As of late January 2026, the World Health Organization (WHO) reported a small-scale Nipah virus (NiV) outbreak in West Bengal, India. Despite that NiV was primarily transmitted through animal sources, we assessed the transmission risks of NiV at human community level based on a total of 23 studies identified from literature of historical outbreaks that investigated human-to-human transmission of laboratory-confirmed NiV in Bangladesh and India. The data included transmission events containing 33 primary NiV cases and 152 secondary cases. We constructed a modelling framework for superspreading risk assessment, and found that 92.0% (95% CrI: 87.0, 95.4) of the NiV cases could not generate secondary cases via human-to-human transmission. With 5 seed cases imported to a community, there was a 1.1% (95% CrI: 0.3, 2.3) chance of observing an outbreak exceeding 50 NiV cases. Our findings may inform public health preparedness at community level and cross-border travel ban.

Background: To analyze temporal trends, sociodemographic pattern, and quantify the independent contributions of age, period, and cohort effects in regular active exercise among Chinese adults over the past three decades. Methods: Based on nationally representative health service surveys (NHSS) in China spanning 1993-2023 and involving 1·56 million participants, we analyzed the prevalence of regular exercise, while also reported standardized rates and sociodemographic stratification by age, sex, education, income, employment status and urban-rural area. We then adopted the age-period-cohort (APC) model to further identify the age, period, and cohort effects. Findings: Regular ​exercise among Chinese adults increased substantially over the past three decades, with a marked acceleration following the launch of the Healthy China 2030 initiative: prevalence rose from 20·85% in 2013 to 38·78% in 2018, and further to 42·97% in 2023. Overall upward shifts in both period and cohort effects also corroborated the observed improvement in regular exercise participation. Nevertheless, regional and sociodemographic disparities persist, particularly among working-age adults and those living in rural areas. The urban–rural gap has narrowed due to accelerated improvements among rural residents; however, inequalities remain pronounced in western rural regions, where inadequate infrastructure continues to constrain exercise participation. Interpretation: Regular physical exercise has been increasingly promoted in China since the launch of Healthy China 2030, but persistent regional and sociodemographic disparities suggest that more targeted interventions are needed.

In November 2025, Marburg virus caused the first outbreak of Marburg virus disease (MVD) in Ethiopia. By December 15, a total of 14 laboratory-confirmed cases were reported, including 9 deaths, corresponding to a case fatality ratio of 64.3% among confirmed cases. In the absence of licenced vaccines or antivirals, non-pharmaceutical interventions (NPIs) were implemented to control transmission. We developed a stochastic epidemic model incorporating a stochastic exponential growth process with reporting adjustment to assess the effectiveness of NPIs. The reporting ratio was modelled using a beta distribution, and transmission parameters were estimated via Markov chain Monte Carlo with particle filtering for likelihood calculation. Using pre-NPI data (November 12-23), we estimated an exponential growth rate of 0.012 (95% credible interval [CrI]: 0.008, 0.014) per day, corresponding to an initial reproduction number of 1.13 (95% CrI: 1.09, 1.16). We projected 64 cases (95% CrI: 19, 189) and 41 deaths (95% CrI: 12, 122) during post-NPI period (November 24 to December 15) without interventions. Compared with 4 observed cases, NPIs were associated with an estimated effectiveness of 93.7% (95% CrI: 78.9, 97.9). These findings indicated moderate transmissibility of MVD, and a potential transmission risk reduction following the implementation of control measures, underscoring the importance of timely intervention and sustained surveillance regarding local MVD activities.

