Zhidong Liu1, Feifei Zhang2, Ying Zhang3, Jing Li4, Xuena Liu5, Guoyong Ding6, Caixia Zhang1, Qiyong Liu7, Baofa Jiang8. 1. Department of Epidemiology, School of Public Health, Shandong University, Jinan City, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China. 2. Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom. 3. School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia. 4. Department of Environmental Health, School of Public Health and Management, Weifang Medical University, Weifang City, Shandong Province, People's Republic of China. 5. Department of Health Statistics, School of Public Health, Taishan Medical College, Taian City, Shandong Province, People's Republic of China. 6. Department of Epidemiology, School of Public Health, Taishan Medical College, Taian City, Shandong Province, People's Republic of China. 7. State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, China CDC, Beijing 102206, People's Republic of China. 8. Department of Epidemiology, School of Public Health, Shandong University, Jinan City, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China. Electronic address: bjiang@sdu.edu.cn.
Abstract
BACKGROUND: Understanding the potential links between floods and infectious diarrhea is important under the context of climate change. However, little is known about the risk of infectious diarrhea after floods and what factors could modify these effects in China. OBJECTIVES: This study aims to quantitatively examine the relationship between floods and infectious diarrhea and their effect modifiers. METHODS: Weekly number of infectious diarrhea cases from 2004 to 2011 during flood season in Hunan province were supplied by the National Notifiable Disease Surveillance System. Flood and meteorological data over the same period were obtained. A two-stage model was used to estimate a provincial average association and their effect modifiers between floods and infectious diarrhea, accounting for other confounders. RESULTS: A total of 134,571 cases of infectious diarrhea were notified from 2004 to 2011. After controlling for seasonality, long-term trends, and meteorological factors, floods were significantly associated with infectious diarrhea in the provincial level with a cumulative RR of 1.22 (95% CI: 1.05, 1.43) with a lagged effect of 0-1 week. Geographic locations and economic levels were identified as effect modifiers, with a higher impact of floods on infectious diarrhea in the western and regions with a low economic level of Hunan. CONCLUSIONS: Our study provides strong evidence of a positive association between floods and infectious diarrhea in the study area. Local control strategies for public health should be taken in time to prevent and reduce the risk of infectious diarrhea after floods, especially for the vulnerable regions identified.
BACKGROUND: Understanding the potential links between floods and infectious diarrhea is important under the context of climate change. However, little is known about the risk of infectious diarrhea after floods and what factors could modify these effects in China. OBJECTIVES: This study aims to quantitatively examine the relationship between floods and infectious diarrhea and their effect modifiers. METHODS: Weekly number of infectious diarrhea cases from 2004 to 2011 during flood season in Hunan province were supplied by the National Notifiable Disease Surveillance System. Flood and meteorological data over the same period were obtained. A two-stage model was used to estimate a provincial average association and their effect modifiers between floods and infectious diarrhea, accounting for other confounders. RESULTS: A total of 134,571 cases of infectious diarrhea were notified from 2004 to 2011. After controlling for seasonality, long-term trends, and meteorological factors, floods were significantly associated with infectious diarrhea in the provincial level with a cumulative RR of 1.22 (95% CI: 1.05, 1.43) with a lagged effect of 0-1 week. Geographic locations and economic levels were identified as effect modifiers, with a higher impact of floods on infectious diarrhea in the western and regions with a low economic level of Hunan. CONCLUSIONS: Our study provides strong evidence of a positive association between floods and infectious diarrhea in the study area. Local control strategies for public health should be taken in time to prevent and reduce the risk of infectious diarrhea after floods, especially for the vulnerable regions identified.
Authors: Alicia N M Kraay; Olivia Man; Morgan C Levy; Karen Levy; Edward Ionides; Joseph N S Eisenberg Journal: Environ Health Perspect Date: 2020-12-07 Impact factor: 9.031