■手,脚,自中国首次爆发以来,口蹄疫(HFMD)一直是严重的公共卫生威胁。分析手足口病的省级时空分布并绘制中国大陆的相对风险图,将有助于确定高危省份和感染暴发的时期,以用于制定预防和控制该疾病的新优先领域。此外,我们的研究调查了空气污染对全国手足口病的影响,到目前为止,很少有研究这样做。
■收集了各省每月手足口病感染人数的数据,空气污染,气象变量,中国大陆2014年至2017年的社会经济变量。我们使用空间自相关来确定手足口病发病率的总体分布。分析了手足口病的时空格局,风险图是使用贝叶斯时空模型开发的,评估潜在影响因素对手足口病的影响。
■在我们的研究中,从2014年到2017年,中国大陆所有省份的手足口病年发病率为每10万人138.80至203.15,年平均发病率为165.86。中国31个省份手足口病的时间风险具有周期性和季节性特征。从2014年到2017年,南部和东部省份的空间相对风险最高(RR>3)。各省手足口病发病风险(湖南,湖北,和重庆)位于中国中部,随着时间的推移而增加。在气象变量中,除了平均两分钟风速(RR0.6878;95%CI0.5841,0.8042),所有其他变量均为手足口病的危险因素.高人均GDP(RR0.9922;95%CI0.9841,0.9999)是手足口病的保护因素。出生率越高(RR1.0657;95%CI1.0185,1.1150),手足口病的风险越高。每1,000人的卫生工作者(RR1.2010;95%CI1.0443,1.3771)与手足口病呈正相关。
■从2014年到2017年,中部省份(湖南,湖北,和重庆)逐渐成为手足口病的高发地区。手足口病风险的时空模式可能部分归因于气象和社会经济因素。中部省份手足口病的流行需要引起重视,因为那里的预防控制工作应该加强。
Hand, foot, and mouth disease (HFMD) has remained a serious public health threat since its first outbreak in China. Analyzing the province-level spatiotemporal distribution of HFMD and mapping the relative risk in mainland China will help determine high-risk provinces and periods of infection outbreaks for use in formulating new priority areas for prevention and control of this disease. Furthermore, our study examined the effect of air pollution on HFMD nationwide, which few studies have done thus far.
Data were collected on the number of provincial monthly HFMD infections, air pollution, meteorological variables, and socioeconomic variables from 2014 to 2017 in mainland China. We used spatial autocorrelation to determine the aggregate distribution of HFMD incidence. Spatiotemporal patterns of HFMD were analyzed, risk maps were developed using the Bayesian spatiotemporal model, and the impact of potential influencing factors on HFMD was assessed.
In our study, from 2014 to 2017, the HFMD annual incidence rate in all provinces of mainland China ranged from 138.80 to 203.15 per 100,000 people, with an average annual incidence rate of 165.86. The temporal risk of HFMD for 31 Chinese provinces exhibited cyclical and seasonal characteristics. The southern and eastern provinces had the highest spatial relative risk (RR > 3) from 2014 to 2017. The HFMD incidence risk in provinces (Hunan, Hubei, and Chongqing) located in central China increased over time. Among the meteorological variables, except for the mean two-minute wind speed (RR 0.6878; 95% CI 0.5841, 0.8042), all other variables were risk factors for HFMD. High GDP per capita (RR 0.9922; 95% CI 0.9841, 0.9999) was a protective factor against HFMD. The higher the birth rate was (RR 1.0657; 95% CI 1.0185, 1.1150), the higher the risk of HFMD. Health workers per 1,000 people (RR 1.2010; 95% CI 1.0443, 1.3771) was positively correlated with HFMD.
From 2014 to 2017, the central provinces (Hunan, Hubei, and Chongqing) gradually became high-risk regions for HFMD. The spatiotemporal pattern of HFMD risk may be partially attributed to meteorological and socioeconomic factors. The prevalence of HFMD in the central provinces requires attention, as prevention control efforts should be strengthened there.