title: Scrub typhus islands in the Taiwan area and the association between scrub typhus disease and forest land use and farmer population density: geographically weighted regression.
abstract: BACKGROUND
  The Taiwan area comprises the main island of Taiwan and several small islands located off the coast of the Southern China. The eastern two-thirds of Taiwan are characterized by rugged mountains covered with tropical and subtropical vegetation. The western region of Taiwan is characterized by flat or gently rolling plains. Geographically, the Taiwan area is diverse in ecology and environment, although scrub typhus threatens local human populations. In this study, we investigate the effects of seasonal and meteorological factors on the incidence of scrub typhus infection among 10 local climate regions. The correlation between the spatial distribution of scrub typhus and cultivated forests in Taiwan, as well as the relationship between scrub typhus incidence and the population density of farm workers is examined.
  
  
  METHODS
  We applied Pearson's product moment correlation to calculate the correlation between the incidence of scrub typhus and meteorological factors among 10 local climate regions. We used the geographically weighted regression (GWR) method, a type of spatial regression that generates parameters disaggregated by the spatial units of analysis, to detail and map each regression point for the response variables of the standardized incidence ratio (SIR)-district scrub typhus. We also applied the GWR to examine the explanatory variables of types of forest-land use and farm worker density in Taiwan in 2005.
  
  
  RESULTS
  In the Taiwan Area, scrub typhus endemic areas are located in the southeastern regions and mountainous townships of Taiwan, as well as the Pescadore, Kinmen, and Matou Islands. Among these islands and low-incidence areas in the central western and southwestern regions of Taiwan, we observed a significant correlation between scrub typhus incidence and surface temperature. No similar significant correlation was found in the endemic areas (e.g., the southeastern region and the mountainous area of Taiwan). Precipitation correlates positively with scrub typhus incidence in 3 local climate regions (i.e., Taiwan's central western and southwestern regions, and the Kinmen Islands). Relative humidity correlates positively with incidence in Southwestern Taiwan and the Kinmen Islands. The number of wet days correlates positively with incidence in Southwestern Taiwan. The duration of sunshine correlates positively with incidence in Central Western Taiwan, as well as the Kinmen and Matou Islands. In addition, the 10 local climatic regions can be classified into the following 3 groups, based on the warm-cold seasonal fluctuations in scrub typhus incidence: (a) Type 1, evident in 5 local climate regions (Taiwan's northern, northwestern, northeastern, and southeastern regions, as well as the mountainous area); (b) Type 2 (Taiwan's central western and southwestern regions, and the Pescadore Islands); and (c) Type 3 (the Kinmen and Matou Islands). In the GWR models, the response variable of the SIR-district scrub typhus has a statistically significantly positive association with 2 explanatory variables (farm worker population density and timber management). In addition, other explanatory variables (recreational forests, natural reserves, and "other purpose" areas) show positive or negative signs for parameter estimates in various locations in Taiwan. Negative signs of parameter estimates occurred only for the explanatory variables of national protectorates, plantations, and clear-cut areas.
  
  
  CONCLUSIONS
  The results of this study show that scrub typhus in Taiwan can be classified into 3 types. Type 1 exhibits no climatic effect, whereas the incidence of Type 2 correlates positively with higher temperatures during the warm season, and the incidence of Type 3 correlates positively with higher surface temperatures and longer hours of sunshine. The results also show that in the mountainous township areas of Taiwan's central and southern regions, as well as in Southeastern Taiwan, higher SIR values for scrub typhus are associated with the following variables: farm worker population density, timber management, and area type (i.e., recreational forest, natural reserve, or other purpose).
authors.affiliation: Center for General Education, Aletheia University, New Taipei 25103, Republic of China. puijentsai@gmail.com
authors.forename: Pui-Jen
authors.initials: PJ
authors.lastname: Tsai
authors.forename: Hsi-Chyi
authors.initials: HC
authors.lastname: Yeh
mesh_terms: D002980:Climate; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D016273:Occupational Exposure; D011156:Population Density; D012612:Scrub Typhus / Q000453:epidemiology*; D012621:Seasons; D013624:Taiwan / Q000453:epidemiology; D019371:Topography, Medical; D014197:Trees