Hao Qiang, Gao Qi, Zhao Ran, Wang Haitao, Li Hao, Jiang Baofa
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong Province, People's Republic of China.
Shandong University Climate Change and Health Center, Jinan, 250012, Shandong Province, People's Republic of China.
Environ Sci Pollut Res Int. 2022 Apr;29(16):23963-23974. doi: 10.1007/s11356-021-17132-y. Epub 2021 Nov 24.
Previous studies have explored the effect between ambient temperature and infectious diarrhea (ID) mostly using relative risk, which provides limited information in practical applications. Few studies have focused on the disease burden of ID caused by temperature, especially for different subgroups and cities in a multi-city setting. This study aims to estimate the effects and attributable risks of temperature on category C ID and explore potential modifiers among various cities in Guangdong. First, distributed lag non-linear models (DLNMs) were used to explore city-specific associations between daily mean temperature and category C ID from 2014 to 2016 in Guangdong and pooled by applying multivariate meta-analysis. Then, multivariate meta-regression was implemented to analyze the potential heterogeneity among various cities. Finally, we assessed the attributable burden of category C ID due to temperature, low (below the 5th percentile of temperature) and high temperature (above the 95th percentile of temperature) for each city and subgroup population. Compared with the 50th percentile of daily mean temperature, adverse effects on category C ID were found when the temperature was lower than 12.27 ℃ in Guangdong Province. Some city-specific factors (longitude, urbanization rate, population density, disposable income per capita, and the number of medical technicians and beds per thousand persons) could modify the relationship of temperature-category C ID. During the study period, there were 60,505 category C ID cases (17.14% of total cases) attributable to the exposure of temperature, with the attributable fraction (AF) of low temperature (4.23%, 95% empirical confidence interval (eCI): 1.79-5.71%) higher than high temperature (1.34%, 95% eCI: 0.86-1.64%). Males, people under 5 years, and workers appeared to be more vulnerable to temperature, with AFs of 29.40%, 19.25%, and 21.49%, respectively. The AF varied substantially at the city level, with the largest AF of low temperature occurring in Shaoguan (9.58%, 95% eCI: 8.36-10.09%), and that of high temperature occurring in Shenzhen (3.16%, 95% eCI: 2.70-3.51%). Low temperature was an important risk factor for category C ID in Guangdong Province, China. The exposure-response relationship could be modified by city-specific characteristics. Considering the whole population, the attributable risk of low temperature was much higher than that of high temperature, and males, people under 5 years, and workers were vulnerable populations.
以往的研究大多使用相对风险来探讨环境温度与感染性腹泻（ID）之间的关系，而这在实际应用中提供的信息有限。很少有研究关注温度导致的ID疾病负担，特别是在多城市环境中不同亚组和城市的情况。本研究旨在估计温度对丙类ID的影响和归因风险，并探索广东省各城市之间的潜在调节因素。首先，使用分布滞后非线性模型（DLNMs）来探索2014年至2016年广东省日平均温度与丙类ID之间的特定城市关联，并通过多变量荟萃分析进行汇总。然后，实施多变量荟萃回归以分析各城市之间潜在的异质性。最后，我们评估了每个城市和亚组人群中由于温度、低温（低于温度的第5百分位数）和高温（高于温度的第95百分位数）导致的丙类ID的归因负担。与日平均温度的第50百分位数相比，在广东省，当温度低于12.27℃时，发现对丙类ID有不良影响。一些特定城市因素（经度、城市化率、人口密度、人均可支配收入以及每千人的医疗技术人员和床位数）可以改变温度与丙类ID之间的关系。在研究期间，有60505例丙类ID病例（占总病例的17.14%）可归因于温度暴露，其中低温的归因分数（AF）（4.23%，95%经验置信区间（eCI）：1.79 - 5.71%）高于高温（1.34%，95% eCI：0.86 - 1.64%）。男性、5岁以下人群和工人似乎对温度更敏感，其AF分别为29.40%、19.25%和21.49%。AF在城市层面差异很大，低温的最大AF出现在韶关（9.58%，95% eCI：8.36 - 10.09%），高温的最大AF出现在深圳（3.16%，95% eCI：2.70 - 3.51%）。低温是中国广东省丙类ID的一个重要危险因素。暴露 - 反应关系可能会因特定城市特征而改变。考虑到总体人群，低温的归因风险远高于高温，男性、5岁以下人群和工人是易感人群。
