Department of Epidemiology, School of Public Health, Shandong University, Jinan City, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China.
Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.
Sci Total Environ. 2018 Jun 1;626:630-637. doi: 10.1016/j.scitotenv.2018.01.130. Epub 2018 Feb 19.
Understanding the potential links between floods and infectious diarrhea is important under the context of climate change. However, little is known about the risk of infectious diarrhea after floods and what factors could modify these effects in China.
This study aims to quantitatively examine the relationship between floods and infectious diarrhea and their effect modifiers.
Weekly number of infectious diarrhea cases from 2004 to 2011 during flood season in Hunan province were supplied by the National Notifiable Disease Surveillance System. Flood and meteorological data over the same period were obtained. A two-stage model was used to estimate a provincial average association and their effect modifiers between floods and infectious diarrhea, accounting for other confounders.
A total of 134,571 cases of infectious diarrhea were notified from 2004 to 2011. After controlling for seasonality, long-term trends, and meteorological factors, floods were significantly associated with infectious diarrhea in the provincial level with a cumulative RR of 1.22 (95% CI: 1.05, 1.43) with a lagged effect of 0-1 week. Geographic locations and economic levels were identified as effect modifiers, with a higher impact of floods on infectious diarrhea in the western and regions with a low economic level of Hunan.
Our study provides strong evidence of a positive association between floods and infectious diarrhea in the study area. Local control strategies for public health should be taken in time to prevent and reduce the risk of infectious diarrhea after floods, especially for the vulnerable regions identified.
在气候变化的背景下，了解洪水与传染性腹泻之间的潜在联系非常重要。然而，人们对洪水后传染性腹泻的风险以及哪些因素可能改变这些影响知之甚少。
本研究旨在定量研究洪水与传染性腹泻之间的关系及其影响因素。
本研究采用两阶段模型，利用国家法定传染病监测系统提供的 2004 年至 2011 年洪水期间湖南省每周的传染性腹泻病例数和同期的洪水及气象数据，估计省级平均关联及其与传染性腹泻的效应修饰物，同时考虑了其他混杂因素。
本研究共报告了 2004 年至 2011 年期间的 134571 例传染性腹泻病例。在控制了季节性、长期趋势和气象因素后，洪水与省级传染性腹泻呈显著相关，其累积 RR 为 1.22（95%CI：1.05，1.43），滞后效应为 0-1 周。地理位置和经济水平被确定为效应修饰物，洪水对湖南西部和经济水平较低地区的传染性腹泻影响更大。
本研究提供了强有力的证据表明，在研究区域内，洪水与传染性腹泻之间存在正相关关系。应及时采取针对特定地区的公共卫生控制策略，以预防和降低洪水后传染性腹泻的风险，特别是针对确定的脆弱地区。
