Impact of temperature on hand, foot and mouth disease and its attributable risk in Guangdong province
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摘要:
目的 分析广东省气温与手足口病发病的关系,探讨其异质性来源并评估其归因风险。 方法 收集广东省2009 — 2016年手足口病日发病数据和同期气象数据,应用分布滞后非线性模型分析城市水平上日均气温对手足口病的效应,应用多变量meta回归模型合并效应值,在此基础上评估气温暴露造成人群手足口病发病的归因风险。 结果 2009 — 2016年广东省共报告手足口病发病2 279 647例,气温升高可增加手足口病的发病风险,以日均气温24 ℃为参照,日均气温为30.5 ℃时手足口病累积发病风险最高(RR = 1.24,95 % CI = 1.12~1.37)。低温的效应在滞后8 d时达到最大,高温的效应在滞后0 d时达到最大。不同城市手足口病发病风险差异的来源有人口密度、GDP增长率、经度、年平均气温、年平均湿度和年平均日照时数。归因于高温暴露的手足口病发病数为241 918例,占总发病数的10.61 %(95 % CI = 9.67%~11.53%)。高温时,男性和 < 5岁儿童的发病风险高于其他人群。 结论 高温会增加手足口病的发病风险,效应出现早且存在滞后效应。夏季高温时应对易感人群和脆弱地区及时采取有针对性的预防措施。 Abstract:Objective To study the impact of ambient temperature on hand, foot and mouth disease (HFMD) and to explore the source of heterogeneity in the impact and the HFMD burden attributable to ambient temperature in Guangdong province. Methods The data on daily reported HFMD cases and meteorological condition from 2009 through 2016 in Guangdong province were collected. The distributed lag nonlinear model (DLNM) was adopted to assess the effect of average daily ambient temperature on HFMD incidence at city level with the pooled effect estimates from multivariate meta-regression model analysis. Fraction and number of HFMD incidents attributable to variation in ambient temperature were estimated according to the results of DLNM analysis. Results Totally 2 279 647 HFMD cases were reported during the period. The risk of HFMD incidence increased with the increment of average daily ambient temperature. The cumulative relative risk (RR) of HFMD incidence reached the highest for the average daily ambient temperature of 30.5 ℃ versus that of 24 ℃ (RR = 1.24, 95% confidence interval [95% CI]: 1.12 – 1.37). The most obvious effect of low average daily ambient temperature on HFMD incidence was on the lag day 8 but that of high temperature was on the lag day zero. The disparity in the effect of average daily ambient temperature on HFMD incidence among various cities was derived from population density, growth rate of gross domestic production, location longitude, and average annual temperature/humidity/hours of sunshine. The estimated total number of HFMD incidents attributed to the exposure to high average daily temperature was 241 918, accounting for 10.61% (95% CI: 9.67% – 11.53%) of all the cases during the period. When exposed to high average