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Minimum mortality temperature (MMT) increases with global warming due to climate adaptation, which is crucial for the precise assessment of mortality burden attributed to climate change. Nevertheless, forecasting future MMT poses a challenge given the unavailability of future mortality data. Here, we attempted to develop a novel approach to project future MMT. First, we estimated the MMT of 334 locations in China using a distributed lag nonlinear model. Then, meta regression models were applied to investigate the associations between MMT and several temperature variables(Most Frequent Temperature(MFT), average daily mean temperature, average daily minimum temperature, average daily maximum temperature and percentiles of temperature from 1st to 100th). A generalized linear regression model was employed to investigate whether significant differences existed in the relationships between MMT and temperature from the 1st to the 100th percentile. Finally, an optional indicator of MMT for projecting future values was identified. Our results indicated that temperatures in the 85th to 89th percentiles were closely associated with MMT, with the 88th percentile temperature serving as the most effective indicator, as confirmed by meta-regression models. Using the 88th percentile of temperature as alternative indicator of MMT, compared with the period of 2006–2015, the projected MMT in most districts and counties in China tended to rise under three representative concentration pathways (RCPs) in the 2030 s (2030–2039), 2060 s (2060–2069), and 2090 s (2090–2099). Our findings provide some insight to project future MMT for assessing mortality burden related to temperature change driven by global warming.

The semantic segmentation of land use and land cover (LULC) is a crucial and widely employed remote sensing task. Conventional convolutional neural networks and vision transformers have been extensively utilized for LULC segmentation. However, high-resolution remote sensing images contain a wealth of spatial and color texture information, which is not fully exploited by traditional deep learning approaches. The information bottleneck of CNNs and transformers results in the loss of a significant amount of texture detail information during the feature extraction process, which further limits the performance of LULC segmentation. We present DDPM-SegFormer, a new framework that merges a denoising diffusion probabilistic model (DDPM) and vision transformer for LULC segmentation. The aim is to address the difficulties arising from extraction in complex geographic landscapes and to alleviate information bottlenecks. The framework utilizes the ability of a DDPM to generate refined semantic features and that of vision transformer to model the global image context. Our framework introduces two main innovations. First, we use a DDPM for the first time in LULC segmentation to generate highly refined multiscale semantic features. This approach alleviates the information bottleneck caused by relying solely on a CNN or transformer architecture. Second, we develop an effective feature-level fusion strategy that utilizes multihead cross-attention between the DDPM and Transformer. This approach achieves the harmonious fusion of fine-scale semantic features, generating continuous and highly refined semantic features that enhance the segmentation accuracy. The results indicate that DDPM-SegFormer achieves an MIOU of 83.72% and an F1-score of 90.97% for the large-scale LoveDA dataset and an MIOU of 90.91% and an F1score of 93.30% for the Tarim Basin LULC dataset in a desert scenario. The research demonstrated that the refined and continuous semantic features produced by DDPM-SegFormer can significantly enhance LULC segmentation performance.

Background: Climate change has shifted and will continue to alter the patterns of daytime and nighttime temperatures. However, it remains unclear whether hot days and nights, as well as cold days and nights, have varying impacts on mental disorders. Methods: Daily hospital-based data on 1.2 million outpatient visits for mental disorders were obtained from 15 Chinese cities (2011-2015). The index of hot day excess, hot night excess, cold day excess, and cold night excess were used to measure the intensity of hot/cold days and nights. Firstly, a distributed lag non-linear model was used to estimate the risk of mental disorders associated with hot/cold days and nights for each city. Secondly, city-specific estimates were pooled by multivariate meta-analysis to obtain national effect estimates. Thirdly, the attributable fraction of mental disorders was estimated for the nation, genders, age groups, heating methods, and air conditioning penetration rates. Results: Our findings revealed that both hot and cold nights were associated with a higher risk of mental disorders compared to hot and cold days. The attributable fraction of mental disorders was higher for cold (night: 25.74%; day: 19.65%) in contrast to heat (night: 16.91%; day: 7.24%). Males, the elderly, cities using central heating, and cities with low air conditioning penetration rates were vulnerable to cold nights. Conclusions: This nationwide study highlights the adverse effects and significant burden of hot and cold nights on mental disorders. It underscores the potential for mitigating these impacts through the adoption of air conditioning, particularly in southern cities across China.

Ecological environmental protection and poverty alleviation are of great significance for the study of human–land relationship coordination and sustainable development, and they have also been a focus of attention in China in the past few decades. In this study, we chose 13 contiguous poverty-stricken areas in China as the study area. Using MODIS Leaf Area Index (LAI) data from 2000 to 2020, the spatial–temporal changes in greenness were obtained using the Bayesian spatial–temporal model (BYM). Spatial autocorrelation was used to identify the spatial distribution of poverty using socio-economic statistical data. Driving factors, including natural factors, poverty factors, and the Grain for Green Policy (GTGP), and their influence on greenness were analyzed by using the Geodetector model for detecting spatial differentiation and factors’ interactions. The results showed the following: (1) In 13 contiguous poverty-stricken areas (CPSAs) in China, 59% of the area presented an increasing trend of greenness. (2) In 2000, the high poverty levels with larger MPI values were widely distributed. After 20 years, the overall MPI value was lower, except in some northwest regions with increased MPI values. The spatial autocorrelation of poverty, which relates to the mutual influence of poverty in adjacent areas, also decreased. (3) In the study area, 65.24% of the regions showed strong synergistic effect between greening progress and poverty reduction in the interaction between poverty status and green development. With the improvement of greenness level, the positive correlation between poverty alleviation and ecological environment improvement has become increasingly close. (4) The impacts of interaction factors with the highest q values changed from temperature interacting with precision to regional division interacting with the Grain for Green Policy. The conclusions are that from 2000 to 2020, the impact of natural factors, geographical division, and poverty status on greenness has shown a decreasing trend; The effect of the Grain for Green Policy is gradually increasing; At the same time, the interaction and overlapping effects between the Grain for Green Policy and poverty were increasing. Taking into account the needs of ecological environment, poverty alleviation, and rural revitalization, this research provides valuable reference for formulating and implementing relevant policies based on the actual situation in different regions to promote harmonious coexistence between human-land relationship.