This study aimed to compare the burden of malaria and dengue worldwide and to project future incidence trends. Incidence and disability-adjusted life-years (DALYs) were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Temporal trends were quantified using estimated annual percentage change (EAPC), age-period-cohort analysis was used to assess age, period, and cohort effects, and Bayesian age-period-cohort models were applied to project incidence to 2036. From 1992 to 2021, the global age-standardized incidence rate (ASIR) of malaria decreased (EAPC= -0.55%), whereas that of dengue increased (EAPC = 1.83%); the corresponding age-standardized DALY rates showed EAPCs of -1.64% and 1.29%, respectively. Across 21 GBD regions, SDI was inversely correlated with ASIR for malaria (r = -0.848) and dengue (r = -0.521), and with age-standardized DALY rates for malaria (r = -0.849) and dengue (r = -0.497). Malaria burden remained concentrated in low-SDI regions, particularly sub-Saharan Africa and Oceania, whereas dengue burden was highest in middle-SDI regions, especially tropical Latin America. From 2021 to 2036, the global ASIR of malaria was projected to decrease slightly by 1.36% (3485.27 to 3437.72). Whereas that of dengue was projected to increase by 10.58% (752.04 to 831.63). In males, the projected ASIR of malaria and dengue increased by 4.18% (3193.24 to 3326.58) and 9.96% (704.83 to 775.06), respectively. In females, the corresponding increases were 4.87% (3379.82 to 3544.27) and 8.83% (819.74 to 892.13). These findings suggest divergent epidemiological trajectories for malaria and dengue. The projections further suggest a consistent upward trajectory for dengue, with sex-specific relative changes differing descriptively by disease: the projected relative increase was numerically greater in females for malaria and in males for dengue.

Mycoplasma pneumoniae (MP) is a major cause of respiratory infections in children and adolescents. COVID-19 pandemic control measures may have disrupted the respiratory microenvironment and increased the risk of co-infection associated with severe community-acquired pneumonia (CAP). Previous studies on MP co-infections were limited by small samples and lacked generalizability, with little evidence on MP-bacterial co-infection. This retrospective cohort study investigated co-infections and clinical severity in pediatric MP patients in Guangzhou. In this single-center retrospective cohort study, patients aged ≤ 18 years with confirmed MP infection were recruited from July 2023 to January 2024 in Guangzhou, China. Blood and/or respiratory specimens were collected for respiratory pathogen testing. Participants who completed testing for all 8 viral and 5 bacterial pathogens were included in the multivariable analyses. Multivariate logistic regression and negative binomial regression models were applied to investigate the co-infection patterns and clinical severity of MP infection. A total of 1499 patients (mean [SD] age: 6.39 [3.49], 50.7

Large clusters in HIV-1 molecular networks contain a substantial proportion of people living with HIV and dominate local epidemics; however, their large size and complex structure pose a challenge for effective public health interventions. We developed an analytical framework to partition the large cluster into small groups for precise intervention. In the HIV-1 CRF07_BC molecular transmission network in Guangzhou, China (2008-2020), a giant component (681 members) was partitioned into 34 communities with dense internal and sparse external links. All 378 inter-community links involved high-centrality members from Community 1 (P < 0.001) and phylogenetic analysis identified Community 1 as the most likely ancestral source of the giant component (marginal probability = 0.989). Exponential random graph models (ERGMs) revealed significant homophily effect among members with specific characteristics in the giant component and its large communities, highlighting potential outbreaks within specific subgroups. Partitioning giant components into communities may be a promising approach to help develop community-level interventions and could improve the effectiveness of interventions targeted at large clusters.

Background Despite significant progress in tuberculosis (TB) prevention, China remains the third-highest TB burdened country globally, with ongoing concerns about drug-resistant tuberculosis (DR-TB) and HIV/TB co-infection. Method The study utilized data from the Global Burden of Disease (GBD) 2021, applying the Age-Period-Cohort (APC) model to analyze age, period, and cohort effects on the incidence and mortality of TB, DR-TB, and HIV/TB co-infection. The Bayesian Age-Period-Cohort (BAPC) model projected future trends from 2022 to 2035. Result Age effects indicated an increased incidence and mortality risk for TB and DR-TB with age, while younger and middle-aged groups were more affected by HIV/TB co-infection. Period effects demonstrated decreasing risks for TB and DR-TB, but an increasing trend for HIV/TB co-infection. Cohort effects similarly indicated a decline for TB and DR-TB, with a slight rise for HIV/TB co-infection among individuals born between 1990 and 2006. BAPC projections indicate that by 2035, the age-standardized incidence rate (ASIR) for TB, DR-TB, and HIV/TB co-infection will be 21.86, 1.04, and 1.21 per 100,000 person-years, respectively, while the age-standardized mortality rate (ASMR) will be 0.90, 0.09, and 0.12 per 100,000 person-years, respectively. None of these projections fulfill the End TB targets. Conclusion Current strategies are unlikely to meet the End TB targets by 2035 in China, suggesting a need for preventive treatment for latent tuberculosis infection (LTBI) and improved screening for HIV and TB in high-risk populations.

