title: Associations between extreme precipitation and childhood hand, foot and mouth disease in urban and rural areas in Hefei, China.
abstract: BACKGROUND
  Understanding the relationship between extreme weather events and childhood hand, foot and mouth disease (HFMD) is important in the context of climate change. This study aimed to quantify the relationship between extreme precipitation and childhood HFMD in Hefei, China, and further, to explore whether the association varied across urban and rural areas.
  
  
  METHODS
  Daily data on HFMD counts among children aged 0-14 years from 2010 January 1st to 2012 December 31st were retrieved from Hefei Center for Disease Control and Prevention. Daily data on mean temperature, relative humidity and precipitation during the same period were supplied by Hefei Bureau of Meteorology. We used a Poisson linear regression model combined with a distributed lag non-linear model to assess the association between extreme precipitation (≥90th precipitation) and childhood HFMD, controlling for mean temperature, humidity, day of week, and long-term trend.
  
  
  RESULTS
  There was a statistically significant association between extreme precipitation and childhood HFMD. The effect of extreme precipitation on childhood HFMD was the greatest at six days lag, with a 5.12% (95% confident interval: 2.7-7.57%) increase of childhood HFMD for an extreme precipitation event versus no precipitation. Notably, urban children and children aged 0-4 years were particularly vulnerable to the effects of extreme precipitation.
  
  
  CONCLUSIONS
  Our findings indicate that extreme precipitation may increase the incidence of childhood HFMD in Hefei, highlighting the importance of protecting children from forthcoming extreme precipitation, particularly for those who are young and from urban areas.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Hefei Center for Disease Control and Prevention of Anhui Province, Hefei, Anhui 230061, China.
authors.forename: Jinju
authors.initials: J
authors.lastname: Wu
authors.affiliation: School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Qld 4509, Australia.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Child and Maternal Health Care, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhu
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
authors.forename: Kesheng
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
authors.forename: Liying
authors.initials: L
authors.lastname: Wen
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
authors.forename: Huihui
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China. Electronic address: suhong5151@sina.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Su
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D002980:Climate; D057231:Climate Change; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data; D012621:Seasons; D014505:Urban Population / Q000706:statistics & numerical data; D014887:Weather
keywords: Child; Extreme precipitation; Hand; Rural area; Urban area; foot and mouth disease