces in mainland China and 32 countries across five continents in a matter of months. This outbreak resulted in 774 deaths. However, the spatial features and potential determinants of SARS input-output flows remain unclear.<h4>Methods</h4>We used an adjusted spatial interaction model to examine the spatial effects and potential factors associated with SARS input-output flows.<h4>Resu ...[more]

PMID: 26924026

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Project description:BackgroundSevere acute respiratory syndrome (SARS) spread to 32 countries and regions within a few months in 2003. There were 5327 SARS cases from November 2002 to May 2003 in Mainland China, which involved 29 provinces, resulted in 349 deaths, and directly caused economic losses of $18.3 billion.MethodsThis study used an in-out flow model and flow mapping to visualize and explore the spatial pattern of SARS transmission in different regions. In-out flow is measured by the in-out degree and clustering coefficient of SARS. Flow mapping is an exploratory method of spatial visualization for interaction data.ResultsThe findings were as follows. (1) SARS in-out flow had a clear hierarchy. It formed two main centers, Guangdong in South China and Beijing in North China, and two secondary centers, Shanxi and Inner Mongolia, both connected to Beijing. (2) "Spring Festival travel" strengthened external flow, but "SARS panic effect" played a more significant role and pushed the external flow to the peak. (3) External flow and its three typical kinds showed obvious spatial heterogeneity, such as self-spreading flow (spatial displacement of SARS cases only within the province or municipality of onset and medical locations); hospitalized flow (spatial displacement of SARS cases that had been seen by a hospital doctor); and migrant flow (spatial displacement of SARS cases among migrant workers). (4) Internal and external flow tended to occur in younger groups, and occupational differentiation was particularly evident. Low-income groups of male migrants aged 19-35 years were the main routes of external flow.ConclusionsDuring 2002-2003, SARS in-out flow played an important role in countrywide transmission of the disease in Mainland China. The flow had obvious spatial heterogeneity, which was influenced by migrants' behavior characteristics. In addition, the Chinese holiday effect led to irregular spread of SARS, but the panic effect was more apparent in the middle and late stages of the epidemic. These findings constitute valuable input to prevent and control future serious infectious diseases like SARS.

Project description:Background:Although acute respiratory distress syndrome (ARDS) has been recognized for more than 50 years, limited information exists about the incidence and management of ARDS in mainland China. To evaluate the potential for improvement in management of patients with ARDS, this study was designed to describe the incidence and management of ARDS in mainland China. Methods:National prospective multicenter observational study over one month (August 31st to September 30th, 2012) of all patients who fulfilled the Berlin or American European Consensus Conference (AECC) definition of ARDS in 20 intensive care units, with data collection related to the management of ARDS, patient characteristics and outcomes. Results:Of the 1,814 patients admitted during the enrollment period, 149 (8.2%) and 147 (8.1%) patients were diagnosed by AECC and Berlin definition, respectively. Lung protective strategy with low tidal volume (Vt) (?8 mL/kg) and limitation of the plateau pressure (Pplat) (?30 cmH2O) was performed in 75.2% patients. And, 36%, 21.1% and 4.1% patients with severe, moderate and mild ARDS had the driving pressure more than 14 cmH2O (P<0.05). Pplat and driving pressure increased significantly in patients with a higher degree of ARDS severity (P=0.002 and P<0.001, respectively), but Vt were comparable in the three groups (P>0.05). In severe ARDS, patient median positive end expiratory pressure (PEEP) was 10.0 (8.0-11.3) cmH2O and median FiO2 was 90%. A recruitment maneuver was performed in 35.5% of the patients, and 8.7% of patients with severe ARDS received prone position. Overall hospital mortality was 34.0%. Hospital mortality was 21.8% for mild, 31.1% for moderate, and 60.0% for patients with severe ARDS (P=0.004). Conclusions:Despite general acceptance of low Vt and limited Pplat, high driving pressure, low PEEP and low use of adjunctive measures may still be a concern in mainland China, especially in patients with severe ARDS. Trial Registration:ClinicalTrials.gov NCT01666834; date of registration release: August 14th 2012.

Dataset Information

Modelling input-output flows of severe acute respiratory syndrome in mainland China.

Background

Methods

Results

Conclusions

Publications

Modelling input-output flows of severe acute respiratory syndrome in mainland China.

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