To investigate the association between long-term exposure to air pollutants and immunoglobulin G (IgG) antibody levels in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection cases, providing evidence for revealing the impacts of environmental factors on post-infection immune responses.

In March 2023, a combined convenience and stratified random sampling strategy was employed to survey community residents in 14 districts and counties of Yichang city, Hubei province. Questionnaire data and IgG measurements were obtained, and 3 885 vaccinated individuals with SARS-CoV-2 breakthrough infections were included in the analysis. Residential addresses were decoded to latitude and longitude. Publicly available environmental databases were used to estimate long-term exposure to fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), ultrafine particulate matter (PM₁), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO), temperature, relative humidity, and population density. Multivariate linear regression models were employed to evaluate the effects of long-term pollutant exposure on IgG levels.

Per interquartile range increase in PM₁ and NO₂ was associated with –2.83% (95%CI: –5.22% to –0.45%) and –3.17% (95%CI: –5.71% to –0.63%) changes in IgG antibody levels, respectively. Combined exposure to PM₁ and NO₂ was associated with a –1.49% (95%CI: –2.89% to –0.10%) change in IgG antibody level, with NO₂ contributing a higher proportion (57.0%) to the overall effect. Negative associations of PM₁ and NO₂ with IgG levels were more pronounced among individuals aged ≥ 60 years, smokers, and those with a time interval ≥ 12 months between the last vaccination and infection (all P_interaction < 0.05).

Long-term exposure to PM₁ and NO₂ may impair the immune response following SARS-CoV-2 breakthrough infection. Individuals aged ≥ 60 years, smokers, and those with extended intervals since last vaccination are predisposed to weaker immune responses.

To investigate the relationship between the metabolites of polycyclic aromatic hydrocarbons (PAHs) in urine and the changes in cognitive function of steel mill workers.

In 2019, 960 workers from a coking plant in Shanxi province were selected to undergo basic information investigations, cognitive function tests, and detection for hydroxylated metabolites of polycyclic aromatic hydrocarbons (OH-PAHs) in urine. During the follow-up in 2023, a total of 567 workers completed the cognitive function tests. The Beijing version of the Montreal Cognitive Assessment (MoCA) was employed to test the cognitive function of the workers. High performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) was utilized to detect OH-PAHs in urine. The generalized linear model and the generalized estimation equation were adopted to analyze the relationship between urinary OH-PAHs and the cognitive function of the workers.

Subjects were 49 (46, 53) years old at baseline, with 91.7% being the male. In the longitudinal study, the high exposure groups of 2-hydroxynaphthalene (2-OHNAP) and 1-hydroxypyrene (1-OHPYR) showed decreases in attention (β = –0.338, 95%CI: –0.454 to –0.222, P < 0.001; β = –0.450, 95%CI: –0.557 to –0.343, P < 0.001), abstract thinking (β = –0.463, 95%CI: –0.549 to –0.377, P < 0.001; β = –0.360, 95%CI: –0.450 to –0.269, P < 0.001) and the total score (β = –0.863, 95%CI: –1.284 to –0.443, P < 0.001; β = –0.548, 95%CI: –0.987 to –0.108, P = 0.015).

Long-term exposure to high concentrations of PAHs can lead to reduced cognitive function in steel mill workers.

To explore the associations between triglyceride glucose (TyG)-obesity composite indices and the risk of hyperuricemia (HUA) in Qingdao, China, providing a basis for the prevention and management of HUA.

A prospective cohort study was conducted, encompassing a total of 3 294 adults recruited in the baseline survey from 2006 to 2009 and participating the follow-up survey from 2012 to 2015 and 2019 to 2023. Cox proportional hazards regression was adopted to analyze the associations of baseline TyG-body mass index (TyG-BMI) and TyG-waist circumference (TyG-WC) with the risk of HUA. The restricted cubic spline method was used to analyze the dose-response relationships of baseline TyG-BMI and TyG-WC with the risk of HUA. Subgroup analyses were performed based on covariates such as gender and age, and their interactions with the TyG-obesity composite indices were analyzed.

