Spatial distribution and natural environment mechanism of the cholera epidemic in ancient Jiangnan area, China

Cholera, as an acute, high-risk and widespread infectious disease, has been studied by many scholars. Based on the data from <Annals of Epidemics in China over the Past 3000 Years>, this research investigated the spatial distribution of the cholera epidemic and natural environment mechanism of the cholera epidemic in the Jiangnan area, from the year 1820 to 1821. We applied a set of spatial statistical analyses to investigate the spatial heterogeneity and the factors that influence the cholera epidemic in the Jiangnan area. Results show that: 1) Spatial distribution of cholera epidemic lied at different geographical scales. The cholera epidemic was highly concentrated in Shanghai, Nanjing and Hangzhou; There was a north-south difference of cholera epidemic distribution at the regional scale. The cholera epidemic was more concentrated in the north part than in the south part of the Jiangnan area; Meanwhile, there was an east-west difference in cholera epidemic distribution where the intensity of the cholera epidemic decreased from east to northwest and southwest. 2) A land-sea distribution of cholera can be also found. The Chang-Hang line and the Hu-Jia line were the two boundaries of the cholera epidemic in the Jiangnan area. 3) There was a close relationship between the distribution of the cholera epidemic and natural environment in the Jiangnan area. The influence intensity of natural factors on epidemic disasters followed the order of temperature (0.760) > precipitation (0.663) > river distance (0.413) > river density (0.398) > elevation (0.395). The present investigation is conductive to establish a prevention system for public health emergencies, which contributes to the sustainable development of society and human health.