Abstract
Background: The disease burden of hepatitis E remains high. We used a new method (richness, diversity, evenness, and similarity analyses) to classify cities according to the occupational classification of hepatitis E patients across regions in China and compared the results of cluster analysis.Methods: Data on reported hepatitis E cases from 2008 to 2018 were collected from 24 cities (9 in Jilin Province, 13 in Jiangsu Province, Xiamen City, and Chuxiong Yi Autonomous Prefecture). Traditional statistical methods were used to describe the epidemiological characteristics of hepatitis E patients, while the new method and cluster analysis were used to classify the cities by analyzing the occupational composition across regions.Results: The prevalence of hepatitis E in eastern China (Jiangsu Province) was similar to that in the south (Xiamen City) and southwest of China (Chuxiong Yi Autonomous Prefecture), but higher than that in the north (Jilin Province). The age of hepatitis E patients was concentrated between 41 and 60 years, and the sex ratio ranged from 1:1.6 to 1:3.4. Farming was the most highly prevalent occupation; other sub-prevalent occupations included retirement, housework and unemployment. The incidence of occupations among migrant workers, medical staff, teachers, and students was moderate. There were several occupational types with few or no records, such as catering industry, caregivers and babysitters, diaspora children, childcare, herders, and fishing (boat) people. The occupational similarity of hepatitis E was high among economically developed cities, such as Nanjing, Wuxi, Baicheng, and Xiamen, while the similarity was small among cities with large economic disparities, such as Nanjing and Chuxiong Yi Autonomous Prefecture. A comparison of the classification results revealed more similarities and some differences when using these two methods.Conclusion: In China, the factors with the greatest influence on the prevalence of hepatitis E are living in the south, farming as an occupation, being middle-aged or elderly, and being male. The 24 cities we studied were highly diverse and moderately similar in terms of the occupational distribution of patients with hepatitis E. We confirmed the validity of the new method on in classifying cities according to their occupational composition by comparing it with the clustering method.
Highlights
Hepatitis E virus (HEV) infection is a great economic burden on Chinese people
Most of the cities in Jilin province were close in similarity and diversity and were classified into the same group
The similarity coefficients between Nanjing and Baishan, Jilin, Liaoyuan, and Changchun (C > 0.8), and Nanjing and Xiamen (C = 0. 924) are similar, which is consistent with the results of the cluster analysis
Summary
Hepatitis E virus (HEV) infection is a great economic burden on Chinese people. The results of a health economics study in Jiangsu Province showed that the total economic burden of HEV cases accounted for 60.77% of the per capita disposable income [3]. Genotypes 1 and 2 are responsible for the majority of acute viral hepatitis infections in endemic areas in South Asia [4], which are limited to humans and non-human primates and have been found in areas with frequent water contamination via fecal-oral transmission, mostly in developing countries with limited access to sanitation. Genotypes 3 and 4 are related to zoonotic diseases, being lowendemic in developed countries, and transmitted by eating infected animal meat or having close contact with animals [5]. We used a new method (richness, diversity, evenness, and similarity analyses) to classify cities according to the occupational classification of hepatitis E patients across regions in China and compared the results of cluster analysis
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