ArticleBMC public health2026
Spatiotemporal lag effects of surface water quality on liver cirrhosis mortality risk in China: a nine-year time-series study of environmental driving mechanism.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSurface water is a major source of domestic water supply in China, yet its quality remains uneven despite recent improvements. Chronic exposure to surface-water pollution has been implicated in liver injury, but evidence linking water quality to cirrhosis mortality—particularly accounting for delayed and non-linear effects—remains limited. We investigated the spatiotemporal associations between surface water quality and cirrhosis mortality in China.
methodsWe conducted a nationwide ecological study integrating surface water monitoring data and cirrhosis mortality data from 2013 to 2021. Distributed lag non-linear models (DLNMs) were applied to assess non-linear and lagged associations (0-2 years) between overall water-quality classes and key pollution indicators, including total phosphorus (TP), chemical oxygen demand, dichromate method (CODCr), and five-day biochemical oxygen demand (BOD5). Analyses were stratified by sex and urban-rural residence.
resultsSurface water quality was associated with cirrhosis mortality in a non-linear, delayed, and population-specific manner. Moderate and poor water quality exhibited distinct temporal risk patterns, with sustained exposure to moderate pollution associated with a higher cumulative mortality risk. TP and CODCr showed clear non-linear associations with mortality that intensified at longer lags, whereas BOD5 displayed a U-shaped relationship with relative risks remaining below unity. Stronger and more persistent effects were observed among males and rural residents.
conclusionsOur findings indicate that long-term exposure to moderate surface-water pollution and persistent nutrient and organic contamination contribute to cirrhosis mortality in China. Water-quality management strategies should account for delayed health effects and population vulnerability, with targeted interventions prioritising sustained pollution reduction and protection of high-risk groups.
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