A 21-year retrospective analysis of environmental impacts on paediatric acute gastroenteritis in an affluent setting

Ka Chun Chong; Emily Ying Yang Chan; Tsz Cheung Lee; Ka Li Kwok; Steven Yuk Fai Lau; Pin Wang; Holly Ching Yu Lam; William Bernard Goggins; Kirran N Mohammad; Shuk Yu Leung; Paul Kay Sheung Chan

doi:10.1016/j.scitotenv.2020.142845

A 21-year retrospective analysis of environmental impacts on paediatric acute gastroenteritis in an affluent setting

Sci Total Environ. 2021 Apr 10:764:142845. doi: 10.1016/j.scitotenv.2020.142845. Epub 2020 Oct 8.

Affiliations

¹ School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; Centre for Health System and Policy Research, The Chinese University of Hong Kong, Hong Kong, China.
² School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
³ Hong Kong Observatory, Hong Kong, China.
⁴ Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China.
⁵ School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: stevenlau@cuhk.edu.hk.
⁶ Yale School of Public Health, Yale University.
⁷ National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
⁸ Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

PMID: 33183801
DOI: 10.1016/j.scitotenv.2020.142845

Abstract

Background: Extreme weather events happen more frequently along with global warming and they constitute a challenge for public health preparedness. For example, many investigations showed heavy rainfall was associated with an increased risk of acute gastroenteritis. In this study, we examined the associations between different meteorological factors and paediatric acute gastroenteritis in an affluent setting in China controlling for pollutant effects.

Methods: Aggregated total weekly number of intestinal infection-related hospital admissions, and meteorological and air pollution data during 1998-2018 in Hong Kong were collected and analysed by a combination of quasi-Poisson generalized additive model and distributed lag nonlinear model. Study population was restricted to children under 5 years of age at the time of admission.

Results: While heavy rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to intestinal infections, low temperature and humidity extremes (both relative humidity and vapour pressure) did. Compared with the temperature at which the lowest risk was detected (i.e. 22.5 °C), the risk was 6.4% higher (95% confidence interval: 0.0% to 13.0% at 15.1 °C (i.e. the 5th percentile)). We also found the risk of paediatric admission was statistically significantly associated with an increase in the number of extreme cold days in a week over the study period.

Conclusion: Cold condition may have greater impact on disease transmission through increased stability and infectivity of enteric viruses in affluent settings like Hong Kong and thus resulted in an increased risk for paediatric acute gastroenteritis. On the contrary, an insignificant impact from heavy rainfall and high temperature may indicate a minor effect on disease transmission through bacterial growth in contaminated food and water. With the identified impacts of weather factors, extreme weather events are likely to distort the prevalence and seasonal pattern of diarrhoeal diseases in the future.

Keywords: Distributed-lag non-linear model; Intestinal infection; Paediatric acute gastroenteritis; Rainfall; Temperature.

MeSH terms

Air Pollution*
Child
Child, Preschool
China / epidemiology
Gastroenteritis* / epidemiology
Hong Kong / epidemiology
Humans
Retrospective Studies
Seasons
Temperature