Association between ambient air pollution and risk of hand, foot, and mouth disease: a systematic review and meta-analysis.

INTRODUCTION

Previous studies examining the relationship between air pollution and the incidence of hand, foot and mouth disease (HFMD) have been inconsistent. We conducted a comprehensive systematic review and meta-analysis to clarify this issue and offer insights into identifying high-risk factors.

METHODS

A comprehensive search was conducted through PubMed, Web of Science,, Embase and Scopus for published literature up to 12 May 2025. The cumulative relative risk and 95% confidence interval (CI) were calculated to assess the association between different pollutants, including particulate matter(PM)10, PM2.5, Nitrogen dioxide(NO2), Sulfur dioxide(SO2), Ozone(O3), and Carbon monoxide(CO), and the incidence of HFMD.

RESULTS

After conducting a comprehensive literature search strategy and rigorous screening process, a total of 17 relevant records were included in this study. The findings revealed significant associations between high concentrations of air pollutants, including PM10 (RR: 1.16; 95% CI: 1.04-1.29; I2 = 97.3%), NO2 (RR: 1.19; 95% CI: 1.03-1.38, I² = 83.1%), and SO2 (RR: 1.51; 95% CI:1.14-1.99, I² = 84.6%), and the risk of HFMD. Consistent research characteristics of included studies, such as larger population and long term lag period can significantly reduce the heterogeneity.

CONCLUSION

Our findings demonstrate that various high-concentration air pollutants are associated with an increased risk of HFMD. It is recommended that government departments implement comprehensive strategies to mitigate air pollution, thereby reducing the prevalence of HFMD. Furthermore, during periods of high air pollution, targeted preventive measures should be adopted, such as minimizing children's outdoor activities.