# Spatiotemporal trends and driving factors of gonorrhea incidence in China: a 20-year analysis (2003–2022)

## TL;DR

This study analyzes 20 years of gonorrhea data in China to understand how incidence rates have changed over time and what factors influence them.

## Contribution

The study introduces a novel spatiotemporal analytical framework combining scan statistics and GTWR to explore gonorrhea trends and drivers in China.

## Key findings

- National gonorrhea incidence rates declined significantly from 2004 to 2022 but slowed after 2013.
- Southeastern China had persistent high-risk clusters, while western provinces showed emerging hotspots.
- Economic development shifted from protective to risk-enhancing effects, and healthcare resources showed weakening influence over time.

## Abstract

Gonorrhea represents a major global public health challenge, demonstrating significant spatiotemporal heterogeneity across China. Therefore, spatiotemporal analytical approaches are required to better understand gonorrhea incidence patterns.

Employing an innovative methodological framework that combines spatiotemporal scan statistics with Geographically and Temporally Weighted Regression (GTWR), this study systematically examines gonorrhea incidence dynamics across mainland China from 2003 to 2022, with particular focus on exploring the impacts of healthcare resources, economic development, education levels, and demographic structure on gonorrhea incidence.

Our comprehensive analysis reveals three key findings: First, while national incidence rates declined significantly from 20.64 cases per 100,000 population in 2004 to 5.99 in 2022, the rate of decrease slowed markedly after 2013, suggesting a stabilization phase in prevention effectiveness. Second, spatial analysis identified distinct epidemiological patterns, with persistent high-risk clusters in the southeastern region contrasting with emerging hotspots in western provinces, reflecting China’s uneven regional development. Third, our GTWR modeling uncovered complex driver dynamics: healthcare resources showed temporally weakening effects, economic development shifted from protective to risk-enhancing effects, education maintained stable protective effects, and demographic influences exhibited significant spatial variation – particularly the increasing association between male predominance and higher incidence in southern provinces.

These findings enhance gonorrhea surveillance precision and inform targeted regional prevention approaches, while providing a scientific basis for optimizing public health resource allocation.