title: Influence of meteorological factors and air pollution on the outbreak of severe acute respiratory syndrome.
abstract: OBJECTIVE
  To understand the association between the outbreak of severe acute respiratory syndrome (SARS) and meteorological factors and air pollution.
  
  
  METHODS
  An ecological study was conducted.
  
  
  METHODS
  Three hundred and fifty primary probable SARS cases diagnosed in mainland China between 1 January and 31 May 2003, and their 6727 close contacts during the period of their clinical symptoms before admission, were included in this study. Of the 6727 close contacts, 135 (2.0%) later developed clinical symptoms and were diagnosed as probable SARS cases. The daily meteorological data and daily air pollution data during the same SARS outbreak period in mainland China were used in the data analysis. Logistic regression analyses were conducted to explore the association between the secondary attack rate of SARS and meteorological factors and air pollution.
  
  
  RESULTS
  In univariate analyses, daily average temperature (DAT), daily average air pressure (DAAP), and daily average relative humidity (DARH) were inversely associated with secondary attack rate (P<0.001); a significant positive association was found for daily hours of sunshine (DHS) (P<0.001). In multivariate analyses, factors associated with secondary attack rate were DAAP (odds ratio (OR)=0.53, 95% confidence interval (CI): 0.42, 0.66), DARH (OR=0.73, 95% CI: 0.53, 1.00), and daily average wind velocity (DAWV; OR=0.81, 95% CI: 0.68, 0.96). Adjustment for the onset time of a primary case led to little change in the results. In addition, in Hebei Province, a major affected area in China, only DAWV (OR=0.38, 95% CI: 0.20, 0.72) was a significant predictor of secondary attack rate with adjustment for the onset time of primary case. In Inner Mongolia, another major affected area in China, DAWV (OR=0.50, 95% CI: 0.26, 0.94) and DHS (OR=0.27, 95% CI: 0.09, 0.81) were significant predictors of secondary attack rate with adjustment for the onset time of primary case.
  
  
  CONCLUSIONS
  Our results suggest that the SARS outbreak was significantly associated with DAWV, and that DAAP, DARH and DHS may also have influenced the SARS outbreak to some extent. However, because of ecological fallacy and uncontrolled confounding effects that may have biased the results, the association between the SARS outbreak and these meteorological factors and air pollution deserve further investigation.
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
authors.forename: Quan-Cai
authors.initials: QC
authors.lastname: Cai
authors.forename: Jian
authors.initials: J
authors.lastname: Lu
authors.forename: Qin-Feng
authors.initials: QF
authors.lastname: Xu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Guo
authors.forename: De-Zhong
authors.initials: DZ
authors.lastname: Xu
authors.forename: Qing-Wen
authors.initials: QW
authors.lastname: Sun
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.forename: Gen-Ming
authors.initials: GM
authors.lastname: Zhao
authors.forename: Qing-Wu
authors.initials: QW
authors.lastname: Jiang
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D002681:China / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D004196:Disease Outbreaks; D006801:Humans; D016015:Logistic Models; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology*; D014887:Weather