【摘要】 目的 探讨我国体感温度与手足口病发病的关系、空间异质性及效应修饰因素。方法 收集我国各省2015—2019年气象数据和2011—2020年手足口病发病情况、经济社会和生态环境数据。采用两阶段时间序列分析法，构建分布滞后非线性模型，评估体感温度的累积效应，通过多变量元回归分析探讨效应修饰因子。同时，构建层次贝叶斯时空模型分析上述因素与手足口病发病的基线关联。结果 全国总体上的体感温度升高与手足口病风险增加呈近似线性趋势，各省效应存在明显空间异质性（I~2=73.99%），归一化植被指数可明显修饰体感温度效应强度。贝叶斯时空模型表明，人口增长率（RR=1.119）、每万人医疗机构床位数（RR=1.002）、幼儿园班级平均人数（RR=1.003）、归一化植被指数（RR=2.649）与手足口病发病呈正关联，而夜间灯光指数（RR=0.978）与手足口病发病呈负关联。结论 体感温度与手足口病发病存在明显关联，且具有空间异质性。归一化植被指数是重要的效应修饰因子，同时多种社会经济与生态环境因素是手足口病发病的独立影响因素。更多还原

【Abstract】 Objective To understand the relationship between apparent temperature(AT)and hand,foot and mouth disease(HFMD) incidence,and its spatial heterogeneity and effect modifying factors in China. Methods The nationwide data of meteorological data from 2015 to 2019,as well as the data on HFMD incidence,economic and social conditions,ecological environment from 2011 to 2020 were collected. The two-stage time series analysis was conducted,distributed lag non-linear models(DLNMs) were fitted to estimate the cumulative effects of AT,and multivariate meta-regression was used to identify effect modifiers. Meanwhile,a hierarchical Bayesian spatiotemporal model was constructed to assess the baseline associations between these factors and HFMD incidence. Results Nationally,higher AT was associated with an increased risk of HFMD in a near-linear trend. Significant spatial heterogeneity was observed across provinces(I~2=73.99%). Meta-regression identified the normalized difference vegetation index(NDVI) as a significant effect modifier. The Bayesian spatiotemporal model revealed positive associations between HFMD incidence and population growth rate(RR=1.119),the number of hospital beds per 10 000 people(RR=1.002),average class size in kindergartens(RR=1.003),and normalized difference vegetation index(NDVI)(RR=2.649),while a negative association was found with the nighttime light index(RR=0.978). Conclusion The association between AT and HFMD is significant and exhibits spatial heterogeneity. NDVI is a key effect modifier,and multiple socioeconomic and ecological factors are independent determinants of HFMD incidence.更多还原