Increasing Dengue Incidence in Singapore over the Past 40 Years: Population Growth, Climate and Mobility.
Increasing Dengue Incidence in Singapore over the Past 40 Years: Population Growth, Climate and Mobility.
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DOI：
10.1371/journal.pone.0136286
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Massad E
中科院分区：
文献类型：
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作者：
Struchiner CJ;Rocklöv J;Wilder-Smith A;Massad E
在新加坡，登革热流行的频率和规模在过去40年里显著增加。重要的是要了解登革热发病率迅速增加的主要驱动因素。我们研究了1974年至2011年期间，新加坡登革热上升的推定驱动因素的相对贡献：人口增长、气候参数和来自登革热流行国家的国际航空旅客人数。我们使用了具有以下预测因子的多变量Poisson回归模型：年人口规模；伊蚊住所指数；年平均气温；每年记录的最低和最高气温；年降雨量和每年从登革热流行的东南亚抵达新加坡的航空乘客数量。在研究期间，人口增长导致登革热发病率增加的相对风险(RR)为42.7，而气候变量(平均和最低气温)共同解释了7.1的RR(RR定义为时间段结束时相对于开始的风险和与模型相关的拟合优度，从而通过伪R2评估这些估计值等于0.83)。估计这些个体因素对登革热发病率上升的贡献程度，我们发现人口增长贡献了86%，其余14%是由气温上升造成的。我们发现从登革热流行国家入境的航空旅客与抵达新加坡的旅客没有相关性。鉴于许多登革热流行国家随着人口增长而快速城市化，我们的研究结果对预测登革热疫情的未来趋势具有重要意义。现在是政策制定者和科学界更多关注城市化和城市气候对登革热等疾病的负面影响的时候了。
In Singapore, the frequency and magnitude of dengue epidemics have increased significantly over the past 40 years. It is important to understand the main drivers for the rapid increase in dengue incidence. We studied the relative contributions of putative drivers for the rise of dengue in Singapore: population growth, climate parameters and international air passenger arrivals from dengue endemic countries, for the time period of 1974 until 2011. We used multivariable Poisson regression models with the following predictors: Annual Population Size; Aedes Premises Index; Mean Annual Temperature; Minimum and Maximum Temperature Recorded in each year; Annual Precipitation and Annual Number of Air Passengers arriving from dengue-endemic South-East Asia to Singapore. The relative risk (RR) of the increase in dengue incidence due to population growth over the study period was 42.7, while the climate variables (mean and minimum temperature) together explained an RR of 7.1 (RR defined as risk at the end of the time period relative to the beginning and goodness of fit associated with the model leading to these estimates assessed by pseudo-R2 equal to 0.83). Estimating the extent of the contribution of these individual factors on the increasing dengue incidence, we found that population growth contributed to 86% while the residual 14% was explained by increase in temperature. We found no correlation with incoming air passenger arrivals into Singapore from dengue endemic countries. Our findings have significant implications for predicting future trends of the dengue epidemics given the rapid urbanization with population growth in many dengue endemic countries. It is time for policy-makers and the scientific community alike to pay more attention to the negative impact of urbanization and urban climate on diseases such as dengue.