Abstract Targeted public health interventions for an emerging epidemic are essential for preventing pandemics. During 2020-2022, China invested significant efforts in strict zero-COVID measures to contain outbreaks of varying scales caused by different SARS-CoV-2 variants. Based on a multi-year empirical dataset containing 131 outbreaks observed in China from April 2020 to May 2022 and simulated scenarios, we ranked the relative intervention effectiveness by their reduction in instantaneous reproduction number. We found that, overall, social distancing measures (38% reduction, 95% prediction interval 31-45%), face masks (30%, 17-42%) and close contact tracing (28%, 24-31%) were most effective. Contact tracing was crucial in containing outbreaks during the initial phases, while social distancing measures became increasingly prominent as the spread persisted. In addition, infections with higher transmissibility and a shorter latent period posed more challenges for these measures. Our findings provide quantitative evidence on the effects of public-health measures for zeroing out emerging contagions in different contexts.

Accurate extraction of urban green space is critical for preserving urban ecological balance and enhancing urban life quality. However, due to the complex urban green space morphology (e.g., different sizes and shapes), it is still challenging to extract green space effectively from high-resolution image. To address this issue, we proposed a novel hybrid method, Multi-scale Feature Fusion and Transformer Network (MFFTNet), as a new deep learning approach for extracting urban green space from high-resolution (GF-2) image. Our method was characterized by two aspects: (1) a multi-scale feature fusion module and transformer network that enhanced the recovery of green space edge information and (2) vegetation feature (NDVI) that highlighted vegetation information and enhanced vegetation boundaries identification. The GF-2 image was utilized to build two urban green space labeled datasets, namely Greenfield and Greenfield2. We compared the proposed MFFTNet with the existing popular deep learning models (like PSPNet, DensASPP, etc.) to evaluate the effectiveness of MFFTNet by the Mean Intersection Over Union (MIOU) benchmark on Greenfield, Greenfield2, and a public dataset (WHDLD). Experiments on Greenfield2 showed that MFFTNet can achieve a high MIOU (86.50%), which outperformed deep learning networks like PSPNet and DensASPP by 0.86% and 3.28%, respectively. Meanwhile, the MIOU of MFFTNet incorporating vegetation feature (NDVI) was further achieved to 86.76% on Greenfield2. Our experimental results demonstrate that the proposed MFFTNet with vegetation feature (NDVI) outperforms the state-of-the-art methods in urban green space segmentation.

Injury poses heavy burden on public health, but little evidence on the potential role of climate change on injury exists. Here, the authors collect data during 2013-2019 in six provinces of China to estimate the associations between temperature and injury mortality, and to project future mortality burden attributable to temperature change driven by climate change.

High-spatial-resolution urban buildings play a crucial role in urban planning, emergency response, and disaster management. However, challenges such as missing building contours due to occlusion problems (occlusion between buildings of different heights and buildings obscured by trees), uneven contour extraction due to mixing of building edges with other feature elements (roads, vehicles, and trees), and slow training speed in high-resolution image data hinder efficient and accurate building extraction. To address these issues, we propose a semantic segmentation model composed of a lightweight backbone, coordinate attention module, and pooling fusion module, which achieves lightweight building extraction and adaptive recovery of spatial contours. Comparative experiments were conducted on datasets featuring typical urban building instances in China and the Mapchallenge dataset, comparing our method with several classical and mainstream semantic segmentation algorithms. The results demonstrate the effectiveness of our approach, achieving excellent mean intersection over union (mIoU) and frames per second (FPS) scores on both datasets (China dataset: 85.11% and 110.67 FPS; Mapchallenge dataset: 90.27% and 117.68 FPS). Quantitative evaluations indicate that our model not only significantly improves computational speed but also ensures high accuracy in the extraction of urban buildings from high-resolution imagery. Specifically, on a typical urban building dataset from China, our model shows an accuracy improvement of 0.64% and a speed increase of 70.03 FPS compared to the baseline model. On the Mapchallenge dataset, our model achieves an accuracy improvement of 0.54% and a speed increase of 42.39 FPS compared to the baseline model. Our research indicates that lightweight networks show significant potential in urban building extraction tasks. In the future, the segmentation accuracy and prediction speed can be further balanced on the basis of adjusting the deep learning model or introducing remote sensing indices, which can be applied to research scenarios such as greenfield extraction or multi-class target extraction.

Abstract Background China now faces an increasingly aging society which may exert economic pressure in the long run. This study illustrates the spatial pattern and evolution of population aging and economic development in China. The coupling coordination degree of population aging and economic development at the national and provincial levels are calculated and demonstrated, and the spatial patterns and characteristics are investigated. Methods This paper presents a coupling analysis of the elderly population rate (EPR) and per capita Gross Regional Product (GRPpc) in China by using the coupling and coordination model. Further, the spatial pattern and evolution of population aging and economic development are investigated based on the standard deviational ellipse. The collected data is at the level of provincial administrative units in mainland China covering the period 2002 to 2020. Results The results reveal the spatial difference in the coupling and coordination degree between EPR and GRPpc across provinces. The eastern coastal areas are higher than the central and western regions of China. The orientation and directions of EPR are more than GRPpc, indicating that the polarization in population aging is more severe than economic development. Significant positive correlations between coupling coordination degree and sustainable competitiveness are detected. Conclusions Policymakers should fully consider regional differences and sustainable development in policy formulation of China. The western and northeastern provinces should be given priority in the regional sustainable development plan. At the same time, the coordination between population aging and economic development also requires to be examined especially.

Objectives: It’s evident that women have a longer life expectancy than men. This study investigates the spatiotemporal trends of gender gaps in life expectancy (GGLE). It demonstrates the spatiotemporal difference of the influence factors of population-weighted air pollution (pwPM2.5) and urbanization on GGLE.Methods: Panel data on GGLE and influencing factors from 134 countries from 1960 to 2018 are collected. The Bayesian spatiotemporal model is performed.Results: The results show an obvious spatial heterogeneity worldwide with a continuously increasing trend of GGLE. Bayesian spatiotemporal regression reveals a significant positive relationship between pwPM2.5, urbanization, and GGLE with the spatial random effects. Further, the regression coefficients present obvious geographic disparities across space worldwide.Conclusion: In sum, social-economic development and air quality improvement should be considered comprehensively in global policy to make a fair chance for both genders to maximize their health gains.