A total of 430 (13.1%) adults were identified with HUA. Multivariate Cox regression analysis showed that the highest quartiles of baseline TyG-BMI and TyG-WC increased the risk of HUA by 48% (HR = 1.48, 95%CI: 1.10–1.99) and 46% (HR = 1.46, 95%CI: 1.08–1.99) compared with the lowest quartiles. Restricted cubic splines indicated linear dose-response relationships of baseline TyG-BMI (P_overall < 0.001, P_non-linear = 0.639) and TyG-WC (P_overall < 0.001, P_non-linear = 0.776) with the risk of HUA. Subgroup analyses showed that the highest quartiles of baseline TyG-obesity composite indices in females, rural adults, and hypertension adults were higher than those in males, urban adults, and non-hypertension adults (all P < 0.05). No significant interactions were observed with TyG-obesity composite indices (all P > 0.05).

Elevated baseline levels of TyG-BMI and TyG-WC are associated with an increased risk of HUA, particularly among females, rural adults, and hypertension adults.

To investigate the impact of positive and negative cervical cancer screening science messages on screening preferences of gynecologic outpatients by using message framing effects to inform decision making to enhance science popularization efficacy as well as improve health screening behaviors of high-risk populations.

From August 2023 to March 2024, we conducted discrete choice experiments with gynecologic outpatients from four hospitals in Minhang district of Shanghai. Participants were randomly assigned to either positive or negative massage intervention groups, with 221 participants in the positive group and 227 participants in the negative group ultimately included. The mixed logit model in STATA 16.0 was used for data analysis.

Both groups demonstrated positive preferences (β > 0) for public hospitals, female physicians, shorter screening intervals, and lower false-negative/positive rates. However, attribute prioritization and willingness-to-pay (WTP) differed substantially between groups: the positive group prioritized screening location (25.08%) over time interval (7.24%), while the negative group emphasized false-positive rate (22.41%) over pain perception (10.96%). Comparative analysis revealed higher WTP in the positive group for public hospitals, painless procedures, and female physicians, whereas the negative group showed greater WTP for annual screening, biennial screening, and protocols with 5% false-negative/positive rates.

Message framing significantly impacts screening preferences, with negative framing emphasizing result accuracy and screening frequency, versus positive framing prioritizing procedural comfort. These findings advocate for differentiated science popularization strategies in health promotion campaigns.

To explore the influencing factors of and differences in cigarette smoking and e-cigarette use among school students in four typical cultural regions (Yangtze River Delta, Pearl River Delta, southwestern China, and northern China) of China, thus providing a data basis for formulating policies tailored to tobacco control interventions for students.

From September 2022 to March 2023, a multi-stage mixed sampling approach combining quota sampling and cluster sampling was employed to conduct a survey on risk behaviors among 2 815 students at four types of schools (secondary vocational schools, senior high schools, junior colleges, and universities) in the four typical cultural regions. Stata 16.0 was used to conduct χ² tests, multivariate logistic regression analyses, and Wald tests based on seemingly unrelated regression.

The prevalence rates of current e-cigarette use and current smoking among school students in the four regions were 1.7% and 5.6%, respectively. Being male (OR = 7.1), having abundant family assets (OR = 4.0), having peers (chatting for ≥ 30 min in the past month) who use e-cigarettes (OR = 3.8), and having peers who smoke cigarettes (OR = 2.5) were significantly associated with current e-cigarette use among school students. For current smoking, being male (OR = 10.4), aging 18–24 years old (OR = 1.8), and having peers who smoke cigarettes (OR = 7.4) were positively associated with current smoking among school students. Comparison of regression coefficients among different influencing factors showed that aging 18–24 years old and having peers who smoke cigarettes had stronger associations with current smoking among school students than current e-cigarette use. Conversely, having abundant family assets and having peers who use e-cigarettes had more significant associations with e-cigarette use among school students (P < 0.05). Although gender was significantly associated in both the models for e-cigarette use and cigarette smoking, the coefficients had no significant difference between the two.

E-cigarette use is consistent with the pattern of diffusion of innovations prioritized for adoption by high socioeconomic status, and smoking is more concentrated among those aged 18–24 years old than among those aged 15–17 years old, reflecting the rising trend of e-cigarette use and the steady or declining trend of cigarette smoking among school students.

To develop the Chinese Version People′s Voice Survey (PVS-CN) that incorporates both international comparability and local characteristics and test its reliability and validity.

