title: Short-term effects of meteorological factors on hand, foot and mouth disease among children in Shenzhen, China: Non-linearity, threshold and interaction.
abstract: BACKGROUND
  Various meteorological factors have been associated with hand, foot and mouth disease (HFMD) among children; however, fewer studies have examined the non-linearity and interaction among the meteorological factors.
  
  
  METHODS
  A generalized additive model with a log link allowing Poisson auto-regression and over-dispersion was applied to investigate the short-term effects daily meteorological factors on children HFMD with adjustment of potential confounding factors.
  
  
  RESULTS
  We found positive effects of mean temperature and wind speed, the excess relative risk (ERR) was 2.75% (95% CI: 1.98%, 3.53%) for one degree increase in daily mean temperature on lag day 6, and 3.93% (95% CI: 2.16% to 5.73%) for 1m/s increase in wind speed on lag day 3. We found a non-linear effect of relative humidity with thresholds with the low threshold at 45% and high threshold at 85%, within which there was positive effect, the ERR was 1.06% (95% CI: 0.85% to 1.27%) for 1 percent increase in relative humidity on lag day 5. No significant effect was observed for rainfall and sunshine duration. For the interactive effects, we found a weak additive interaction between mean temperature and relative humidity, and slightly antagonistic interaction between mean temperature and wind speed, and between relative humidity and wind speed in the additive models, but the interactions were not statistically significant.
  
  
  CONCLUSIONS
  This study suggests that mean temperature, relative humidity and wind speed might be risk factors of children HFMD in Shenzhen, and the interaction analysis indicates that these meteorological factors might have played their roles individually.
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Xie
authors.affiliation: Department of Clinical Laboratory, The People's Hospital of Zhangqiu City, Zhangqiu 250215, China.
authors.forename: Xiliang
authors.initials: X
authors.lastname: Chen
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
authors.forename: Shujiang
authors.initials: S
authors.lastname: Mei
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
authors.forename: Yuxue
authors.initials: Y
authors.lastname: Liao
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China. Electronic address: linhualiang2002@163.com.
authors.forename: Hualiang
authors.initials: H
authors.lastname: Lin
mesh_terms: D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006813:Humidity; D008297:Male; D008685:Meteorological Concepts; D013696:Temperature; D014919:Wind
keywords: Hand foot and mouth disease; Interaction effect; Shenzhen; Time series analysis