Cholera outbreaks are prevalent in coastal regions, where hydroclimatic factors play a critical role. However, evidence on their associations with different genotypes remains limited, and global projection remains lacking. We compiled cholera data from EnteroBase and WHO weekly reports covering 110 coastal countries from 1980 to 2022. A generalized additive model was used to examine the associations between hydroclimatic factors and different cholera serotypes and genotypes. We further projected future cholera occurrences for each coastal country under three climate change scenarios from 2025 to 2100. During the study period, Wave 3 of O1 replaced Wave 1 as the predominant genotype of cholera, while cholera O139 remained at low levels and only occurred in Asia. At the country–year level, each 1 °C increase in sea surface temperature (SST) was significantly associated with cholera occurrence (OR: 1.032, 95% CI: 1.023 to 1.040) and Wave 3 of O1 (OR: 1.149, 95% CI: 1.097 to 1.203). Drainage density (m/km2) and coastline ratio (%) were positively related to cholera, with ORs of 1.067 (95% CI: 1.046 to 1.087) and 1.022 (95% CI: 1.019 to 1.027). For future projections, five trend patterns were identified under different emission scenarios, with most countries showing increased cholera risk due to global hydroclimatic changes, peaking under the SSP585 scenario. Our findings reveal associations between hydroclimatic factors and different cholera genotypes and project future cholera risk across coastal countries, thereby providing evidence to inform genotype-specific surveillance and targeted prevention strategies at the global scale.

Non-methane volatile organic compounds (NMVOC) are widespread ambient pollutants with documented toxicological properties, yet population-level evidence on their long-term health impacts remains limited. We analyzed data from 394,153 adults in a large prospective cohort study. Individual exposure to NMVOC was estimated by linking residential addresses with modeled concentrations. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) per standard deviation (SD) increase in exposure for 14 major mortality categories and 97 specific causes. Population attributable fractions were calculated to characterize the potential mortality burden, and accelerated failure time models assessed the impact of exposure on timing of death. Over a median follow-up of 13.71 years, 32,310 deaths occurred. Long-term NMVOC exposure was associated with increased mortality risks across a range of disease systems. Of the major disease categories, mortality from respiratory system diseases exhibited the strongest and positive association (HR = 1.048, 95% CI: 1.028-1.069). Notably, subtype analysis highlighted particularly strong associations with asthma (HR = 1.130) as well as phlebitis and thrombophlebitis (HR = 1.129). The estimated population attributable fractions of mortality associated with NMVOC exposure ranged from 2.243% for circulatory diseases to 7.673% for other symptoms. In addition, accelerated failure time models suggested that higher exposure levels were associated with differences in survival time corresponding to 1.517 to 3.935 years earlier mortality. These findings suggest associations between long-term NMVOC exposure and increased and earlier mortality across multiple organ systems, highlighting potential public health relevance.

The biomolecular pathways linking fine particulate matter (PM2.5) and its constituents to depression remain elusive. With 24,940 depression-free participants in the UK Biobank, exposure to PM2.5 and its 5 constituents (ammonium, nitrate, sulfate, elemental carbon, and organic carbon) was estimated. We integrated Olink-based proteomics and NMR-based metabolomics using Cox proportional hazards models, mediation analyses, functional enrichment analyses, and drug predictive analyses. We identified 982 depression cases during a mean follow-up of thirteen years. PM2.5 and its constituents was associated with increased depression risk, with HRs up to 1.20 per SD increment in ammonium. We identified 140 proteins and 3 metabolites as statistically-significant mediators, with mediation proportions up to 8.00% and 3.42%. These mediators were enriched in lipid and unsaturated fatty acid metabolism, immune regulation, and inflammation responses. Drug predictive analyses showed potential drug repurposing. Shifts in biomolecules partially explained PM2.5-depression associations, highlighting inflammation and lipid dysregulation as potential pathways.

BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a leading global cause of mortality, with ambient fine particulate matter (PM2.5) recognized as a key environmental risk factor. However, the circulating proteomic alterations that may underlie the association between long-term PM2.5 exposure and incident COPD remain incompletely characterized. METHODS:We included 48,219 participants from the UK Biobank. Baseline plasma proteins were measured using the Olink Explore 3072 platform, and PM2.5 concentrations were assigned using the ESCAPE land-use regression model. The PM2.5-protein associations were estimated using multivariable linear regression. An elastic net model was used to construct a PM2.5-related proteomic score. Cox proportional hazards models were then applied to evaluate the associations of PM2.5 and PM2.5-related proteomic score with incident COPD. Statistical mediation, pathway enrichment, protein-protein interaction, and druggability analyses were further performed. RESULTS:Over a median follow-up of 12.6 years, 1955 participants developed COPD. We identified 1629 proteins associated with PM2.5 exposure and 1185 proteins associated with incident COPD. Among proteins associated with both PM2.5 exposure and incident COPD, 500 showed evidence consistent with statistical mediation in exploratory analyses. The largest estimated statistical mediation proportions were observed for PLAUR (24.7%), GDF15 (17.4%), and MMP12 (16.3%). Enrichment analyses highlighted inflammatory and stress-response pathways, and protein-protein interaction analysis identified IL1B, TGFB1, and CXCL8 as network hubs. Database screening and molecular docking further prioritized PLAUR, MMP12, and CXCL8 as potentially druggable candidate proteins for future experimental evaluation. CONCLUSION:Long-term PM2.5 exposure was associated with widespread plasma proteomic alterations, and a subset of proteins showed evidence consistent with statistical mediation of the PM2.5-COPD association. These systems-level findings provide pathway-level biological plausibility and prioritize candidate biomarkers and potentially druggable proteins for external replication, mechanistic validation, and future translational research.

OBJECTIVES:Human mobility may facilitate dengue transmission, but the contributions of different mobility patterns in China remain unclear. METHODS:We collected dengue data from 2005 to 2023 in China and applied the Getis-Ord Gi* statistic to identify high-incidence provinces. A generalized additive model was used to quantify the effects of intra-provincial, inter-provincial, and international inflows on dengue incidence in high-incidence provinces. Inflows from Southeast Asia were further assessed in Guangdong and Yunnan, where most imported cases are reported. RESULTS:Dengue distribution expanded northward in China, with high-incidence clusters in Yunnan and southeastern coastal provinces. All patterns of inflow were positively associated with increased dengue risk, with consistent lag effects from day 0 to day 14. International inflow showed the strongest association, with the highest relative risk (RR) in Yunnan (RR = 2.95; 95% CI: 2.68-3.25). The inflows from Southeast Asia were significantly associated with dengue fever in Guangdong (RR = 1.85; 95% CI: 1.81-1.90) and Yunnan (RR = 2.99; 95% CI: 2.48-3.60). CONCLUSION:The three population mobility patterns play key roles in dengue transmission in China, which underscores the need for differentiated prevention strategies and collaboration with transportation and customs departments to curb dengue fever at an early stage.

Background: Armed conflicts, floods, droughts, and earthquakes are suggested as potential drivers in cholera transmission. However, the extent to which the occurrence and intensity of these events are associated with cholera outbreaks is unknown. Methods: We collected cholera reports, genetic records, armed conflict, natural disaster, socioeconomic, geographical, and climate data of 152 countries from 1980 to 2022. A modified Poisson generalized additive mixed model (GAMM) was applied to estimate the impact of armed conflicts and natural disasters on cholera occurrence. The cholera burden attributed to these events was further estimated and aggregated by region to analyze geographical inequality. Results: Three-year cumulative armed conflicts and earthquakes were significantly associated with cholera, with prevalence ratios (PR) of 1.03 (95% CI: 1.02-1.04) and 1.04 (95% CI: 1.03-1.06) respectively. Countries with high-intensity armed conflicts (i.e., the upper tertile of three-year cumulative armed conflict counts) had a PR of 1.27 (95% CI: 1.16-1.39) for cholera. High-intensity natural disasters were also positively associated with cholera risk: floods (PR =1.24, 95% CI: 1.16-1.32), earthquakes (PR = 1.31, 95% CI: 1.19-1.4 4), and drought (PR = 1.06, 95% CI: 1.02-1.11). Furthermore, regional disparities in the frequency of armed conflicts and natural disasters exacerbated inequalities in cholera burden. Sub-Saharan Africa bore the greatest number of cholera occurrences attributed to armed conflicts, floods, and droughts, with attributable fractions (AFs) of 6.05%, 11.39%, and 2.14%, respectively. Conclusion: Our findings underscore the necessity of maintaining stable social conditions and strengthening disaster preparedness, early warning, and response capacity in the effort to eradicate cholera, particularly in high-burden areas. (c) 2026 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

