Spatiotemporal Changes and Influencing Factors of Hand, Foot, and Mouth Disease in Guangzhou, China, From 2013 to 2022: Retrospective Analysis

Abstract

Background: In the past 10 years, the number of hand, foot, and mouth disease (HFMD) cases reported in Guangzhou, China, has averaged about 60,000 per year. It is necessary to conduct an in-depth analysis to understand the epidemiological pattern and related influencing factors of HFMD in this region.

Objective: This study aims to describe the epidemiological characteristics and spatiotemporal distribution of HFMD cases in Guangzhou from 2013 to 2022 and explore the relationship between sociodemographic factors and HFMD incidence.

Methods: The data of HFMD cases in Guangzhou come from the Infectious Disease Information Management System of the Guangzhou Center for Disease Control and Prevention. Spatial analysis and space-time scan statistics were used to visualize the spatiotemporal distribution of HFMD cases. Multifactor ordinary minimum regression model, geographically weighted regression, and geographically and temporally weighted regression were used to analyze the influencing factors, including population, economy, education, and medical care.

Results: From 2013 to 2022, a total of 599,353 HFMD cases were reported in Guangzhou, with an average annual incidence rate of 403.62/100,000. Children aged 5 years and younger accounted for 93.64% (561,218/599,353) of all cases. HFMD cases showed obvious bimodal distribution characteristics, with the peak period from May to July and the secondary peak period from August to October. HFMDs in Guangzhou exhibited a spatial aggregation trend, with the central urban area showing a pattern of low-low aggregation and the peripheral urban area demonstrating high-high aggregation. High-risk areas showed a dynamic trend of shifting from the west to the east of peripheral urban areas, with coverage first increasing and then decreasing. The geographically and temporally weighted regression model results indicated that population density (β=-0.016) and average annual income of employees (β=-0.007) were protective factors for HFMD incidence, while the average number of students in each primary school (β=1.416) and kindergarten (β=0.412) was a risk factor.

Conclusions: HFMD cases in Guangzhou were mainly infants and young children, and there were obvious differences in time and space. HFMD is highly prevalent in summer and autumn, and peripheral urban areas were identified as high-risk areas. Improving the economic level of peripheral urban areas and reducing the number of students in preschool education institutions are key strategies to controlling HFMD.

Keywords: geographically and temporally weighted regression; hand, foot, and mouth disease; infectious disease; space-time scan statistics; spatial analysis.

Figure 1.. Location of the study area. The location of (A) Guangdong Province in China, (B) Guangzhou city in Guangdong Province, and (C) 11 county-level administrative districts in Guangzhou city.

Figure 2.. The prevalence and trend of hand, foot, and mouth disease (HFMD) in Guangzhou from 2013 to 2022.

Figure 3.. Reported hand, foot, and mouth disease (HFMD) incidence rates by street/township in Guangzhou from 2013 to 2022.

Figure 4.. Local spatial association analysis of hand, foot, and mouth disease (HFMD) incidence in Guangzhou from 2013 to 2022.

Figure 5.. Spatiotemporal scan cluster analysis of hand, foot, and mouth disease (HFMD) in Guangzhou from 2013 to 2022.

Figure 6.. Spatial distribution of regression coefficients of protective factors in the geographically and temporally weighted regression (GTWR) model. A) represents the impact of population density on the incidence of HFMD in different spatial regions over various years. B) represents the impact of annual wage of employees on the incidence of HFMD.

Figure 7.. Spatial distribution of regression coefficients of risk factors in the geographically and temporally weighted regression (GTWR) model. A) represents the impact of average number of students per primary school on the incidence of HFMD in different spatial regions over various years. B) represents the impact of average number of students per kindergarten on the incidence of HFMD.