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The effect of climate variables on the incidence of cutaneous leishmaniasis in Isfahan, Central Iran

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Abstract

In recent years, there have been considerable changes in the distribution of diseases that are potentially tied to ongoing climate variability. The aim of this study was to investigate the association between the incidence of cutaneous leishmaniasis (CL) and climatic factors in an Iranian city (Isfahan), which had the highest incidence of CL in the country. CL incidence and meteorological data were acquired from April 2010 to March 2017 (108 months) for Isfahan City. Univariate and multivariate seasonal autoregressive integrated moving average (SARIMA), generalized additive models (GAM), and generalized additive mixed models (GAMM) were used to identify the association between CL cases and meteorological variables, and forecast CL incidence. AIC, BIC, and residual tests were used to test the goodness of fit of SARIMA models; and R2 was used for GAM/GAMM. 6798 CL cases were recorded during this time. The incidence had a seasonal pattern and the highest number of cases was recorded from August to October. In univariate SARIMA, (1,0,1) (0,1,1)12 was the best fit for predicting CL incidence (AIC=8.09, BIC=8.32). Time series regression (1,0,1) (0,1,1)12 showed that monthly mean humidity after 4-month lag was inversely related to CL incidence (AIC=8.53, BIC=8.66). GAMM results showed that average temperature with 2-month lag, average relative humidity with 3-month lag, monthly cumulative rainfall with 1-month lag, and monthly sunshine hours with 1-month lag were related to CL incidence (R2=0.94). The impact of meteorological variables on the incidence of CL is not linear and GAM models that include non-linear structures are a better fit for prediction. In Isfahan, Iran, meteorological variables can greatly predict the incidence of CL, and these variables can be used for predicting outbreaks.

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Availability of data

The number of cases was inquired from the Iranian Ministry of Health and Medical Education. Weather variables were inquired from the Isfahan City Meteorological Organization.

Code availability

R statistical software (version 3.5.3).

Funding

This study was supported by Grant No. 97-433, from Kerman University of Medical Science, Kerman, Iran.

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Authors and Affiliations

  1. Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran

    Sairan Nili

  2. Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran

    Narges Khanjani

  3. Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, 76169-13555, Iran

    Narges Khanjani

  4. Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

    Younes Jahani

  5. Water Engineering Department, Faculty of Agriculture, Shahid Bahonar University of Kerman, Kerman, Iran

    Bahram Bakhtiari

  6. Maryland Institute of Applied Environmental Health (MIAEH), University of Maryland School of Public Health, College Park, MD, USA

    Amir Sapkota

  7. Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran

    Ghobad Moradi

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  1. Sairan Nili
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Contributions

NK suggested the topic and was the main supervisor, and helped in writing and editing the manuscript. SN acquired the data, cleaned the data, analyzed the data, and prepared the initial draft. YJ supervised data analysis, provided statistical consultation, and edited the final manuscript. BB, AS, and GM provided scientific advice and edited the final article. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Narges Khanjani.

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Ethic approval

This project was approved by the Ethics Committee of Kerman University of Medical Sciences, Kerman, Iran (Ethics Code: IR.KMU.REC.1397.233). All human data was inquired without identity.

Competing interests

The authors declare no competing interests.

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Nili, S., Khanjani, N., Jahani, Y. et al. The effect of climate variables on the incidence of cutaneous leishmaniasis in Isfahan, Central Iran. Int J Biometeorol 65, 1787–1797 (2021). https://doi.org/10.1007/s00484-021-02135-8

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  • DOI: https://doi.org/10.1007/s00484-021-02135-8

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