Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Environ Int. 2017 Mar;100:102-109. doi: 10.1016/j.envint.2016.11.021. Epub 2017 Jan 6.
Hand, foot and mouth disease (HFMD) is a rising public health issue in the Asia-Pacific region. Numerous studies have tried to quantify the relationship between meteorological variables and HFMD but with inconsistent results, in particular for temperature. We aimed to characterize the relationship between temperature and HFMD in various locations and to investigate the potential heterogeneity.
We retrieved the daily series of childhood HFMD counts (aged 0-12 years) and meteorological variables for each of 143 cities in mainland China in the period 2009-2014. We fitted a common distributed lag nonlinear model allowing for over dispersion to each of the cities to obtain the city-specific estimates of temperature-HFMD relationship. Then we pooled the city-specific estimates through multivariate meta-regression with city-level characteristics as potential effect modifiers.
We found that the overall pooled temperature-HFMD relationship was shown as an approximately inverted V shape curve, peaking at the 91th percentile of temperature with a risk ratio of 1.30 (95% CI: 1.23-1.37) compared to its 50th percentile. We found that 68.5% of the variations of city-specific estimates was attributable to heterogeneity. We identified rainfall and altitude as the two main effect modifiers.
We found a nonlinear relationship between temperature and HFMD. The temperature-HFMD relationship varies depending on geographic and climatic conditions. The findings can help us deepen the understanding of weather-HFMD relationship and provide evidences for related public health decisions.
手足口病（HFMD）是亚太地区日益严重的公共卫生问题。许多研究试图量化气象变量与 HFMD 之间的关系，但结果不一致，特别是对于温度。我们旨在描述不同地点温度与 HFMD 之间的关系，并探讨潜在的异质性。
我们检索了中国大陆 143 个城市 2009-2014 年期间儿童 HFMD 计数（0-12 岁）和气象变量的每日序列。我们为每个城市拟合了一个具有过离散的常见分布式滞后非线性模型，以获得城市特定的温度-HFMD 关系估计值。然后，我们通过多元荟萃回归将城市特定的估计值与城市层面的特征进行汇总，这些特征可能是潜在的效应修饰剂。
我们发现总体上，温度-HFMD 关系呈近似倒 V 形曲线，在温度的第 91 百分位达到峰值，风险比为 1.30（95%CI：1.23-1.37），与第 50 百分位相比。我们发现，城市特定估计值的 68.5%差异归因于异质性。我们确定降雨量和海拔高度是两个主要的效应修饰剂。
我们发现温度与 HFMD 之间存在非线性关系。温度-HFMD 关系因地理位置和气候条件而异。研究结果有助于加深对手足口病与天气关系的理解，并为相关公共卫生决策提供依据。