OBJECTIVE:This study aimed to identify metabolic signatures reflecting air pollution and further explore their associations with gout risk. METHODS:We retrieved 207,908 gout-free participants from a large cohort study. Annual average concentrations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOx) were estimated using bilinear interpolation based on the residential address. Elastic net regression was used to identify air pollutant-related metabolites and construct metabolic signatures. Cox regression models were performed to evaluate the association between air pollutants, related metabolic signatures, and the risk of gout. Mediation analyses were performed to explore how metabolites mediate the relationships linking air pollutants to gout. RESULTS:During a median follow-up of 12.56 years, 2,474 incident gout cases were identified. We identified metabolite biomarkers reflecting air pollutants, including 87 metabolites for PM2.5, 76 for PM10, 68 for NO2, and 71 for NOx. Air pollution-related metabolic signatures were associated with elevated gout risk, with hazard ratios of 1.10 (95% confidence interval [CI] 1.05-1.14) for PM2.5, 1.12 (95% CI 1.08-1.17) for PM10, 1.09 (95% CI 1.04-1.13) for NO2, and 1.11 (95% CI 1.06-1.15) for NOx. Consistently, per-interquartile range increase in PM2.5, PM10, NO2, and NOx was associated with 17%, 15%, 6%, and 6% increased gout risk, respectively. Additionally, metabolic signatures mediated the air pollutants-gout associations, with the mediation proportions varying from 2.36% for PM2.5 to 4.30% for NOx. CONCLUSION:Our study indicated that air pollutants and metabolic signatures were associated with elevated gout risk, with metabolomic signatures playing a mediating role in the air pollutants-gout relationship.

BACKGROUND:Air pollution exposure has been linked to ischaemic stroke (IS), yet the sensitive life stages for pollution-related IS risk and the interplay of genetic susceptibility remain unclear. METHODS:We analysed 404 234 IS-free participants from a large UK prospective cohort. Exposures to PM2.5, SO2 and O3 were estimated across five life stages (toddlerhood, childhood, adolescence, youth and middle-aged to older adulthood) and cumulatively from birth. Bayesian life-course models identified sensitive exposure windows and quantile g-computation estimated mixture effects. Gene-environment interactions with polygenic risk scores (PRSs) were evaluated using relative excess risk due to interaction (RERI), attributable proportion (AP) and synergy index (S). RESULTS:During a median follow-up of 13.6 years, 8130 IS cases occurred. Associations between air pollutants and IS varied by life stage, with stronger associations observed in middle-aged to older adulthood (HRs: 1.586 (95% CI 1.554 to 1.618) for PM2.5, 1.180 (1.167-1.193) for SO2, 1.588 (1.552-1.624) for O3). For cumulative exposures, elevated risks were seen from toddlerhood to older adulthood (HRs: 1.139-1.313). Mixture effects were most pronounced in toddlerhood (HR=2.829, 95% CI 2.623 to 3.052), largely driven by SO2 (weight=0.500). Bayesian life-course models suggested PM2.5 (25.2%) and O3 (24.5%) had greater relative contributions in childhood and adolescence whereas SO2 (45.9%) contributed more in later life. Higher pollutant exposure and elevated PRS were associated with higher IS risk (RERI>0, AP>0 and S>1). CONCLUSIONS:Air pollution associations with IS risk vary across life stages and may be influenced by genetic susceptibility, supporting a life-course prevention approach.

