Fisman David N, Tuite Ashleigh R, Brown Kevin A
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
Division of Infectious Diseases, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Proc Natl Acad Sci U S A. 2016 Dec 20;113(51):14589-14594. doi: 10.1073/pnas.1604980113. Epub 2016 Oct 24.
Although the global climate is changing at an unprecedented rate, links between weather and infectious disease have received little attention in high income countries. The "El Niño Southern Oscillation" (ENSO) occurs irregularly and is associated with changing temperature and precipitation patterns. We studied the impact of ENSO on infectious diseases in four census regions in the United States. We evaluated infectious diseases requiring hospitalization using the US National Hospital Discharge Survey (1970-2010) and five disease groupings that may undergo epidemiological shifts with changing climate: (i) vector-borne diseases, (ii) pneumonia and influenza, (iii) enteric disease, (iv) zoonotic bacterial disease, and (v) fungal disease. ENSO exposure was based on the Multivariate ENSO Index. Distributed lag models, with adjustment for seasonal oscillation and long-term trends, were used to evaluate the impact of ENSO on disease incidence over lags of up to 12 mo. ENSO was associated more with vector-borne disease [relative risk (RR) 2.96, 95% confidence interval (CI) 1.03-8.48] and less with enteric disease (0.73, 95% CI 0.62-0.87) in the Western region; the increase in vector-borne disease was attributable to increased risk of rickettsioses and tick-borne infectious diseases. By contrast, ENSO was associated with more enteric disease in non-Western regions (RR 1.12, 95% CI 1.02-1.15). The periodic nature of ENSO may make it a useful natural experiment for evaluation of the impact of climatic shifts on infectious disease risk. The impact of ENSO suggests that warmer temperatures and extreme variation in precipitation events influence risks of vector-borne and enteric disease in the United States.
尽管全球气候正以前所未有的速度变化，但在高收入国家，天气与传染病之间的联系却很少受到关注。“厄尔尼诺 - 南方涛动”（ENSO）不定期发生，并与温度和降水模式的变化有关。我们研究了ENSO对美国四个普查地区传染病的影响。我们使用美国国家医院出院调查（1970 - 2010年）以及可能随气候变化发生流行病学变化的五个疾病分组来评估需要住院治疗的传染病：（i）媒介传播疾病，（ii）肺炎和流感，（iii）肠道疾病，（iv）人畜共患细菌性疾病，以及（v）真菌病。ENSO暴露基于多变量ENSO指数。采用分布式滞后模型，并对季节性振荡和长期趋势进行调整，以评估ENSO对长达12个月滞后的疾病发病率的影响。在西部地区，ENSO与媒介传播疾病的关联更强[相对风险（RR）2.96，95%置信区间（CI）1.03 - 8.48]，而与肠道疾病的关联较弱（0.73，95%CI 0.62 - 0.87）；媒介传播疾病的增加归因于立克次体病和蜱传传染病风险的增加。相比之下，在非西部地区，ENSO与更多的肠道疾病有关（RR 1.12，95%CI 1.02 - 1.15）。ENSO的周期性可能使其成为评估气候变化对传染病风险影响的有用自然实验。ENSO的影响表明，气温升高和降水事件的极端变化会影响美国媒介传播疾病和肠道疾病的风险。
