The Spatio-temporal Patterns and Formation Mechanisms of Cholera Epidemics in Hubei Province , China from 1949 to 2020

Background The global epidemic of cholera, a virulent enteric infection, poses a serious threat to public health and socio-economics. The rapid spread and high lethality of the disease not only cause large numbers of deaths and injuries, but also have far-reaching effects by disrupting production, increasing the burden of health care and impeding economic exchanges. Method Based on cholera historical and environmental data, M-K test, wavelet analysis, hotspot analysis, epidemic 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. Results Temporally, high incidence occurred in the 1980s and 1990s, with summer and fall being the dominant seasons. Four fluctuation cycles were identified: 55 years, 29 years, 19 years, and 8 years. Spatially, 71 counties and districts were cumulatively affected, with Wuhan and Xianning serving as the primary hotspots. The epidemic was distributed along rivers and lakes, and its center of gravity shifted southward and westward over time. Mechanistically, the spread was influenced by multiple factors, including natural drivers (temperature, river networks), disasters (floods and droughts), and socioeconomic conditions (population, GDP). The spatial and temporal characteristics of the cholera epidemic were influenced by the spatial and temporal scales of various factors. Conclusion This study will help to reveal the spatiotemporal patterns and formation mechanisms of regional cholera epidemics, fill the gap in cholera research in Hubei Province, and provide a reference for cholera prevention and control in areas with dense rivers and lakes.