The comprehensive use of high-resolution remote sensing (HRS) images and deep learning (DL) methods can be used to further accurate urban green space (UGS) mapping. However, in the process of UGS segmentation, most of the current DL methods focus on the improvement of the model structure and ignore the spectral information of HRS images. In this paper, a multiscale attention feature aggregation network (MAFANet) incorporating feature engineering was proposed to achieve segmentation of UGS from HRS images (GaoFen-2, GF-2). By constructing a new decoder block, a bilateral feature extraction module, and a multiscale pooling attention module, MAFANet enhanced the edge feature extraction of UGS and improved segmentation accuracy. By incorporating feature engineering, including false color image and the Normalized Difference Vegetation Index (NDVI), MAFANet further distinguished UGS boundaries. The UGS labeled datasets, i.e., UGS-1 and UGS-2, were built using GF-2. Meanwhile, comparison experiments with other DL methods are conducted on UGS-1 and UGS-2 to test the robustness of the MAFANet network. We found the mean Intersection over Union (MIOU) of the MAFANet network on the UGS-1 and UGS-2 datasets was 72.15% and 74.64%, respectively; outperforming other existing DL methods. In addition, by incorporating false color image in UGS-1, the MIOU of MAFANet was improved from 72.15% to 74.64%; by incorporating vegetation index (NDVI) in UGS-1, the MIOU of MAFANet was improved from 72.15% to 74.09%; and by incorporating false color image and the vegetation index (NDVI) in UGS-1, the MIOU of MAFANet was improved from 72.15% to 74.73%. Our experimental results demonstrated that the proposed MAFANet incorporating feature engineering (false color image and NDVI) outperforms the state-of-the-art (SOTA) methods in UGS segmentation, and the false color image feature is better than the vegetation index (NDVI) for enhancing green space information representation. This study provided a practical solution for UGS segmentation and promoted UGS mapping.

This study examined the impact of temporary air quality control measures on reducing pollutants during the 2022 Winter Olympics in China, utilizing real-time monitoring data from 2017 and 2022 to assess spatial and temporal variations in critical air pollutant concentrations. The results showed that concentrations of PM2.5, PM10, CO, SO2, and NO2 in the Beijing–Tianjin–Hebei region during the Olympic Games showed a marked decrease compared to the historical period, with reductions of 36.59%, 20.35%, 33.95%, 28.90%, and 22.70%, respectively. Significant north–south spatial differences were observed in Beijing, Tianjin, and Hebei Province during the Olympic period. The cities of Zhangjiakou, Chengde, Qinhuangdao, Beijing, and Tangshan showed the most significant pollution reduction. Based on assessments conducted during the Olympic period, it was noted that more than 95% of the daily average concentrations of pollutants are below the maximum values set by the World Health Organization for the interim target. Our research shows that provisional regulations effectively control the emission of air pollutants, providing a solid reference and basis for ensuring air quality during major international events.

BackgroundDengue fever is a mosquito-borne disease transmitted by Aedes aegypti and Aedes albopictus. Under the background of climate change, there are great challenges in the prevention and control of dengue fever, posing a serious health risk to the population.ObjectiveTo analyze the mechanism of temperature on dengue fever transmission and estimate the risk of dengue fever under different climate change scenarios by establishing a coupled human-mosquito dynamics model using Guangzhou as a research site, and to provide reference for adaptation to climate change.MethodsReported dengue fever cases and meteorological data from January 1, 2015 to December 31, 2019 in Guangzhou were collected from Guangdong Provincial Center for Disease Control and Prevention and China Meteorological Data Service Centre, respectively. The temperature data under three Representative Concentration Pahtyway (RCP2.6, RCP4.5, and RCP8.5) scenarios in 2030s (2031–2040), 2060s (2061–2070), and 2090s (2091–2099) were calculated by five general circulation models (GCMs) provided by the fifth phase of the Coupled Model Intercomparison Project. A dengue fever transmission dynamics (ELPSEI-SEIR) model was constructed to analyze the mechanism of temperature affecting dengue fever transmission by fitting the dengue fever epidemic trend from 2015–2019, and then the daily mean temperature under selected RCP scenarios for 2030s, 2060s, and 2090s was incorporated into the established dynamics model to predict the risk of dengue fever under different climate change scenarios in the future.ResultsFrom January 1, 2015 to December 31, 2019, a total of 4 234 cases of dengue fever were reported in Guangzhou, including 3741 local cases and 493 imported cases. The regression results showed that the model well fitted the dengue fever cases in Guangzhou from 2015 to 2019, and the coefficient of determination R2 to evaluate goodness of fit and the root mean squared error were 0.82 and 1.96, respectively. A U-shaped or inverted U-shaped relationship between temperature and mosquito habits could directly affect the number of mosquitoes and the transmission of dengue fever. We also found that temperature increase in most future scenarios could promote the transmission of dengue fever, and the epidemic period was significantly wider than the baseline stage. The epidemic of dengue fever would peak in the 2060s under the scenarios of RCP2.6 and RCP4.5. The estimated incidence of dengue fever was predicated to be highest in the 2030s and then decrease in the following years under RCP8.5, and in the 2090s, the incidence would decrease significantly, but the incidence peak would be earlier in each year, mainly from May to July.ConclusionTemperature can directly affect mosquito population and dengue fever transmission by affecting mosquito habits. The cases of dengue fever will increase under most climate scenarios in the future. However, the epidemic risk of dengue fever may be suppressed, and the epidemic season may be advanced under RCP8.5.

BackgroundNeonatal mortality rate (NMR), infant mortality rate (IMR), and child mortality rate (CMR) show a huge difference across countries, which has been posing challenges for public health policies and medical resource allocation.MethodsBayesian spatiotemporal model is applied to assess the detailed spatiotemporal evolution of NMR, IMR, and CMR from a global perspective. Panel data from 185 countries from 1990 to 2019 are collected.ResultsThe continuously decreasing trend of NMR, IMR, and CMR indicated a great improvement in neonatal, infant, and child mortality worldwide. Further, huge differences in the NMR, IMR, and CMR still exist across countries. In addition, the gap of NMR, IMR, and CMR across the countries presented a widening trend from the perspective of dispersion degree and kernel densities. The spatiotemporal heterogeneities demonstrated that the decline degree among these three indicators could be observed as CMR > IMR > NMR. Countries such as Brazil, Sweden, Libya, Myanmar, Thailand, Uzbekistan, Greece, and Zimbabwe showed the highest values of b1i, indicating a weaker downward trend compared to the overall downward trend in the world.ConclusionsThis study revealed the spatiotemporal patterns and trends in the levels and improvement of NMR, IMR, and CMR across countries. Further, NMR, IMR, and CMR show a continuously decreasing trend, but the differences in improvement degree present a widening trend across countries. This study provides further implications for policy in newborns, infants, and children's health to reduce health inequality worldwide.

