title: A systematic review of methodology: time series regression analysis for environmental factors and infectious diseases.
abstract: BACKGROUND
  Time series analysis is suitable for investigations of relatively direct and short-term effects of exposures on outcomes. In environmental epidemiology studies, this method has been one of the standard approaches to assess impacts of environmental factors on acute non-infectious diseases (e.g. cardiovascular deaths), with conventionally generalized linear or additive models (GLM and GAM). However, the same analysis practices are often observed with infectious diseases despite of the substantial differences from non-infectious diseases that may result in analytical challenges.
  
  
  METHODS
  Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic review was conducted to elucidate important issues in assessing the associations between environmental factors and infectious diseases using time series analysis with GLM and GAM. Published studies on the associations between weather factors and malaria, cholera, dengue, and influenza were targeted.
  
  
  RESULTS
  Our review raised issues regarding the estimation of susceptible population and exposure lag times, the adequacy of seasonal adjustments, the presence of strong autocorrelations, and the lack of a smaller observation time unit of outcomes (i.e. daily data). These concerns may be attributable to features specific to infectious diseases, such as transmission among individuals and complicated causal mechanisms.
  
  
  CONCLUSIONS
  The consequence of not taking adequate measures to address these issues is distortion of the appropriate risk quantifications of exposures factors. Future studies should pay careful attention to details and examine alternative models or methods that improve studies using time series regression analysis for environmental determinants of infectious diseases.
authors: Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University , 1-12-4 Sakamoto, Nagasaki, Japan 852-8523 (CI and MH) ; Research Fellow of Japan Society for the Promotion of Science , Japan.
authors: Chisato
authors: C
authors: Imai
authors: Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University , 1-12-4 Sakamoto, Nagasaki, Japan 852-8523 (CI and MH).
authors: Masahiro
authors: M
authors: Hashizume
keywords: GAM; GLM; environmental factor; infectious disease; review; seasonality; time series; weather