On the basis of collaborative development of the global version of the evaluation tool, the PVS-CN was formed through localization revisions, translation–back translation, cross-cultural adaptation, and adjustments, with the scale items being tested. In October 2023, a mobile phone survey was conducted across China′s mainland (excluding Hong Kong, Macao, and Taiwan), where mobile phone numbers were randomly selected. A total of 534 valid questionnaires were collected, with 42 participants undergoing retesting after a two-week interval. The reliability and validity of the scale were assessed by item analysis, exploratory factor analysis, confirmatory factor analysis, and other methods of reliability and validity testing.

The PVS-CN scale consists of 27 items, covering five dimensions: self-assessed health status, recent healthcare experience, evaluation of the public healthcare system, overall evaluation of the health system, and expectations for the quality of the health system, explaining 67.663% of the total variance. The scale presents the item-level content validity index (I-CVI) ranging from 0.71 to 1.00, the scale-level content validity index/universal agreement (S-CVI/UA) of 0.85, and the average scale-level content validity index (S-CVI/Ave) of 0.98, demonstrating strong content validity. Confirmatory factor analysis shows that the structural validity of the scale is good, with χ²/df = 2.131, normed fit index (NFI) = 0.934, comparative fit index (CFI) = 0.964, goodness-of-fit index (GFI) = 0.910, Tucker-Lewis index (TLI) = 0.960, incremental fit index (IFI) = 0.964, and root mean square error of approximation (RMSEA) = 0.046. The reliability test results show that the overall scale has the Cronbach′s α coefficient of 0.942, the split-half reliability of 0.849, and the test-retest reliability of 0.874, indicating good internal consistency and stability of the scale.

The PVS-CN developed in this study demonstrates good reliability and validity, serving as an effective tool for assessing China′s healthcare system from the public perspective, with potential for further application.

To analyze the variation trends of health resources and service levels of infectious disease departments in hospitals in different regions of China from 2018 to 2022, thus providing evidence for optimizing resource allocation and improving the ability of medical institutions to prevent and control infectious diseases.

The national and provincial statistical data from China Statistical Yearbook (2023) and China Health Statistics Yearbook (2019 to 2023) were used to analyze the incidence of notifiable infectious diseases, the distribution of medical resources, and the provision of medical services in infectious diseases departments. The Lorentz curve, Gini coefficient, health resource density index, and Moran′s index were adopted to evaluate the spatial and temporal equity of health resources and service supply for infectious disease treatment in China from 2018 to 2022.

From 2018 to 2022, the number of beds in infectious disease departments of hospitals in China increased by 30 000 and the number of practicing (assistant) physicians increased by 10 000, with compound growth rates of 5.25% and 15.91%, respectively, which were significantly higher than the overall growth rates of hospitals but still accounted for a low proportion in the overall hospitals. In 2022, the Gini coefficients of the number of beds in infectious disease department, the number of outpatients and emergency patients, and the number of discharged patients according to the population allocation were 0.153, 0.200, and 0.183, respectively, and those according to geographical allocation were 0.612, 0.717, and 0.639, respectively, indicating that population equity was better than geographical equity. From 2018 to 2022, the Moran′s index of the health resource density index of the three indicators ranged from 0.236 to 0.475, showing positive spatial autocorrelation and spatial clustering. The low-low clustering areas were mainly distributed in northwestern and southwestern China, the high-high clustering areas in eastern China, and the low-high clustering areas in Hebei, Anhui, Hubei, Jiangxi and other places near the high-high clustering areas.

The infectious disease departments of hospitals in China faced problems such as a low proportion of health resources, large disparity of resources and services among different regions, and agglomeration of areas with slow development. The capacity of medical institutions to prevent and control infectious diseases should be enhanced from three aspects: strengthening policy support and financial input, promoting the coordinated allocation of medical resources, and raising social awareness of prevention and control.

To establish an evaluation index system for branches of the Chinese Preventive Medicine Association, providing a basis for the management and performance assessment of these branches.

On the basis of literature research and theoretical analysis, an initial evaluation index system for the branches was constructed. The Delphi method was used to consult 22 experts in two rounds from October to December 2024 and then determine the index system, and the analytic hierarchy process was employed to calculate the weights of the indexes.