Background: Hemorrhagic fever with renal syndrome (HFRS) occurs widely in Northeastern China, but the mechanism and interactions of meteorological and socio-economic factors on the transmission of HFRS are still largely unknown. Objective: We explored the effects of socioeconomic-environmental factors on the spatio-temporal variation of HFRS incidence from 2001 to 2019 in Northeastern China. Specifically, the relative importance and contribution rates (CR) of determinants of HFRS were identified by boosted regression tree and variance partitioning analysis, respectively. Structural equation models (SEMs) were used to explain the roles of climatic and socio-economic factors in the transmission of HFRS. And a negative binomial regression was used to identify the risk effect between monthly meteorological variables and HFRS with 0–6 months lags in Northeastern China. Results: Over the past decades, the high-risk areas of HFRS were mainly concentrated in the northern and eastern areas of Northeastern China. Additionally, HFRS mainly presented a decreasing trend from 2001 to 2019 in most areas of Northeastern China, but slightly increased in the cities of Daqing, Songyuan, Baicheng, and Tonghua. The temporal dynamics of the incidence of HFRS were primarily explained by the variations in population density (CR = 27.30%), climate (CR = 13.30%), and economic condition(CR = 1.90%). The spatial variations of HFRS were medicated by the climate (CR = 16.95%) and population density (CR = 9.45%) and medical health care (CR = 2.25%). The SEM models indicated that humid and warm climates were conducive to the incidence and increase of HFRS, but the improvement in education and an increase in population density reduced the transmission of HFRS. Conclusion: Climate and population density appeared to mediate the spatio-temporal variation of HFRS in Northeastern China. These findings may provide valuable empirical evidence for the management of HFRS in endemic areas.

Nighttime light data and land use data derived from remote sensing satellites are commonly used to monitor human activities on the Earth. A thorough understanding of the spatiotemporal interactions between these data enables better characterization and reconstruction of urbanization processes. In this work, a pixelwise fusion analysis using nighttime light data and land use data was performed to explore the spatiotemporal correlation between urban nighttime light luminosity transitions and land use changes. We found that the nighttime luminosity transitions are tightly related to the corresponding land use change types at the pixel level. A significant spatial correlation was identified between the nighttime light luminosity transitions and urban lands with intensive human activity. Relevant policies enacted in Beijing have greatly influenced the local light luminosity and land use type transitions. Pixels with change values in light luminosity in the same range have the same types of land use changes, the reasons for the changes in light luminosity are similar, and the spatial distribution characteristics are the same. This study provides a theoretical basis for quickly assessing changes in urban land use types through transitions in nighttime light luminosity. Simultaneously, the data in our study after integrating nighttime light luminosity and land use information perform well in urban development research and can provide valuable datasets and decision-making references for adjusting and optimizing urban sustainable development policies.

Ground-level ozone (O3) is a well-known atmospheric pollutant aside from particulate matter. China as a global populous country is facing serious surface O3 pollution. To detect the complex spatiotemporal transformation of the population exposure to ambient O3 pollution in China from 2005 to 2019, the Bayesian multi-stage spatiotemporal evolution hierarchy model was employed. To insight the drivers of the population exposure to ambient O3 pollution in China, a Bayesian spatiotemporal LASSO regression model (BST-LASSO-RM) and a spatiotemporal propensity score matching (STPSM) were firstly applied; then, a spatiotemporal causal inference method integrating the BST-LASSO-RM and STPSM was presented. The results show that the spatial pattern of the annual population-weighted ground-level O3 (PWGLO3) concentrations, representing population exposure to ambient O3, in China has transformed since 2014. Most regions (72.2%) experienced a decreasing trend in PWGLO3 pollution in the early stage, but in the late stage, most areas (79.3%) underwent an increasing trend. Some drivers on PWGLO3 concentrations have partial spatial spillover effects. The PWGLO3 concentrations in a region can be driven by this region’s surrounding areas’ economic factors, wind speed, and PWGLO3 concentrations. The major drivers with six local factors in 2005–2014 changed to five local factors and one spatial adjacent factor in 2015–2019. The driving of the traffic and green factors have no spatial spillover effects. Three traffic factors showed a negative driving effect in the early stage, but only one, bus ridership per capita (BRPC), retains the negative driving effect in the late stage. The factor with the maximum driving contribution is BRPC in the early stage, but PM2.5 pollution in the late stage, and the corresponding driving contribution is 17.57%. Green area per capita and urban green coverage rates have positive driving effects. The driving effects of the climate factors intensified from the early to the later stage.

Background: Maternal gestational PM2.5 exposure was associated with small for gestational age (SGA). Identifying potential mediating factors may help design preventive strategies to reduce this risk. Objective: This study aimed to explore the roles of maternal blood pressure and hemoglobin may play in the PM2.5 exposure and SGA relationship among 117,162 births in 16 counties across China during 2014–2018. Methods: Daily PM2.5 concentration was collected from China National Environmental Monitoring Center. According to maternal residency during pregnancy, the PM2.5 exposure for each trimester and the whole pregnancy was assessed using an inverse-distance weighting approach. Repeated measurements of maternal blood pressure and hemoglobin during pregnancy were collected for each woman. We estimated the total effect of gestational PM2.5 exposure on SGA, and further tested the mediation effects of maternal blood pressure and hemoglobin concentration during pregnancy. Results: Of 117,162 included mother-infant pairs, 11,361 (9.7 %) were SGA. The odds ratios of SGA associated with PM2.5 exposure (per 10 μg/m3 increase) in the second trimester and the whole pregnancy were 1.023 (95 % CI: 1.009, 1.037) and 1.024 (1.001, 1.048), respectively. We identified the independent mediating effect of blood pressure and hemoglobin in the second and third trimesters, with the proportion of mediation ranging from 1.64 % to 5.78 % and 2.40 % to 8.70 %, respectively. When considering the mediators jointly, we found a stronger mediating effect with a proportion of mediation ranging from 3.93 % to 13.69 %. Discussion: Increases in maternal blood pressure and hemoglobin in the second and third trimesters can independently and jointly mediate the effects of gestational PM2.5 exposure on SGA. Monitoring and managing maternal blood pressure and hemoglobin during prenatal care may constitute a promising avenue to reducing SGA risk associated with gestational PM2.5 exposure.

The Visible Infrared Imaging Radiometer Suite Day/Night Band (VIIRS/DNB) nighttime light data is a powerful remote sensing data source. However, due to stray light pollution, there is a lack of VIIRS data in mid-high latitudes during the summer, resulting in the absence of high-precision spatiotemporal continuous datasets. In this paper, we first select nine-time series interpolation methods to interpolate the missing images. Second, we construct image pixel-level temporal continuity constraints and spatial correlation constraints and remove the pixels that do not meet the constraints, and the eliminated pixels are filled with the focal statistics tool. Finally, the accuracy of the time series interpolation method and the spatiotemporally constrained interpolation method (STCIM) proposed in this paper are evaluated from three aspects: the number of abnormal pixels (NP), the total light brightness value (TDN), and the absolute value of the difference (ADN). The results show that the images simulated by the STCIM are more accurate than the nine selected time series interpolation methods, and the image interpolation accuracy is significantly improved. Relevant research results have improved the quality of the VIIRS dataset, promoted the application research based on the VIIRS DNB long-time series night light remote sensing image, and enriched the night light remote sensing theory and method system.