BACKGROUND:Studies have documented the impact of temperature on the incidence of hand, foot, and mouth disease (HFMD); however, no study has examined its impact on the transmissibility. METHODS:The longitudinal surveillance data of HFMD in Zhejiang Province during 2013-2019 were collected from National Notifiable Infectious Diseases Reporting Information System. The incidence of HFMD was represented by daily case counts, and the transmissibility was quantified as the instantaneous reproductive number ([Formula: see text]). The case time series design was applied to investigate the association between temperature and HFMD incidence at small-scale spatial patterns (i.e., townships). General additive model was further employed to analyze the effects of temperature and other driving factors on the transmissibility of HFMD. Separate models were also conducted for each city, along with seasonal and spatial stratified analysis. RESULTS:We observed an inverted V-shaped association between temperature and HFMD incidence, with the highest cumulative relative risk (RR: 3.81, 95% CI: 3.75-3.86) at 28°C compared to the reference temperature. Notably, we discovered that HFMD transmissibility exhibited a similar but more pronounced sensitivity to temperature changes, peaking at a lower temperature of 19.69°C. City-specific and stratified results were aligned with the overall provincial pattern. Additionally, other significant driving factors of HFMD transmissibility included the depletion of susceptible individuals, school holidays, vaccination program, relative humidity, and the Normalized Difference Vegetation Index. CONCLUSION:Nonlinear associations between temperature and HFMD incidence, as well as transmissibility, are observed. Other driving factors potentially contribute to changes in HFMD dynamic transmission. These findings underscore the importance of implementing targeted policies aimed at early intervention, particularly when HFMD transmissibility begins to reach its peak.

Although studies have demonstrated the adverse influence of air pollution, the optimal strategy for reducing air pollution levels to alleviate mortality burden remains elusive. With data from the UK Biobank, annual mean concentrations of five air pollutants (PM2.5, PM10, NO2, NOx, and SO2) for each participant were estimated. The parametric g-computation was applied to estimate the risk differences (RDs) in all-cause and cause-specific mortality under various air pollution intervention strategies. We implemented both dynamic threshold interventions and percentage decremental interventions (e.g., 15%, 25% decrease in concentration) for each pollutant individually (separate strategies) and for multiple pollutants simultaneously (joint strategies). During a median follow-up of 11.51 years, 22,159 (5.98%) deaths occurred among the 370,357 participants. Both separate and joint air pollution intervention strategies were significantly associated with reduced risks of all-cause and cause-specific mortality, with all-cause mortality risk reduced by up to 2.0%. Notably, joint intervention strategies contributed to greater risk reductions compared to separate interventions. For example, the RDs for cancer mortality under the joint intervention scenarios were 1.3 to 3.4 times greater than those under separate interventions when the concentrations of PM2.5, NO2, and SO2 were concurrently lowered by 35%. Our study indicates that targeting air pollution reduction could significantly reduce mortality risks. Joint intervention strategies are more highly recommended than separate intervention strategies.

BACKGROUND:To estimate the disease-specific mortality burden attributable to fine particulate matter (PM2.5) pollution in China across multiple sectors and fuel types during 2015-2022. METHODS:The Greenhouse Gas-Air Pollution Interactions and Synergies (GAINS) model was used to estimate PM2.5 concentrations in Chinese provinces from seven sectors and five fuel types. The relative risks (RR) of seven diseases were assessed using the Integrated Exposure-Response (IER) model. The number of deaths attributable to PM2.5 pollution (DAPP) and the attributable fraction (AF), representing the proportion of total deaths caused by PM2.5 exposure, were estimated by province, sector, and fuel type, then compared across the years 2015, 2019, 2021, and 2022. RESULTS:Ambient PM2.5 concentrations in China exhibited a gradual decline, the most substantial reductions were observed in household, industry, and agriculture. There were 1,440,000 PM2.5-related deaths and 13.8 % AF for China in 2022, with a reduction of 290,000 compared with 2015. The largest reductions among 31 provinces were observed in Henan, followed by Hebei and Shandong, with 27,000, 26,000, and 25,000 decreases, respectively. Additionally, DAPP decreased most in stroke and ischemic heart disease (IHD). For different sectors, agriculture, household and industry sectors demonstrated the greatest reductions in DAPP from 2015 to 2022, accounting for 131,000, 130,000, and 72,000, respectively. In 2022, DAPP attributable to coal combustion decreased by 190,000, with the most substantial reduction observed in the household sector. However, DAPP increased by 23,000 in 2022 compared to 2021, despite a continued decline in AF. CONCLUSION:The findings highlight the substantial public health benefits of emission control measures implemented across multiple sectors in China, including industry, agriculture, and transport. To alleviate the health burden of an aging population, it is necessary and feasible to implement further PM2.5 control efforts and develop targeted policies for different regions, diseases, and industries in China.

