The epidemiological characteristics of respiratory infections and their association with air pollution and meteorological factors in China during 2004-2018: a cross-sectional study

Background The changes of respiratory infectious diseases’ epidemiological characteristics, and the relationship between respiratory infectious diseases and meteorological conditions and pollutants rarely explored in recent 10 years in China. Methods The seven respiratory infectious diseases’ data were collected from the NNIDSS, meteorological data and air pollutants data were from the meteorological monitoring stations and national air quality monitoring stations, respectively. Descriptive analyses were used to present trends, and joinpoint regression models were used to examine changes in incidence and mortality for each respiratory infectious disease and to estimate average annual percentage changes (AAPCs). A Distributed Lag Non-Linear Model (DLNM) with relative risk was applied to analyze the impact of meteorological conditions and air pollutants on respiratory infectious diseases. We also applied a time-series decomposition approach based on LOESS (locally weighted regression) to present the seasonality of seven respiratory infectious diseases. Results A total of 23,444,640 cases and 45,291 deaths caused by seven respiratory infectious diseases were recorded in China, and the national mean age-standardized incidence and mortality were 115.87/100,000 and 0.23/100,000, respectively; the change of incidence and mortality differed by age groups. SO ₂ and PM ₁₀ in air pollutants and relative humidity and air pressure in climatic factors had significant effects on most respiratory diseases in this study. Additionally, meteorological factors had a stronger impact on respiratory infectious diseases with an acute and short-term lag effect compared with air pollutants. Conclusions In view of the large regional difference in environmental factors, air pollutants, and geographical location, the prevention and control strategies for respiratory infectious diseases need to be formulated based on their own characteristics.