The spatial pattern and determinants of vulnerability to infectious disease outbreaks in the United States

doi:10.3969/j.issn.1004-9479.2023.09.2021648

Abstract

Abstract:

In the context of globalization and urbanization, mobility has expanded the geographical scope of infectious diseases transmission, and the epidemic outbreak has posed big challenges to human health and economic and social steadiness. From a local scale, the natural and social diversity in each region makes it show differentiated characteristics of vulnerability and resilience when facing the epidemic. Therefore, this article focused on the types of infectious diseases which can be transferred by infected person, constructed a vulnerability evaluation index system based on the three dimensions, including exposure, sensitivity and adaptability, used entropy method to identify the spatial differentiated characteristics of vulnerability to infectious disease outbreaks in American counties, utilized various methods containing comprehensively clusters analysis, literature analysis and others to discuss the division of vulnerability types in America counties, and clarified the impact mechanism that affects the vulnerability of infectious disease outbreaks through analyzing the literature. The results are as follows: ①Overall, the vulnerability of infectious disease infection in American counties is mostly at a low or lower level, with relatively significant spatial differentiation characteristics.②Summarize the mechanism of infectious disease outbreaks: The outbreak of infectious disease is driven by natural and anthropogenic disturbance factors, including genetic mutation, biological disasters, land use changes, globalization and the like. Exposure involves social connections at domestic and international scales. Sensitivity involves four aspects, individual risks, urban environment, economic security, and social proliferation. Adaptability involves three aspects, government emergency response, medical systems, and social security. ③Based on the score of the influencing factors of vulnerability of infectious disease outbreaks, American counties are divided into 10 regional types to analyze the driving mechanism of vulnerability.

Key words: infectious diseases, vulnerability, spatial differentiation, impact mechanisms, sustainable development, United States

摘要：

全球化与城市化背景下，流动性扩大了传染病波及的地域范围，疫情暴发给人类健康与经济社会稳定带来严峻挑战。从地方尺度看，区域多元的自然与社会条件使其在面对疫情时表现出差异化的脆弱性与韧性特征。针对人与人接触传播的传染病类型，基于暴露度、敏感性与适应性三个维度构建地域传染病暴发脆弱性评价指标体系，揭示美国县域传染病暴发脆弱性的空间分异特征，划分脆弱性地域类型，阐明传染病暴发脆弱性强弱的影响机制。结果如下：①整体上，美国县域传染病暴发脆弱性大部分处于较低或低水平，空间分异特征显著；②自然与人为扰动因素驱动下，传染病暴发受暴露度（与外界社会的联系）、敏感性（个体风险、城市环境、经济保障、社会扩散）与适应性（政府应急、医疗系统与社会保障）三个维度综合影响；③基于传染病暴发脆弱性的影响因素得分，将美国县域划分为10个地域类型，具体解析其脆弱性的驱动机制。

关键词: 传染病, 脆弱性, 空间分异, 影响机制, 可持续发展, 美国

Nuoya ZHUANG, Fanglin HUA, Yiying LIU, Yuling HUANG, Ye LIU. The spatial pattern and determinants of vulnerability to infectious disease outbreaks in the United States[J]. World Regional Studies, 2023, 32(9): 40-54.

庄诺亚, 华芳琳, 刘羿滢, 黄俞菱, 刘晔. 美国传染病暴发脆弱性的空间分异格局与影响机制研究[J]. 世界地理研究, 2023, 32(9): 40-54.

Figures/Tables 5

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准则层	指标层	具体指标	年份	计算方法	均值	方差
暴露度	外界社会联系	航空客流量^a/百万人	2019（州级）	一年内地区总航空客流数(国际+国内)	24.150	833.055
		来自不同州的迁移人口^b/千人	2014—2018	不同州的迁移人口数	2.500	50.215
		来自同州内不同县的迁移人口^b/千人	2014—2018	同州不同县迁移人口数	3.499	54.930
		非法国际移民^c/十万人	2014—2018（州级）	非法国际移民数估计数	3.444	37.302
		合法国际移民^c/十万人	2014—2018（州级）	合法国际移民统计数	8.601	192.309
		跨县通勤人口占比^a	2019—2020	跨县日常通勤人数/总人口*100%	30.118	305.489
敏感性	个人健康状况	5岁以下人口占比^b	2019	5岁以下人口数/总人口数*100%	5.792	1.200
		65岁以上人口占比^b	2019	65岁以上人口数/总人口数*100%	18.736	19.628
		每十万人心脏病死亡人口^d/ 人	2016—2018	心脏病死亡人数/总人数*10万	185.599	1 896.879
		每十万人中风病死亡人口^d/人	2016—2018	中风病死亡人数/总人数*10万	39.917	66.715
		糖尿病诊断率^d	2017	20岁以上的人口糖尿病率*100%	10.587	12.246
		肥胖率^d	2017	20岁以上的人口肥胖率*100%	32.951	31.405
	政治社会背景	民主党派支持率^e	2020	总投票数/总人口*100%	33.516	241.776
	政治社会背景	宗教组织数^b/ （个/万人）	2019	每万人宗教组织统计数值/总人口	9.728	25.904
	人口聚集程度	人口密度^b/ (百人/平方英里)	2019	人口数/地区面积	2.702	351.702
	人口聚集程度	制度化团体宿舍居住占比^b	2014—2018	居住在制度化团体宿舍(包括监狱、养老院等)的人口占比*100%	3.475	18.226
	城市环境条件	PM2.5浓度^d/(µg/m³)	2016	年均PM2.5浓度	7.743	2.682
	城市环境条件	空气免疫危险指数^f	2014	空气对人体免疫危害评估指数*100	1.365	0.872
	公共卫生意识	25岁以上人口中高中学历及以上人口占比^b★	2019	高中学历以上人口数/总人口数*100%	86.938	35.828
		每十万人流行病学家数^g/(个/十万人)^★	2018（州级）	每十万人中流行病学家数占比	54.573	854.687
		预防质量指数^h★	2017	通过多种疾病入院率调整的医疗保健研究和预防质量综合指标/10 000	0.490	0.025
	经济保障水平	失业人口占比^b	2019	失业人口数/总人口数*100%	5.286	5.836
		贫困人口占比^b	2019	贫困人口数/总人口数*100%	14.420	32.080
		人均收入^b/万美元^★	2019	各县区人均财政收入	4.568	1.677
		人均卫生支出^h/万美元^★	2014（州级）	综合各种保险、补助等的人均卫生支出估计值	1.590	0.029
适应性	政府治理能力	政府响应指数^i★	2019（州级）	各项政府响应指数求均值	19.833	6.048
	社会医疗服务	每十万人紧急服务^b/ (个/十万人)^★	2017（州级）	每10万人提供的紧急服务(包括紧急和救济服务以及独立流动外科和紧急中心)	2.666	0.510
	社会医疗服务	无健康保险人口占比^b	2019	无保险人口数/总人口数*100%	11.339	25.233

