Interactions between climate factors and air pollution on daily HFMD cases: A time series study in Guangdong, China.

Background: Prior studies have shown that climate factors and air pollution are associated with hand, foot, and mouth disease (HFMD) epidemics. However, the interaction between air pollution and climate factors remains unknown. Methods: Daily HFMD counts from2009 through 2012 in Guangdongwere collected. We used distributed lag non-linear models to assess the associations of climate factors and air pollution on HFMD cases. The effects of climate factors were stratified by air pollution stratum to examine the interaction effect of air quality index (AQI) and temperature, as well as relative humidity. In addition, we explored the variability across gender groups. Results: We observed associations between HFMD cases and environmental factors, including temperature, relative humidity, and AQI. The highest relative risks (RR) were observed at themiddle level of temperature and AQI, and high level of relative humidity. The effects for the interaction between AQI and climate factors on HFMD cases were also statistically observed. Compared with low level temperatures (<= 23.5 degrees C), high level temperatures (>= 23.5 degrees C) had a RR of 1.486 (95% CI: 1.469,1.503) on days with "good"air quality (AQI <= 46), and RR of 1.013 (95% CI: 1.003,1.023) on days with "moderate" air quality (AQI > 46). For relative humidity, the high level (>77%) had a RR of 1.082 (95% CI: 1.076,1.089) on days with "good"air quality, and RR of 1.039 (95% CI: 1.033,1.046) on days with "moderate" air quality. The associations and the interactions remained robust for males and females. Conclusions: Our findings indicate that climate factors and air pollution imposed lagged and non-linear effects on HFMD epidemics. The effects of climate factors on health potentially vary by AQI. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence. (c) 2018 Elsevier B.V. All rights reserved.