分布滞后非线性模型评估浙江省宁海县气温对0～6岁儿童其他感染性腹泻的发病影响

刘世科; 孙家盛; 章海斌; 王帆; 陈伟; 任丛汉

doi:10.3784/jbjc.202112060624

分布滞后非线性模型评估浙江省宁海县气温对0～6岁儿童其他感染性腹泻的发病影响

doi: 10.3784/jbjc.202112060624

宁海县疾病预防控制中心, 浙江宁波 315600

基金项目: 浙江省宁海县社会发展类科技项目（No. 2119）

详细信息

作者简介:
刘世科，男，甘肃省宁县人，医学学士，主要从事传染性疾病防控工作

通讯作者:
刘世科，Tel：13968326935，Email：shikeliu@163.com

中图分类号: R211; R183
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出版历程
- 收稿日期: 2021-12-06
- 网络出版日期: 2022-10-19
- 刊出日期: 2022-12-01

Evaluation of effect of ambient temperature on other infectious diarrhea incidence in children aged 0−6 years in Ninghai by distributed lag non-linear model

Ninghai County Centers for Disease Control and Prevention, Ningbo 315600, Zhejiang, China

Funds: This study was supported by the Fund for Science and Technology Projects of Social Development of Ninghai, Zhejiang (No. 2119)

More Information

Corresponding author: Liu Shike, Email: shikeliu@163.com

摘要

摘要: 目的利用分布滞后非线性模型（distributed lag non-linearmodel，DLNM）探讨气温对浙江省宁海县0～6岁儿童其他感染性腹泻的发病影响，为科学制定预防控制策略提供帮助。方法收集2016－2020年宁海县有关气象资料和0～6岁儿童其他感染性腹泻的发病资料，采用SPSS 20.0软件分析气象因素与发病数的相关性，利用R 4.1.0软件构建DLNM探讨气温对0～6岁儿童其他感染性腹泻的发病影响。结果 2016－2020年宁海县0～6岁儿童其他感染性腹泻的发病呈一定季节性，每年12月至次年2月为发病高峰。 Spearman分析显示，日平均气温与其他感染性腹泻的相关性最高（r=−0.291）。 DLNM显示，日平均气温为−5 ℃时对其他感染性腹泻的累计发病效应最大（RR=16.601，95%CI：2.667～103.333），在滞后0 d 时，发病风险最小（相对危险度RR=0.815，95%CI：0.730～0.910）；滞后30 d时，发病风险最大（RR=1.265，95%CI：1.148～1.395）。−5、5、11.5 ℃的气温条件对其他感染性腹泻的发病影响持续时间长，其累计滞后天数分别可达30、21和30 d。结论日平均气温和宁海县0～6岁儿童其他感染性腹泻的发病明显相关，在低温条件下发病风险显著增加且有较长的滞后效应，高温条件下不显著。
- 分布滞后非线性模型 /
- 气温 /
- 其他感染性腹泻 /
- 儿童 /
- 发病风险
Abstract: Objective To evaluate the effect of ambient temperature on the incidence of other infectious diarrhea in children aged 0−6 years in Ninghai county of Zhejiang province by distributed lag non-linear model, and provide evidence for the prevention and control of other infectious diarrhea in children. Methods The relevant meteorological data and the incidence data of other infectious diarrhea in children aged 0–6 years in Ninghai from 2016 to 2020 were collected. Software SPSS 20.0 was used to analyze the correlation between meteorological factors and the incidence of other infectious diarrhea, and software R 4.1.0 was used to construct a distributed lag non-linear model to explore the impact of ambient temperature on the incidence of other infectious diarrhea in children aged 0−6 years in Ninghai. Results The incidence of other infectious diarrhea in children aged 0–6 years in Ninghai showed obvious seasonality during 2016−2020, with the peak from December to February. Spearman analysis showed that the correlation between daily average ambient temperature and the incidence of other infectious diarrhea was strongest (r=−0.291). Distributed lag non-linear model showed that the cumulative effect on the incidence of other infectious diarrhea was greatest when the daily average ambient temperature was −5℃ (RR=16.601, 95% CI: 2.667−103.333). The incidence risk was lowest at lag 0 days (RR=0.815, 95% CI: 0.730−0.910) and the incidence risk was highest at lag 30 days (RR=1.265, 95% CI: 1.148−1.395). The ambient temperature of −5 ℃, 5 ℃ and 11.5 ℃ had long impacts on the incidence of other infectious diarrhea, and the cumulative lag days could reach 30 days, 21 days and 30 days, respectively. Conclusion The daily average ambient temperature was significantly related to the incidence of other infectious diarrhea in children aged 0–6 years in Ninghai. The risk of other infectious diarrhea increased significantly at low ambient temperature and had a long lag effect. But it was not significant at high ambient temperature.
- Distributed lag non-linear model /
- Ambient temperature /
- Other infectious diarrhea /
- Child /
- Morbidity risk