daily ambient temperature, the elderly and the children less than 5 years old were at a higher risk of HFMD incidence than other populations. Conclusion High average daily ambient temperature could increase the risk of HFMD incidence and the impact of the high temperature may appear immediately or at lag days. The results suggest that specific measures should be taken in vulnerable populations during seasons with high temperature for the prevention of HFMD incidents. -
表 1 广东省2009 — 2016年不同城市气象因素、手足口病日发病数等基本情况
城市 日发病例数 平均气温(℃) 平均相对湿度(%) 平均降雨量(mm) 日照时数(h) 人口密度(km2) GDP增长率(%) 经度(°E) 广州市 136(162) 22.0(9.9) 77.2(15.0) 5.8(3.1) 4.3(8.0) 1208.6 8.2 113.5 韶关市 16(19) 20.2(12.6) 77.1(16.0) 5.0(2.7) 4.6(8.6) 181.1 6.3 113.8 深圳市 93(115) 23.2(8.9) 73.9(15.0) 4.8(1.1) 5.2(7.3) 2060.8 9.0 114.2 珠海市 29(31) 23.1(9.3) 77.9(15.0) 5.4(1.4) 5.1(8.7) 755.4 8.5 113.3 汕头市 20(22) 22.7(10.6) 76.1(14.2) 3.9(0.8) 5.2(8.9) 2645.1 8.7 116.5 佛山市 85(102) 22.0(9.9) 77.2(15.0) 5.8(3.1) 4.3(8.0) 1036.5 8.3 112.9 江门市 28(31) 22.8(9.4) 77.9(14.2) 5.3(1.7) 5.1(8.4) 419.9 7.4 112.6 湛江市 19(22) 23.3(8.5) 81.3(12.0) 4.8(1.3) 5.1(8.4) 682.8 7.9 110.3 茂名市 14(17) 23.3(8.2) 82.5(11.0) 4.5(0.9) 5.1(8.0) 701.6 7.1 111.0 肇庆市 33(39) 22.7(10.2) 74.2(18.0) 4.6(2.1) 4.2(7.9) 297.5 5.0 112.1 惠州市 54(61) 22.4(9.4) 75.2(15.0) 4.8(1.9) 4.3(8.0) 321.3 8.2 114.6 梅州市 24(30) 21.8(10.5) 73.8(14.0) 4.3(2.4) 4.9(7.9) 347. 9 7.5 116.1 汕尾市 9(11) 22.7(9.6) 77.2(15.0) 4.6(1.1) 5.4(8.6) 751.8 7.0 115.5 河源市 14(18) 21.7(10.5) 74.2(16.0) 5.3(2.7) 4.8(8.1) 238.3 8.6 114.9 阳江市 16(20) 22.7(8.8) 80.0(15.0) 6.5(2.0) 4.7(8.4) 296.0 6.0 111.8 清远市 28(31) 21.9(10.5) 74.3(19.0) 5.6(3.1) 4.4(8.5) 432.0 7.9 112.9 东莞市 85(97) 22.8(9.3) 74.7(17.0) 5.5(2.3) 5.0(7.8) 201.0 8.1 113.9 中山市 37(39) 22.8(9.6) 76.2(14.0) 5.4(1.9) 5.1(8.1) 161.0 7.8 113.4 潮州市 8(9) 22.7(10.6) 76.1(14.2) 3.9(0.8) 5.2(8.9) 274.0 7.1 116.8 揭阳市 12(14) 21.5(9.9) 78.1(15.0) 5.4(2.6) 5.2(8.2) 697.0 6.3 116.1 云浮市 22(27) 22.4(9.9) 80.3(12.0) 4.0(1.6) 4.3(7.6) 301.0 7.9 111.8 注:括号外数据为M(median,中位数),括号内数据为QR(quantile range,四分位数间距)。 表 2 日均气温对手足口病的城市水平效应修饰因子分析结果