Introduction: The United Nations Sustainable Development Goals (UN SDG) include targets for safe drinking water, sanitation, and hygiene (WASH), which are critical in preventing cholera, a persistent health threat in low- and middle-income countries (LMICs). We aimed to assess the attributable burden of WASH on cholera under the UN SDG framework to inform global control efforts. Methods: We extracted cholera-related information along with socioeconomic, geographical, and climate data across 89 LMICs from 2000 to 2017. Genome data from Enterobase and World Health Organization (WHO) weekly reports, were utilized to identify cholera occurrence. A modified Poisson generalized additive mixed model (GAMM) was employed to investigate the impact of WASH access on cholera, and the attributable burden and prevention fraction were further estimated. Results: Statistically significant protective effects against cholera were observed for improved WASH facilities (e.g., piped water: prevalence ratio, PR = 0.88, 95 % CI: 0.85–0.91), while harmful effects were noted for unimproved facilities (e.g., open defecation: PR = 1.09, 95 % CI: 1.06–1.12). Regional disparities in WASH access further contributed to unequal cholera burden. In Sub-Saharan Africa, 25.77 % of cholera occurrences were attributed to the high proportion of unimproved drinking water, much higher than 9.09 % in Northern Africa and Western Asia. Achieving universal access to improved sanitation could reduce cholera risk by 32.98 % in Sub-Saharan Africa, compared to 7.47 % in Central and Southern Asia. Conclusion: Our findings highlight the need for maintaining and increasing access to safe WASH in cholera-affected countries, and offer comprehensive information for implementing targeted, local-level control approaches to end cholera globally.

According to the World Meteorological Organization (WMO), 2024 was the hottest year on record. China had unprecedented heat and heavy precipitation, with a national average temperature of 10 center dot 9 degrees C, 1 center dot 01 degrees C higher than the historical average (1991-2020), and annual precipitation of 697 center dot 7 mm, which is 9 center dot 0% higher than the average. As 2025 marks the 10th anniversary of the Paris Agreement and a key juncture for submitting new contributions, accelerating global climate action is imperative, especially in cities, which account for 58% of the world's population and 70% of total carbon emissions. The sixth annual Lancet Countdown China report on health and climate change, led by the Lancet Countdown Asia Centre at Tsinghua University and coauthored by 80 experts from 27 institutions, tracks 33 indicators across five domains. This year's report features several key updates. Methodologically, the Countdown used the China Meteorological Administration's Chinese global land-surface reanalysis product (CRA40) reanalysis dataset to replace European reanalysis product (ERA5, the fifth generation European Centre for Medium-Range Weather Forecasts reanalysis dataset) data for improved accuracy. The report expanded 17 indicators from the provincial to city level to support targeted local policy making. Furthermore, the report introduced three new indicators-sleep loss (indicator 1.1.4), compound heatwaves (indicator 1.1.5), and the Greenspace Exposure Inequality Index (indicator 2.2.3), along with two new panels on city-level research. As with previous years, where possible, all indicators have been updated with the latest data and methodological refinements.