The positive coefficients of the experts in the two rounds of consultation were 100.00% and 90.91%, respectively, and the authority coefficient was 0.925. The mean scores of the importance of the indexes in the first and second rounds were (4.56 ± 0.28) and (4.59 ± 0.26), respectively. The coordination coefficients in the second round ranged from 0.294 to 0.393 (all P < 0.05), indicating that the expert opinions tended to be consistent. The finally determined index system was composed of 3 first-level indexes, 14 second-level indexes, and 27 third-level indexes, with the comprehensive weights of the third-level indexes ranging from 0.015 9 to 0.157 7.

The index system constructed in this study demonstrates high scientific rigor, reliability, and practical value. It comprehensively reflects the performance of branches of the Chinese Preventive Medicine Association, providing a scientific basis for their assessment and evaluation. This system will contribute to promoting the high-quality development of China’s disease prevention and control efforts and advancing the Healthy China initiative.

To investigate the knowledge, attitude, and practice (KAP) about automated external defibrillators (AEDs) among college students and analyze the influencing factors.

From May to August 2023, a questionnaire survey was conducted among 1 447 students selected by convenient sampling from 6 universities in Beijing. The information on demographic characteristics, understanding of AEDs, and KAP of AEDs was collected. Logistic regression analysis was employed to analyze the factors influencing KAP of AEDs.

A total of 1 447 students were investigated, with an average age of (22.51 ± 4.73) years. Among the population surveyed, 123 (8.50%) individuals had never heard of AEDs; 867 (59.92%) individuals were aware of AEDs and their functions but were unable to operate AEDs; only 68 (4.70%) individuals were capable of operating AEDs. The median (interquartile ranges) of KAP score about AEDs was 62 (55, 68). The logistic regression analysis revealed that participants who had never participated in first aid training (OR = 0.71, 95%CI: 0.52–0.97), were unaware of the legal protection associated with rescue action (OR = 0.72, 95%CI: 0.56–0.91), and lacked knowledge about the availability of AEDs around them (OR = 0.69, 95%CI: 0.53–0.89) scored lower in KAP about AEDs. Conversely, participants who were aware of AEDs and their functions but could not operate AEDs (OR = 1.97, 95%CI: 1.50–2.57) and those who could operate AEDs (OR = 4.51, 95%CI: 2.36–8.64) demonstrated higher scores in KAP about AEDs.

The study indicates that the population has limited knowledge of AEDs but a good level of KAP. Factors such as participation in first aid training, awareness of AEDs function, understanding of legal protection for rescue action, and knowledge of the availability of AEDs around them significantly influence the KAP about AEDs.

To compare the characteristics of HIV/AIDS cases detected through medical institutions and voluntary counseling and testing (VCT) clinics in Liaoning province, China, from 2018 to 2024.

Data on newly reported HIV/AIDS cases, follow-up information, and HIV testing volumes from 2018 to 2024 were extracted from the AIDS Comprehensive Prevention and Control Information System of the Chinese Center for Disease Control and Prevention. Demographic and clinical characteristics of cases from the two detection channels were compared using the chi-square test. Trends in crude detection rates were analyzed using Joinpoint regression to calculate the average annual percent change (AAPC).

From 2018 to 2024, 9 314 and 4 657 HIV/AIDS cases were detected through medical institutions and VCT clinics, respectively. Both channels showed significant declining trends in crude detection rates (medical institutions: AAPC = –5.78%, P = 0.036; VCT clinics: AAPC = –12.38%, P = 0.009). Significant differences (P < 0.001) were observed in all demographic characteristics (gender, age, education, marital status, occupation). Cases from medical institutions were predominantly male (89.50%), aged 20–39 years (51.21%), had a junior high school education or below (46.17%), and were infected via male-to-male sexual contact (59.30%). In contrast, cases from VCT clinics had a higher proportion of males (94.09%), were younger (63.62% aged 20–39), had a higher education level (44.56% with college or above), and a greater proportion were infected via male-to-male sexual contact (78.48%). A stark contrast was noted in the initial CD4⁺ T lymphocyte count: 44.07% of cases from medical institutions had a count < 200 cells/μL, whereas 42.97% from VCT clinics had a count ≥ 350 cells/μL (P < 0.001).

