Matlab code for Mann-Kendall test.

BackgroundThe global epidemics of cholera, a virulent enteric infection, pose a serious threat to public health and socio-economics. The disease’s rapid spread and high mortality have led to heavy casualties, along with disruptions to production, rising healthcare burdens and impaired economic exchanges.MethodsBased on cholera historical and environmental data, Mann-Kendall test, wavelet analysis, hotspot analysis, epidemics center of gravity, and structural equation modeling were employed to investigate the spatial and temporal distribution pattern and formation mechanism of cholera epidemics in Hubei Province during the period of 1949–2020.ResultsBased on existing historical monitoring records. Temporally, high incidence occurred in the 1980s and 1990s, with summer and autumn being the dominant seasons. Three fluctuation cycles were identified: 29 years, 19 years, and 8 years. Spatially, 71 counties and districts were cumulatively affected, with Wuhan and Xianning serving as the primary hotspots. Cholera epidemics were distributed along rivers and lakes, and their centers of gravity shifted southward and westward over time. Mechanistically, cholera epidemics were the result of the combined effects of natural, disaster, and human factors. Population density and summer temperatures were the direct factors driving the spread of cholera epidemics, while river networks formed the basic environmental background that facilitated transmission. Natural environmental factors such as drought and flood disasters, elevation, and precipitation, as well as human environmental factors including road networks and economic conditions, could not only directly drive the spread of epidemics but also regulate epidemics development through indirect pathways. The coupling effects of various factors across different spatiotemporal scales jointly shaped the unique spatiotemporal distribution and evolutionary characteristics of cholera epidemics.Conclusion/SignificanceThis study helped to reveal the spatiotemporal patterns and formation mechanisms of regional cholera epidemics, filled the gap in cholera research in Hubei Province, and provided a reference for cholera prevention and control in areas with dense rivers and lakes.