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图 1 2016－2020年宁海县0～6岁儿童其他感染性腹泻的时间分布

Figure 1. Time distribution of other infectious diarrhea cases in children aged 0−6 years in Ninghai, 2016−2020

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图 2 2016－2020年宁海县0～6岁儿童其他感染性腹泻的发病率

Figure 2. Incidence rate of other infectious diarrhea in children aged 0−6 years in Ninghai, 2016−2020

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图 3 2016－2020年宁海县不同地区0～6岁儿童其他感染性腹泻的发病率

Figure 3. Incidence rate of other infectious diarrhea in children aged 0−6 years in different areas in Ninghai 2016−2020

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图 4 日平均气温和滞后时间对0～6岁儿童其他感染性腹泻的影响

Figure 4. Effects of different daily average ambient temperature and lag time on incidence of other infectious diarrhea in children aged 0−6 years

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图 5 日平均气温对0～6岁儿童其他感染性腹泻影响的总体累积效应

Figure 5. Overall cumulative effect of daily average ambient temperature on incidence of other infectious diarrhea in children aged 0−6 years

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表 1 2016－2020年宁海县气象因素和0～6岁儿童其他感染性腹泻的基本情况

Table 1. Meteorological factors and other infectious diarrhea in children aged 0−6 years in Ninghai during 2016−2020

指标	均值（n=1 827）	最小值	P₅	M（P₂₅～P₇₅）	P₉₅	最大值
日发病数（例）	7.07	0.00	1.00	6.00（3.00～9.00）	18.00	41.00
日平均温差（℃）	8.81	0.00	3.00	9.00（7.00～11.00）	14.00	24.00
日平均气温（℃）	18.10	−5.00	5.00	18.50（11.50～24.50）	30.00	34.00
日平均湿度（%）	80.35	0.00	58.00	82.00（75.00～88.00）	95.00	100.00
日平均降水量（mm）	7.00	0.00	0.00	1.45（0.00～8.15）	28.89	282.00
日空气质量指数	53.32	12.00	23.00	47.00（34.00～66.00）	103.00	277.00
注：P₅. 第5百分位数；M（P₂₅～P₇₅）. 中位数（第25～75百分位数）；P₉₅. 第95百分位数

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表 2 宁海县内0～6岁儿童其他感染性腹泻发病数与同期气象因素的Spearman相关性

Table 2. Spearman correlation between incidence of other infectious diarrhea and meteorological factors in children aged 0−6 years in Ninghai

指标	日发病数	日平均温差	日平均气温	日平均湿度	日平均降水量	日空气质量指数
日发病数	1.00
日平均温差	−0.118^a	1.00
日平均气温	−0.291^a	0.295^a	1.00
日平均湿度	−0.016	−0.471^a	0.092^a	1.00
日平均降水量	−0.089^a	−0.272^a	0.301^a	0.660^a	1.00
日空气质量指数	0.101^a	0.194^a	−0.358^a	−0.394^a	−0.345^a	1.00
注：a. P<0.05

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表 3 日平均气温对宁海县0～6岁儿童其他感染性腹泻发病风险的累积滞后效应

Table 3. Cumulative lag effect of different daily average temperatures on risk of other infectious diarrhea in children aged 0−6 years in Ninghai

