# The spatio-temporal patterns and formation mechanisms of cholera epidemics in Hubei Province, China from 1949 to 2020

## TL;DR

This study analyzes cholera epidemics in Hubei, China from 1949 to 2020, identifying spatiotemporal patterns and factors driving outbreaks.

## Contribution

The study reveals spatiotemporal patterns and formation mechanisms of cholera epidemics in Hubei, filling a research gap in this region.

## Key findings

- Cholera incidence peaked in the 1980s and 1990s, with summer and autumn as dominant seasons.
- Epidemics clustered along rivers and lakes, with Wuhan and Xianning as hotspots.
- Population density and summer temperatures were direct drivers, while river networks facilitated transmission.

## Abstract

The global epidemics of cholera, a virulent enteric infection, pose a serious threat to public health and socio-economics. The disease’s rapid spread and high mortality have led to heavy casualties, along with disruptions to production, rising healthcare burdens and impaired economic exchanges.

Based on cholera historical and environmental data, Mann-Kendall test, wavelet analysis, hotspot analysis, epidemics center of gravity, and structural equation modeling were employed to investigate the spatial and temporal distribution pattern and formation mechanism of cholera epidemics in Hubei Province during the period of 1949–2020.

Based on existing historical monitoring records. Temporally, high incidence occurred in the 1980s and 1990s, with summer and autumn being the dominant seasons. Three fluctuation cycles were identified: 29 years, 19 years, and 8 years. Spatially, 71 counties and districts were cumulatively affected, with Wuhan and Xianning serving as the primary hotspots. Cholera epidemics were distributed along rivers and lakes, and their centers of gravity shifted southward and westward over time. Mechanistically, cholera epidemics were the result of the combined effects of natural, disaster, and human factors. Population density and summer temperatures were the direct factors driving the spread of cholera epidemics, while river networks formed the basic environmental background that facilitated transmission. Natural environmental factors such as drought and flood disasters, elevation, and precipitation, as well as human environmental factors including road networks and economic conditions, could not only directly drive the spread of epidemics but also regulate epidemics development through indirect pathways. The coupling effects of various factors across different spatiotemporal scales jointly shaped the unique spatiotemporal distribution and evolutionary characteristics of cholera epidemics.

This study helped to reveal the spatiotemporal patterns and formation mechanisms of regional cholera epidemics, filled the gap in cholera research in Hubei Province, and provided a reference for cholera prevention and control in areas with dense rivers and lakes.

Cholera remains a major threat to public health, especially in regions with dense water networks. As a “province of a thousand lakes” in China, Hubei Province has a long history of cholera epidemics, but its long-term spatiotemporal patterns and driving forces were not fully understood. We studied cholera cases in Hubei Province from 1949 to 2020, combining historical records and environmental data with analytical tools like spatial analysis and statistical modeling. Based on existing historical monitoring records, we found cholera epidemics were most severe in the 1980s–1990s, peaked in summer and autumn, and had three cycles (29, 19, 8 years). Spatially, it clustered in eastern Hubei Province along rivers/lakes, with its center shifting southwest over time. Population density and summer temperatures were the direct factors driving the outbreak of cholera epidemics, while river networks constituted the basic environmental background that facilitated epidemics transmission. Natural environmental factors such as elevation and precipitation, human environmental factors including road networks and economic conditions, as well as drought and flood disasters, could not only directly drive the spread of epidemics but also regulate the development of epidemics through indirect pathways. Our findings filled gaps in Hubei’s cholera research and provided targeted containment and prevention clues for water-rich regions globally, thereby helping to balance environmental protection and disease control.