Exposure to air pollution and scarlet fever resurgence in China: a six-year surveillance study
Yonghong Liu, Hui Ding, Shu‐Ting Chang, Ran Lu, Hui Zhong, Na Zhao, Tzu-Hsuan Lin, Yīmíng Bào, Liwei Yap, Weijia Xu, Minyi Wang, Yuan Li, Shuwen Qin, Zhao Yu, Xingyi Geng, Supen Wang, Enfu Chen, Zhi Yu, Ta‐Chien Chan, Shelan Liu
Abstract
Abstract Scarlet fever has resurged in China starting in 2011, and the environment is one of the potential reasons. Nationwide data on 655,039 scarlet fever cases and six air pollutants were retrieved. Exposure risks were evaluated by multivariate distributed lag nonlinear models and a meta-regression model. We show that the average incidence in 2011–2018 was twice that in 2004–2010 [RR = 2.30 (4.40 vs. 1.91), 95% CI: 2.29–2.31; p < 0.001] and generally lower in the summer and winter holiday (p = 0.005). A low to moderate correlation was seen between scarlet fever and monthly NO 2 (r = 0.21) and O 3 (r = 0.11). A 10 μg/m 3 increase of NO 2 and O 3 was significantly associated with scarlet fever, with a cumulative RR of 1.06 (95% CI: 1.02–1.10) and 1.04 (95% CI: 1.01–1.07), respectively, at a lag of 0 to 15 months. In conclusion, long-term exposure to ambient NO 2 and O 3 may be associated with an increased risk of scarlet fever incidence, but direct causality is not established.