Abstract
BACKGROUND: Meteorological factors are known to influence the transmission of infectious diseases. Studying historical epidemics in ancient China provides valuable insights into how environmental stressors shaped public health, with implications for modern disease control. We aimed to quantitatively assess the relationship between meteorological events and epidemic severity in China from 674 BC to 1911 AD. METHODS: We extracted data from 'A Compendium of Chinese Meteorological Records of the Last 3000 Years'. We digitised epidemic events, consequences, and associated meteorological conditions and categorised them into ordinal levels. We used descriptive statistics and multivariable logistic regression to analyse annual patterns and associations across historical periods. RESULTS: We identified 5338 epidemic-related records. While the number of reported epidemics increased over time, the proportion associated with meteorological events declined by 0.24% (95% confidence interval (CI) = 0.17-0.31) per decade between 1451 and 1911. Flood frequency was associated with higher epidemic severity: each additional flood increased the odds of moderate (vs. mild) consequences by 42% (95% CI = 8-87) and severe (vs. moderate) consequences by 46% (95% CI = 12-91). Droughts similarly raised the risk of severe consequences by 23% (95% CI = 7-41). Famines were also linked with heightened epidemic severity and were among the most commonly co-reported meteorological events, along with drought. CONCLUSIONS: As global climate intensifies, the historical relationship between environmental stressors and epidemic severity offers crucial lessons for modern public health. Regions vulnerable to climate extremes may require targeted, climate-informed epidemic preparedness and response strategies.