Socioeconomic transitions and the spatial dynamics of syphilis transmission in urbanizing China.
9 affiliations
- 1Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310001, China.
- 2WHO Collaborating Centre for Comprehensive Management of HIV Treatment and Care, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China.
- 3Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, NO. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China.
- 4Beijing Key Laboratory of Technology and Application of Anti-Infective New Drugs Research and Development, NO. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China.
- 5Infectious Diseases Department, Wuming Hospital of Guangxi Medical University, No. 26 Yongning Road, Wuming District, Nanning, Guangxi, 530199, China.
- 6Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, NO. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China. [email protected].
- 7Beijing Key Laboratory of Technology and Application of Anti-Infective New Drugs Research and Development, NO. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China. [email protected].
- 8National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, NO. 8 Jingshun East Street, Chaoyang District, Beijing, 102206, China. [email protected].
- 9Infectious Diseases Department, Wuming Hospital of Guangxi Medical University, No. 26 Yongning Road, Wuming District, Nanning, Guangxi, 530199, China. [email protected].
Abstract
Background
Syphilis remains a re-emerging sexually transmitted infection in China, with transmission increasingly shaped by regional socioeconomic disparities. Understanding spatial heterogeneity and inter-provincial inequality is essential for equitable disease control.Methods
A balanced panel dataset of syphilis incidence was constructed across 31 provinces in mainland China from 2004 to 2020. Temporal trends were stratified by age and disease stage using joinpoint regression analysis. Spatial clustering patterns of syphilis incidence were evaluated through Global Moran's I and Local Moran's I statistics. To disentangle the socioeconomic determinants of spatial inequality, the Spatial Durbin Model (SDM) for regional spillovers and Multiscale Geographically Weighted Regression (MGWR) were employed to detect structural heterogeneity in risk factors associated with a regime shift external shocks (the Global Financial Crisis and COVID-19).Results
Syphilis incidence rose substantially (AAPC = 10.69%), driven predominantly by a surge in latent infections among the elderly (≥ 65 years). Spatially, the epidemic exhibited a distinct "westward shift" from affluent coastal regions to the less-developed Northwest. The SDM indicated that economic growth and population mobility generally increased risk, while educational investment exerted a robust protective spillover effect. Crucially, MGWR revealed a deepening spatial inequity in risk mechanisms: Specifically, the 2008 Financial Crisis associated with a regime shift in the less-developed Northwest, transitioning the epidemic from a "wealth-driven" model to a "poverty-driven" risk model. Furthermore, The COVID-19 pandemic inverted the role of transportation, shifting it from a protective factor associated with urban resilience into a primary vector for disease diffusion.Conclusions
Syphilis transmission in China exhibits clear spatial stratification, where the burden is increasingly shifting to resource-constrained regions. The divergence between consumption-based risk in developed areas and survival-based risk in underdeveloped hinterlands underscores how macroeconomic instability amplifies health inequalities Equity-oriented interventions must prioritize "poverty-driven" transmission pathways and vulnerable older populations to prevent the entrenchment of disease in lagging regions.
Related
- Socioeconomic and healthcare-related correlates of reported syphilis incidence in China: a spatiotemporal geographically weighted analysis, 2006–2022
- Exploring the nexus of climate-socioeconomic drivers of dengue transmission: a covariate-augmented SEIR-SEI mechanistic model
- Mortality dynamics of West Nile virus and Lyme disease in the United States : Temporal, spatial, and socioeconomic dimensions (2003–2021)
- Stochastic SEIR dynamics via graph Laplacian diffusion under transmission uncertainty
- Feedbacks between human behavior, disease transmission, and vector ecology generate culture-linked dynamics in vector-borne diseases
BibTeX
@article{li2026socioeconomic,
title = {{Socioeconomic transitions and the spatial dynamics of syphilis transmission in urbanizing China.}},
author = {Chengcheng Li and Hanxi Zhang and Jinfeng Li and Ximan Ye and Shangcheng Zhou and Xiaojie Lao and Maowei Chen},
journal = {International journal for equity in health},
year = {2026},
month = jul,
doi = {10.1186/s12939-026-02949-1},
url = {https://europepmc.org/article/MED/42902267},
note = {CC BY},
}
RIS
TY - JOUR
TI - Socioeconomic transitions and the spatial dynamics of syphilis transmission in urbanizing China.
AU - Chengcheng Li
AU - Hanxi Zhang
AU - Jinfeng Li
AU - Ximan Ye
AU - Shangcheng Zhou
AU - Xiaojie Lao
AU - Maowei Chen
PY - 2026
DA - 2026/07/01
JO - International journal for equity in health
DO - 10.1186/s12939-026-02949-1
UR - https://europepmc.org/article/MED/42902267
AB - Background Syphilis remains a re-emerging sexually transmitted infection in China, with transmission increasingly shaped by regional socioeconomic disparities. Understanding spatial heterogeneity and inter-provincial inequality is essential for equitable disease control.Methods A balanced panel dataset of syphilis incidence was constructed across 31 provinces in mainland China from 2004 to 2020. Temporal trends were stratified by age and disease stage using joinpoint regression analysis. Spatial clustering patterns of syphilis incidence were evaluated through Global Moran's I and Local Moran's I statistics. To disentangle the socioeconomic determinants of spatial inequality, the Spatial Durbin Model (SDM) for regional spillovers and Multiscale Geographically Weighted Regression (MGWR) were employed to detect structural heterogeneity in risk factors associated with a regime shift external shocks (the Global Financial Crisis and COVID-19).Results Syphilis incidence rose substantially (AAPC = 10.69%), driven predominantly by a surge in latent infections among the elderly (≥ 65 years). Spatially, the epidemic exhibited a distinct "westward shift" from affluent coastal regions to the less-developed Northwest. The SDM indicated that economic growth and population mobility generally increased risk, while educational investment exerted a robust protective spillover effect. Crucially, MGWR revealed a deepening spatial inequity in risk mechanisms: Specifically, the 2008 Financial Crisis associated with a regime shift in the less-developed Northwest, transitioning the epidemic from a "wealth-driven" model to a "poverty-driven" risk model. Furthermore, The COVID-19 pandemic inverted the role of transportation, shifting it from a protective factor associated with urban resilience into a primary vector for disease diffusion.Conclusions Syphilis transmission in China exhibits clear spatial stratification, where the burden is increasingly shifting to resource-constrained regions. The divergence between consumption-based risk in developed areas and survival-based risk in underdeveloped hinterlands underscores how macroeconomic instability amplifies health inequalities Equity-oriented interventions must prioritize "poverty-driven" transmission pathways and vulnerable older populations to prevent the entrenchment of disease in lagging regions.
SN - 1475-9276
ER -