因素 Q检验 I2 值 信息准则 Wald检验 Q值 df P 值 AIC BIC stat df P 值 空模型 344.9 60 0 82.6 93.2 112.0 人口密度 278.0 57 0 79.5 77.4 103.1 18.2 3 0.004 a 人口增长率 337.1 57 0 83.1 88.1 113.8 2.2 3 0.528 GDP 314.1 57 0 81.9 87.3 113.0 3.3 3 0.354 人均GDP 319.0 57 0 82.1 87.5 113.2 3.1 3 0.382 GDP增长率 279.2 57 0 79.6 83.6 109.3 8.1 3 0.044 a 学生数 325.4 57 0 82.5 84.2 109.9 6.6 3 0.086 学人数 321.2 57 0 82.3 88.3 114.0 2.0 3 0.577 医院数 338.7 57 0 83.2 89.8 115.5 0.4 3 0.935 床位数 327.7 57 0 82.6 89.0 114.8 1.2 3 0.746 医生数 314.6 57 0 81.9 87.7 113.4 2.8 3 0.417 经度 273.1 57 0 79.1 79.1 104.8 14.3 3 0.002 a 纬度 328.2 57 0 82.6 84.1 109.8 7.6 3 0.055 年平均日照 301.7 57 0 81.1 75.4 101.2 23.2 3 < 0.001 a 年平均温度 312.6 57 0 81.8 75.1 100.8 23.8 3 < 0.001 a 年平均湿度 309.4 57 0 81.6 82.0 107.7 9.8 3 0.021 a 年平均风速 341.6 57 0 83.3 89.5 115.3 0.6 3 0.885 年平均降雨 324.9 57 0 82.5 85.0 110.8 5.9 3 0.118 区域 160.0 42 0 73.8 69.6 127.5 80.1 18 < 0.001 a 注:AIC 赤池信息准则;BIC 贝叶斯信息准则;a P < 0.05。 表 3 气温对广东省手足口病人群发病的归因风险
城市 归因发病人数 归因分值 气温 高温 气温 高温 n 95 % CI n 95 % CI n 95 % CI n 95 % CI 广州市 22 843 11 488~33 177 57 396 47 411~68 174 5.74 2.89~8.33 14.42 11.91~17.12 韶关市 2 129 – 247~4 386 2 619 191~4 753 4.48 – 0.52~9.23 5.51 0.40~10.01 深圳市 21 681 12 724~29 622 45 162 36 437~54 000 7.99 4.69~10.92 16.64 13.43~19.90 珠海市 3 561 400~6 731 12 069 8 673~15 274 4.22 0.47~7.98 14.31 10.28~18.10 汕头市 1 841 – 1 567~4 531 11 414 9 126~13 530 3.16 – 2.69~7.78 19.61 15.68~23.24 佛山市 – 7473 – 18 389~1 968 12 309 2 445~21 279 – 3.02 – 7.43~0.80 4.98 0.99~8.60 江门市 – 4876 – 8 485~ – 1 185 – 3 234 – 7 182~286 – 6.02 – 10.48~ – 1.46 – 3.99 – 8.87~0.35 湛江市 18 – 2 216~2 204 5 098 3 381~6 778 0.03 – 4.09~4.07 9.42 6.24~12.52 茂名市 – 3889 – 6 098~ – 1 831 – 819 – 2 994~1 143 – 9.28 – 14.55~ – 4.37 – 1.96 – 7.15~2.73 肇庆市 – 3004 – 7 188~1 172 290 – 4 180~4 680 – 3.09 – 7.41~1.21 0.30 – 4.31~4.82 惠州市 6 008 585~11 546 15 774 10 628~20 850 3.82 0.37~7.34 10.03 6.76~13.26 梅州市 8 373 5 459~10 868 12 136 8 976~14 620 11.79 7.69~15.30 17.08 12.64~20.58 汕尾市 1 427 – 238~2 822 3 155 1 714~4 493 5.4 – 0.90~10.68 11.94 6.49~17.01 河源市 4 471 2 400~6 372 8 706 6 826~10 296 10.73 5.76~15.29 20.89 16.38~24.70 阳江市 2 299 – 15~4 412 6 587 4 188~8 759 5.06 – 0.03~9.72 14.51 9.23~19.30 清远市 – 818 – 5 391~3 112 5 442 1 031~9 308 – 1.02 – 6.70~3.87 6.76 1.28~11.57 东莞市 12 469 4 465~19 387 30 780 23 839~37 295 5.05 1.81~7.85 12.46 9.65~15.09 中山市 1 382 – 2 860~5 674 9 911 6 155~13 391 1.29 – 2.68~5.31 9.28 5.76~12.54 潮州市 598 – 937~1 964 3 675 2 409~4 914 2.73 – 4.28~8.96 16.77 10.99~22.42 揭阳市 285 – 1 714~1 927 4 117 2 317~5 651 0.81 – 4.84~5.44 11.61 6.54~15.94 云浮市 – 7126 – 11 743~ – 3 182 – 668 – 4 605~3 085 – 10.94 – 18.02~ – 4.88 – 1.03 – 7.07~4.73 全省 62 199 37 929~82 086 241 918 220 853~ 262 926 2.73 1.66~3.60 10.61 9.67~11.53 -
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