# Spatiotemporal Distribution of Hand, Foot, and Mouth Disease in Guangdong Province, China and Potential Predictors, 2009–2012

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## Abstract

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## 1. Introduction

## 2. Materials and Methods

#### 2.1. Study Area

^{2}and a population of 106 million (from the 2013 China Statistical Yearbook). There were 21 administrative districts, comprising of 123 counties in Guangdong Province. We used the county level division as the geographical unit for this spatiotemporal analysis because the county administrative level was often used for governmental statistics.

#### 2.2. Surveillance Data of HFMD

#### 2.3. Potential Predictors Data

#### 2.4. Statistical Methods

#### 2.4.1. Bayesian Spatiotemporal Model

#### 2.4.2. Geographical Detectors

## 3. Results

#### 3.1. Descriptive Statistics

#### 3.2. Model Selection

#### 3.3. Spatial Distribution

#### 3.4. Temporal Distribution

#### 3.5. Spatiotemporal Interaction Patterns

#### 3.6. Potential Predictors

## 4. Discussion

## 5. Conclusions

## Author Contributions

## Funding

## Acknowledgments

## Conflicts of Interest

## References

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**Figure 1.**The four parts of Guangdong Province and cumulative incidence of hand, foot, and mouth disease (HFMD), 2009–2012.

**Figure 4.**Annual number of cases of HFMD (

**a**), monthly distribution of HFMD cases (

**b**), and RR values of monthly effect (

**c**) in Guangdong, 2009–2012.

Covariates | Minimum | 2.5% Percentile | Median | 97.5% Percentile | Maximum |
---|---|---|---|---|---|

Average relative humidity (%) | 54.10 | 59.25 | 76.53 | 85.83 | 91.56 |

Average temperature (°C) | 4.79 | 10.47 | 23.01 | 29.18 | 29.65 |

Average rainfall (mm) | 0 | 1.66 | 98.76 | 410.11 | 645.50 |

Sunshine duration (hour) | 18.91 | 38.05 | 149.18 | 253.48 | 303.47 |

Average wind speed (m/s) | 1.25 | 1.53 | 2.10 | 3.38 | 5.33 |

Average GDP (yuan) | 5717 | 9981 | 26,370 | 110,421 | 123,247 |

Covariates | VIF | Covariates | VIF |
---|---|---|---|

Average relative humidity (%) | 2.305 | Sunshine duration (hour) | 3.126 |

Average temperature (°C) | 3.827 | Average wind speed (m/s) | 1.091 |

Average rainfall (mm) | 2.129 | Average GDP (yuan) | 1.025 |

Model | Component | DIC | |
---|---|---|---|

1 | Non-spatiotemporal model | $\mathrm{log}({\theta}_{ij})={b}_{0}+{\displaystyle \sum _{p}{\beta}_{p}}{X}_{pij}$ | 1,083,638.0 |

2 | Spatial model | $\mathrm{log}({\theta}_{ij})={b}_{0}+{\displaystyle \sum _{p}{\beta}_{p}}{X}_{pij}+{\mu}_{i}+{\upsilon}_{i}$ | 422,115.3 |

3 | Temporal model | $\mathrm{log}({\theta}_{ij})={b}_{0}+{\displaystyle \sum _{p}{\beta}_{p}}{X}_{pij}+{\gamma}_{j}+{\phi}_{j}$ | 816,474.6 |

4 | Spatiotemporal model | $\mathrm{log}({\theta}_{ij})={b}_{0}+{\displaystyle \sum _{p}{\beta}_{p}}{X}_{pij}+{\mu}_{i}+{\upsilon}_{i}+{\gamma}_{j}+{\phi}_{j}$ | 202,885.9 |

5 | Spatiotemporal interaction model | $\mathrm{log}({\theta}_{ij})={b}_{0}+{\displaystyle \sum _{p}{\beta}_{p}}{X}_{pij}+{\mu}_{i}+{\upsilon}_{i}+{\gamma}_{j}+{\phi}_{j}+{\delta}_{ij}$ | 45,036.5 |

Data | q | p | Data | q | p | Data | q | p | Data | q | p |
---|---|---|---|---|---|---|---|---|---|---|---|

2009-01 | 0.122 | 0.856 | 2010-01 | 0.179 | 0.663 | 2011-01 | 0.145 | 0.771 | 2012-01 | 0.321 | 0.013 * |

