Spatiotemporal decomposition and risk determinants of hand, foot and mouth disease in Henan, China

Hand, foot and mouth disease (HFMD) remains an increasing public health concern. The spatiotemporal variation of HFMD can be represented from multiple-perspectives, and it may be driven by different dominant factors. In this study, the HFMD cases in children under the age of five years in each county in Henan province, China, from 2009 to 2013 were assessed to explore the integrative spatiotemporal patterns of HFMD and investigate their driving factors. The empirical orthogonal function was applied to identify representative spatiotemporal patterns. Then, GeoDetector was used to quantify the determinant powers of driving factors to the disease. The results indicated that the most prominent spatiotemporal pattern explained 56.21% of the total variance, presented in big cities, e.g. capital city and municipal districts. The dominant factors of this pattern were per capita gross domestic product and relative humidity, with determinant powers of 62% and 42%, respectively. The secondary spatiotemporal pattern explained 10.52% of the total variance, presented in the counties around big cities. The dominant factors for this pattern were the ratio of urban to rural population and precipitation, with determinant powers of 26% and 41%, respectively. These findings unveiled the key spatiotemporal features and their determinants related to the disease; this will be helpful in establishing accurate spatiotemporal preventing of HFMD.