Abstract Background The effect of the COVID-19 outbreak has led policymakers around the world to attempt transmission control. However, lockdown and shutdown interventions have caused new social problems and designating policy resumption for infection control when reopening society remains a crucial issue. We investigated the effects of different resumption strategies on COVID-19 transmission using a modeling study setting. Methods We employed a susceptible-exposed-infectious-removed model to simulate COVID-19 outbreaks under five reopening strategies based on China’s business resumption progress. The effect of each strategy was evaluated using the peak values of the epidemic curves vis-à-vis confirmed active cases and cumulative cases. Two-sample t-test was performed in order to affirm that the pick values in different scenarios are different. Results We found that a hierarchy-based reopen strategy performed best when current epidemic prevention measures were maintained save for lockdown, reducing the peak number of active cases and cumulative cases by 50 and 44%, respectively. However, the modeled effect of each strategy decreased when the current intervention was lifted somewhat. Additional attention should be given to regions with significant numbers of migrants, as the potential risk of COVID-19 outbreaks amid society reopening is intrinsically high. Conclusions Business resumption strategies have the potential to eliminate COVID-19 outbreaks amid society reopening without special control measures. The proposed resumption strategies focused mainly on decreasing the number of imported exposure cases, guaranteeing medical support for epidemic control, or decreasing active cases.

Global warming is expected to increase mortality due to heat stress in many regions. Here, the authors asses how mortality due to high temperatures changes in China changes for different demographic groups and show that heat-related excess mortality is increasing under climate change, a process that is strongly amplified by population ageing.

Malaria occurrence is highly related to the geographical distribution of Anopheles dirus (An. dirus) in the South-East Asia Region and Western Pacific Region (SEAR/WPR). Future climate change has been shown to alter the geographical distribution of malaria vectors. However, few studies have investigated the impact of climate change on the potential distribution of An. dirus in the SEAR/WPR. We considered future climate and land-use data under two climate change scenarios for Representative Concentration Pathways (RCP 4.5 and RCP 8.5) and population data from five Shared Socioeconomic Pathways (SSPs), by using three machine learning models, namely, Random Forest (RF), Boosted Regression Trees (BRT), and Maximum entropy (Maxent) to project the geographical distribution of An. Dirus and to estimate the exposed population. A pseudo-absence dataset was generated based on the relationships between model performance and the distance from the pseudo-absence point to the occurrence point in order to improve model accuracy for projection of the Environmentally Suitable Area (ESA) and exposed human population. The results show that the pseudo-absence data corresponding to the distance of 250 km are appropriate for modeling. The RF method ultimately proved to have the highest accuracy. The predicted ESA of An. dirus would mainly be distributed across Myanmar, Thailand, the southern and eastern part of India, Vietnam, the northern part of Cambodia, and the southern part of Laos. The future ESA is estimated to be reduced under the RCP 4.5 climate change scenario. In the 2070s under RCP 8.5, the reduction of ESA is even greater, especially in Thailand (loss of 35.49 10,000 square kilometers), Myanmar (26.24), Vietnam (17.52), and India (15), which may prevent around 282.6 million people from the risk of malaria under the SSP3 scenarios in the SEAR/WPR. Our predicted areas and potential impact groups for An. dirus under future climate change may provide new insights into regional malaria transmission mechanisms and deployment of malaria control measures based on local conditions in the SEAR/WPR’s.

Tracking progress in poverty alleviation and promptly identifying the distribution of poor areas are critical for strategic policy interventions, especially for regions with poor statistical systems. The massive satellite imagery and geospatial data provide great opportunities for timely and cost-effective socioeconomic evaluations. However, existing research on poverty identification is mostly based on satellite images, and the potential of combined multi-source geospatial data on poverty identification has not been fully explored. Here, we propose an approach that evaluates how village-level poverty can be identified by integrating high-resolution imagery (HRI), point-of-interest (POI), OpenStreetMap (OSM), and digital surface model (DSM) data. The study area included 338 villages from Yunyang County, located in Hubei Province, central China. We extracted the explanatory variables indicating access to facilities and services, agricultural production conditions, village construction, and the spatial distribution of village settlements from the HRI, POI, OSM, and DSM data. The random forest algorithm was then used to model the relationship between village-level poverty and explanatory variables. The results demonstrated a 54% accuracy in the prediction of village-level poverty; the best prediction performance (72%) was observed for the villages categorized as poor. The built-up land proportion and the time cost to the facilities and services contributed the most to the identification of village-level poverty, while the proxy variables of agricultural production conditions contributed the least. This study provides an approach to village-level poverty identification using satellite imagery and geospatial data and proves that the data employed in this study could identify the poorest areas that are highly coupled with natural geographical conditions and backward public services.

Minimum mortality temperature (MMT) changes geographically and over time. Here, by analysing MMTs in 420 global locations during 1984-2018, the authors found that MMT is very close to the local most frequent temperature (MFT) in the same period, and the association between MFT and MMT is not changed when adjusted for lattitude and study year.

BACKGROUND:As one of its Millennium Development Goals (MDGs), China has achieved a dramatic reduction in the maternal mortality ratio (MMR), although a distinct spatial heterogeneity still persists. Evidence of the quantitative effects of determinants on MMR in China is limited. A better understanding of the spatiotemporal heterogeneity and quantifying determinants of the MMR would support evidence-based policymaking to sustainably reduce the MMR in China and other developing areas worldwide. METHODS AND FINDINGS:We used data on MMR collected by the National Maternal and Child Health Surveillance System (NMCHSS) at the county level in China from 2010 to 2013. We employed a Bayesian space-time model to investigate the spatiotemporal trends in the MMR from 2010 to 2013. We used Bayesian multivariable regression and GeoDetector models to address 3 main ecological determinants of the MMR, including per capita income (PCI), the proportion of pregnant women who delivered in hospitals (PPWDH), and the proportion of pregnant women who had at least 5 check-ups (PPWFC). Among the 2,205 counties, there were 925 (42.0%) hotspot counties, located mostly in China's western and southwestern regions, with a higher MMR, and 764 (34.6%) coldspot counties with a lower MMR than the national level. China's westernmost regions, including Tibet and western Xinjiang, experienced a weak downward trend over the study period. Nationwide, medical intervention was the major determinant of the change in MMR. The MMR decreased by 1.787 (95% confidence interval [CI]: 1.424-2.142, p < 0.001) per 100,000 live births when PPWDH increased by 1% and decreased by 0.623 (95% CI 0.436-0.798, p < 0.001) per 100,000 live births when PPWFC increased by 1%. The major determinants for the MMR in China's western and southwestern regions were PCI and PPWFC, while that in China's eastern and southern coastlands was PCI. The MMR in western and southwestern regions decreased nonsignificantly by 1.111 (95% CI -1.485-3.655, p = 0.20) per 100,000 live births when PCI in these regions increased by 1,000 Chinese Yuan and decreased by 1.686 (95% CI 1.275-2.090, p < 0.001) when PPWFC increased by 1%. Additionally, the western and southwestern regions showed the strongest interactive effects between different factors, in which the corresponding explanatory power of any 2 interacting factors reached up to greater than 80.0% (p < 0.001) for the MMR. Limitations of this study include a relatively short study period and lack of full coverage of eastern coastlands with especially low MMR. CONCLUSIONS:Although China has accomplished a 75% reduction in the MMR, spatial heterogeneity still exists. In this study, we have identified 925 (hotspot) high-risk counties, mostly located in western and southwestern regions, and among which 332 counties are experiencing a slower pace of decrease than the national downward trend. Nationally, medical intervention is the major determinant. The major determinants for the MMR in western and southwestern regions, which are developing areas, are PCI and PPWFC, while that in China's developed areas is PCI. The interactive influence of any two of the three factors, PCI, PPWDH, and PPWFC, in western and southwestern regions was up to and in excess of 80% (p < 0.001).

