title: Short-term weather variability in Chicago and hospitalizations for Kawasaki disease.
abstract: BACKGROUND
  : Kawasaki disease exhibits a distinct seasonality, and short-term changes in weather may affect its occurrence.
  
  
  METHODS
  : To investigate the effects of weather variability on the occurrence of this syndrome, we conducted a time-between-events analysis of consecutive admissions for Kawasaki disease to a large pediatric hospital in Chicago. We used gamma regression to model the times between admissions. This is a novel application of gamma regression to model the time between admissions as a function of subject-specific covariates.
  
  
  RESULTS
  : We recorded 723 admissions in the 18-year (1986-2003) study period, of which 700 had complete data for analysis. Admissions for Kawasaki disease in Chicago were seasonal: The mean time between admissions was 34% shorter (relative time = 0.66, 95% confidence interval 0.54-0.81) from January-March than from July-September. In 1998, we recorded a larger number of admissions for Kawasaki disease (n = 65) than in other years (mean n = 37). January-March months of 1998 were warmer by a mean of 3 degrees C (1.5 degrees C-4.4 degrees C) and the mean time between admissions was 48% shorter (relative time = 0.52, 0.36-0.75) than in equivalent periods of other study years.
  
  
  CONCLUSIONS
  : Our findings show that atypical changes in weather affect the occurrence of Kawasaki disease and are compatible with a link to an infectious trigger. The analysis of interevent times using gamma regression is an alternative to Poisson regression in modeling a time series of sparse daily counts.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA. wcheckl1@jhmi.edu
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.forename: Judith
authors.initials: J
authors.lastname: Guzman-Cottrill
authors.forename: Leonardo
authors.initials: L
authors.lastname: Epstein
authors.forename: Nancy
authors.initials: N
authors.lastname: Innocentini
authors.forename: Jonathan
authors.initials: J
authors.lastname: Patz
authors.forename: Stanford
authors.initials: S
authors.lastname: Shulman
mesh_terms: D002641:Chicago / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends*; D006776:Hospitals, Pediatric; D006801:Humans; D008485:Medical Audit; D009080:Mucocutaneous Lymph Node Syndrome / Q000453:epidemiology*; D016012:Poisson Distribution; D012189:Retrospective Studies; D014887:Weather