Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China.
Hefei Centre for Disease Control and Prevention, Hefei, Anhui 230032, China.
Sci Total Environ. 2019 Mar 25;658:116-121. doi: 10.1016/j.scitotenv.2018.11.481. Epub 2018 Dec 2.
Sulfur dioxide (SO) is an important component of air pollution, adversely impacting human health worldwide. This study aimed to examine the association between short-term exposure to SO and childhood hand, foot, and mouth disease (HFMD) in Hefei, China.
A Poisson generalized additive model (GAM) combining the time-series regression analyses was used to fit the SO-HFMD association. The effect of SO was estimated using the single-day lag models (lag0, lag1, lag2) and the moving average lag models (lag01, lag02) We also conducted stratified analyses by season, ages (0-4 years old, 5-14 years old), gender (male, female), childcare patterns (scattered children, kindergarten children) and residence areas (urban, rural). Two-pollutant models were adopted to test the robustness of the results.
There was a statistically significant association between SO and the risk of childhood HFMD. For total cases, the relative risk (RR) at lag0 was 1.038 (95% confidence interval (CI): 1.018-1.057) in whole-period and 1.088 (95% CI: 1.059-1.118) in cold season. During cold season, we observed significant associations between SO and HFMD among all subgroups except for children aged 5-14 years old and the adverse effects occurred on lag0, lag1, lag01, lag02. However, in hot season, SO were significant only for females (lag01 with RR = 1.054; 95%CI = 1.007-1.101) and scattered children (lag01 with RR = 1.054; 95%CI = 1.007-1.101). In general, females and scattered children appeared to be more vulnerable to SO.
This study suggests a significant association between SO and HFMD. especially during cold season. Compared with males and kindergarten children, females and scattered children are at higher risk of developing HFMD.
二氧化硫（SO）是空气污染的重要组成部分，对全球人类健康造成不利影响。本研究旨在探讨中国合肥短期 SO 暴露与儿童手足口病（HFMD）之间的关系。
采用时间序列回归分析的泊松广义相加模型（GAM）拟合 SO-HFMD 关联。使用单日滞后模型（lag0、lag1、lag2）和移动平均滞后模型（lag01、lag02）估计 SO 的影响。我们还按季节、年龄（0-4 岁、5-14 岁）、性别（男、女）、保育模式（散居儿童、幼儿园儿童）和居住区域（城市、农村）进行分层分析。采用双污染物模型检验结果的稳健性。
SO 与儿童 HFMD 风险之间存在统计学显著关联。对于总病例，全期 lag0 的相对风险（RR）为 1.038（95%置信区间（CI）：1.018-1.057），冷季为 1.088（95%CI：1.059-1.118）。在冷季，我们观察到 SO 与所有亚组之间均存在显著关联，除了 5-14 岁儿童以及滞后 0、1、01、02 外，不良反应发生。然而，在热季，SO 仅对女性（lag01，RR=1.054；95%CI=1.007-1.101）和散居儿童（lag01，RR=1.054；95%CI=1.007-1.101）有显著影响。总体而言，女性和散居儿童似乎更容易受到 SO 的影响。
本研究表明 SO 与 HFMD 之间存在显著关联，尤其是在冷季。与男性和幼儿园儿童相比，女性和散居儿童患 HFMD 的风险更高。
