基于分布滞后非线性模型探讨日均气温对曲靖市手足口病发病的影响

沈秀莲; 郑尔达; 黄甜; 彭霞; 何继波

doi:10.16462/j.cnki.zhjbkz.2020.11.007

基于分布滞后非线性模型探讨日均气温对曲靖市手足口病发病的影响

doi: 10.16462/j.cnki.zhjbkz.2020.11.007

650022 昆明，云南省疾病预防控制中心疫情监测/突发公共卫生事件应急处置中心

基金项目:

云南省应用基础研究计划青年项目 2018FD107

详细信息

通讯作者:
黄甜，E-mail：99600694@qq.com

中图分类号: R181
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出版历程
- 收稿日期: 2020-05-22
- 修回日期: 2020-08-14
- 刊出日期: 2020-11-10

Effect of temperature on hand, foot and mouth disease incidence in QuJing: a distributed lag non-linear model analysis

Center for Epidemic Surveillance /Public Health Emergency Preparedness and Response, Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, China

Funds:

The Youth Project of Applied Basic Study in Yunnan Province 2018FD107

More Information

Corresponding author: HUANG Tian，E-mail:99600694@qq.com

摘要

摘要: 目的探究气象因素对曲靖市手足口病(hand, foot, and mouth disease, HFMD)发病的影响及其滞后效应。方法采用分布滞后非线性模型(distributed lag non-linear model, DLNM)分析2017-2019年曲靖市气象因素与HFMD发病的相关性及滞后效应。结果 2017-2019年曲靖市共报告25 902例HFMD，HFMD日发病数与日均气温、降雨量呈正相关，与日照时数呈负相关，以气温对HFMD发病影响最为明显(r=0.51)；DLNM拟合结果显示，日均温度20 ℃左右时对HFMD发病的影响最大(RR=1.408, 95% CI: 1.064~1.864, P=0.017)；日均温度在无滞后情况下，对HFMD产生的影响最大，随后逐渐降低直至消失。结论气温是曲靖市手足口病发病的重要影响因素，其影响有明显的滞后效应；不同温度对不同人群的滞后效应明显不同，高温影响更为显著。
- 手足口病 /
- 分布滞后非线性模型 /
- 气温
Abstract: Objective To explore the impact of meteorological factors on the incidence of hand-foot-mouth disease (HFMD) in Qujing and its lag effect. Methods The distributed lag non-linear model (DLNM) was used to analyze the delayed and cumulative effects of meteorological factors on incidence of HFMD in Qujing from 2017 to 2019. Results A total of 25 902 HFMD cases were reported in Qujing from 2017 to 2019. The daily number of HFMD cases was positively correlated with daily average temperature and rainfall, but negatively correlated with sunshine duration. Temperature was the most significant effect on the incidence of HFMD (r=0.51); The daily average temperature of about 20 ℃ had the greatest impact on HFMD (RR=1.408, 95% CI: 1.064-1.864, P=0.017); The daily average temperature without delay had the greatest influence on HFMD, and then gradually decreased until disappeared. Conclusions Temperature is an important influencing factor of HFMD in Qujing, and its influence has obvious lag effect. The lag effect of different temperature on different population is obviously different, and the effect of high temperature is more significant.
- Hand, food, and mouth disease /
- Distributed lag non-linear model /
- Temperature

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图 1 日均气温与手足口病风险关联剂量反应图

Figure 1. Dose response diagram of daily average temperature and risk of HFMD

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图 2 相对危险度(RR)随温度与滞后时间的变化趋势3D图

Figure 2. Three-D plots for variation trend of relative risk (RR) with temperature and lag time

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图 3 冷/热效应对手足口病发病数的影响

注：冷效应：9℃，热效应：26℃。

Figure 3. Effect of cold / heat effect on cases of HFMD

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图 4 改变最长滞后时间，DLNM模型总效应的变化

Figure 4. The overall effects of the DLNM model by changing maximum lag time

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表 1 2017-2019年曲靖市手足口病与气象因素分布情况

Table 1. Description of hand, foot, and mouth disease and meteorological factors in Qujing from 2017 to 2019

变量	最小值	P₅	P₂₅	M	P₇₅	P₉₅	最大值	x±s
手足口病(例)	0.00	4.00	8.00	18.00	30.00	74.00	116.00	23.65±21.05
气温(℃)	1.80	9.00	13.90	18.80	22.90	26.00	29.20	18.23±5.54
相对湿度(%)	26.00	47.00	63.00	75.00	81.00	89.00	100.00	72.06±13.00
降雨量(mm)	0.00	0.00	0.00	0.00	0.80	13.89	106.40	2.62±8.16
日照时数(h)	0.00	0.00	2.30	6.10	8.90	10.80	11.90	5.61±3.62