COPD may be influenced by complex environmental interactions. Current evidence is limited to isolated stages and is lacking on the effects of mixture exposures. This study assessed the effects of environmental mixtures on COPD risk trajectories. We analyzed the impact of mixture exposures (air pollution, meteorological factors, built environment features) on COPD hospitalization/mortality for 67,235 participants. We applied Weighted Quantile Sum regression to quantify mixture effects and mixture contributions. In the WQS regression analysis, each quartile increase in the WQS index was associated with a 29.9% higher risk of transitioning from hospitalization to death, with NO2 (21.8%) and SO42- (19.4%) contributing the most. No significant associations were observed for the transition from baseline to hospitalization or the transition from baseline to death. Furthermore, we employed K-means clustering to identify distinct exposure patterns. Three exposure patterns were identified. Compared with the Urbanization-Dominant Pattern, the Urbanization-Ecology Balanced and Ecology-Dominant Patterns were inversely associated with transitions from baseline to hospitalization (17.5% and 9.0% lower risk, respectively) and to death (17.8% and 9.2% lower risk, respectively). The elderly had an 37.8% higher risk of the transition from hospitalization to death. Environmental mixtures significantly affect COPD trajectories. Controlling critical pollutants and optimizing ecological planning are essential for the COPD burden.

Background:Infectious diseases remain a major source of health loss, yet long-term, cause-comparable assessments that jointly integrate incidence, disability-adjusted life-years (DALYs), age patterns, and risk attribution for China are fragmented and not comprehensively synthesized within a unified framework. We aimed to evaluate the trends in incidence and DALYs of infectious diseases in China from 2000 to 2023 to inform current priority setting by clarifying long-term trends and changes observed during the COVID-19 pandemic. Methods:Data on the number and rate of incidence and DALYs of five major infectious-disease cause groups (HIV/AIDS and sexually transmitted infections, respiratory infections and tuberculosis, enteric infections, neglected tropical diseases and malaria, and other infectious diseases) and 40 specific infectious diseases in China were obtained from the Global Burden of Disease Study (GBD) 2023. Estimated annual percentage changes (EAPCs) in age-standardized incidence rates (ASIRs) and age-standardized DALY rates (ASDRs) were calculated overall and by sex and age group to quantify temporal trends from 2000 to 2023. We conducted comparative risk assessment using population attributable fractions (PAFs) to quantify risk-attributable DALYs, and decomposition analyses to assess the contributions of population growth, population ageing and epidemiologic change to changes in incident cases, deaths, and DALYs. Sensitivity analyses were also conducted to examine the robustness of the results. Findings:From 2000 to 2023, age-standardized DALY rates declined in four of the five major infectious disease cause groups in China. The largest decrease was observed for enteric infections, with DALY rates falling from 365.4 to 43.8 per 100,000 (EAPC -11.0% [95% CI -12.2 to -9.7]). Among all groups, respiratory infections and tuberculosis had the highest DALY burden throughout the study period, while their DALY rates decreased from 2559.5 to 688.1 per 100,000 (EAPC -8.1% [-9.2 to -7.0]). It's estimated that HIV/AIDS and sexually transmitted infections were the only cause group with an increasing DALY rate, rising from 79.7 to 103.7 per 100,000 (EAPC 1.0% [0.6 to 1.4]). The increase was greatest among adults aged 20-54 years, in whom DALY rates rose from 71.1 to 152.0 per 100,000 (EAPC 3.3% [2.7 to 3.9]). Risk attribution varied by cause and age group. Unsafe sex accounted for most DALYs for sexually transmitted infections excluding HIV and more than 70% of HIV/AIDS DALYs. For lower respiratory infections, child and maternal malnutrition accounted for 42.2% of DALYs in those aged < 20 years, whereas tobacco use accounted for 38.1% in adults aged 20-54 years. Enteric infection DALYs were mainly attributable to unsafe water, sanitation, and handwashing, accounting for more than 70% across age groups. Decomposition analysis showed that epidemiologic change was the main driver of changes in infectious disease burden from 2000 to 2023. Interpretation:China's infectious disease DALY burden declined from 2000 to 2023, but progress was uneven across causes and increasingly concentrated in older adults. Persistent incidence-DALY discordance and heterogeneous age-specific risk profiles indicate that current priority setting should move beyond incidence-led targets towards reducing preventable disability and premature mortality through age- and mechanism-tailored prevention and care. Funding:Prevention and Control of Emerging and Major Infectious Diseases-National Science and Technology Major Project.