日平均气温（℃）	累积滞后天数（d）	相对危险度	95%置信区间
−5	0	0.815^a	0.730～0.910
	0～1	0.693^a	0.563～0.854
	0～3	0.567^a	0.389～0.826
	0～7	0.590	0.311～1.120
	0～14	1.405	0.477～4.136
	0～21	3.410	0.788～14.755
	0～30	16.601^a	2.667～103.333
P₅=5	0	0.921^a	0.880～0.965
	0～1	0.856^a	0.785～0.933
	0～3	0.755^a	0.648～0.881
	0～7	0.641^a	0.495～0.829
	0～14	0.565^a	0.369～0.866
	0～21	0.519^a	0.294～0.918
	0～30	0.553	0.270～1.132
P₂₅=11.5	0	0.973	0.934～1.013
	0～1	0.944	0.875～1.018
	0～3	0.882	0.772～1.008
	0～7	0.754^a	0.605～0.938
	0～14	0.559^a	0.389～0.803
	0～21	0.438^a	0.266～0.721
	0～30	0.335^a	0.173～0.648
P₇₅=24.5	0	1.014	0.970～1.060
	0～1	1.030	0.948～1.120
	0～3	1.067	0.922～1.235
	0～7	1.156	0.914～1.461
	0～14	1.232	0.849～1.786
	0～21	1.059	0.643～1.745
	0～30	0.900	0.477～1.698
P₉₅=30	0	0.996	0.937～1.058
	0～1	0.998	0.890～1.118
	0～3	1.020	0.837～1.244
	0～7	1.132	0.826～1.550
	0～14	1.366	0.827～2.255
	0～21	1.291	0.649～2.569
	0～30	1.165	0.465～2.918
34	0	0.970	0.876～1.075
	0～1	0.952	0.787～1.151
	0～3	0.948	0.684～1.315
	0～7	1.057	0.644～1.735
	0～14	1.475	0.703～3.095
	0～21	1.712	0.634～4.622
	0～30	1.844	0.480～7.075
注：a. P<0.05

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参考文献(25)

