title: Spatio-temporal analysis of the relationship between climate and hand, foot, and mouth disease in Shandong province, China, 2008-2012.
abstract: BACKGROUND
  Hand, foot, and mouth disease (HFMD) is the most common communicable disease in China. Shandong Province is one of the most seriously affected areas. The distribution of HFMD had spatial heterogeneity and seasonal characteristic in this setting. The aim of this study was to explore the associations between climate and HFMD by a Bayesian approach from spatio-temporal interactions perspective.
  
  
  METHODS
  The HFMD data of Shandong Province during 2008-2012 were derived from the China National Disease Surveillance Reporting and Management System. And six climatic indicators were obtained from the Meteorological Bureau of Shandong Province. The global spatial autocorrelation statistic (Moran's I) was used to detect the spatial autocorrelation of HFMD cases in each year. The optimal one among four Bayesian models was further adopted to estimate the relative risk of the occurrence of HFMD via Markov chain Monte Carlo.
  
  
  RESULTS
  The annual average incidence rate of HFMD was 104.40 per 100,000 in Shandong Province. Positive spatial autocorrelation appeared at county level (Moran's I≥0.30, P<0.001). The best fitting Spatio-temporal interactive model showed that annual average temperature, annual average pressure, annual average relative humidity, annual average wind speed and annual sunshine hours were significantly positive related to the occurrence of HFMD. The estimated relative risk of 36, 87, 91, 79, 65 out of 140 counties for 2008-2012 respectively were significantly more than 1.
  
  
  CONCLUSIONS
  There were obvious spatio-temporal heterogeneity of HFMD in Shandong Province, and the climatic indicators were associated with the epidemic of HFMD. Bayesian approach should be recommended to capture the spatial-temporal pattern of HFMD.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China. yunxialiu@163.com.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Shandong Center for Disease Control and Prevention, Jinan, Shandong, China. xjwang62@163.com.
authors.forename: Xianjun
authors.initials: X
authors.lastname: Wang
authors.affiliation: Institute office, Shandong Academy of Medical Science, Jinan, Shandong, China. ckpang@163.com.
authors.forename: Chunkun
authors.initials: C
authors.lastname: Pang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China. yuanzhongshang@163.com.
authors.forename: Zhongshang
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China. lihongkaiyouxiang@163.com.
authors.forename: Hongkai
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China. xuefzh@sdu.edu.cn.
authors.forename: Fuzhong
authors.initials: F
authors.lastname: Xue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D002980:Climate; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D012621:Seasons; D013029:Space-Time Clustering; D062211:Spatio-Temporal Analysis; D013696:Temperature; D055815:Young Adult