准则层	指标层	具体指标	年份	计算方法	均值	方差
暴露度	外界社会联系	航空客流量^a/百万人	2019（州级）	一年内地区总航空客流数(国际+国内)	24.150	833.055
		来自不同州的迁移人口^b/千人	2014—2018	不同州的迁移人口数	2.500	50.215
		来自同州内不同县的迁移人口^b/千人	2014—2018	同州不同县迁移人口数	3.499	54.930
		非法国际移民^c/十万人	2014—2018（州级）	非法国际移民数估计数	3.444	37.302
		合法国际移民^c/十万人	2014—2018（州级）	合法国际移民统计数	8.601	192.309
		跨县通勤人口占比^a	2019—2020	跨县日常通勤人数/总人口*100%	30.118	305.489
敏感性	个人健康状况	5岁以下人口占比^b	2019	5岁以下人口数/总人口数*100%	5.792	1.200
		65岁以上人口占比^b	2019	65岁以上人口数/总人口数*100%	18.736	19.628
		每十万人心脏病死亡人口^d/ 人	2016—2018	心脏病死亡人数/总人数*10万	185.599	1 896.879
		每十万人中风病死亡人口^d/人	2016—2018	中风病死亡人数/总人数*10万	39.917	66.715
		糖尿病诊断率^d	2017	20岁以上的人口糖尿病率*100%	10.587	12.246
		肥胖率^d	2017	20岁以上的人口肥胖率*100%	32.951	31.405
	政治社会背景	民主党派支持率^e	2020	总投票数/总人口*100%	33.516	241.776
	政治社会背景	宗教组织数^b/ （个/万人）	2019	每万人宗教组织统计数值/总人口	9.728	25.904
	人口聚集程度	人口密度^b/ (百人/平方英里)	2019	人口数/地区面积	2.702	351.702
	人口聚集程度	制度化团体宿舍居住占比^b	2014—2018	居住在制度化团体宿舍(包括监狱、养老院等)的人口占比*100%	3.475	18.226
	城市环境条件	PM2.5浓度^d/(µg/m³)	2016	年均PM2.5浓度	7.743	2.682
	城市环境条件	空气免疫危险指数^f	2014	空气对人体免疫危害评估指数*100	1.365	0.872
	公共卫生意识	25岁以上人口中高中学历及以上人口占比^b★	2019	高中学历以上人口数/总人口数*100%	86.938	35.828
		每十万人流行病学家数^g/(个/十万人)^★	2018（州级）	每十万人中流行病学家数占比	54.573	854.687
		预防质量指数^h★	2017	通过多种疾病入院率调整的医疗保健研究和预防质量综合指标/10 000	0.490	0.025
	经济保障水平	失业人口占比^b	2019	失业人口数/总人口数*100%	5.286	5.836
		贫困人口占比^b	2019	贫困人口数/总人口数*100%	14.420	32.080
		人均收入^b/万美元^★	2019	各县区人均财政收入	4.568	1.677
		人均卫生支出^h/万美元^★	2014（州级）	综合各种保险、补助等的人均卫生支出估计值	1.590	0.029
适应性	政府治理能力	政府响应指数^i★	2019（州级）	各项政府响应指数求均值	19.833	6.048
	社会医疗服务	每十万人紧急服务^b/ (个/十万人)^★	2017（州级）	每10万人提供的紧急服务(包括紧急和救济服务以及独立流动外科和紧急中心)	2.666	0.510
	社会医疗服务	无健康保险人口占比^b	2019	无保险人口数/总人口数*100%	11.339	25.233

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