Key result
Temperature exhibited a strong non-linear and lagged association with childhood hand, foot and mouth disease, with the risk peaking at the 79th percentile of temperature compared to the median.
Why the study?
Previous studies showed temperature may influence HFMD incidence, but most focused on single cities with highly heterogeneous results.
Observational (n=1,048,574)
Yes
There is a strong non-linear and lagged correlation between temperature and childhood HFMD incidence, with latitude significantly modifying this relationship.
Answers are grounded in this paper and cite their sources.
Temperature-HFMD links vary by city; leaves open which modifiers explain heterogeneity for targeted interventions.
Background Hand, foot and mouth disease (HFMD) is a serious infectious disease, which has become a public health problem. Previous studies have shown that temperature may influence the incidence of HFMD, but most only focus on single city and the results are highly heterogeneous. Therefore, a multicity study was conducted to explore the association between temperature and HFMD in different cities and search for modifiers that influence the heterogeneity. Methods We collected daily cases of childhood HFMD (aged 0-5 years) and meteorological factors of 21 cities in Guangdong Province in the period of 2010-2013. Distributed lag non-linear model (DLNM) with quasi-Poisson was adopted to quantify the effects of temperature on HFMD in 21 cities. Then the effects of each city were pooled by multivariate meta-analysis to obtain the heterogeneity among 21 cities. Potential city-level factors were included in meta-regression to explore effect modifiers. Results A total of 1,048,574 childhood cases were included in this study. There was a great correlation between daily childhood HFMD cases and temperature in each city, which was non-linear and lagged. High heterogeneity was showed in the associations between temperature and HFMD in 21 cities. The pooled temperature-HFMD association was peaking at the 79th percentile of temperature with relative risk (RR) of 2.474(95%CI: 2.065-2.965) as compared to the median temperature. Latitude was the main modifier for reducing the heterogeneity to 69.28% revealed by meta-analysis. Conclusions There was a strong non-linear and lagged correlation between temperature and HFMD. Latitude was strongly associated with the relationship between temperature and HFMD. Meanwhile, it had an effect on modifying the relationship. These findings can conducive to local governments developing corresponding preventive measures.
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Xu et al. (2019) conducted an observational in Hand, foot and mouth disease (HFMD) (n=1,048,574). Temperature vs. Median temperature was evaluated on Relative risk of HFMD incidence at 79th percentile of temperature (RR 2.474, 95% CI 2.065-2.965). Temperature exhibited a strong non-linear and lagged association with childhood hand, foot and mouth disease, with the risk peaking at the 79th percentile of temperature compared to the median.
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