Urban environmental and climatic determinants of pediatric respiratory infection: Microscale spatiotemporal evidence from Fuzhou, China

Urban environmental and climatic conditions play a pivotal role in shaping pediatric respiratory health, yet their microscale influences on specific infectious diseases such as mycoplasma pneumoniae pneumonia (MPP) remain poorly understood. To address this gap, this study investigated the spatiotemporal dynamics of pediatric MPP across 46 urban subdistricts in Fuzhou, China. Using global and local spatial autocorrelation, space–time scan statistics, and interpretable machine learning models, we also assessed both incidence patterns and progression to severe disease as well as their built-environment determinants. Key findings include: (1) Seasonality remains pronounced, with autumn–winter peaks and summer troughs; high-risk clusters are concentrated in central urban areas, whereas peripheral regions exhibit weaker clustering, driven by climate, population density, transport networks, greenspace, and school-term cycles. (2) Autumn–winter as the critical risk period encompasses a large share of cases and centers on repeatedly high-incidence subdistricts. Demographically, boys and children aged 5–9 years have the highest risk, whereas the 10–14 age group—particularly girls—shows the lowest incidence. (3) Machine learning highlighted age, near-road exposure, and selected land-use/amenity intensities as core predictors, especially for severe progression MPP cases. Age exhibits a non-monotonic incidence profile, while distance from primary roads has a steep inverse gradient, with elevated risk confined to a 100–150 m roadside buffer zone. School density contributes a monotonic positive association, whereas greenspace is broadly protective. These results support seasonally tailored, microscale interventions, strengthened school health monitoring, and targeted urban design in high-prevalence corridors.