The year 2023 marked a pivotal moment for climate change globally, across Asia, and within China. China experienced its highest recorded average annual temperature of 10.71 degrees C (0.82 degrees C above the 1981-2010 average), its second-lowest annual rainfall since 2012, and endured significant flood and drought events. The 1.5 degrees C warming limit set by the Paris Agreement is on the verge of being exceeded, posing severe threats to human health, underscoring the urgent need for immediate action. In 2024, the Lancet Countdown Asia Centre, leading a collaboration of 77 experts from 28 prominent research institutions, released the fifth China Report of the Lancet Countdown on health and climate change. This report tracks China's progress in addressing health and climate change.The report is structured around five thematic domains encompassing 31 indicators: (1) climate change impacts, exposures, and vulnerability; (2) adaptation, planning, and resilience for health; (3) mitigation actions and health co-benefits; (4) economics and finance; (5) public and political engagement. The report in this year adopted a forward-looking perspective, including predictive analyses of climate-related health risks and tracks trends in compound exposures (Pannel 2), emphasizing the urgent need for adaptive measures. Two new indicators are introduced this year: health-care sector emissions (Indicator 3.4) and stranded coal assets from the low-carbon transition (Indicator 4.2.5), both underscoring the necessity of mitigation efforts to safeguard public health. The findings reveal that health risks are already severe and are projected to worsen significantly. In 2023, the average number of heatwave exposure days per capita in China reached 16 days, over three times the historical average (1986-2005). Heatwave-related mortality surged by 1.9 times, while heat-related losses in labor productivity increased by approximately 24%, and safe outdoor activity hours dropped by 60%. Compound hot and dry days also rose sharply, with 2023 recording 30 times the average from 1986-2005. By 2060, compared to the baseline (1986-2005), annual average heatwave-related mortality is projected to increase by 183%-275%, and labor productivity losses by 28%-37%. By 2030, mortality attributable to wildfires are expected to rise by 28%-36% compared to the baseline. Moreover, compared to 2013-2019 levels, the annual excess risk of dengue fever incidence is anticipated to increase by 15.3%-15.5%by 2060, with provinces such as Hainan, Guangdong, Jiangsu, and Shanxi facing a surge of 30%-60%. Based on the findings, the following recommendations are put forth to safeguard against the climate change-related health risks: Establish an effective inter-departmental coordination mechanism for responding to health risks from climate change. China should implement a ministerial coordination mechanism at the national level to coordinate resources, and explore best practices for establishing local coordination mechanisms. Accelerate the implementation of the control of overall carbon emissions at the regional level. With national policies now issued, regions need to quickly expand renewable energy, reduce the carbon intensity of energy, and enhance carbon emissions control to avoid future risks of stranded assets and health damages. Advance climate and health-friendly investment and financing. China will need to cut fossil fuel subsidies and increase financial support for essential mitigation and adaptation technologies. Develop a low-carbon health-care system. China should set China will need to cut fossil fuel subsidies and increase financial support for essential mitigation and adaptation technologies. Provide high-quality health meteorological services. Current tailored weather-related health services should be expanded to other parts in China. These services should offer personalised warnings that consider the specific geographical location, the prevalent diseases in the area, and individual susceptibilities.

Exposure to low and high ambient daily temperature has been associated with cardiovascular diseases. However, the hourly association, which may enable a more precise healthcare response, has rarely been explored. This study conducted a time-stratified case-crossover analysis of emergency patients with acute chest pain at the Chest Pain Center (CPC) in Foshan, China from 2018 to 2023. We employed a conditional logistic regression model coupled with a distributed lag non-linear model (DLNM) to evaluate the hourly exposure-lag-response associations with adjustment for potential confounding factors. A total of 17,634 emergency patients with acute chest pain were recorded in this study. We found that cold exposure was significantly associated with the risk of cardiac chest pain (CCP) onset within 0–144 h prior to onset. The odds ratios (ORs) of CCP onset were 1.793 (95

As China's population ages rapidly, the health risks associated with a changing climate are becoming more threatening. The 2022 China report of the Lancet Countdown, led by Tsinghua University with the contributions of 73 experts from 23 leading global institutions, tracks progress in climate change and health in China through 27 indicators across five domains: (1) Climate change impacts, exposure, and vulnerability; (2) adaptation, planning, and resilience for health; (3) mitigation actions and health co-benefits; (4) economics and finance; and (5) public and political engagement. This report is the third China Lancet Countdown report, paying particular attention to the impacts on the elderly and highlighting the urgency of taking action. We selected the most urgent and relevant indicators to complete a policy brief that provides a better understanding of recent progress on climate change and health in China. We found heat-related health impacts increased from 2020 to 2021, increasing heat-related mortality, reducing labour capacity, and undermining the capacity to partake in physical activity due to rising temperature. In addition, exposure to wildfire, extreme drought, and extreme rainfall also increased in different regions across China. In 2021, compared with the 1986-2005 average, people in China had an average of 7.85 more heatwave days (which led to an extra 13185 heatwave-related deaths), and a loss of 0.67 more hours of safe outdoor physical exercise per day. The rising temperature also caused the annual average exposure to wildfire to increase by 60.0% between 2017-2021 compared with the 2001-2005 average. Meanwhile, the engagement on health and climate issues from individuals, scholars, and public sectors continues to grow rapidly. From 2020 to 2021, the number of climate-related articles and documents on the official websites of four Chinese Government departments grew by 1.83 times, and the number of climate-and-health-related articles and documents grew by 3.7 times. However, older populations received marginal attention on this issue in media coverage, although they are more vulnerable to the health threats of climate change than younger populations. In most provinces, people aged 65 years and older are facing higher health risks of climate change than the general population. In addition, we found that the inputs and attention to adaptation are still insufficient compared with the increasing health risks posed by climate change. Based on the findings, the following recommendations are made to protect climate change-related health risks: (1) Increasing adaptation across governmental departments and accelerating investment in climate resilience. Adaptation across governmental departments and investment in climate resilience must be substantially increased to protect the health of Chinese populations. (2) Developing a stand-alone Health National Climate Adaptation Plan. Leaders must strengthen the response of local efforts to national plans, for example, by establishing a nationwide heat and cold and health early warning system with regional characteristics. (3) Prioritise climate change in health policies, with a focus on the wellbeing of vulnerable populations. Leaders should include climate change health impact prevention and treatment as one of the key responsibilities of the new National Bureau of Disease Control and Prevention. (4) Accelerating coal reduction and integrating health considerations into China's pathway to carbon neutrality. Leaders must strictly control the capacity of coal-fired power generation and accelerate the pace of coal reduction (especially in the household sector). (5) Promoting renewable energy generation and consumption by redirecting fossil fuel subsidies to China's low-carbon economy. Leaders should keep encouraging renewable energy generation and consumption.