Significant differences exist in the characteristics of HIV/AIDS cases detected through medical institutions and VCT clinics in Liaoning province. Medical institutions serve as the primary case detection channel, while VCT clinics play a crucial role in identifying cases at an earlier disease stage. Public health strategies should leverage the complementary advantages of both approaches to promote early HIV testing and case detection.

To understand the changing trends of places of death among residents in Hunan province from 2014 to 2023 and provide an empirical basis for constructing a hospice care service system in line with national conditions.

The cause-of-death surveillance data of Hunan province from 2014 to 2023 were collected. The 2020 Hunan census data were taken as the standard population to calculate the age-standardized composition ratio of the places of death. The Joinpoint regression model was adopted to analyze the changing trend of different places of death.

From 2014 to 2023, 81.18% of the registered deaths in Hunan province were dying at home, with an average annual increase of 0.40% (AAPC = 0.40%, P < 0.001). The ratio of death in hospitals first decreased (2014–2017: APC =–2.49%, P = 0.020) and then increased (2017–2023: APC = 1.55%, P < 0.001). The ratio of death in nursing institutions increased by 8.59% annually (AAPC = 8.59%, P < 0.001). The ratio of death on the way to hospitals decreased by 4.32% annually (AAPC = –4.32%, P < 0.001). From 2014 to 2023, the ratio of death in rural hospitals in Hunan province was 8.52%, which differed from that (19.69%) in urban hospitals (χ² = 106 862.300, P < 0.001). The ratio of death in rural hospitals increased by 1.31% annually (AAPC = 1.31%, P < 0.001).

Home is still the dominated place of death in Hunan province, while the ratios of death in hospitals and nursing institutions are rising rapidly. Future policies should balance resource equity and cultural adaptation and improve medical access while maintaining the diversity and dignity of end-of-life choices.

To construct a scenario expression model reflecting the objective state of unconventional healthcare-associated infection outbreak events, providing a basis for hospital decision-makers to formulate targeted prevention and control strategies.

On the basis of the "triangular" framework of public safety and the theory of disaster science, the components of scenarios of unconventional healthcare-associated infection outbreak events were classified, and the theoretical method of knowledge elements was used to structurally express each component.

The scenario components of unconventional healthcare-associated infection outbreak events were classified into disaster-causing factors (DF), disaster-bearing body (DB), disaster-prone environment (DE), and emergency activities (EA). The spatial and temporal expression models of unconventional healthcare-associated infection outbreak events were constructed according to the binary form of knowledge elements, and some scenarios of the events were expressed as examples. Finally, the five-dimensional scenario expression model of unconventional healthcare-associated infection outbreak events was proposed, consisting of component (K), denotation (N), feature (P), value (D), and time (T) dimensions.

The cross-domain application of the method of knowledge elements provides an innovative model demonstration for unconventional healthcare-associated infection outbreak events, which is of great significance for improving the preparedness for healthcare-associated infection emergencies.

To understand the epidemiological trends of SARS-CoV-2 Omicron variants and evolutionary variations of the spike protein in Quzhou city of Zhejiang province from 2023 to 2024.

Respiratory specimens (including nasopharyngeal swabs and sputum specimens) were collected from COVID-19 cases at sentinel surveillance sites for SARS-CoV-2 variants and influenza in Quzhou between January 2023 and September 2024. The whole genome sequences of SARS-CoV-2 from 267 cases were obtained by nanopore sequencing. The genotypes and amino acid variations were analyzed through Pangolin v4.3 and Nextclade v3.13.1 platforms. Heatmaps of amino acid mutations in the key domains of the spike protein were generated by TBtools-Ⅱ v2.222, while the impact of amino acid mutations on viral adaptability was assessed by the VarEPS system.