2009-02 | 0.292 | 0.095 | 2010-02 | 0.296 | 0.221 | 2011-02 | 0.238 | 0.302 | 2011-02 | 0.191 | 0.507 |

2009-03 | 0.336 | 0.022 * | 2010-03 | 0.366 | 0.058 | 2011-03 | 0.089 | 0.980 | 2011-03 | 0.409 | <0.001 * |

2009-04 | 0.301 | 0.038 * | 2010-04 | 0.251 | 0.184 | 2011-04 | 0.215 | 0.534 | 2011-04 | 0.379 | 0.004 * |

2009-05 | 0.229 | 0.257 | 2010-05 | 0.190 | 0.507 | 2011-05 | 0.292 | 0.207 | 2011-05 | 0.465 | <0.001 * |

2009-06 | 0.265 | 0.362 | 2010-06 | 0.315 | 0.038 * | 2011-06 | 0.274 | 0.112 | 2011-06 | 0.341 | 0.019 * |

2009-07 | 0.287 | 0.202 | 2010-07 | 0.403 | 0.002 * | 2011-07 | 0.498 | <0.001 * | 2011-07 | 0.325 | 0.033 * |

2009-08 | 0.402 | 0.013 * | 2010-08 | 0.458 | <0.001 * | 2011-08 | 0.299 | 0.069 | 2011-08 | 0.319 | 0.037 * |

2009-09 | 0.254 | 0.198 | 2010-09 | 0.221 | 0.541 | 2011-09 | 0.260 | 0.203 | 2011-09 | 0.573 | <0.001 * |

2009-10 | 0.246 | 0.243 | 2010-10 | 0.281 | 0.265 | 2011-10 | 0.259 | 0.267 | 2011-10 | 0.290 | 0.101 |

2009-11 | 0.266 | 0.264 | 2010-11 | 0.179 | 0.710 | 2011-11 | 0.153 | 0.763 | 2011-11 | 0.158 | 0.715 |

2009-12 | 0.129 | 0.916 | 2010-12 | 0.174 | 0.589 | 2011-12 | 0.239 | 0.149 | 2011-12 | 0.264 | 0.096 |

Covariates | Unstandardized Coefficients (95% CI) | Standardized Coefficients (95% CI) |
---|---|---|

Intercept | 0.054 (0.021, 0.138) | 0.397 (0.359, 0.439) |

Average relative humidity (%) | 1.015 (1.006, 1.024) | 1.102 (1.042, 1.166) |

Average temperature (°C) | 1.045 (1.021, 1.069) | 1.291 (1.128, 1.476) |

Average rainfall (cm) | 1.004 (1.001, 1.008) | 1.050 (1.008, 1.094) |

Sunshine duration (10 h) | 0.997 (0.985, 1.009) | 0.982 (0.915, 1.054) |

Average wind speed (dm/s) | 0.998 (0.990, 1.007) | 0.991 (0.951, 1.032) |

Average GDP (1000 yuan) | 0.999 (0.994, 1.003) | 0.961 (0.835, 1.105) |

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## Share and Cite

**MDPI and ACS Style**

Wang, Y.; Lai, Y.; Du, Z.; Zhang, W.; Feng, C.; Li, R.; Hao, Y.
Spatiotemporal Distribution of Hand, Foot, and Mouth Disease in Guangdong Province, China and Potential Predictors, 2009–2012. *Int. J. Environ. Res. Public Health* **2019**, *16*, 1191.
https://doi.org/10.3390/ijerph16071191

**AMA Style**

Wang Y, Lai Y, Du Z, Zhang W, Feng C, Li R, Hao Y.
Spatiotemporal Distribution of Hand, Foot, and Mouth Disease in Guangdong Province, China and Potential Predictors, 2009–2012. *International Journal of Environmental Research and Public Health*. 2019; 16(7):1191.
https://doi.org/10.3390/ijerph16071191

**Chicago/Turabian Style**

Wang, Yijing, Yingsi Lai, Zhicheng Du, Wangjian Zhang, Chenyang Feng, Ruixue Li, and Yuantao Hao.
2019. "Spatiotemporal Distribution of Hand, Foot, and Mouth Disease in Guangdong Province, China and Potential Predictors, 2009–2012" *International Journal of Environmental Research and Public Health* 16, no. 7: 1191.
https://doi.org/10.3390/ijerph16071191