Abstract
Studies about the role of urban characteristics in modifying the health effect of temperature extremes are still unclear. This study is aimed at quantifying the morbidity risk of infectious diarrhea attributable to temperature extremes and the modified effect of a range of city-specific indicators. Distributed lag non-linear model and multivariate meta-regression were applied to estimate fractions of infectious diarrhea morbidity attributable to temperature extremes and to explore the effect modification of city-level characteristics. Extreme heat- and extreme cold-related infectious diarrhea amounted to 0.99% (95% CI: 0.57–1.29) and 1.05% (95% CI: 0.64–1.24) of the total cases, respectively. The attributable fraction of temperature extremes on infectious diarrhea varied between southern and northern China. Several city characteristics modified the association of extreme cold with infectious diarrhea, with a higher morbidity impact related to increased water consumption per capita and decreased latitude. Regions with higher levels of latitude or GDP per capita appeared to be more sensitive to extreme hot. In conclusion, exposure to temperature extremes was associated with increased risks of infectious diarrhea and the effect can be modified by urban characteristics. This finding can inform public health interventions to decrease the adverse effects of temperature extremes on infectious diarrhea.
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Data availability
The data that support the findings of this study are available from the Chinese Center for Disease Control and Prevention, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Chinese Center for Disease Control and Prevention.
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Acknowledgements
We would like to thank Chinese Center for Disease Control and Prevention, National Meteorological Information Center of China, for sharing the data needed for this study.
Funding
This study was supported by the Special Foundation of Basic Science and Technology Resources Survey of Chinese Ministry of Science and Technology (No. 2017FY101202), the Natural Science Foundation of Shandong Province in China (ZR2021QH318), and the Shandong Excellent Young Scientists Fund Program (Overseas) (2022HWYQ-055).
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Data analysis and writing of the first draft of the manuscript were performed by Haitao Wang. Baofa Jiang and Qi Zhao provided assistance for data acquisition and data analysis. Chengchao Zhou and We Ma participated in the coordination of the study and reviewed the manuscript. All authors commented on previous versions of the manuscript and approved the final manuscript.
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Ethical approval for the analysis of this de-identified data was granted by the Ethics Review Committee, School of Public Health, Shandong University (20190402).
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Wang, H., Jiang, B., Zhao, Q. et al. Temperature extremes and infectious diarrhea in China: attributable risks and effect modification of urban characteristics. Int J Biometeorol 67, 1659–1668 (2023). https://doi.org/10.1007/s00484-023-02528-x
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DOI: https://doi.org/10.1007/s00484-023-02528-x