The Risk Factors of Acquiring Severe Hand, Foot, and Mouth Disease: A Meta-Analysis

Table 2

Meta-analysis of risk factors for the hand, foot, and mouth disease in 18 separate studies.

Risk factors	Number of studies	Severe HFMD		Mild HFMD		OR (95% CI)	Test of heterogeneity
		Yes	No	Yes	No		Model	Chi-square	value	I^2 (%)
Female	4	202	301	438	611	0.918 (0.738, 1.142)	F	5.94	0.115	49.5
Scatter-lived/sporadic children	4	370	343	515	268	1.347 (0.245, 7.397)	R	108.61	≤0.001	97.2
Floating population/migrant	4	307	485	377	650	0.847 (0.202, 3.549)	R	94.44	≤0.001	96.8
Fever	8	1334	34	1176	371	7.396 (3.565, 15.342)	R	18.6	0.005	67.7
Fever for more than 3 days	3	207	124	99	370	5.773 (4.199, 7.939)	F	4.39	0.111	54.5
Vomiting	6	478	603	132	870	6.023 (2.598, 13.963)	R	59.18	≤0.001	91.6
Limb trembling/shaking	4	588	343	46	630	42.348 (11.765, 152.437)	R	21.76	≤0.001	86.2
Dyspnea/breathlessness	4	210	721	29	647	12.869 (1.948, 85.017)	R	23.81	≤0.001	87.4
Contact with HFMD children	4	215	269	84	832	5.326 (1.263, 22.466)	R	54.58	≤0.001	94.5
Rash on the palm/hands	3	700	75	601	52	0.740 (0.292, 1.874)	R	10.73	0.005	81.4
Rash on the soles/foot	3	680	92	558	93	0.905 (0.645, 1.272)	F	0.2	0.904	0
Rashes on the hips/buttocks	3	533	237	368	285	1.650 (1.303, 2.090)	F	2.16	0.340	7.2
Level of the clinic visited first (below the country level)	3	238	160	114	725	5.276 (0.781, 35.630)	R	65.87	≤0.001	97
Breast feeding	3	613	196	824	129	0.523 (0.167, 1.643)	R	30.46	≤0.001	93.4
Pathologic reflexes	3	267	13	0	330	3057.064 (494.409, 19000)	F	3.09	0.213	35.3
Lethargy/hypersomnia	5	278	344	25	732	31.791 (3.369, 300.020)	R	76.16	≤0.001	94.7
Convulsions/twitch	5	334	676	25	1083	23.652 (1.973, 283.592)	R	104.46	≤0.001	96.2
EV71 infection	7	521	149	586	1012	9.056 (4.102, 19.996)	R	56.03	≤0.001	89.3

OR, odds ratio; CI, confidence interval; HFMD, hand, foot, and mouth disease; EV71, enterovirus 71; R, random effect model; F, fixed effect model.