Abstract：
Hand, foot, and mouth disease (HFMD) is a major public health concern in the Asia-Pacific region. Previous studies have implied that ambient air pollution may affect the incidence of HFMD, but the results among different regions are inconsistent. We aimed to deepen the understanding of the associations between air pollutants and HFMD by conducting a multicity study. Daily data on childhood HFMD counts and meteorological and ambient air pollution (PM2.5, PM10, NO2, CO, O3, and SO2) concentrations in 21 cities in Sichuan Province from 2015 to 2017 were collected. A spatiotemporal Bayesian hierarchical model framework was established, and then a distributed lag nonlinear models (DLNMs) was constructed to reveal exposure-lag-response relationships between air pollutants and HFMD while controlling for spatiotemporal effects. Furthermore, given the differences in the levels and seasonal trends of air pollutants between the basin region and plateau region, we explored whether these associations varied between different areas (basin and plateau). The associations between air pollutants and HFMD were nonlinear, with different lag responses. Low NO2 concentrations and both low and high PM2.5 and PM10 concentrations were associated with a decreased risk of HFMD. No significant associations between CO, O3, and SO2 and HFMD were found. The associations between air pollutant concentrations and HFMD were different between the basin and plateau regions. Our study revealed associations between PM2.5, PM10, and NO2 concentrations and HFMD, deepening the understanding of the relationships between air pollutants and HFMD. These findings provide evidence to support the formulation of relevant prevention measures and the establishment of an early warning system.
摘要：
手,脚,和口蹄疫（HFMD）是亚太地区主要的公共卫生问题。以前的研究表明，环境空气污染可能会影响手足口病的发病率，但是不同地区之间的结果不一致。我们旨在通过进行多因素研究来加深对空气污染物与手足口病之间关联的理解。关于儿童手足口病计数以及气象和环境空气污染的每日数据（PM2.5，PM10，NO2，CO，收集了2015年至2017年四川省21个城市的O3和SO2）浓度。建立了时空贝叶斯层次模型框架,然后构建了分布式滞后非线性模型（DLNMs），以揭示空气污染物与HFMD之间的暴露-滞后-响应关系，同时控制时空效应。此外，鉴于流域地区和高原地区之间空气污染物水平和季节性趋势的差异，我们探讨了这些关联是否在不同地区（盆地和高原）之间有所不同。空气污染物和手足口病之间的关系是非线性的，具有不同的滞后响应。低NO2浓度以及低和高PM2.5和PM10浓度与HFMD风险降低相关。CO，O3，并发现SO2和HFMD。流域和高原地区的空气污染物浓度与手足口病之间的关联不同。我们的研究揭示了PM2.5，PM10和NO2浓度与手足口病之间的关系，加深对大气污染物与手足口病关系的认识。这些发现为支持制定相关预防措施和建立预警系统提供了证据。
