Environmental Health Institute, National Environment Agency, 40 Scotts Road, Environment Building, #13-00, 228231, Singapore; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, New South Wales, Australia.
Environmental Health Institute, National Environment Agency, 40 Scotts Road, Environment Building, #13-00, 228231, Singapore.
Int J Hyg Environ Health. 2020 Jun;227:113517. doi: 10.1016/j.ijheh.2020.113517. Epub 2020 Apr 6.
Diarrhoeal disease is common and imposes substantial health and economic burdens across the globe, especially in the African and Southeast Asian regions. Besides causing high mortality and morbidity, diarrhoeal disease has also been associated with growth and cognitive shortfalls in children in low-resource settings. Extreme weather events brought about by climate change may increase diarrhoeal disease and impact vulnerable populations in countries regardless of levels of development. We examined the seasonal and climatic influences of acute diarrhoeal disease reports in Singapore, a city-state located in Southeast Asia.
We used a time-series analysis, adjusting for time-varying potential confounders in a negative binomial regression model and fitting fractional polynomials to investigate the relationship between climatic factors (temperature, relative humidity and rainfall) and reported diarrhoeal disease.
We included 1,798,198 reports of diarrhoeal disease from 2005 to 2018. We observed annual trimodal peaks in the number of reports. Every 10% increase in relative humidity in the present week was positively associated with an increase in reports one week later [Incidence Rate Ratio (IRR): 1.030, 95% CI 1.004-1.057] and negatively associated with a decrease in reports six weeks later (IRR: 0.979, 95% CI 0.961-0.997). We observed effect modification of relative humidity on the risk of diarrhoeal disease in the first calendar quarter (January to March). There was weak evidence of a delayed effect of ambient air temperature on reports of diarrhoeal disease one week later (IRR: 1.013, 95% CI 0.998-1.027). No threshold effects of climatic factors were observed. Each week of school holidays was associated with a 14.4% reduction in diarrhoeal disease reports (IRR: 0.856, 95% CI: 0.840 to 0.871). Public holidays were associated with a reduction in reports in the same week and an increase a week later.
Diarrhoeal disease is highly seasonal and is associated with climate variability. Food safety and primary healthcare resource mitigation could be timed in anticipation of seasonal and climate driven increases in disease reports.
腹泻病在全球范围内很常见，给健康和经济带来了巨大负担，尤其是在非洲和东南亚地区。除了导致高死亡率和发病率外，腹泻病还与资源匮乏地区儿童的生长和认知发育不足有关。气候变化引起的极端天气事件可能会增加腹泻病的发生，并影响到无论发展水平如何的国家的脆弱人群。我们研究了位于东南亚的城市国家新加坡急性腹泻病报告的季节性和气候影响。
我们使用时间序列分析，在负二项回归模型中调整随时间变化的潜在混杂因素，并拟合分数多项式，以研究气候因素（温度、相对湿度和降雨量）与报告的腹泻病之间的关系。
我们纳入了 2005 年至 2018 年期间 1798198 例腹泻病报告。我们观察到报告数量呈每年三峰模式。本星期相对湿度每增加 10%，下星期报告的腹泻病就会增加[发病率比（IRR）：1.030，95%可信区间（CI）：1.004-1.057]，而六周后报告的腹泻病就会减少[IRR：0.979，95%CI：0.961-0.997]。我们观察到相对湿度对第一日历季度（1 月至 3 月）腹泻病风险的影响存在修饰作用。环境空气温度对下星期腹泻病报告的影响有较弱的证据表明存在延迟效应（IRR：1.013，95%CI：0.998-1.027）。未观察到气候因素的阈值效应。每一周的学校假期都会使腹泻病报告减少 14.4%（IRR：0.856，95%CI：0.840 至 0.871）。公共假日与本周报告减少和下周报告增加有关。
腹泻病具有很强的季节性，与气候变率有关。食品安全和初级医疗保健资源的缓解可以根据疾病报告的季节性和气候驱动因素进行调整。
