Journal Article Research Support, Non-U.S. Gov't Epublish 1 citation
PubMed: 38263020 DOI: 10.1186/s12889-023-17484-9
How multiple air pollutants affect hand, foot, and mouth disease incidence in children: assessing effect modification by geographical context in multicity of Sichuan, southwest China.
BMC Public Health 24(1):263
Authors: Caiying Luo, Yue Ma, Kai Lu, Ying Li, Yaqiong Liu, Tao Zhang, Fei Yin, Tiejun Shui
Affiliations
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- Yunnan Center for Disease Control and Prevention, Kunming, China.
- Sichuan Center for Disease Control and Prevention, Chengdu, China.
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- Yunnan Center for Disease Control and Prevention, Kunming, China.
Abstract
BACKGROUND
Several studies have suggested a significant association of hand, foot, and mouth disease (HFMD) with ambient air pollutants. Existing studies have characterized the role of air pollutants on HFMD using only risk ratio measures while ignoring the attributable burden. And whether the geographical context (i.e., diverse topographic features) could modulate the relationships is unclear.
METHODS
Daily reported childhood HFMD counts, ambient air pollution, and meteorological data during 2015-2017 were collected for each of 21 cities in Sichuan Province. A multistage analysis was carried out in different populations based on geographical context to assess effect modification by topographic conditions. We first constructed a distributed lag nonlinear model (DLNM) for each city to describe the relationships with risk ratio measures. Then, we applied a multivariate meta-regression to estimate the pooled effects of multiple air pollutants on HFMD from the exposure and lagged dimensions. Finally, attributable risks measures were calculated to quantify HFMD burden by air pollution.
RESULTS
Based on 207554 HFMD cases in Sichuan Province, significant associations of HFMD with ambient air pollutants were observed mainly at relatively high exposure ranges. The effects of ambient air pollutants on HFMD are most pronounced on lag0 or around lag7, with relative risks gradually approaching the reference line thereafter. The attributable risks of O were much greater than those of other air pollutants, particularly in basin and mountain regions.
CONCLUSIONS
This study revealed significant pooled relationships between multiple air pollutants and HFMD incidence from both exposure and lag dimensions. However, the specific effects, including RRs and ARs, differ depending on the air pollution variable and geographical context. These findings provide local authorities with more evidence to determine key air pollutants and regions for devising and implementing targeted interventions.
MeSH
Incidence, Risk, Child, Public Health, Air Pollutants, Foot-And-Mouth Disease, Hand, Foot And Mouth Disease, Odds Ratio, Environmental Pollutants, Air Pollution, Mouth Diseases