Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Sci Total Environ. 2020 Mar 10;707:136103. doi: 10.1016/j.scitotenv.2019.136103. Epub 2019 Dec 13.
BACKGROUND: Hand, foot, and mouth disease (HFMD) remains a serious health threat to young children in East and Southeast Asia. The humidity is crucial for the survival of enterovirus, but the evidence of the humidity-HFMD association is inconsistent. In this study we investigated the spatial heterogeneity of humidity-HFMD associations and related effect modifiers. METHODS: We retrieved the daily surveillance data of childhood HFMD counts and meteorological variables from 143 cities in mainland China between 2009 and 2014 and then adopted a three-stage time series analysis. We first fitted a common distributed lag nonlinear model (DLNM) for each of the 143 cities separately to obtain the city-specific estimates of humidity-HFMD association. Then, we pooled the city-specific estimates through multivariate meta-regression with city-level characteristics as potential effect modifiers to study the reasons for heterogeneity. Finally, we applied a region-specific analysis to verify our findings and to better visualize our results. RESULTS: We found that the overall pooled humidity-HFMD relationship was shown as an approximately U-shaped curve with substantial spatial heterogeneity (I2 = 77.8%). Taking the reference relative humidity as 70%, the minimum relative risk (RR) was obtained at 45% with a value of 0.83 (0.79, 0.87), while the maximum RR was found to be at both 20% and over 85% separately with a value of 1.10 (1.05, 1.15). The spatial heterogeneity can be well explained by the climatic, social characteristics and terrains among cities. The modification effects can be roughly classified into two types, including change in the overall slope and the shape of the curve. CONCLUSIONS: Due to substantial spatial heterogeneity, caution should be taken when interpreting the weather-HFMD association in a single-site study and to avoid generalizing its findings to another site. Our study also implied the existence of interactions among meteorological factors given that climatic factors can modify the weather-HFMD association.
背景：手足口病（HFMD）仍然是东亚和东南亚幼儿的严重健康威胁。湿度对肠道病毒的生存至关重要，但湿度与 HFMD 之间关联的证据并不一致。在这项研究中，我们调查了湿度与 HFMD 之间关联的空间异质性及其相关的调节因素。
方法：我们从 2009 年至 2014 年期间检索了中国大陆 143 个城市的儿童 HFMD 计数和气象变量的日常监测数据，并采用了三阶段时间序列分析。我们首先为每个城市分别拟合了一个通用的分布滞后非线性模型（DLNM），以获得城市特定的湿度与 HFMD 关联的估计值。然后，我们通过多元荟萃回归将城市特定的估计值汇总，将城市水平的特征作为潜在的调节因素，以研究异质性的原因。最后，我们应用区域特异性分析来验证我们的发现，并更好地可视化我们的结果。
结果：我们发现，总体上，合并后的湿度与 HFMD 之间的关系呈近似 U 形曲线，存在很大的空间异质性（I2=77.8%）。以参考相对湿度为 70%为例，相对风险（RR）最小值出现在 45%，RR 值为 0.83（0.79，0.87），最大值分别出现在 20%和 85%以上，RR 值为 1.10（1.05，1.15）。城市之间的气候、社会特征和地形可以很好地解释空间异质性。调节作用可以大致分为两类，包括总体斜率和曲线形状的变化。
结论：由于存在很大的空间异质性，在单个地点的研究中解释天气与 HFMD 之间的关联时应谨慎，避免将其发现推广到另一个地点。我们的研究还暗示了气象因素之间存在相互作用，因为气候因素可以改变天气与 HFMD 之间的关联。
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