The burden of childhood hand-foot-mouth disease morbidity attributable to relative humidity: a multicity study in the Sichuan Basin, China

Hand, foot and mouth disease (HFMD) is a growing threat to children's health, causing a serious public health burden in China. The relationships between associated meteorological factors and HFMD have been widely studied. However, the HFMD burden due to relative humidity from the perspective of attributable risk has been neglected. This study investigated the humidity-HFMD relationship in three comprehensive perspectives, humidity-HFMD relationship curves, effect modification and attributable risks in the Sichuan Basin between 2011 and 2017. We used multistage analyses composed of distributed lag nonlinear models (DLNMs), a multivariate meta-regression model and the calculations of attributable risk to quantify the humidity-HFMD association. We observed a J-shaped pattern for the pooled cumulative humidity-HFMD relationship, which presented significant heterogeneity relating to the geographical region and number of primary school students. Overall, 27.77% (95% CI 25.24-30.02%) of HFMD infections were attributed to humidity. High relative humidity resulted in the greatest burden of HFMD infections. The proportion of high humidity-related HFMD in the southern basin was higher than that in the northern basin. The findings provide evidence from multiple perspectives for public health policy formulation and health resource allocation to develop priorities and targeted policies to ease the HFMD burden associated with humidity.