Objective:Hand, foot, and mouth disease (HFMD) transmission is sensitive to temperature-humidity interactions; however, the role of wind speed in modifying these effects remains unknown. This study investigated how wind speed modifies the combined effects of temperature and humidity on HFMD burden and identified subgroups of individuals with increased vulnerability to these climate exposures. Methods:We analyzed data from 524,100 HFMD cases and daily meteorological measurements across Guizhou, China, between 2012 and 2019. Disease burden was quantified as the number of years lived with disability. Exposure-response relationships and lag effects were modeled via distributed lag non-linear models. Additive interactions were assessed based on the proportions attributable to the interaction. The effects of sex, ethnicity, and urbanization were examined using stratified analyses. Results:Meteorological factors showed synergistic effects on HFMD burden. The peak burden occurred at moderate mean temperatures (8.7-22.8 °C) combined with high relative humidity (> 73.7%), showing a 2.4-fold increase versus the reference. High wind speed (> 2.5 m/s) further increased this effect, with a 3.1-fold increase in burden. This joint effect was attributable to the additive interaction involving wind speed and remained robust in stratified analyses that identified heightened vulnerability among boys, minority areas, and urban agglomerations. Conclusion:The HFMD burden was highest under specific combinations of temperature and humidity, and further increased with concurrent exposure to high wind speeds. Public health strategies for HFMD prevention should incorporate wind speed monitoring into early warning systems and address vulnerable subgroups, including boys and populations in minority areas and urban agglomerations.

STUDY OBJECTIVE:Promoting healthy lifespan equity is a pivotal challenge in the global wave of population ageing, aiming to enable the majority of people in today's long-lived societies to reach a similar age in good health. This study aims to develop a systematic analytical framework to identify age-specific priority diseases and injuries for intervention, thereby comprehensively improving healthy lifespan equity measured by health-adjusted life expectancy (HALE, the average number of years a person can expect to live in full health). METHODS:First, we quantify the contribution of reducing the disease burden at each age to changes in overall HALE and healthy lifespan equity. Then, we decompose these contributions into portions attributable to mortality versus disability, ensuring no residual. Finally, we combine these weights with measures of the stability and relative importance of various causes to produce a list of priority causes for intervention across the entire life course. RESULTS:Globally, the age-specific leading causes where mortality prevention shall be a priority to achieve healthy lifespan equity are enlisted as follows: neonatal disorders (0 years), malaria (1-4 years), drowning (5-9 years), road injuries (10-24 years), HIV/AIDS (25-44 years) and ischaemic heart disease (45-84 years and over 85 years). The age-specific leading causes of disability in need of prioritisation regarding health lifespan equity are as follows: dietary iron deficiency (0-9 years), headache disorders (10-34 years), low back pain (35-69 years), age-related and other hearing loss (70-84 years) and Alzheimer's disease and other dementias (over 85 years). Notably, the specific ranking and relative importance of these causes varied substantially by region and sex, underscoring the need for context-specific strategies. DISCUSSION:Our comprehensive framework can inform policy-makers of whether resources need to be reallocated to meet the healthy lifespan equity challenges in an ageing era.

Cardiovascular, kidney, and metabolic (CKM) diseases are leading causes of mortality in the United States (US), with geographic and socioeconomic disparities. The community food environment, including food accessibility and security, is a modifiable determinant of CKM health. We systematically examined associations between county-level multidimensional food environment indicators and CKM-related mortality across US counties. We conducted an ecological analysis integrating data from the County Health Rankings and CDC WONDER. Generalized linear models estimated rate ratios (RR) for age-adjusted CKM mortality across quartiles of the food environment index, limited access to healthy foods, and food insecurity. Adjusting for demographic and socioeconomic factors, the most favorable quartile of the food environment index was associated with reduced mortality from cardiovascular disease (RR 0.85, 95% CI 0.84-0.86), diabetes (RR 0.76, 0.73-0.79), renal failure (RR 0.73, 0.69-0.77), and overall CKM disease (RR 0.83, 0.82-0.84) compared with the least favorable quartile. Conversely, limited access to healthy foods (RR 1.11, 1.09-1.12) and food insecurity (RR 1.19, 1.18-1.21) correlated with higher overall CKM mortality. Counties with less favorable food environments are linked to higher CKM-related mortality. Improving structural food access and security may be essential for reducing disease burden and promoting health equity.

