Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
China Population Communication Center, Beijing, 100013, China.
J Expo Sci Environ Epidemiol. 2021 Jul;31(4):664-671. doi: 10.1038/s41370-021-00291-y. Epub 2021 Feb 5.
Hand, foot, and mouth disease (HFMD) remains a significant public health issue, especially in developing countries. Many studies have reported the association between environmental temperature and HFMD. However, the results are highly heterogeneous in different regions. In addition, there are few studies on the attributable risk of HFMD due to temperature.
The study aimed to assess the association between temperature and HFMD incidence and to evaluate the attributable burden of HFMD due to temperature in Ningbo China.
The research used daily incidence of HFMD from 2014 to 2017 and distributed lag non-linear model (DLNM) to investigate the effects of daily mean temperature (Tmean) on HFMD incidence from lag 0 to 30 days, after controlling potential confounders. The lag effects and cumulative relative risk (CRR) were analyzed. Attributable fraction (AF) of HFMD incidence due to temperature was calculated. Stratified analysis by gender and age were also conducted.
The significant associations between Tmean and HFMD incidence were observed in Ningbo for lag 0-30. Two peaks were observed at both low (5-11 °C) and high (16-29 °C) temperature scales. For low temperature scale, the highest CRR was 2.22 (95% CI: 1.61-3.07) at 7 °C on lag 0-30. For high temperature scale, the highest CRR was 3.54 (95% CI: 2.58-4.88) at 24 °C on lag 0-30. The AF due to low and high temperature was 5.23% (95% CI: 3.10-7.14%) and 39.55% (95% CI: 30.91-45.51%), respectively. There was no significant difference between gender- and age-specific AFs, even though the school-age and female children had slightly higher AF values.
The result indicates that both high and low temperatures were associated with daily incidence of HFMD, and more burdens were caused by heat in Ningbo.
手足口病（HFMD）仍然是一个重大的公共卫生问题，特别是在发展中国家。许多研究报告了环境温度与 HFMD 之间的关联。然而，不同地区的结果差异很大。此外，关于温度导致 HFMD 的归因风险的研究很少。
本研究旨在评估温度与 HFMD 发病率之间的关系，并评估中国宁波因温度导致 HFMD 的归因负担。
本研究使用了 2014 年至 2017 年的 HFMD 日发病率数据，并采用分布滞后非线性模型（DLNM），在控制潜在混杂因素后，研究了日平均温度（Tmean）对 HFMD 发病率的滞后 0 至 30 天的影响。分析了滞后效应和累积相对风险（CRR）。计算了因温度导致 HFMD 发病率的归因分数（AF）。还进行了性别和年龄分层分析。
在宁波，Tmean 与 HFMD 发病率之间存在显著关联，滞后 0-30 天。在低温（5-11°C）和高温（16-29°C）范围内均观察到两个高峰。对于低温范围，滞后 0-30 天，温度为 7°C 时 CRR 最高为 2.22（95%CI：1.61-3.07）。对于高温范围，滞后 0-30 天，温度为 24°C 时 CRR 最高为 3.54（95%CI：2.58-4.88）。低温和高温导致的 AF 分别为 5.23%（95%CI：3.10-7.14%）和 39.55%（95%CI：30.91-45.51%）。虽然学龄期和女童的 AF 值略高，但性别和年龄特异性 AF 之间没有显著差异。
结果表明，高温和低温均与 HFMD 日发病率有关，在宁波，热导致的负担更大。