[1]	孙婕, 杨雯雯, 曾令佳, 等. 2011-2016年全国6~22岁学生人群法定传染病监测数据分析[J]. 中华流行病学杂志,2018,39(12):1589–1595. DOI:10.3760/cma.j.issn.0254−6450.2018.12.010. Sun J, Yang WW, Zeng LJ, et al. Surveillance data on notifiable infectious diseases among students aged 6−22 years in China, 2011−2016[J]. Chin J Epidemiol, 2018, 39(12): 1589–1595. DOI: 10.3760/cma.j.issn.0254−6450.2018.12.010.
[2]	白杉. 2009-2018年沈阳市其他感染性腹泻流行特征分析[J]. 职业与健康,2019,35(23):3228–3232. DOI: 10.13329/j.cnki.zyyjk.2019.0866. Bai S. Analysis of epidemic characteristics of other infectious diarrhea in Shenyang city from 2009−2018[J]. Occup Health, 2019, 35(23): 3228–3232. DOI: 10.13329/j.cnki.zyyjk.2019.0866.
[3]	骆洪梅. 2005－2019年我国其他感染性腹泻病流行特征及变化趋势研究[D]. 北京: 中国疾病预防控制中心, 2020. DOI: 10.27511/d.cnki.gzyyy.2020.000117. Luo HM. Study on epidemic characteristics and change trend of other infectious diarrhea diseases in China from 2005 to 2019[D]. Beijing: Chinese Center for Disease Control and Prevention, 2020. DOI: 10.27511/d.cnki.gzyyy.2020.000117.
[4]	丁哲渊, 吴昊澄, 鲁琴宝, 等. 2020年浙江省法定传染病疫情分析[J]. 预防医学,2021,33(4):325–331. DOI:10.19485/j.cnki.issn2096−5087.2021.04.001. Ding ZY, Wu HC, Lu QB, et al. Epidemiological characteristics of the notifiable infectious diseases reported in Zhejiang province, 2020[J]. Prev Med, 2021, 33(4): 325–331. DOI: 10.19485/j.cnki.issn2096−5087.2021.04.001.
[5]	张臣. 2015-2017年城关医院传染病报卡分析[J]. 世界最新医学信息文摘,2018,18(87):185–186. DOI:10.19613/j.cnki.1671−3141.2018.87.126. Zhang C. Analysis of infectious disease reporting cards in Chengguan hospital from 2015 to 2017[J]. World Latest Med Inf, 2018, 18(87): 185–186. DOI: 10.19613/j.cnki.1671−3141.2018.87.126.
[6]	李世雄, 王玉明, 董继元. 嘉峪关市其他感染性腹泻与气象相关影响因素研究[J]. 中国公共卫生管理,2019,35(2):157–159. DOI:10.19568/j.cnki.23−1318.2019.02.004. Li SX, Wang YM, Dong JY. Association between incidence of other infectious diarrhea and meteorological factors in Jiayuguan[J]. Chin J Public Health Manag, 2019, 35(2): 157–159. DOI: 10.19568/j.cnki.23−1318.2019.02.004.
[7]	王海涛, 赵哲, 姜宝法. 绍兴市气温对其他感染性腹泻发病影响及归因风险评估[J]. 中国公共卫生,2021,37(2):328–332. DOI: 10.11847/zgggws1124062. Wang HT, Zhao Z, Jiang BF. Impact of ambient temperature on other infectious diarrhea incidence and its attributable risk in Shaoxing city[J]. Chin J Public Health, 2021, 37(2): 328–332. DOI: 10.11847/zgggws1124062.
[8]	Arvelo W, Hall AJ, Henao O, et al. Incidence and etiology of infectious diarrhea from a facility-based surveillance system in Guatemala, 2008-2012[J]. BMC Public Health, 2019, 19(1): 1340. DOI: 10.1186/s12889−019−7720−2.
[9]	薛鸣, 林君芬, 徐校平, 等. 2011-2014年浙江省其他感染性腹泻病发病及病原分析[J]. 疾病监测,2016,31(3):209–214. DOI:10.3784/j.issn.1003−9961.2016.03.008. Xue M, Lin JF, Xu XP, et al. Epidemiology and etiology of other infectious diarrheal diseases in Zhejiang, 2011−2014[J]. Dis Surveill, 2016, 31(3): 209–214. DOI: 10.3784/j.issn.1003−9961.2016.03.008.
[10]	罗兰, 朱利, 王芳, 等. 5岁及以下其他感染性腹泻病患儿家长对其他感染性腹泻病防治知识知晓状况及影响因素[J]. 医学动物防制,2020,36(12):1153–1156. DOI: 10.7629/yxdwfz202012009. Luo L, Zhu L, Wang F, et al. Awareness of parents of children aged 5 or below with other infectious diarrhea about prevention and treatment of the disease and influencing factors[J]. J Med Pest Control, 2020, 36(12): 1153–1156. DOI: 10.7629/yxdwfz202012009.
[11]	骆洪梅, 冉陆, 孟玲, 等. 2005-2018年中国5岁以下轮状病毒腹泻报告病例流行特征分析[J]. 中华预防医学杂志,2020,54(2):181–186. DOI:10.3760/cma.j.issn.0253−9624.2020.02.013. Luo HM, Ran L, Meng L, et al. Analysis of epidemiological characteristics of report cases of rotavirus diarrhea in children under 5 years old in China, 2005−2018[J]. Chin J Prev Med, 2020, 54(2): 181–186. DOI: 10.3760/cma.j.issn.0253−9624.2020.02.013.
[12]	肖峰, 李瑞莉, 王利红, 等. 我国0~6岁儿童健康管理服务实施情况分析[J]. 中国妇幼保健,2014,29(35):5741–5744. DOI:10.7620/zgfybj.j.issn.1001−4411.2014.35.01. Xiao F, Li RL, Wang LH, et al. Analysis on the implementation situation of health management service for 0-6-year-old children in China[J]. Mate Child Health Care China, 2014, 29(35): 5741–5744. DOI: 10.7620/zgfybj.j.issn.1001−4411.2014.35.01.
