{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:39:07Z","timestamp":1777955947123,"version":"3.51.4"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81872713"],"award-info":[{"award-number":["81872713"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81803332"],"award-info":[{"award-number":["81803332"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Several studies have examined the effects of city-level meteorological conditions on the associations between meteorological factors and hand, foot, and mouth disease (HFMD) risk. However, evidence that city-level meteorological conditions modify air pollutant-HFMD associations is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>For each of the 17 cities in the Sichuan Basin, we obtained estimates of the relationship between exposures to multiple air pollutants and childhood HFMD risk by using a unified distributed lag nonlinear model (DLNM). Multivariate meta-regression models were used to identify the effects of city-level meteorological conditions as effect modifiers. Finally, we conducted subgroup analyses of age and sex to explore whether the modification effects varied in different subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The associations between PM<jats:sub>2.5<\/jats:sub>\/CO\/O<jats:sub>3<\/jats:sub> and HFMD risk showed moderate or substantial heterogeneity among cities (<jats:inline-formula><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mrow><mml:msup><mml:mi>I<\/mml:mi><mml:mn>2<\/mml:mn><\/mml:msup><\/mml:mrow><\/mml:math><\/jats:inline-formula> statistics: 48.5%, 53.1%, and 61.1%). Temperature conditions significantly modified the PM<jats:sub>2.5<\/jats:sub>-HFMD association, while relative humidity and rainfall modified the O<jats:sub>3<\/jats:sub>-HFMD association. Low temperatures enhanced the protective effect of PM<jats:sub>2.5<\/jats:sub> exposure against HFMD risk [PM<jats:sub>2.5<\/jats:sub> &amp;lt;32.7\u2009 \u03bcg\/m<jats:sup>3<\/jats:sup> or PM<jats:sub>2.5<\/jats:sub> &amp;gt;100\u2009 \u03bcg\/m<jats:sup>3<\/jats:sup>, at the 99th percentile: relative risk (RR)\u2009=\u20090.14, 95% CI: 0.03\u20130.60]. Low relative humidity increased the adverse effect of O<jats:sub>3<\/jats:sub> exposure on HFMD risk (O<jats:sub>3<\/jats:sub> &amp;gt;128.7 \u03bcg\/m<jats:sup>3<\/jats:sup>, at the 99th percentile: RR\u2009=\u20092.58, 95% CI: 1.48\u20134.50). However, high rainfall decreased the risk of HFMD due to O<jats:sub>3<\/jats:sub> exposure (O<jats:sub>3<\/jats:sub>: 14.1\u201341.4 \u2009\u03bcg\/m<jats:sup>3<\/jats:sup>). In addition, the modification effects of temperature and relative humidity differed in the female and 3\u20135 \u2009years-old subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings revealed moderate or substantial heterogeneity in multiple air pollutant-HFMD relationships. Temperature, relative humidity, and rainfall modified the relationships between PM<jats:sub>2.5<\/jats:sub> or O<jats:sub>3<\/jats:sub> exposure and HFMD risk.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1140639","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T04:54:55Z","timestamp":1689051295000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["City-level meteorological conditions modify the relationships between exposure to multiple air pollutants and the risk of pediatric hand, foot, and mouth disease in the Sichuan Basin, China"],"prefix":"10.3389","volume":"11","author":[{"given":"Wennian","family":"Cai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caiying","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoran","family":"Geng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanyi","family":"Zha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huadong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changhong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Yin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiejun","family":"Shui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/S1473-3099(13)70342-6","article-title":"Hand, 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