Zhicheng Du1, Wayne R Lawrence2, Wangjian Zhang3, Dingmei Zhang4, Shicheng Yu5, Yuantao Hao6. 1. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address: duzhch3@mail2.sysu.edu.cn. 2. Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA. Electronic address: wlawrence@albany.edu. 3. Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA. Electronic address: wzhang27@albany.edu. 4. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address: zhdingm@mail.sysu.edu.cn. 5. Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: shicheng_yu@163.com. 6. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address: haoyt@mail.sysu.edu.cn.
Abstract
BACKGROUND: Prior studies have shown that climate factors and air pollution are associated with hand, foot, and mouth disease (HFMD) epidemics. However, the interaction between air pollution and climate factors remains unknown. METHODS: Daily HFMD counts from 2009 through 2012 in Guangdong were collected. We used distributed lag non-linear models to assess the associations of climate factors and air pollution on HFMD cases. The effects of climate factors were stratified by air pollution stratum to examine the interaction effect of air quality index (AQI) and temperature, as well as relative humidity. In addition, we explored the variability across gender groups. RESULTS: We observed associations between HFMD cases and environmental factors, including temperature, relative humidity, and AQI. The highest relative risks (RR) were observed at the middle level of temperature and AQI, and high level of relative humidity. The effects for the interaction between AQI and climate factors on HFMD cases were also statistically observed. Compared with low level temperatures (≤23.5 °C), high level temperatures (>23.5 °C) had a RR of 1.486 (95%CI: 1.469,1.503) on days with "good" air quality (AQI ≤ 46), and RR of 1.013 (95%CI: 1.003,1.023) on days with "moderate" air quality (AQI > 46). For relative humidity, the high level (>77%) had a RR of 1.082 (95%CI: 1.076,1.089) on days with "good" air quality, and RR of 1.039 (95%CI: 1.033,1.046) on days with "moderate" air quality. The associations and the interactions remained robust for males and females. CONCLUSIONS: Our findings indicate that climate factors and air pollution imposed lagged and non-linear effects on HFMD epidemics. The effects of climate factors on health potentially vary by AQI. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence.
BACKGROUND: Prior studies have shown that climate factors and air pollution are associated with hand, foot, and mouth disease (HFMD) epidemics. However, the interaction between air pollution and climate factors remains unknown. METHODS: Daily HFMD counts from 2009 through 2012 in Guangdong were collected. We used distributed lag non-linear models to assess the associations of climate factors and air pollution on HFMD cases. The effects of climate factors were stratified by air pollution stratum to examine the interaction effect of air quality index (AQI) and temperature, as well as relative humidity. In addition, we explored the variability across gender groups. RESULTS: We observed associations between HFMD cases and environmental factors, including temperature, relative humidity, and AQI. The highest relative risks (RR) were observed at the middle level of temperature and AQI, and high level of relative humidity. The effects for the interaction between AQI and climate factors on HFMD cases were also statistically observed. Compared with low level temperatures (≤23.5 °C), high level temperatures (>23.5 °C) had a RR of 1.486 (95%CI: 1.469,1.503) on days with "good" air quality (AQI ≤ 46), and RR of 1.013 (95%CI: 1.003,1.023) on days with "moderate" air quality (AQI > 46). For relative humidity, the high level (>77%) had a RR of 1.082 (95%CI: 1.076,1.089) on days with "good" air quality, and RR of 1.039 (95%CI: 1.033,1.046) on days with "moderate" air quality. The associations and the interactions remained robust for males and females. CONCLUSIONS: Our findings indicate that climate factors and air pollution imposed lagged and non-linear effects on HFMD epidemics. The effects of climate factors on health potentially vary by AQI. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence.
Authors: Zhicheng Du; Yong Huang; Wayne R Lawrence; Jianxiong Xu; Zhicong Yang; Jianyun Lu; Zhoubin Zhang; Yuantao Hao Journal: Int J Environ Res Public Health Date: 2021-01-02 Impact factor: 3.390