Abstract：
The occurrence of hand, foot, and mouth disease (HFMD) is closely related to meteorological factors. However, location-specific characteristics, such as persistent air pollution, may increase the complexity of the impact of meteorological factors on HFMD, and studies across different areas and populations are largely lacking. In this study, a two-stage multisite time-series analysis was conducted using data from 16 cities in Shandong Province from 2015 to 2019. In the first stage, we obtained the cumulative exposure-response curves of meteorological factors and the number of HFMD cases for each city. In the second stage, we merged the estimations from the first stage and included city-specific air pollution variables to identify significant effect modifiers and how they modified the short-term relationship between HFMD and meteorological factors. High concentrations of air pollutants may reduce the risk effects of high average temperature on HFMD and lead to a distinct peak in the cumulative exposure-response curve, while lower concentrations may increase the risk effects of high relative humidity. Furthermore, the effects of average wind speed on HFMD were different at different levels of air pollution. The differences in modification effects between subgroups were mainly manifested in the diversity and quantity of significant modifiers. The modification effects of long-term air pollution levels on the relationship between sunshine hours and HFMD may vary significantly depending on geographical location. The people in age＜3 and male groups were more susceptible to long-term air pollution. These findings contribute to a deepening understanding of the relationship between meteorological factors and HFMD and provide evidence for relevant public health decision-making.
摘要：
手的发生，脚,口蹄疫与气象因素密切相关。然而,特定位置的特征，比如持续的空气污染，可能会增加气象因素对手足口病影响的复杂性，在很大程度上缺乏不同地区和人群的研究。在这项研究中,利用2015-2019年山东省16个地市的数据进行两阶段多站点时间序列分析。在第一阶段,我们获得了每个城市的气象因素和手足口病病例数的累积暴露-反应曲线。在第二阶段,我们合并了第一阶段的估计值,并纳入了特定城市的空气污染变量,以确定显著的效应修正因子,以及它们如何修正手足口病与气象因素之间的短期关系.高浓度的空气污染物可能会降低高平均温度对手足口病的风险影响，并导致累积暴露-反应曲线出现明显的峰值。而较低的浓度可能会增加高相对湿度的风险影响。此外，在不同的空气污染程度下，平均风速对手足口病的影响不同。亚组之间修饰效果的差异主要表现在显著修饰剂的多样性和数量上。长期空气污染水平对日照时间与手足口病之间关系的影响可能会因地理位置而异。年龄＜3岁的人群和男性群体更容易受到长期空气污染的影响。这些发现有助于加深对气象因素与手足口病之间关系的认识，并为相关公共卫生决策提供依据。
