Association between diurnal temperature range and outpatient visits for hand, foot, and mouth disease in Hefei, China: a
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RESEARCH ARTICLE
Association between diurnal temperature range and outpatient visits for hand, foot, and mouth disease in Hefei, China: a distributed lag nonlinear analysis Jixiang Deng 1 & Xing Gao 1 & Changchun Xiao 2 & Shanshan Xu 1 & Yubo Ma 1 & Jiajia Yang 1 & Meng Wu 1 & Faming Pan 1 Received: 25 December 2019 / Accepted: 23 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract We aimed to quantify the relationship between the outpatient visits of hand, foot, and mouth disease (HFMD) and diurnal temperature range (DTR). The data of daily HFMD outpatient visits and meteorological parameters were obtained. A distributed lag nonlinear model combined with generalized linear model was used to estimate simultaneously nonlinear and delayed effects between DTR and daily HFMD outpatient visits after controlling confounding factors. A total of 15,275 HFMD visits were enrolled. DTR was significantly associated with HFMD outpatient visits in children. High DTR (P75: 11.4 °C) and extreme DTR (P95: 15.3 °C) were compared with 8.5 °C, and HFMD visits increased by a maximum of 3.93% (95% CI: 1.82 to 6.07%) and 4.47% (95% CI: 0.45 to 8.65%) in single-day lag effect, respectively. Furthermore, the extreme DTR effect decreased with the lag time and lasted for 10 days. Cumulative lag effects with markedly increasing percent of visits are over 64.88%. Furthermore, the effects were most pronounced among female children and children aged 0–2 years. Our study suggested that DTR changes were associated with HFMD outpatient visits, and populations of female and aged 0–2 years were more sensitive. Keywords Diurnal temperature range . Hand, foot, and mouth disease . Outpatient visit . Time-series study
Abbreviations AIC Akaike’s information criterion CI confidence interval DLNM distributed lag nonlinear model DTR diurnal temperature range
GLM HFMD ICD RH RR
Jixiang Deng, Xing Gao and Changchun Xiao contributed equally to this work.
Introduction
Keypoints • We quantified the association between DTR changes and HFMD outpatient visits. • The extreme DTR effect was greater than the high DTR effect; HFMD outpatient visits increased significantly after 8.5 °C. • Populations of female and aged 0–2 years were more sensitive. Responsible Editor: Lotfi Aleya * Faming Pan [email protected] 1
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui Province, China
2
Hefei Center for Disease Control and Prevention, 86 Luan Road, Hefei 230032, Anhui Province, China
generalized linear model hand, foot, and mouth disease International Classification of Diseases relative humidity relative risk
Hand, foot, and mouth disease (HFMD) is a highly contagious disease caused by human enteroviruses and most common in children aged 5 years or younger (Esposito and Principi 2018), which is frequently reported worldwide (Palani et al. 2018; Sousa et al. 2018; Teo et al. 2019). The main pathogens are human enterovirus 71 (EV-A71) and Coxsackievirus
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