目的 分析2014-2016年山东省各县手足口的分布及时空聚集性,为提高山东省手足口病防治工作的高效性、针对性提供理论依据.方法 首先对每个年份的疫情分布进行描述性分析,并使用了空间自相关、热点分析(Geti-Ord)、时空扫描分析以研究手足口病的时空聚集性.结果 全局空间自相关结果(MoranⅠ均大于0)提示存在聚集性;局部空间自相关和热点分析均提示鲁中、鲁西北存在局部聚集性;时空扫描得出2014-2016年间的多级聚集性区域,其中一级聚集区(RR=1.33,LLR=2045.94)和二级聚集区(RR=2.43,LLR=1321.5)包含鲁中、西北的44个区县,并且主要于温度回暖的月份出现.结论 山东省手足口病发病率存在时空聚集性.今后的防治工作、医疗资源配置应更加针对人口流动大的地区以及气候回暖的高风险季节.

BACKGROUND:Ambient sulfur dioxide (SO2) has been associated with morbidity and mortality of respiratory diseases, however, its effect on length of hospital stays (LOS) and cost for these diagnoses remain unclear. METHODS:We collected hospital admission information for respiratory diseases from all 11 cities in the Shanxi Province of China during 2017-2019. We assessed individual-level exposure by using an inverse distance weighting approach based on geocoded residential addresses. A generalized additive model was built to delineate city-specific effects of SO2 on hospitalization, hospital expenditure, and length of hospital stay for respiratory diseases. The overall effects were obtained by random-effects meta-analysis. We further estimated the respiratory burden attributable to SO2 by comparing different reference concentrations. RESULTS:We observed significant effects of SO2 exposure on respiratory diseases. At the provincial level, each 10 μg/m3 increase in SO2 on lag03 was associated with a 0.63% (95% CI: 0.14-0.11) increase in hospital admission, an increase of 4.56 days (95% CI: 1.16-7.95) of hospital stay, and 3647.97 renminbi (RMB, Chinese money) (95% CI: 1091.05-6204.90) in hospital cost. We estimated about 6.13 (95% CI: 1.33-11.10) thousand hospital admissions, 65.77 million RMB (95% CI: 19.67-111.87) in hospital expenditure, and 82.13 (95% CI: 20.87-143.40) thousand days of hospital stay could have potentially been avoided had the daily SO2 concentrations been reduced to WHO's reference concentration (40 µg/m3). Variable values in correspondence with this reference concentration could reduce the hospital cost and LOS of each case by 52.67 RMB (95% CI: 15.75-89.59) and 0.07 days (95% CI: 0.02-0.117). CONCLUSION:This study provides evidence that short-term ambient SO2 exposure is an important risk factor of respiratory diseases, indicating that continually tightening policies to reduce SO2 levels could effectively reduce respiratory disease burden in Shanxi Province.