Understanding the spatiotemporal trends of temperature in the context of global warming is significant for public health. Although many studies have examined changes in temperature and the impacts on human health over the past few decades in many regions, they have often been carried out in data-rich regions and have rarely considered acclimatization explicitly. The most frequent temperature (MFT) indicator provides us with the ability to solve this problem. MFT is defined as the longest period of temperature throughout the year to which a human is exposed and therefore acclimates. In this study, we propose a new method to estimate the number of heat exposure days from the perspective of temperature distribution and MFT, based on the daily mean temperature readings of 2142 weather stations in eight major climate zones in China over the past 20 years. This method can be used to calculate the number of heat exposure days in terms of heat-related mortality risk without the need for mortality data. We estimated the distribution and changes of annual mean temperature (AMT), minimum mortality temperature (MMT), and the number of heat exposure days in different climate zones in China. The AMT, MMT, and number of heat exposure days vary considerably across China. They all tend to decrease gradually from low to high latitudes. Heat exposure days are closely related to the risk of heat-related mortality. In addition, we utilized multiple linear regression (MLR) to analyze the association between the risk of heat-related mortality and the city and its climatic characteristics. Results showed that the number of heat exposure days, GDP per capita, urban population ratio, proportion of elderly population, and climate zone were found to modify the estimate on heat effect, with an R2 of 0.71. These findings will be helpful for the creation of public policies protecting against high-temperature-induced mortalities.

Abstract Since the disclosure of the “Illegal vaccine operation series case in Jinan, Shandong” in March, 2016, this issue has attracted a great deal of attention and has led to public concerns about the safety and efficacy of the vaccines involved in this case. The main purpose of this paper is to scientifically and scrupulously predict the possible geographic distribution of illegal vaccines in China, and provide a foundation to guide future governmental policies and actions. A species distribution model was used because of the advantages of using presence/pseudo-absence or presence-only data, and it performs well with incomplete species distribution data. A series of socioeconomic variables were used to simulate habitat suitability distribution. Maxent (Maximum Entropy Model) and GARP (Genetic Algorithm for Rule set Production) were used to predict the risks of illegal vaccines in China, and define the spatial distribution and significant factors of the area at risk from illegal vaccines. Jackknife tests were used to evaluate the relative importance of socioeconomic variables. It was found that: (1) Shandong, Hebei, Henan, Jiangsu and Anhui are the main high-risk areas impacted by the vaccines involved in Jinan case. (2) Population density and industrial structure are the main socioeconomic factors affecting areas which may be at risk from illegal vaccines.

Understanding geospatial impacts of multi-sourced drivers on the tourism industry is of great significance for formulating tourism development policies tailored to regional-specific needs. To date, no research in China has explored the combined impacts of socioeconomic and environmental drivers on city-level tourism from a spatiotemporal heterogeneous perspective. We collected the total tourism revenue indicator and 30 potential influencing factors from 343 cities across China during 2008–2017. Three mainstream regressions and an emerging local spatiotemporal regression named the Bayesian spatiotemporally varying coefficients (Bayesian STVC) model were constructed to investigate the global-scale stationary and local-scale spatiotemporal nonstationary relationships between city-level tourism and various vital drivers. The Bayesian STVC model achieved the best model performance. Globally, eight socioeconomic and environmental factors, average wage (coefficient: 0.47, 95% credible intervals: 0.43–0.51), employed population (−0.14, −0.17–−0.11), GDP per capita (0.47, 0.42–0.52), population density (0.21, 0.16–0.27), night-time light index (−0.01, −0.08–0.05), slope (0.10, 0.06–0.14), vegetation index (0.66, 0.63–0.70), and road network density (0.34, 0.29–0.38), were identified to have nonlinear effects on tourism. Temporally, the main drivers might have gradually changed from the local macro-economic level, population density, and natural environment conditions to the individual economic level over the last decade. Spatially, city-specific dynamic maps of tourism development and geographically clustered influencing maps for eight drivers were produced. In 2017, China formed four significant city-level tourism industry clusters (hot spots, 90% confidence), the locations of which coincide with China’s top four urban agglomerations. Our local spatiotemporal analysis framework for geographical tourism data is expected to provide insights into adjusting regional measures to local conditions and temporal variations in broader social and natural sciences.

Geo-environmental factors are believed to be major determinants of rural poverty. However, few studies have quantified the effects of these factors on rural poverty in China. In this paper, we used county-level poverty incidence data and geo-environmental factors to explore spatial patterns of the incidence of poverty using global and local spatial autocorrelation analysis and to investigate the effect of geo-environment factors on rural poverty using a geo-detector model. Our results demonstrated that there was spatial clustering of the incidence of poverty in the study area. The incidence of poverty decreased from south to north and from the east and west to the central area. The incidence of high–high poverty areas was mainly distributed in the southeast of Guizhou Province and the incidence of low–low poverty areas was distributed in the northeast. The results also demonstrated that percentage of effective irrigation on arable land, slope, elevation and vegetation cover were the dominant factors explaining the spatial pattern of poverty. Interaction analysis demonstrated that the slope non-linearly enhanced the percentage of effective irrigation on arable land. Our findings suggested that geo-environment is the fundamental control factor explaining the spatial pattern of rural poverty in China. Through analysis of the impact of the geo-environment on the spatial pattern of poverty, this study provides a reference for effectively implementing targeted alleviation of poverty.