BackgroundTo determine the relationship between health- and skill-related physical fitness indicators and cardiometabolic risk factors (CMRFs) in Chinese adults.MethodsA total of 925 participants (483 males and 442 females) in Longhua district, Shenzhen, China were included in this study. Physical fitness assessments were conducted using an all-in-one machine. CMRFs, including blood pressure, fasting plasma glucose concentration, lipid and lipoprotein profiles and uric acid, were measured with standard methods. Linear regression models were used for analysis.ResultsAmong health-related physical fitness indicators, body fat mass, body fat percentage and sit-and-reach score were positively associated with diastolic blood pressure (DBP) and/or systolic blood pressure, while step index score was inversely associated with DBP in the fully adjusted models (all p < 0.05). Push-up, curl-up, and grip strength scores were not significantly associated with any CMRFs. Among skill-related physical fitness indicators, one-leg standing time was inversely associated with DBP, while choice reaction time was positively associated with concentrations of fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol, and the ratio of LDL-C to high-density lipoprotein cholesterol in the fully adjusted models (all p < 0.05). Vertical jump score was not significantly associated with CMRFs.ConclusionIn conclusion, our study unveils the interplay between various health- and skill-related physical fitness indicators and CMRFs in healthy adults. These findings underscore that improvements in physical fitness, specifically body composition, cardiovascular fitness, and reaction time, were associated with favorable CMRF profiles.

Introduction:In China, the increase in high-risk pregnancies along with rising maternal age and complications has underscored the need for the development of maternal and newborn risk management programmes. The Chinese National Maternal and Newborn Safety Action Plan (CNMNSAP) was initiated in 2017. Given that neonatal mortality is a key indicator of healthcare quality, we evaluate the real-world effects of CNMNSAP against neonatal mortality among pregnant women with high-risk conditions. Methods:In this retrospective, matched, population-based cohort study, we collected information on all pregnant women with clinically diagnosed conditions from electronic medical records in Chengdu, China, between July 2014 and December 2019. Individual-level data, covering all healthcare services and testing records in public hospitals, were obtained and categorised into two groups based on the timing of CNMNSAP implementation (pre-CNMNSAP vs post-CNMNSAP). After 1:1 propensity score matching, we calculated the annual percentage change (APC) of neonatal mortality within 7 days post-delivery and compared outcomes between two groups of pregnant women with conditions. We then employed multivariate log-binomial regression models to examine the association between the CNMNSAP implementation and temporal changes in neonatal mortality. Results:During the 5-year study period, a total of 241 343 women with high-risk conditions delivered prior to CNMNSAP and 163 367 after its implementation. After 1:1 propensity score matching, 299 190 mothers were included for analysis. We estimated that the APC changed from 10.0% (95% CI -0.4% to 21.5%) prior to the maternal risk management programme to -28.5% (95% CI -44.2% to -8.4%) after its implementation, with an attributed risk reduction of 1.29 neonatal deaths per 1000 deliveries annually. In subgroup analysis, we found a significant reduction in neonatal mortality after policy implementation among mothers aged 18-34 years, those with a normal body mass index and those having a history of abortion. Conclusions:The CNMNSAP was found to be associated with a significant annual reduction in early neonatal mortality risk among pregnant women with high-risk conditions in Chengdu, China. The maternal risk management programme effectively improved outcomes for high-risk pregnancies, highlighting the importance of maternal risk classification and management throughout pregnancy.

