| Objectives: Other infectious diarrhea(OID),as a high-ranking disease in the infectious disease reporting system,poses a significant threat to the health of the residents.The purpose of this study is to quantify the expose-lag effect of the diurnal temperature range(DTR),mean temperature,and their interaction on OID in Tongcheng city and to conduct subgroup analysis to investigate the differences between gender,age,and incidence season,to provide guidance for health authorities to formulate prevention and control measures.Methods: The daily incidence of other infectious diarrhea from 2010 to 2019 were collected from the Infectious disease Surveillance Information system of Tongcheng Center for Disease Control and Prevention.Daily meteorological data in the Tongcheng area,including mean temperature,rainfall 24 hours,mean wind velocity,relative humidity,sunshine duration,and mean air pressure,were obtained from the meteorological monitoring point of Tongcheng City,National Meteorological Information Center of China.The diurnal temperature difference(DTR)is the difference between the maximum temperature and the minimum temperature.After establishing the time series of the daily new cases of other infectious diarrhea and the study date,using a Distributed lag nonlinear model(DLNM)and Generalized additive model(GAM),the median of the diurnal temperature range and mean temperature was used as control values.To quantitatively analyze the relationship between the diurnal temperature range(DTR),mean temperature,and the incidence of other infectious diarrhea(OID),and to explore the interaction effect of DTR and mean temperature on OID.The population was divided into male and female according to sex and into 0-5 years,6-18 years,19-64 years,and 65 years and above according to age.The effects of DTR,mean temperature,and their interaction on the incidence risk in different subgroups were analyzed.At the same time,the whole year was divided into the warm season,and the cold season according to month,May to October was the warm season,November to April was the cold season,and the different risk of warm and cold seasons was explored.Finally,sensitivity analysis was conducted to evaluate the robustness of the model.Results:(1)During the 10-year study period,there were 8231 cases of other infectious diarrhea in Tongcheng City,including 4202 males and 4029 females,with a male-tofemale ratio of 1.04:1.When grouped by age,children accounted for 24%,adolescents accounted for 8.6%,adults accounted for 50%,and the elderly accounted for 17.4%.The average daily incidence was 2.25 cases,and the peak incidence was 17 cases per day.The cases in cold and warm seasons were 4367 and 3864,respectively.In addition,the medians of diurnal temperature range,mean temperature,rainfall 24 hours,mean wind velocity,relative humidity,sunshine duration,and mean air pressure were 8.20°C,17.60°C,0.00 mm,2.20 m/s,78.00%,4.60 h,and 1006.2 hpa,respectively.(2)DTR and mean temperature were significantly associated with the risk of OID with lag effects.A J-shaped relationship was observed between DTR and the incidence of OID.The RR of the maximum DTR at lag 14 days was 2.651(95%CI: 1.320-5.323).The independent effect of DTR was at lag 0(RR:1.020,95%CI: 1.007-1.033),and the minimum effect was at lag 7(RR: 1.003,95%CI: 0.996-1.010).The cumulative effect of the mean temperature on OID only lasted until the fourth day.With the increase of mean temperature,the RR increased gradually in a J shape when lag 0 day,with the maximum value at the highest temperature(RR: 1.064,95%CI: 1.025-1.105).The independent effect of mean temperature was the largest on day 0(RR: 1.064,95%CI: 1.025-1.105)and the smallest on day 7(RR: 0.975,95%CI: 0.958-0.993).(3)Stratified analysis by sex and age showed that women and adults were more susceptible to high DTR at a lag of 14 days.In addition,the effects of DTR differed between the cold and warm seasons.The cumulative effect of mean temperature on other infectious diarrhea was observed only in women.However,no statistical significance was found in the warm and cold seasons in the seasonal stratification.(4)In the interaction analysis,we found that the incidence of OID was highest when low DTR and high mean temperature occurred simultaneously.Stratified analysis showed that males and warm seasons were more susceptible to high DTR in the high-temperature period.At the same time,females and cold seasons were more sensitive to low DTR in the high-temperature period.The interaction effect varied in different age groups.By changing the degrees of freedom of meteorological variables,long-term trends,and seasonality,it was found that the results did not change significantly,indicating that the model established in this study was robust and the results were reliable.Conclusions: High DTR and high temperature were positively associated with OID with a lag effect.Subgroup analysis showed that women and adults were more susceptible to high DTR and high temperature,and high DTR was positively associated with the incidence in the warm season.The interaction effect had a specific impact on the incidence risk.The results of this study suggested that the health authorities should comprehensively consider the impact of DTR and mean temperature and formulate targeted prevention and control measures for different populations in different seasons. |
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