Abstract Background After the earthquake on 14, April 2010 at Yushu in China, a plague epidemic hosted by Himalayan marmot (Marmota himalayana) became a major public health concern during the reconstruction period. A rapid assessment of the distribution of Himalayan marmot in the area was urgent. The aims of this study were to analyze the relationship between environmental factors and the distribution of burrow systems of the marmot and to predict the distribution of marmots. Methods Two types of marmot burrows (hibernation and temporary) in Yushu County were investigated from June to September in 2011. The location of every burrow was recorded with a global positioning system receiver. An ecological niche model was used to determine the relationship between the burrow occurrence data and environmental variables, such as land surface temperature (LST) in winter and summer, normalized difference vegetation index (NDVI) in winter and summer, elevation, and soil type. The predictive accuracies of the models were assessed by the area under the curve of the receiving operator curve. Results The models for hibernation and temporary burrows both performed well. The contribution orders of the variables were LST in winter and soil type, NDVI in winter and elevation for the hibernation burrow model, and LST in summer, NDVI in summer, soil type and elevation in the temporary burrow model. There were non-linear relationships between the probability of burrow presence and LST, NDVI and elevation. LST of 14 and 23 °C, NDVI of 0.22 and 0.60, and 4100 m were inflection points. A substantially higher probability of burrow presence was observed in swamp soil and dark felty soil than in other soil types. The potential area for hibernation burrows was 5696 km2 (37.7 % of Yushu County), and the area for temporary burrows was 7711 km2 (51.0 % of Yushu County). Conclusions The results suggested that marmots preferred warm areas with relatively low altitudes and good vegetation conditions in Yushu County. Based on these results, the present research is useful in understanding the niche selection and distribution pattern of marmots in this region.

The adverse effects of air pollution during pregnancy have been studied intensively, but mainly utilizing linear and logistic models, which generally yield little information about how air pollution may change the distribution of birth weight in populations. We aimed to examine the effects of fine particulate matter (PM _2.5 ) on quantiles of birth weight, and if effects were heterogeneous in different populations and regions. We used a prospective cohort study of 196 283 singleton term live births from 16 counties across China during 2014–2018. PM _2.5 exposure for full gestation, each trimester and last gestational month were assessed by Inverse Distance Weighting interpolation. Linear and quantile regression were conducted to estimate associations between PM _2.5 exposure and mean birth weight, as well as birth weight distribution, with birthweight z -score as the main outcome. Stratified analyses and Cochran Q tests were conducted by maternal and geographical characteristics. Each 10 µ g m ^−3 increase in average PM _2.5 over the entire pregnancy was associated with reduced birthweight z -score (−0.010, 95% CI: −0.015, −0.005) and birth weight (−3.21 g, 95% CI: −5.27, −1.15). In quantile regression, more pronounced effects were observed in lower and intermediate quantiles, with a decrease of 0.021 (95% CI: 0.033, 0.009) and 0.009 (95% CI: 0.015, 0.002) in the 5th and 50th quantiles of birthweight z -score, respectively. Additionally, we observed stronger associations among well-educated, migrant and primiparous mothers as well as in coastal areas. Maternal exposure to PM _2.5 was associated with reduction in birth weight, especially for those with very low birth weight. Well-educated, migrant and primiparous mothers, as well as births in coastal areas may be more sensitive to PM _2.5 in our study population. The results may be relevant to targeted public health interventions to reduce maternal exposure to air pollution.

Protected areas (PAs) play an important role in biodiversity conservation and ecosystem integrity. However, human development has threatened and affected the function and effectiveness of PAs. The Defense Meteorological Satellite Program/Operational Linescan System (DMSP/OLS) night-time stable light (NTL) data have proven to be an effective indicator of the intensity and change of human-induced urban development over a long time span and at a larger spatial scale. We used the NTL data from 1992 to 2013 to characterize the human-induced urban development and studied the spatial and temporal variation of the NTL of global terrestrial PAs. We selected seven types of PAs defined by the International Union for Conversation of Nature (IUCN), including strict nature reserve (Ia), wilderness area (Ib), national park (II), natural monument or feature (III), habitat/species management area (IV), protected landscape/seascape (V), and protected area with sustainable use of natural resources (VI). We evaluated the NTL digital number (DN) in PAs and their surrounding buffer zones, i.e., 0−1 km, 1−5 km, 5−10 km, 10−25 km, 25−50 km, and 50−100 km. The results revealed the level, growth rate, trend, and distribution pattern of NTL in PAs. Within PAs, areas of types V and Ib had the highest and lowest NTL levels, respectively. In the surrounding 1−100 km buffer zones, type V PAs also had the highest NTL level, but type VI PAs had the lowest NTL level. The NTL level in the areas surrounding PAs was higher than that within PAs. Types Ia and III PAs showed the highest and lowest NTL growth rate from 1992 to 2013, respectively, both inside and outside of PAs. The NTL distributions surrounding the Ib and VI PAs were different from other types. The areas close to Ib and VI boundaries, i.e., in the 0−25 km buffer zones, showed lower NTL levels, for which the highest NTL level was observed within the 25−100 km buffer zone. However, other types of PAs showed the opposite NTL patterns. The NTL level was lower in the distant buffer zones, and the lowest night light was within the 1−25 km buffer zones. Globally, 6.9% of PAs are being affected by NTL. Conditions of wilderness areas, e.g., high latitude regions, Tibetan Plateau, Amazon, and Caribbean, are the least affected by NTL. The PAs in Europe, Asia, and North America are more affected by NTL than South America, Africa, and Oceania.