Chronic obstructive pulmonary disease (COPD) imposes a major burden on global health, yet evidence on the prolonged health effects of individual PM2.5 constituents remains limited. Previous research has primarily employed traditional models, which may struggle to capture the complex correlations among the PM2.5 components and be less effective in confounding adjustment. We conducted a prospective cohort study involving 182,009 participants from the Pearl River Cohort (2013-2015) followed through 2020, applying inverse probability-weighted marginal structural Cox models and quantile g-computation (QGC) to assess the associations of individual PM2.5 components and their mixtures with COPD mortality, followed by stratified analyses for effect modification. Over 1.18 million person-years of follow-up, 422 COPD deaths were documented. Long-term exposure to ammonium (NH4+), black carbon (BC), nitrate (NO3-), organic matter (OM) and chloride (Cl-) was associated with higher COPD mortality, with HRs (95% CI) of 2.75 (1.86-4.05), 2.41 (1.64-3.55), 1.86 (1.45-2.39), 1.85 (1.33-2.57) and 1.45 (1.15-1.82), respectively. Mixture analysis showed that each one-quartile increase in the PM2.5 component mixture was associated with a 39% (29%-50%) higher risk of COPD mortality, primarily driven by OM, Cl-, and NO3- (weights = 0.34, 0.34, 0.32). Stratified analyses indicated greater associations among older adults, suggesting increased susceptibility in this group. Our findings underscore the potential contribution of individual PM2.5 constituents and their mixtures in COPD mortality, while suggesting actionable source-control priorities and coordinated precursor-reduction strategies, as well as population-specific prevention approaches.

Introduction Hand, foot and mouth disease (HFMD) is influenced by meteorological and air pollution factors. However, few studies have evaluated their joint and interactive effects under real-world multi-exposure conditions. This study examined the health impacts of environmental mixtures and identified susceptible populations in western China.Methods A total of 484 928 HFMD cases in children under 6 years old were collected from western China. Bayesian kernel machine regression was used to estimate the effects of simultaneous exposure to temperature, precipitation, shortwave radiation, pressure, fine particulate matter (PM2.5) and ozone (O3). Subgroup analyses were conducted by age, sex and region type.Results Temperature, precipitation, shortwave radiation, PM2.5 and O3 were associated with HFMD risk. Notable non-linear interactions were detected between temperature, shortwave radiation or O3 and other exposures. For instance, under median temperature conditions, increasing shortwave radiation was associated with a higher HFMD risk, with relative risks (RRs) of 1.20 (95% credible interval (95% CrI) 0.95 to 1.51), 1.91 (1.54 to 2.37) and 3.16 (2.05 to 4.87) at the 25th, 50th and 75th percentiles, respectively. In contrast, O₃ appeared to attenuate the risk, with RRs decreasing from 4.19 (3.06 to 5.73) at the 25th percentile to 1.33 (1.03 to 1.72) at the 75th. Joint exposure analysis further revealed a protective association under low combined exposure levels, with the RR of 0.46 and an elevated risk under high exposure levels, with an RR of 1.62. Subgroup analyses indicated higher susceptibility among boys, children aged 0–2 years and residents of ethnic minority-concentrated regions.Conclusion This study enhanced understanding of the joint and interactive effects of meteorological and air pollution factors on HFMD risk under real-world conditions and identified vulnerable subgroups, supporting future research and targeted prevention efforts.

While meteorological and socioeconomic factors are well-documented modifiers of spatial heterogeneity in temperature-hand, foot, and mouth disease (HFMD) associations, substantial unexplained heterogeneity remains. This study investigates underexplored environmental modifiers-including extreme temperature events (heat waves and cold spells), air pollution, and normalized difference vegetation index (NDVI)-by analyzing 484,928 HFMD cases among children under six years old in western China (2013-2019) using distributed lag nonlinear models and meta-regression. We found that cold spells (accounted for 3.84% of the spatial heterogeneity attributable above the baseline level), PM2.5 (3.06%), heat waves (2.72%), PM10 (2.08%), NDVI (1.57%) and O3 (0.78%) were statistically significant modifiers of spatial heterogeneity in the temperature-HFMD associations. Further analysis of PM2.5 components identified nitrate (1.78%) and ammonium (1.58%) as additional modifiers. Among these, cold spells, heat waves, PM2.5, and NDVI were the primary contributors. Specifically, the relative risk (RR) of HFMD at the 95th temperature percentile reached 3.17 (95% CI: 2.39-4.19) in frequent heat waves regions and 3.05 (2.35-3.95) in high-PM2.5 areas. Conversely, regions with low cold-spell frequency also exhibited increased temperature-related risk (RR = 3.13, 2.40-4.07) at the same temperature, as did low NDVI regions (RR = 2.16, 1.79-2.59). Spatial cluster analysis further revealed that the central and northeastern regions exhibited higher temperature-related HFMD risks compared to the southwestern region. These pronounced spatial modification effects challenge the generalizability of single-site study and highlight the importance of region-specific public health strategies that integrate early warning systems for extreme temperatures, air pollution mitigation, and locally adapted greening interventions.

