Effects Of Meteorological Factors And Air Pollutants And Their Interactions On Herpes Zoster Visits In Hefei

Objective The purpose of this study was to explore the association between meteorological factors and air pollutants and herpes zoster in Hefei,and their differences by sex,age and season,in order to provide a reference for reducing the risk of herpes zoster and for disease prevention and control in the region.Methods Daily outpatient numbers and herpes zoster patients’information from January1,2015 to December 31,2019 were collected from two large tertiary hospitals,the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of the University of Science and Technology of China.In additional,data on meteorological factors and air pollutants are collected for the same period.Firstly,Spearman correlation analysis was used to preliminarily explore the relationship between meteorological factors,air pollutants and herpes zoster,and to screen the correlation between temperature,humidity,SO2 and O3 and herpes zoster.Secondly,a distribution lag nonlinear model（DLNM）was used to analyze exposure response relationships and lagged effects of meteorological factors,air pollutants,and daily outpatient visits for herpes zoster,as well as differences by gender,age,and season,controlling for confounding factors.Thirdly,a two-factor DLNM model was developed to assess the interactions existing between meteorological factors,air pollutants.Fourth,qualitative and quantitative analyses of the interaction between meteorological factors and air pollutants on herpes zoster visits were conducted using response planes and temperature and humidity stratification models.Results（1）A total of 43547 patients attended herpes zoster outpatient clinics in two large tertiary hospitals in Hefei from 2015 to 2019,with slightly more female patients than male.There were 826 patients aged 0-17,10252 patients aged 18-39,19842 patients aged40-64,and 12627 patients aged 65 or above.And there were significantly more patients aged 40 years and older than those aged under 40 years.There were 20,918 patients in the cold season and 22629 in the warm season.（2）The relationship between the number of herpes zoster visits and temperature showed an"M-shaped",and relative humidity was"U-shaped".The relationship between the number of herpes zoster visits with SO₂and O₃ were linear negative correlation.（3）The single factor model showed that the one-day lag effect of high temperature on the number of herpes zoster visits was greatest on the day of exposure,which was 1.027 times greater than the original.The single-day lag effect of high humidity on the number of shingles outpatient visits was greatest on the day of exposure（RR=1.008,95%CI:1.001-1.016）.The single-day lag effect of each 10?g/m³ increase in SO₂ on herpes zoster visits was statistically significant on days 0-1 and 6-7 and was lowest on the day of exposure,was 0.966（95%CI:0.940-0.993）.For every 10?g/m³ increase in O₃,the cumulative RR value in Lag07 d,the strongest protective effect was observed（RR=0.992,95%CI:0.985-1.000）.（4）Gender stratification showed that high humidity has a similar effect on men and women,while low humidity has a higher risk effect on women than men.For every 10?g/m³ increase in SO₂ concentration,the protective effect on women is higher than that of men.For every 10?g/m³ increase in O₃ concentration,the protective effect on female herpes zoster outpatients is higher than that of male patients.（5）Age stratification showed that the single-day lag effect of high temperature on those aged 0-17 began to appear on day 5 and continued until day 7.The effect of patients aged18-39 was statistically significant at Lag5-Lag7 d.The single-day lag effect of high humidity on the 40-64 years occurred in the first 4 days,and the RR value was the largest on Lag0 d.With increasing SO₂ concentration,the single-day lag effect in patients aged0-17 years appeared on day 2.In patients aged 40-64 years,the smallest cumulative lag effect also appeared in Lag07 d with 0.899（95%CI:0.822-0.984）.For patients 65 years and older,the single-day lag effect occurred at 0-1 and 6-7 days.For every 10?g/m³increase in O_3,the single-day lag effect in the≥65-year-old group had the largest protective effect on the currently day.（6）Stratification of cold and warm seasons showed that the single-day lag effect of SO₂on herpes zoster visits was protective at day 7 in the subgroup analysis of cold seasons.And in warm season conditions,and the cumulative lag effect had the largest protective effect at lag 07 d（RR=0.834,95%CI:0.725-0.958）.For every 10?g/m³ increase in O₃,the single day lag effect of the cold season on patients with herpes zoster at 3-5 days,showing a dangerous effect.For the warm season,the single-day lag was 1-2 days,a protective effect.The cumulative effect was statistically significant for all 7 days,showing a decreasing trend.（7）The results of the two-factor DLNM model analysis showed that temperature,humidity,SO₂ and O₃ will affect each other.Temperature were not statistically significant after the inclusion of humidity,O₃ and SO₂.In the single model for humidity,the risk of herpes zoster visits increased with high humidity after the inclusion of temperature and O₃ cross-basis,respectively;while the risk decreased instead after the inclusion of SO₂.In the single-pollutant model for SO₂,the cross base incorporating temperature and humidity,respectively,showed that as SO₂ concentration increased,the resulting risk of patient visits was reduced compared to the single-factor model.While the two-factor model incorporating O₃ produced an increased cumulative RR value and a weaker protective effect.When O₃ is included in the temperature variable,every 10?g/m³increase in O3 will reduce the risk of herpes zoster,that is,the protective effect will increase.（8）The interaction results showed that the protective effect of O₃ increased by 10?g/m³on herpes zoster was maximum at the cumulative lag on day 6（RR=0.991,95%CI:0.983-1.000）at high temperature,and enhanced the protective effect of O₃.The cumulative lagged effect of SO₂ at high temperature,as well as O₃ and SO₂ at low temperature,on herpes zoster was not statistically significant.At low humidity,the cumulative lag effect was only significant at a lag of 07 d for every 10?g/m³ increase in O₃.The effect was smaller than that of single-factor O₃,indicating that low humidity can also enhance the effect of O₃.At high humidity,the protective effect of both O₃ and SO₂ disappeared.Conclusions From 2015-2019,meteorological factors and air pollutants had short-term effects on the number of daily outpatient visits for herpes zoster in Hefei,with cumulative lagged effects.High temperature and high humidity may be a risk factor for herpes zoster visits,and every 10?g/m³ increase in the concentration of SO₂ and O₃ may be its protective factor.High humidity has a greater impact on middle-aged patients,low humidity has a greater impact on women and elderly patients,and SO₂ and O₃ have a stronger protective effect on women and elderly patients with herpes zoster.High temperature and low humidity enhance the protective effect of O₃ on herpes zoster.