All the 246 sequences were Omicron variants of SARS-CoV-2, showing the turnover of BA.5-XBB-BA.2 lineages. These variants were classified into ten sub-lineages, with JN.1 and its sub-lineages showing the highest prevalence (42.28%, 104/246). This classification was consistent with the results of the phylogenetic analysis. The distribution of SARS-CoV-2 genotypes across different age groups showed differences (P < 0.001). Amino acid mutation analysis revealed frequent mutations in the spike protein, with the number of mutation sites gradually increasing over time and involving substitutions, insertions, and deletions. JN.1, XDV.1, and their sub-lineages exhibited higher mutation frequency in the spike protein, accumulating novel mutations (K356T, R403K, N450D, N481K, E544K, A570V, P621S, etc.) in key domains. Functional assessments indicated that multiple spike protein mutations (R346T, S371F, S373P, T376A, D405N, R408S, K417N, G446S, F456L, Y505H, etc.) may reduce the binding stability between the spike protein with neutralizing antibodies.

The Omicron variants were the predominant circulating variants in Quzhou during 2023–2024, exhibiting diverse genotypes. Monitoring and analyzing amino acid mutations in the spike protein facilitate timely understanding of the evolutionary characteristics of SARS-CoV-2, providing a theoretical basis for risk assessment of COVID-19 variant prevalence and the implementation of epidemic prevention and control measures.

To explore the application value of regional health information platform data in reducing garbage code rates and improving data quality at the source.

We analyzed 8 717 death records of registered residents in Putuo district, Shanghai from March 1, 2023 to February 29, 2024. Using the GBD-2019 ICD-10, we extracted cases with the underlying cause of death being classified as a garbage code and examined their baseline characteristics. Using the regional health information platform, we supplemented medical records for cases with garbage-coded underlying causes of death. Two trained mortality coders then revised the underlying causes to evaluate data quality improvement.

The garbage code rates were higher for underlying causes of deaths among individuals < 60 years (14.14%), cases documented in resident death inference certificates (12.74%), and deaths occurring at locations categorized as dead on arrival (23.81%), at home (13.43%), and others (13.04%). On the basis of the regional health information platform, the successful matching rate for medical records with garbage-coded underlying causes was 55.32%, and the effective correction rate for underlying causes reached 50.00%. After correction, the overall garbage code rate decreased from 7.01% to 5.28% (χ² = 22.683, P < 0.001). Notably, significant reductions were observed in the garbage code rates for individuals ≥ 60 years, cases recorded in both official death certificates and death inference certificates, and deaths occurring in hospital wards, at home, and in nursing homes (all P < 0.05). Regarding garbage code classification, prior to correction, the coding rates for Level I (severe impact) to Level Ⅳ (limited impact) were 1.96%, 2.90%, 1.28%, and 0.86%, respectively (χ² = 336.015, P < 0.001), with Level Ⅱ (major impact) codes predominating at 41.41% of cases. Post-correction, the coding rates for Level I to Level Ⅲ reduced (all P < 0.05), with 26.48% of Level Ⅱ codes and 29.46% of Level Ⅲ codes reclassified as non-garbage codes. High-frequency Level Ⅱ codes such as hypertension and hypertensive encephalopathy, as well as Level Ⅲ codes including other diseases of the lung and other specified respiratory conditions exhibited decreases (χ² = 15.599, P < 0.001; χ² = 4.838, P = 0.028).

The regional health information platform effectively targets major mortality reporting sources and significantly reduces garbage code rates, thus substantially improving the overall data quality in mortality statistics.

To understand the status of antibiotic contamination in drinking water in Ma′anshan city, Anhui province and assess the ecological and human health risks of antibiotics, thus providing a scientific basis for drinking water management and antibiotic contamination control.

In 2024, 36 drinking water samples were collected. Solid-phase extraction-high performance liquid chromatography-tandem mass spectrometry was employed to measure the concentrations of 13 antibiotics of 4 categories in source water, finished water, and tap water. Ecological and health risks were assessed for the detected antibiotics.

A total of 7 antibiotics of 3 categories were detected, with the detection rates ranging from 0.00% to 75.00% and concentrations ranging from ND (not detected) to 43.70 ng/L. The antibiotic with the highest concentration was enrofloxacin (43.70 ng/L). The water treatment process demonstrated good removal efficiency for antibiotics, with a removal rate of 89.97%. Specifically, sulfamethoxazole, sulfachloropyridazine, and clarithromycin were completely removed (100.00%). In source water, sulfachloropyridazine and clarithromycin showed no ecological risk to three aquatic organisms, while sulfamethoxazole and enrofloxacin showed no ecological risk to invertebrates and fish but exhibited low-level ecological risk to algae. Under the premise of using the most sensitive species, algae, as an indicator, the combined toxicity of antibiotics posed a moderate ecological risk. Among the detected antibiotics, clarithromycin had the highest health risk quotient (RQ_H), which, however, was less than 1×10⁻², indicating negligible health risks to people of all age groups. The combined effect of antibiotics showed the RQ_sum < 1×10⁻², presenting an increasing-decreasing-increasing trend.

