气象因素对中国广东小儿手足口病的短期影响：一项多城市时间序列分析
Short-term effects of meteorological factors on pediatric hand, foot, and mouth disease in Guangdong, China: a multi-city time-series analysis.
作者信息
Guo Cui, Yang Jun, Guo Yuming, Ou Qiao-Qun, Shen Shuang-Quan, Ou Chun-Quan, Liu Qi-Yong
机构信息
State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
出版信息
BMC Infect Dis. 2016 Sep 29;16(1):524. doi: 10.1186/s12879-016-1846-y.
BACKGROUND
Literature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors.
METHODS
Based on daily time-series data in eight major cities in Guangdong, China during 2009-2013, mixed generalized additive models were employed to estimate city-specific meteorological effects on pediatric HFMD. Then, a random-effect multivariate meta-analysis was conducted to obtain the pooled risks and to explore heterogeneity explained by city-level factors.
RESULTS
There were a total of 400,408 pediatric HFMD cases (children aged 0-14 years old) with an annual incidence rate of 16.6 cases per 1,000 children, clustered in males and children under 3 years old. Daily average temperature was positively associated with pediatric HFMD cases with the highest pooled relative risk (RR) of 1.52 (95 % CI: 1.30-1.77) at the 95th percentile of temperature (30.5 °C) as compared to the median temperature (23.5 °C). Significant non-linear positive effects of high relative humidity were also observed with a 13 % increase (RR = 1.13, 95 % CI: 1.00-1.28) in the risk of HFMD at the 99th percentile of relative humidity (86.9 %) as compared to the median value (78 %). The effect estimates showed geographic variations among the cities which was significantly associated with city's latitude and longitude with an explained heterogeneity of 32 %.
CONCLUSIONS
Daily average temperature and relative humidity had non-linear and delayed effects on pediatric HFMD and the effects varied across different cities. These findings provide important evidence for comprehensive understanding of the climatic effects on pediatric HFMD and for the authority to take targeted interventions and measures to control the occurrence and transmission of HFMD.
背景
文献表明，不同城市中气象因素对手足口病（HFMD）的影响存在不一致性。这项多城市研究旨在调查气象因素对小儿手足口病发病情况的影响以及地理因素的潜在效应修正作用。
方法
基于2009 - 2013年中国广东省八个主要城市的每日时间序列数据，采用混合广义相加模型来估计特定城市气象因素对小儿手足口病的影响。然后，进行随机效应多变量荟萃分析以获得合并风险，并探索由城市层面因素解释的异质性。
结果
共有400,408例小儿手足口病病例（0 - 14岁儿童），年发病率为每1000名儿童16.6例，病例集中在男性和3岁以下儿童。日平均温度与小儿手足口病病例呈正相关，在温度第95百分位数（30.5°C）时，合并相对风险（RR）最高，为1.52（95%CI：1.30 - 1.77），而中位数温度为23.5°C。与相对湿度中位数（78%）相比，在相对湿度第99百分位数（86.9%）时，手足口病风险也观察到显著的非线性正向效应，增加了13%（RR = 1.13，95%CI：1.00 - 1.28）。效应估计显示各城市之间存在地理差异，这与城市纬度和经度显著相关，可解释的异质性为32%。
结论
日平均温度和相对湿度对小儿手足口病有非线性和延迟效应，且不同城市的效应有所不同。这些发现为全面理解气候因素对小儿手足口病的影响以及当局采取针对性干预措施控制手足口病的发生和传播提供了重要证据。
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