BACKGROUND:Robust malaria vector surveillance is essential for optimally selecting and targeting vector control measures. Sixty-two vector surveillance sites were established between 2005 and 2008 by the national malaria surveillance program in China to measure Anopheles sinensis human biting rates. Using these data to determine the primary ecological drivers of malaria vector human biting rates in malaria epidemic-prone regions of China will allow better targeting of vector control resources in space and time as the country aims to eliminate malaria. METHODS:We analyzed data from 62 malaria surveillance sentinel sites from 2005 to 2008. Linear mixed effects models were used to identify the primary ecological drivers for Anopheles sinensis human biting rates as well as to explore the spatial-temporal variation of relevant factors at surveillance sites throughout China. RESULTS:Minimum semimonthly temperature (β = 2.99; 95% confidence interval (CI) 2.07- 3.92), enhanced vegetation index (β =1.07; 95% CI 0.11-2.03), and paddy index (the percentage of rice paddy field in the total cultivated land area of each site) (β = 0.86; 95% CI 0.17-1.56) were associated with greater An. Sinensis human biting rates, while increasing distance to the nearest river was associated with lower An. Sinensis human biting rates (β = -1.47; 95% CI -2.88, -0.06). The temporal variation (σ(s0)(2) = 0.83) in biting rates was much larger than the spatial variation (σ(t)(2) = 1.35), with 19.3% of temporal variation attributable to differences in minimum temperature and enhanced vegetation index and 16.9% of spatial variance due to distance to the nearest river and the paddy index. DISCUSSION:Substantial spatial-temporal variation in An. Sinensis human biting rates exists in malaria epidemic-prone regions of China, with minimum temperature and enhanced vegetation index accounting for the greatest proportion of temporal variation and distance to nearest river and paddy index accounting for the greatest proportion of spatial variation amongst observed ecological drivers. CONCLUSIONS:Targeted vector control measures based on these findings can support the ongoing malaria elimination efforts in China more effectively.

Understanding the spatial heterogeneity and driving force identification of energy-related CO2 emissions (ECEs) can help build consensus for mitigating CO2 emissions and designing appropriate policies. However, previous studies on ECEs that focus on both the global-regional scale and the interaction of factors have been seldom conducted. In this paper, ECE data from 143 countries from 1990 to 2014 were selected to analyze regional differences in ECE growth rates by using the coefficient of variation. Then a geographical detector was used to analyze the key determinant factors on ECE growth rates around the world and in eight types of regions. The results show that: (1) the ECE growth rate in the Organization for Economic Cooperation and Development (OECD) region is low and tended to decrease, while in the non-OECD region it is high and tended to increase; (2) the coefficient of variation and detection factor of ECE growth rates at a regional scale are higher than those at a global scale; (3) in terms of the key determinant factors, population growth rate, growth rate of per capita GDP, and energy intensity growth rate are the three key determinant factors of ECE growth rates in the OECD region and most of the non-OECD regions such as non-OECD European and Eurasian (NO-EE), Asia (NO-AS), non-OECD Americas (NO-AM). The key determinant factors in the African (NO-AF) region are population growth rates and natural gas carbon intensity growth rates. The key determinant factors of the Middle East (NO-ME) are population growth rate, coal carbon intensity growth rate and per capita GDP growth rate; (4) the determinant power of the detection factor, the population growth rate at the global scale and regional scale is the strongest, showing a significant spatial consistency. The determinant power of per capita GDP growth rate and energy intensity growth rate in the OECD region, respectively, rank second and third, also showing a spatial consistency. However, the carbon intensity growth rates of the three fossil fuels contribute little to the growth rate of ECEs, and their spatial coherence is weak; (5) from the perspective of the interaction of detection factors, six detection factors showed bilinear or non-linear enhancement at a global and a regional scale, and the determinant power of the interaction of factors was significantly enhanced; and (6) from the perspective of ecological detection, the growth rate of carbon intensity and the growth rate of natural gas carbon intensity at the global scale and NO-ME region are significantly stronger than other factors, with a significant difference in the spatial distribution of its incidence. Therefore, the OECD region should continue to reduce the growth of energy intensity, and develop alternative energy resources in the future, while those that are plagued by carbon emissions in non-OECD regions should pay more attention to the positive influence of lower population growth rates on reducing the growth rate of energy-related CO2 emissions. Reducing energy intensity growth rates and reducing, fossil energy consumption carbon intensity.

More than a million Japanese encephalitis (JE) cases occurred in mainland China from the 1960s to 1970s without vaccine interventions. The aim of this study is to analyze the spatial and temporal pattern of JE cases reported in mainland China from 1965 to 1973 in the absence of JE vaccination, and to discuss the impacts of climatic and geographical factors on JE during that period. Thus, the data of reported JE cases at provincial level and monthly precipitation and monthly mean temperature from 1963 to 1975 in mainland China were collected. Local Indicators of Spatial Association analysis was performed to identify spatial clusters at the province level. During that period, The epidemic peaked in 1966 and 1971 and the JE incidence reached up to 20.58/100000 and 20.92/100000, respectively. The endemic regions can be divided into three classes including high, medium, and low prevalence regions. Through spatial cluster analysis, JE epidemic hot spots were identified; most were located in the Yangtze River Plain which lies in the southeast of China. In addition, JE incidence was shown to vary among eight geomorphic units in China. Also, the JE incidence in the Loess Plateau and the North China Plain was showed to increase with the rise of temperature. Likewise, JE incidence in the Loess Plateau and the Yangtze River Plain was observed a same trend with the increase of rainfall. In conclusion, the JE cases clustered geographically during the epidemic period. Besides, the JE incidence was markedly higher on the plains than plateaus. These results may provide an insight into the epidemiological characteristics of JE in the absence of vaccine interventions and assist health authorities, both in China and potentially in Europe and Americas, in JE prevention and control strategies.

Rationale: Evidence for the association between fine particulate matter (PM2.5) and mortality among patients with tuberculosis (TB) is limited. Whether greenness protects air pollution-related mortality among patients with multidrug-resistant tuberculosis (MDR-TB) is completely unknown.Methods: 2305 patients reported in Zhejiang and Ningxia were followed up from MDR-TB diagnosis until death, loss to follow-up or end of the study (31 December 2019), with an average follow-up of 1724 days per patient. 16-day averages of contemporaneous Normalised Difference Vegetation Index (NDVI) in the 500 m buffer of patient's residence, annual average PM2.5 and estimated oxidant capacity Ox were assigned to patients regarding their geocoded home addresses. Cox proportional hazards regression models were used to estimate HRs per 10 μg/m3 exposure to PM2.5 and all-cause mortality among the cohort and individuals across the three tertiles, adjusting for potential covariates.Results: HRs of 1.702 (95% CI 1.680 to 1.725) and 1.169 (1.162 to 1.175) were observed for PM2.5 associated with mortality for the full cohort and individuals with the greatest tertile of NDVI. Exposures to PM2.5 were stronger in association with mortality for younger patients (HR 2.434 (2.432 to 2.435)), female (2.209 (1.874 to 2.845)), patients in rural (1.780 (1.731 to 1.829)) and from Ningxia (1.221 (1.078 to 1.385)). Cumulative exposures increased the HRs of PM2.5-related mortality, while greater greenness flattened the risk with HRs reduced in 0.188-0.194 on average.Conclusions: Individuals with MDR-TB could benefit from greenness by having attenuated associations between PM2.5 and mortality. Improving greener space and air quality may contribute to lower the risk of mortality from TB/MDR-TB and other diseases. [ABSTRACT FROM AUTHOR]