[13]	李骏, 顾敏华, 钱程, 等. 基于DLNM模型探讨江阴市手足口病发病与气象因素之间的关联[J]. 中华疾病控制杂志,2019,23(4):412–416. DOI: 10.16462/j.cnki.zhjbkz.2019.04.009. Li J, Gu MH, Qian C, et al. Exploration of the association between meteorological factors and incidence of hand, foot, and mouth disease based on the distributed lag non-linear model in Jiangyin[J]. Chin J Dis Control Prev, 2019, 23(4): 412–416. DOI: 10.16462/j.cnki.zhjbkz.2019.04.009.
[14]	魏俊妮, 尚瑾, 张军锋, 等. 山西省四城市其他感染性腹泻时空分布特征与气象因子的相关性研究[J]. 中国预防医学杂志,2019,20(7):588–591. DOI:10.16506/j.1009−6639.2019.07.007. Wei JN, Shang J, Zhang JF, et al. The spatial distribution characteristics of other infectious diarrhea and the correlation with meteorological factors in four cities of Shanxi province[J]. Chin Prev Med, 2019, 20(7): 588–591. DOI: 10.16506/j.1009−6639.2019.07.007.
[15]	杨军, 欧春泉, 丁研, 等. 分布滞后非线性模型[J]. 中国卫生统计,2012,29(5):772–773,777. Yang J, Ou CQ, Ding Y, et al. Distributed lag non-linear model[J]. Chin J Health Stat, 2012, 29(5): 772–773,777.
[16]	王海涛, 刘志东, 劳家辉, 等. 浙江省气温对其他感染性腹泻的滞后效应及影响因素[J]. 中华流行病学杂志,2019,40(8):960–964. DOI:10.3760/cma.j.issn.0254−6450.2019.08.016. Wang HT, Liu ZD, Lao JH, et al. Lag effect and influencing factors of temperature on other infectious diarrhea in Zhejiang province[J]. Chin J Epidemiol, 2019, 40(8): 960–964. DOI: 10.3760/cma.j.issn.0254−6450.2019.08.016.
[17]	李海娇, 李丽丽, 董瑞强, 等. 2006-2015年北京市房山区其他感染性腹泻流行特征[J]. 职业与健康,2017,33(5):639–641. DOI: 10.13329/j.cnki.zyyjk.2017.0195. Li HJ, Li LL, Dong RQ, et al. Epidemiological characteristics of other infectious diarrhea in Fangshan district of Beijing from 2006−2015[J]. Occup Health, 2017, 33(5): 639–641. DOI: 10.13329/j.cnki.zyyjk.2017.0195.
[18]	Ganguly E, Sharma PK, Bunker CH. Prevalence and risk factors of diarrhea morbidity among under-five children in India: A systematic review and meta-analysis[J]. Ind J Child Health, 2015, 2(4): 152–160. DOI: 10.32677/IJCH.2015.v02.i04.004.
[19]	Baker KK, O'Reilly CE, Levine MM, et al. Sanitation and hygiene-specific risk factors for moderate-to-severe diarrhea in young children in the global enteric multicenter study, 2007-2011: case-control study[J]. PLoS Med, 2016, 13(5): e1002010. DOI: 10.1371/journal.pmed.1002010.
[20]	鲁影, 汪慧, 陈纯, 等. 广州市2018年其他感染性腹泻流行特征分析[J]. 医学动物防制,2020,36(1):32–35. DOI: 10.7629/yxdwfz202001010. Lu Y, Wang H, Chen C, et al. Epidemiological characteristics of other infectious diarrhea in Guangzhou in 2018[J]. J Med Pest Control, 2020, 36(1): 32–35. DOI: 10.7629/yxdwfz202001010.
[21]	Huang NN, Zheng H, Li B, et al. The short-term effects of temperature on infectious diarrhea among children under 5 years old in Jiangsu, China: a time-series study (2015−2019)[J]. Curr Med Sci, 2021, 41(2): 211–218. DOI: 10.1007/s11596−021−2338−x.
[22]	D'Souza RM, Hall G, Becker NG. Climatic factors associated with hospitalizations for rotavirus diarrhoea in children under 5 years of age[J]. Epidemiol Infect, 2008, 136(1): 56–64. DOI: 10.1017/s0950268807008229.
[23]	Gasparrini A, Armstrong B, Kenward MG. Distributed lag non-linear models[J]. Stat Med, 2010, 29(21): 2224–2234. DOI: 10.1002/sim.3940.
[24]	Van Gaalen RD, Van De kassteele J, Hahné SJM, et al. Determinants of rotavirus transmission: a lag nonlinear time series analysis[J]. Epidemiology, 2017, 28(4): 503–513. DOI: 10.1097/EDE.0000000000000654.
[25]	郝强, 高琦, 赵然, 等. 2014-2016年气温和相对湿度对深圳市5岁以下儿童轮状病毒腹泻的影响[J]. 山东大学学报(医学版),2022,60(2):89–95,114. DOI:10.6040/j.issn.1671−7554.0.2021.0820. Hao Q, Gao Q, Zhao R, et al. Effects of ambient temperature and relative humidity on rotavirus diarrhea among children under 5 years old in Shenzhen city during 2014−2016[J]. J Shandong Univ (Health Sci), 2022, 60(2): 89–95,114. DOI: 10.6040/j.issn.1671−7554.0.2021.0820.