Abstract
Hand, foot, and mouth disease (HFMD) is the leading Category C infectious disease affecting millions of children in China every year. In the context of global climate change, the understanding and quantification of the impact of weather factors on human health are particularly critical to the development and implementation of climate change adaptation and mitigation strategies. The aim of this study was to quantify the attributable burden of a combined bioclimatic indicator (apparent temperature) on HFMD and to identify temperature-specific sensitive populations. A total of 123,622 HFMD cases were included in the study. The non-linear relationship between apparent temperature and the incidence of HFMD was approximately M-shaped, with hot weather being more likely to be attributable than cold conditions, of which moderately hot accounting for the majority of cases (21,441, 17.34%). Taking the median apparent temperature (19.2 °C) as reference, the cold effect showed a short acute effect with the highest risk on the day of lag 0 (RR = 1.086, 95% CI: 1.024 ~ 1.152), whereas the hot effect lasted longer with the greatest risk at a lag of 7 days (RR = 1.081, 95% CI: 1.059 ~ 1.104). Subgroup analysis revealed that males, children under 3 years old, and scattered children tended to be more vulnerable to HFMD in hot weather, while females, those aged 3 ~ 5 years, and nursery children were sensitive to cold conditions. This study suggests that high temperatures have a greater impact on HFMD than low temperatures as well as lasting longer, of particular concern being moderately high temperatures rather than extreme temperatures. Early intervention takes on greater importance during cold days, while the duration of HFMD intervention must be longer during hot days.
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The data for this study will be available from the corresponding author upon reasonable request.
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Acknowledgements
The authors would like to thank the staff of the Hunan Provincial Centre for Disease Control and Prevention who contributed greatly to the data collection, supplementation, review, and database management of this study. We are also appreciative of the support of the Natural Science Foundation of Hunan Province and Major Scientific and Technological Projects for Collaborative Prevention and Control of Birth Defects in Hunan Province for this work.
Funding
This research was supported by the Natural Science Foundation of Hunan Province (2020JJ4388) and Major Scientific and Technological Projects for Collaborative Prevention and Control of Birth Defects in Hunan Province (2019SK1012).
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Lijun Meng: Methodology, formal analysis, roles/writing (original draft), writing (review and editing). Chunliang Zhou: Funding acquisition, supervision, visualization, resources. Yiqing Xu: Methodology, validation. Fuqiang Liu: Data curation, conceptualization. Cui Zhou: Validation, visualization. Meng Yao: Conceptualization, formal analysis. Xingli Li: Methodology, validation, project administration, writing—review and editing.
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Meng, L., Zhou, C., Xu, Y. et al. The lagged effect and attributable risk of apparent temperature on hand, foot, and mouth disease in Changsha, China: a distributed lag non-linear model. Environ Sci Pollut Res 30, 11504–11515 (2023). https://doi.org/10.1007/s11356-022-22875-3
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DOI: https://doi.org/10.1007/s11356-022-22875-3