Mpox resurged globally in 2022 after five decades of African confinement. Pooling 70 studies (1970–2025) and WHO surveillance, we show hospitalisation and case-fatality fell from 33% and 3.3% pre-2022 to 10% and 0.7% during the clade-IIb pandemic. Clade-Ia remained high deadlier (≈80% admission, 9% death). Since 2024, Central Africa has again driven cases and deaths. High-income regions recorded milder, larger outbreaks; Africa continues to bear excess mortality. Targeted clade-Ia surveillance, vaccination and health-system support in Central Africa are urgently needed to curb mpox’s persistent global burden.

Background Artificial light at night (LAN) pollution is a growing public health concern. However, there has been limited epidemiological research on the LAN-lung cancer mortality links. Evidence from large cohorts and causal inference approaches is far more limited. Methods We included 476,328 individuals from 35 randomly selected communities in southern China. A satellite-based approach was used to assess LAN exposure, which was assigned to participants based on their home address. The LAN-lung cancer mortality connections were investigated using marginal structural Cox proportional hazards regression models with inverse probability weightings. The modification effects of sociodemographics on the above relationships were also assessed. Results During a median follow-up of 9.0 years, the incidence of lung cancer mortality was 6.43 per 10,000 person-years. We found a hazard ratio (HR) of 1.055 [95 ​% confidence interval (CI): 1.010–1.102] for lung cancer mortality following each 10 ​nW/cm2/sr increase in long-term LAN exposure. Further stratified analyses revealed that those <65 years, males, and those with primary school and below were more vulnerable to LAN exposure. The LAN-lung cancer mortality relationship was significant in those <65 years (HR ​= ​1.132, 95 %CI: 1.047–1.224) but not in those ≥65 years (HR ​= ​1.041, 95 %CI: 0.984–1.101). The HR for male participants was 1.105 (95 %CI: 1.044–1.169), while the HR for females was 1.033 (95 %CI: 0.958–1.113). A significant positive association was observed only among those with primary school and below. Discussion This large cohort study suggests that long-term LAN exposure was linked to increased lung cancer mortality, particularly in certain vulnerable populations.

ObjectiveOlder adults with coexisting hypertension and type 2 diabetes are at high risk for metabolic dysfunction-associated steatotic liver disease (MASLD). Normal-weight visceral obesity (NWVO)—excess visceral fat despite normal body mass index and waist circumference—is an overlooked risk factor. Lifestyle is modifiable, but its role in explaining the NWVO-MASLD association is unknown. We quantified the proportion of this association statistically mediated by unhealthy lifestyle patterns.MethodsThis retrospective cohort study included 26,289 adults aged ≥50 years with hypertension and type 2 diabetes from the Shenzhen National Basic Public Health Services Program (2010–2023). NWVO was defined using the Chinese Visceral Adiposity Index alongside normal body size criteria. MASLD was diagnosed by ultrasound and cardiometabolic criteria. A composite lifestyle score (physical activity, alcohol, smoking, dietary salt intake) was derived. We applied the generalized front-door formula for causal mediation analysis to estimate the path-specific effect of NWVO on MASLD incidence explained by lifestyle, robust to unmeasured confounding.ResultsOver a mean 5.5-year follow-up, NWVO was associated with a significantly increased MASLD risk (adjusted HR: 1.82, 95% CI: 1.76, 1.89). In marginal models, NWVO was associated with a 2.35-fold higher risk of having an unhealthy lifestyle (2.25, 2.44) and an 11.2% higher MASLD risk (8.7, 13.8). Using the front-door formula, unhealthy lifestyle statistically explained 19.8% (12.1, 33.6) of the total NWVO-MASLD effect, corresponding to a mediated risk increase of 41.2% (3.5, 92.7).ConclusionIn this multimorbid older population, NWVO is a significant MASLD risk factor, and modifiable lifestyle patterns account for approximately one-fifth of this association. Our findings support integrating visceral adiposity assessment into routine care and implementing multifaceted lifestyle interventions—targeting diet, physical activity, and substance use—to reduce the burden of MASLD in aging populations with metabolic comorbidities.