Lin Szu Yu, Chua Paul L C, Yuan Lei, Hossain Nasif, He Jinyu, Yamasaki Lisa, Madaniyazi Lina, Ng Chris Fook Sheng, Tobias Aurelio, Hashizume Masahiro
Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan.
Environ Epidemiol. 2025 Jan 9;9(1):e366. doi: 10.1097/EE9.0000000000000366. eCollection 2025 Feb.
Tropical cyclones pose significant health risks and can trigger outbreaks of diarrheal diseases in affected populations. Although the effects of individual hazards, such as rainfall and flooding, on diarrheal diseases are well-documented, the complex multihazard nature of tropical cyclones is less thoroughly explored. To date, no dedicated review comprehensively examines the current evidence and research on the association between tropical cyclones and diarrheal diseases.
We performed a scoping review to map the literature on tropical cyclones and diarrheal diseases. A comprehensive literature search was performed across multiple online databases, including PubMed/MEDLINE, Web of Science, Scopus, Google Scholar, and ProQuest. We then performed a thematic analysis on the specific transmission pathways between tropical cyclones and diarrheal diseases as described in the literature.
A total of 96 studies were included and categorized in this scoping review. Of these, 23 studies quantitatively assessed the association between tropical cyclones and diarrheal diseases, with more than half reporting a positive association. Additionally, we identified 30 studies that detailed transmission pathways, which we used for thematic analysis. Significant variability was observed in the definition of tropical cyclone exposure, with studies using different criteria such as an event, wind speed, or rainfall. Most studies used pre-post comparison designs without concurrent control groups, which can introduce limitations affecting internal validity by not accounting for temporal confounders. Diarrheal diseases can either increase or decrease during and after tropical cyclones, depending on the specific pathogens and the different strengths of tropical cyclones.
The variability in exposure definitions and study designs impedes the ability to quantitatively pool evidence. To improve the comparability and reliability of future research, we recommend that studies explore how different tropical cyclone exposure definitions impact results to identify the most appropriate metrics. We also suggest adopting more robust study designs, such as difference-in-difference or controlled interrupted time series for studying single tropical cyclone events, and case-crossover designs for studying multiple events. Additionally, studies examining specific causal pathways, such as integrating environmental sampling with health outcomes, should be explored to identify effective prevention strategies.
热带气旋带来重大健康风险，可引发受灾人群腹泻病的暴发。尽管诸如降雨和洪水等个别危害因素对腹泻病的影响已有充分记录，但热带气旋复杂的多重危害性质却较少得到深入探究。迄今为止，尚无专门的综述全面审视关于热带气旋与腹泻病之间关联的现有证据和研究。
我们开展了一项范围综述，以梳理有关热带气旋与腹泻病的文献。在多个在线数据库中进行了全面的文献检索，包括PubMed/MEDLINE、科学网、Scopus、谷歌学术和ProQuest。然后，我们对文献中描述的热带气旋与腹泻病之间的特定传播途径进行了主题分析。
本范围综述共纳入并分类了96项研究。其中，23项研究定量评估了热带气旋与腹泻病之间的关联，超过半数报告存在正相关。此外，我们确定了30项详细阐述传播途径的研究，并将其用于主题分析。在热带气旋暴露的定义方面观察到显著差异，各研究使用了不同标准，如事件、风速或降雨量。大多数研究采用前后比较设计，没有同期对照组，这可能因未考虑时间混杂因素而引入影响内部效度的局限性。腹泻病在热带气旋期间及之后可能增加或减少，这取决于具体病原体以及热带气旋的不同强度。
暴露定义和研究设计的差异妨碍了定量汇总证据的能力。为提高未来研究的可比性和可靠性，我们建议研究探索不同的热带气旋暴露定义如何影响结果，以确定最合适的指标。我们还建议采用更稳健的研究设计，如用于研究单个热带气旋事件的差分法或对照中断时间序列，以及用于研究多个事件的病例交叉设计。此外，应探索研究特定因果途径的研究，如将环境采样与健康结果相结合，以确定有效的预防策略。
