Effects of ambient temperature on bacillary dysentery: A multi-city analysis in Anhui Province, China

[[[ Background: ]]] Rising ambient temperature is expected to increase incidence of bacillary dysentery (BD), but few studies have compared the temperature-BD effects of different age groups and cities in China, especially in a multi-city setting. [[[ Objectives: ]]] We used city-specific data including BD cases and meteorological variables to determine the relationship between BD incidence and temperature at provincial level. [[[ Methods: ]]] Weekly BD disease surveillance data and meteorological variables were collected in all 16 prefecture-level cities in Anhui Province of China. Firstly, city-specific weekly mean temperature-BD incidence associations were estimated with Distributed Lag Nonlinear Model (DLNM). Secondly, city-specific estimates were pooled at province-level through multivariate meta-analysis. Also, we conducted subgroup analyses for ages (children <5 years old and population of other ages) and urbanization of cities (high and low level), respectively. [[[ Results: ]]] In Anhui, BD morbidity risk increased with increasing weekly mean temperature. Relative risks (RR) at the 90th percentile (27.5 °C) versus the 50th percentile (17 °C) of weekly mean temperature were 1.42 (95% confidence interval (CI): 1.16, 1.75) and 2.02 (95% CI: 1.76, 2.32) for children <5 and population of other ages, respectively. The relative risk of high temperature on other ages group was higher than that of children under five years old (p = 0.006). Children under 5 in high urbanized cities appeared to be more vulnerable to the effects of ambient high temperature (RR: 1.56, 95% CI: 1.20, 1.92) than in low urbanized cities (RR: 1.01, 95% CI: 0.70, 1.46), the difference between two intervals was statistically significant (p = 0.044). [[[ Conclusions: ]]] This study suggests that high temperatures may be an important trigger of BD incidence, and especially lead to a substantial burden of BD for high urbanized cities in Anhui Province of China.