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表 2 2017-2019年曲靖市手足口病日发病数与气象因子间的Spearman等级相关分析结果

Table 2. Spearman correlation between hand, foot, and mouth disease cases and meteorological factors in Qujing from 2017 to 2019

变量	手足口病发病数	平均气温	相对湿度	日照时数	降水量
手足口病发病数	1.00
平均气温	0.51^a	1.00
相对湿度	0.02	-0.16^a	1.00
日照时数	-0.06^b	0.05	-0.73^a	1.00
降雨量	0.08^b	0.15^a	0.55^a	-0.56^a	1.00
注：^a：P＜0.01；^b：P＜0.05。

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表 3 冷/热效应对手足口病发病风险分析[RR(95% CI)]

Table 3. Risk analysis of cold/heat effect to HFMD [RR(95% CI)]

不同滞后天数	热效应			冷效应
不同滞后天数	全人群	男性	女性	全人群	男性	女性
lag0	0.914(0.848~0.986)^a	0.919(0.842~1.003)	0.907(0.820~1.004)	0.986(0.928~1.047)	1.005(0.936~1.078)	0.958(0.883~1.039)
lag1	0.942(0.893~0.992)^a	0.951(0.895~1.011)	0.928(0.865~0.996)^a	0.998(0.958~1.040)	1.011(0.963~1.060)	0.979(0.926~1.034)
lag2	0.963(0.927~1.000)^a	0.976(0.933~1.020)	0.945(0.898~0.995)^a	1.006(0.977~1.036)	1.014(0.980~1.049)	0.995(0.956~1.035)
lag3	0.979(0.947~1.011)	0.993(0.957~1.031)	0.958(0.917~1.001)	1.012(0.986~1.037)	1.015(0.985~1.045)	1.007(0.974~1.042)
lag4	0.989(0.958~1.021)	1.005(0.969~1.042)	0.967(0.927~1.009)	1.014(0.988~1.040)	1.013(0.983~1.043)	1.015(0.981~1.051)
lag5	0.995(0.963~1.027)	1.011(0.974~1.049)	0.973(0.932~1.016)	1.013(0.987~1.041)	1.009(0.978~1.040)	1.020(0.984~1.057)
lag6	0.997(0.965~1.029)	1.012(0.974~1.050)	0.976(0.935~1.020)	1.011(0.984~1.038)	1.003(0.972~1.035)	1.021(0.985~1.059)
lag7	0.995(0.964~1.027)	1.008(0.972~1.045)	0.977(0.937~1.019)	1.006(0.980~1.033)	0.997(0.967~1.027)	1.020(0.985~1.057)
lag8	0.991(0.962~1.020)	1.001(0.968~1.036)	0.976(0.938~1.015)	1.000(0.976~1.025)	0.989(0.961~1.017)	1.017(0.984~1.051)
lag9	0.984(0.958~1.011)	0.992(0.962~1.024)	0.973(0.939~1.010)	0.993(0.971~1.016)	0.981(0.955~1.007)	1.011(0.981~1.043)
lag10	0.977(0.952~1.002)	0.982(0.953~1.011)	0.970(0.938~1.004)	0.986(0.964~1.008)	0.972(0.948~0.997)^a	1.005(0.975~1.035)
lag11	0.969(0.945~0.993)^a	0.970(0.943~0.998)^a	0.966(0.935~0.999)^a	0.978(0.957~1.000)^a	0.964(0.940~0.990)^a	0.997(0.967~1.027)
lag12	0.961(0.936~0.986)^a	0.959(0.931~0.988)^a	0.963(0.930~0.997)^a	0.970(0.948~0.993)^a	0.957(0.931~0.983)^a	0.988(0.958~1.020)
lag13	0.953(0.927~0.980)^a	0.948(0.919~0.979)^a	0.960(0.925~0.996)^a	0.963(0.938~0.988)^a	0.950(0.922~0.979)^a	0.980(0.947~1.014)
lag14	0.947(0.920~0.975)^a	0.940(0.908~0.972)^a	0.958(0.921~0.996)^a	0.956(0.931~0.983)^a	0.944(0.915~0.975)^a	0.972(0.937~1.008)
lag15	0.943(0.915~0.972)^a	0.933(0.901~0.967)^a	0.957(0.919~0.997)^a	0.951(0.924~0.979)^a	0.940(0.909~0.972)^a	0.965(0.929~1.002)
lag16	0.942(0.914~0.971)^a	0.930(0.897~0.963)^a	0.959(0.920~0.999)^a	0.947(0.921~0.974)^a	0.938(0.907~0.969)^a	0.958(0.923~0.995)^a
lag17	0.944(0.916~0.972)^a	0.930(0.899~0.963)^a	0.963(0.926~1.002)	0.945(0.920~0.972)^a	0.937(0.908~0.968)^a	0.954(0.919~0.989)^a
lag18	0.950(0.922~0.978)^a	0.935(0.904~0.968)^a	0.970(0.932~1.010)	0.945(0.920~0.972)^a	0.940(0.910~0.970)^a	0.951(0.916~0.987)^a
lag19	0.960(0.928~0.993)^a	0.946(0.909~0.984)^a	0.981(0.937~1.027)	0.948(0.918~0.979)^a	0.944(0.910~0.981)^a	0.950(0.910~0.992)^a
lag20	0.976(0.932~1.022)	0.963(0.913~1.016)	0.996(0.936~1.060)	0.954(0.913~0.997)^a	0.953(0.905~1.003)	0.952(0.898~1.010)
lag21	0.999(0.934~1.067)	0.987(0.914~1.067)	1.016(0.929~1.112)	0.963(0.903~1.026)	0.964(0.895~1.038)	0.957(0.879~1.043)
注：冷效应：9℃，热效应：26℃；^a：P＜0.05。

