Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA.
Sci Total Environ. 2019 Mar 15;656:1358-1364. doi: 10.1016/j.scitotenv.2018.11.391. Epub 2018 Nov 27.
Prior studies have shown that climate factors and air pollution are associated with hand, foot, and mouth disease (HFMD) epidemics. However, the interaction between air pollution and climate factors remains unknown.
Daily HFMD counts from 2009 through 2012 in Guangdong were collected. We used distributed lag non-linear models to assess the associations of climate factors and air pollution on HFMD cases. The effects of climate factors were stratified by air pollution stratum to examine the interaction effect of air quality index (AQI) and temperature, as well as relative humidity. In addition, we explored the variability across gender groups.
We observed associations between HFMD cases and environmental factors, including temperature, relative humidity, and AQI. The highest relative risks (RR) were observed at the middle level of temperature and AQI, and high level of relative humidity. The effects for the interaction between AQI and climate factors on HFMD cases were also statistically observed. Compared with low level temperatures (≤23.5 °C), high level temperatures (>23.5 °C) had a RR of 1.486 (95%CI: 1.469,1.503) on days with "good" air quality (AQI ≤ 46), and RR of 1.013 (95%CI: 1.003,1.023) on days with "moderate" air quality (AQI > 46). For relative humidity, the high level (>77%) had a RR of 1.082 (95%CI: 1.076,1.089) on days with "good" air quality, and RR of 1.039 (95%CI: 1.033,1.046) on days with "moderate" air quality. The associations and the interactions remained robust for males and females.
Our findings indicate that climate factors and air pollution imposed lagged and non-linear effects on HFMD epidemics. The effects of climate factors on health potentially vary by AQI. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence.
先前的研究表明，气候因素和空气污染与手足口病（HFMD）疫情有关。然而，空气污染和气候因素之间的相互作用仍不清楚。
收集了 2009 年至 2012 年广东的每日 HFMD 病例数据。我们使用分布式滞后非线性模型来评估气候因素和空气污染对 HFMD 病例的关联。根据空气污染水平分层研究气候因素的影响，以检查空气质量指数（AQI）和温度以及相对湿度之间的交互作用。此外，我们还探讨了不同性别组之间的差异。
我们观察到 HFMD 病例与环境因素（包括温度、相对湿度和 AQI）之间存在关联。在温度和 AQI 的中值以及相对湿度的高值水平下，观察到最高的相对风险（RR）。还观察到 AQI 与气候因素之间相互作用对 HFMD 病例的影响具有统计学意义。与低温（≤23.5°C）相比，高温（>23.5°C）在空气质量“良好”（AQI≤46）时的 RR 为 1.486（95%CI：1.469，1.503），在空气质量“中等”（AQI>46）时的 RR 为 1.013（95%CI：1.003，1.023）。对于相对湿度，在空气质量“良好”时，高水平（>77%）的 RR 为 1.082（95%CI：1.076，1.089），在空气质量“中等”时，RR 为 1.039（95%CI：1.033，1.046）。这些关联和相互作用对男性和女性均具有稳健性。
我们的研究结果表明，气候因素和空气污染对 HFMD 疫情产生了滞后和非线性影响。气候因素对健康的影响可能因 AQI 而异。我们的研究为有针对性的预防和控制提供了实用且有用的信息，并提供了基于环境的证据。