Antibiotic contamination in the drinking water in Ma′anshan is primarily dominated by enrofloxacin. The combined effect of antibiotics poses a moderate ecological risk.

To understand the detection rates of different pneumonia pathogens in children < 5 years in China′s mainland from 2014 to 2023 and provide a basis for the development of preventive and control measures related to childhood pneumonia in China.

We searched China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, SinoMed, PubMed, Embase, and Web of Science with the time interval from January 1, 2014 to October 10, 2024 for the articles about the detection of different pneumonia pathogens in children < 5 years in China′s mainland. Stata 18.0 was used for meta-analysis of the included articles.

A total of 65 articles (55 in Chinese and 10 in English) involving 197 146 patients were included. The meta-analysis revealed that from 2014 to 2023 in China′s mainland, the overall detection rate of bacterial pathogens causing pneumonia in children < 5 years was 50.9% (95%CI: 41.8%–60.0%), with Streptococcus pneumoniae having the highest detection rate of 14.8% (95%CI: 12.4%–17.1%). The overall detection rate of viral pathogens was 47.8% (95%CI: 37.8%–57.8%), with respiratory syncytial virus (RSV) having the highest detection rate of 21.8% (95%CI: 18.3%–25.2%). The overall detection rate of Mycoplasma and Chlamydia was 18.0% (95%CI: 14.9%–21.1%), with Mycoplasma having the highest detection rate of 16.5% (95%CI: 13.3%–19.7%). Subgroup analysis revealed that the detection rates of bacterial pathogens among children in the < 1-year group, 1–< 3-year group, 3–< 5-year group, and ungrouped < 5-year children were 49.2%, 49.4%, 75.0%, and 43.6%, respectively. In eastern and central-western China, the detection rates of bacterial pathogens in children < 5 years were 38.9% and 54.6%, respectively. During 2014–2019 and 2020–2023, the detection rates of bacterial pathogens in children < 5 years were 53.7% and 31.5%, respectively. The detection rates of bacterial pathogens varied across different ages, regions, and time periods (all P < 0.001). The detection rates of viral pathogens among children in the < 1-year group, 1–< 3-year group, 3–< 5-year group, and ungrouped < 5-year children were 53.5%, 48.3%, 62.0%, and 38.7%, respectively. In eastern and central-western China, the detection rates of viral pathogens in children < 5 years were 47.0% and 42.8%, respectively. During 2014–2019 and 2020–2023, the detection rates of viral pathogens in children < 5 years were 47.1% and 51.2%, respectively. The detection rates of viral pathogens varied across different ages, regions, and time periods (all P < 0.001). The detection rates of Mycoplasma and Chlamydia among children in the < 1-year group, 1–< 3-year group, 3–< 5-year group, and ungrouped < 5-year children were 10.1%, 25.1%, 27.6%, and 20.7%, respectively. In eastern and central-western China, the detection rates of Mycoplasma and Chlamydia in children < 5 years were 18.2% and 16.5%, respectively. During 2014–2019 and 2020–2023, the detection rates of Mycoplasma and Chlamydia in children < 5 years were 18.7% and 19.3%, respectively. The detection rates of Mycoplasma and Chlamydia varied across different ages, regions, and time periods (all P < 0.001).

From 2014 to 2023 in China′s mainland, bacterial pathogens causing pneumonia showed the highest detection rates among children < 5 years, with S. pneumoniae being the predominant bacterial pathogen. Children in the 3–< 5-year group showed elevated detection rates across all pathogen types. Regional and temporal variations were significant: bacterial infections dominated in central-western China and during 2014–2019, whereas eastern China and the 2020–2023 period were characterized by higher rates of viral infections and Mycoplasma and Chlamydia infections.