气温对兰州市手足口病发病的滞后效应研究

摘要

Objective To discuss the lag effects of daily average temperature on the daily cases of hand,foot and mouth disease (HFMD) in Lanzhou City.Methods The data of daily cases of HFMD was collected in the city from 2008 to 2015,and the meteorological data at the same period was integrated.The spearman correlation test was used to analyze the relevance between meteorological factors and the morbidity of HFMD,and the distributed lag non-linear model was used to analyze the relevance between daily average temperature and the morbidity of HFMD.Results A total of 25644 cases were reported from 2008 to 2015,of which children below 5 years old accounted for 78.68％.The morbidity of HFMD was positively corrected with temperature,amount of precipitation and wind speed,while was negatively corrected with air pressure;and the temperature was the major factor among all the meteorological factors (r =0.528).A inverse U-shaped relationship was found consistently between daily mean temperature and the daily cases of HFMD.The relative risks of HFMD increased when temperature was below 20.3℃,while decreased when temperature was below 20.3℃.There was an obviously increasing risk of the high temperature (25.1℃) with respect to 13℃,and the lag effect was highest at about lag of 0-14 days.The RR (95％ CI) values of HFMD of high temperature was 9.51 (3.27 ～ 18.02),7.67(2.18 ～ 15.04) and 9.66(3.75 ～ 17.56) for males,females,and children 0-4years old,respectively;However,the results were not statistically significant for children 5-14 years.The low temper ature (-5.1 ℃) effects were not statistically significant for both gender-specific and age-specific subjects.Conclusion We concluded that the high temperature may increase risks of HFMD,and the males and children 0-4years old were the sensitive population.%目的 探讨日均气温对手足口病发病的影响及其滞后效应.方法 收集兰州市2008-2015年每日手足口病发病资料和同期气象资料,首先采用Spearman等级相关分析兰州市主要气象因子之间及其与手足口病发病数的相关性,然后利用分布滞后非线性模型(DLNM)分析日均气温与手足口病发病的关联性.结果 2008-2015年兰州市共报告手足口病例25644例,男/女为1.59:1,5岁及以下儿童占78.68％;手足口病日均发病数与气温、降水量、风速呈正相关,与气压呈负相关,以气温对手足口病发病影响最为显著(r=0.528);日均气温与手足口病发病的暴露-反应关系呈倒“U”型,发病风险在20.3℃以下随湿度升高而升高,高于20.3℃时下降;相对于气温的中位数13℃,高温(25.1℃)能显著增加手足口病发病风险,男性、女性、0(5岁儿童在滞后期为0～14 d的累计风险效应最大,RR(95％ CI)值分别为9.51(3.27～ 18.02)、7.67(2.18～15.04)、9.66(3.75 ～17.56);高温对6(14岁人群、低温(-5.1℃)对不同性别、年龄别人群在整个滞后期内的累计效应均无统计学意义.结论 高温可显著增加兰州市手足口病发病风险,男性和0(5岁人群是敏感人群.