Associations between the spatiotemporal distribution of Kawasaki disease and environmental factors: evidence supporting a multifactorial etiologic model

Tisiana Low,Chun-Po S Fan,Brian W Mccrindle,Cedric Manlhiot,Brigitte Mueller,Leonard J S Tsuji,Emily Somerset,Hong Chen,Sunita O'Shea

doi:10.1038/s41598-021-93089-9

Abstract

The etiology of Kawasaki Disease (KD), the most common cause of acquired heart disease in children in developed countries, remains elusive, but could be multifactorial in nature as suggested by the numerous environmental and infectious exposures that have previously been linked to its epidemiology. There is still a lack of a comprehensive model describing these complex associations. We present a Bayesian disease model that provides insight in the spatiotemporal distribution of KD in Canada from 2004 to 2017. The disease model including environmental factors had improved Watanabe-Akaike information criterion (WAIC) compared to the base model which included only spatiotemporal and demographic effects and had excellent performance in recapitulating the spatiotemporal distribution of KD in Canada (98% and 86% spatial and temporal correlations, respectively). The model suggests an association between the distribution of KD and population composition, weather-related factors, aeroallergen exposure, pollution, atmospheric concentration of spores and algae, and the incidence of healthcare encounters for bacterial pneumonia or viral intestinal infections. This model could be the basis of a hypothetical data-driven framework for the spatiotemporal distribution of KD. It also generates novel hypotheses about the etiology of KD, and provides a basis for the future development of a predictive and surveillance model.

Highlights

The etiology of Kawasaki Disease (KD), the most common cause of acquired heart disease in children in developed countries, remains elusive, but could be multifactorial in nature as suggested by the numerous environmental and infectious exposures that have previously been linked to its epidemiology
Kawasaki disease (KD) is an acute vasculitis of childhood which can be complicated by the development of coronary artery aneurysms (CAA)[1]
From April 2004-March 2017, a total of 5,882 acute hospital admissions for KD were identified in the discharge abstract database maintained by the Canadian Institute of Health Information (CIHI) based on the ICD-10-CA standard code M30.3, of which 266 were excluded according to our previously designed algorithm to identify readmissions and between-hospital transfers (Fig. 1)[22]