Influence of natural and anthropogenic drivers on plague risk in Southwest China: A multicenter cross-sectional study

Abstract

The natural and anthropogenic environment have contributed to the dynamic risk of plague and their threats to human health. Although evidence has indicated the environmental suitability for disease dynamics, the alteration of the risk by anthropogenic factors have not been fully investigated. We conducted a multicenter cross-sectional survey among 2998 residences across 54 villages in 13 counties in Southwest China. With the survey data, we developed composite anthropogenic indices to make systematic assessment of people's living environment, household sanitation levels, and risk perception regarding plague. We identified disparities of these anthropogenic indices among ethnic groups. By featuring plague, we further established statistical model to assess how environmental and anthropogenic factors associate with the occurrence of the typical zoonotic disease. Our results show that the improved living environment is significantly linked to the lower risk of plague occurrence. In contrast, we have no evidence for the significant association between household sanitation, protective behaviors, environmental conditions and plague risk. These findings pointed at the improved living environment as the most likely anthropogenic driver that is associated with the reduced risk of plague. Integrating anthropogenic modulators of disease dynamics in public health strategies would be the key for the effective management of disease risks.

Keywords: Anthropogenic factors; Epidemiology; Ethnic disparities; Living conditions; Plague.

Fig. 1

Disparities of the sociodemographic characteristics across ethnic groups. (A) County-level number of respondents and ethnic groups involved in the survey. Circle size and color indicates the number of respondents and ethnic groups in each county, respectively. The (B) fraction of male and female respondents and (C) median age are stratified by ethnic groups.

Fig. 2

Protective behaviors and risk perception of plague among respondents. Each panel represents the fraction of respondents reporting specific behaviors or practices. Stacked bars represent binary responses for questions regarding protective behaviors and risk perception of plague. For the respondents who answered “Yes”, details of the frequency of the behaviors or practices are provided by grouped bars.

Fig. 3

Comprehensive anthropogenic indices of living environment, household sanitation, and protective behavior. (A) Estimates of anthropogenic indices across villages. (B) Disparities of the indices between villages with and without endemic plague circulation, as well as the urban and rural settings. (C) Disparities of the indices across ethnic groups. Statistically significant results (p < 0.05) are marked with *.

Fig. 4

Estimates of the effect of comprehensive indices and environmental factors on the occurrence of plague. Odds ratios (OR) and 95 % confidence intervals (CI) for variables are presented. Significant associations (p < 0.05) are marked with *.