Aims Hand, foot, and mouth disease (HFMD) has brought millions of attacks and a substantial burden in the Asia-Pacific region. Previous studies assessed disease risks around the world, which demonstrated great heterogeneity, and few determined the modification effect of social factors on temperature–disease relationship.
Methods We conducted a time-series study based on 107,906 HFMD cases in Wuxi (a city in the Yangtze River Delta, China) reported from the National Center for Public Health Surveillance and Information Services (from 2011 to 2017) to evaluate the temperature-associated HFMD morbidity risk and to identify potential modifiers relating to urban–rural status and aggregation mode of children. Controlling for time-varying factors and other meteorological factors, a distributed lag nonlinear model (DLNM) was used.
Results We found that the relationship between daily mean temperature and the cumulative risk of HFMD was an approximately M-shaped curve. With the reference of −6°C, the cumulative relative risk (RR) values of high temperature (95 percentile) and low temperature (5 percentile) were 3.74 (95% CI: 2.50–5.61) and 1.72 (95% CI: 1.24–2.37) at lag 4–7, respectively. The effects of higher temperature appeared to be greater and more persistent than those of lower temperature. Temperature-associated HFMD morbidity risks were more pronounced among rural children and those attending kindergartens or schools at specific lags and temperatures, whereas no gender difference was observed.
Conclusions Our results suggested that urban–rural status, and aggregation mode of the population modify the short-term effects of temperature on HFMD. These findings enhance the knowledge of the disease dynamics caused by changing environments, provide information for temperature-based early warning, and facilitate policy-making and resource allocation.

HFMD;Meteorological factors;Susceptible populations