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表 4 不同温度、不同滞后时间对手足口病发病数影响的累积滞后效应[RR(95% CI)]

Table 4. Cumulative RR value and its 95% CI of different temperature for daily cases of HFMD at different lag times [RR(95% CI)]]

气温 (℃)	滞后时间(d)	全人群	男性	女性
P₅=9	0	0.986(0.928~1.047)	1.005(0.936~1.078)	0.958(0.883~1.039)
	0~3	1.001(0.868~1.155)	1.045(0.883~1.235)	0.939(0.775~1.137)
	0~5	1.029(0.872~1.213)	1.067(0.880~1.294)	0.972(0.780~1.213)
	0~7	1.046(0.868~1.260)	1.067(0.858~1.326)	1.013(0.790~1.300)
	0~14	0.896(0.687~1.167)	0.833(0.611~1.135)	0.982(0.690~1.399)
	0~21	0.628(0.432~0.912)^a	0.561(0.362~0.869)^a	0.713(0.433~1.175)
P₂₅=14	0	0.992(0.979~1.005)	0.997(0.982~1.012)	0.984(0.967~1.002)
	0~3	0.987(0.957~1.017)	0.997(0.962~1.034)	0.971(0.932~1.012)
	0~5	0.991(0.957~1.026)	1.000(0.960~1.042)	0.978(0.934~1.025)
	0~7	0.996(0.957~1.035)	1.000(0.956~1.047)	0.989(0.939~1.042)
	0~14	0.976(0.924~1.030)	0.966(0.907~1.030)	0.990(0.921~1.065)
	0~21	0.909(0.843~0.981)^a	0.897(0.821~0.981)^a	0.926(0.837~1.024)
P₇₅=23	0	0.975(0.912~1.043)	0.981(0.907~1.061)	0.966(0.883~1.057)
	0~3	1.010(0.857~1.190)	1.059(0.875~1.282)	0.946(0.759~1.179)
	0~5	1.079(0.891~1.306)	1.170(0.937~1.462)	0.964(0.746~1.247)
	0~7	1.149(0.927~1.424)	1.285(1.002~1.648)^a	0.985(0.738~1.315)
	0~14	1.133(0.861~1.493)	1.305(0.948~1.795)	0.934(0.644~1.354)
	0~21	0.972(0.681~1.387)	1.065(0.704~1.609)	0.861(0.534~1.390)
P₉₅=26	0	0.914(0.848~0.986)^a	0.919(0.842~1.003)	0.907(0.820~1.004)
	0~3	0.811(0.675~0.975)^a	0.847(0.684~1.049)	0.763(0.595~0.977)^a
	0~5	0.798(0.644~0.989)^a	0.860(0.671~1.103)	0.718(0.538~0.958)^a
	0~7	0.792(0.624~1.005)	0.878(0.665~1.157)	0.685(0.497~0.944)^a
	0~14	0.633(0.466~0.861)^a	0.710(0.497~1.014)	0.540(0.357~0.817)^a
	0~21	0.472(0.312~0.715)^a	0.482(0.297~0.780)^a	0.460(0.263~0.804)^a
注：^a：P＜0.05。

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