Spatiotemporal Distribution of Human Rabies and Identification of Predominant Risk Factors in China from 2004 to 2020

Human rabies is a prevalent issue in China, posing a significant public health concern in the country. This study fitted the Bayesian model of separable in spatial and temporal variation and inseparable spatiotemporal variation in disease risk respectively based on Integrated Nested Laplace Approximation (INLA) to investigate the spatiotemporal characteristics of human rabies across 31 provinces in China from 2004 to 2020. It also investigated the influence of natural and socio-environmental factors on the incidence of the disease. Within the study period, a total of 26,807 cases of human rabies were reported, with the highest risk of incidence occurring in 2007, followed by a steady annual decline to the lowest risk in 2020. Guangxi Province exhibited the highest risk, while Jilin Province had the lowest, with the southern, central, and eastern regions reporting higher risks than the northern and western areas. By 2020, most provinces such as Guangxi and Guizhou had significantly reduced their relative risk (RR) of human rabies from historical highs. However, some provinces like Hunan, Henan, and Jiangsu experienced an increase in RR compared to previous years. As the annual average temperature increases, the risk of human rabies incidence in China correspondingly rises. Conversely, with increases in the annual average daily sunshine duration, per capita disposable income of urban residents, and local government healthcare expenditures, the risk of human rabies incidence declines. We conclude that the risk of human rabies in China initially increased and then decreased annually from 2004 to 2020. Future efforts should continuously increase financial investments in rabies prevention and control, focusing particularly on Hunan, Henan, Jiangsu, and provinces characterized by higher temperatures, shorter sunshine durations, and lower economic levels.