Injury is a major public health problem posing a severe threat to the health of Chinese residents. In recent years, China has continuously improved its policy system for injury prevention and control, gradually refined its surveillance network, intensified interventions targeting key populations and key settings, and initially established a multi-departmental collaboration mechanism. Nevertheless, prominent challenges remain in terms of disease burden, institutional capacity, inter-departmental coordination, surveillance and scientific research, and health equity. To systematically advance the integrated prevention and control of injuries, 15 departments including the National Disease Control and Prevention Administration jointly issued the Action Plan for Injury Prevention and Control (2026-2030). From the perspective of preventive medicine and in light of the requirements set forth in the latest national action plan, this paper systematically reviews the progress made in China's injury prevention and control work, analyzes its core challenges, and puts forward strategic considerations. The paper aims to provide a reference for improving the integrated prevention and control of injuries and supporting the construction of a Healthy China.

Objective To analyze the results of tuberculosis screening and the characteristics of detected cases in freshmen entrance physical examination in Anhui Province from 2022 to 2024, and to provide theoretical basis for optimizing screening strategies. Methods Data of tuberculosis screening for freshmen in Anhui Province from 2022 to 2024 were collected. Descriptive epidemiological method was used to analyze the temporal, population, and regional distributions of relevant indicators, as well as differences in screening methods. Results A total of 9 203 416 freshmen were screened in Anhui Province from 2022 to 2024, and the screening rate was 98.57%. A total of 283 cases of pulmonary tuberculosis were detected, with a detection rate of 3.07/100 000. The abnormal screening rate increased year by year (0.51%, 0.60%, 0.79%, respectively). The highest abnormal tuberculosis screening rate was observed in northern Anhui (0.86%), and the highest detection rate was found in freshmen in junior colleges/universities and above (8.35/100 000). Among different screening methods, the tuberculosis detection rate was the highest (1.96%) among individuals with abnormal chest X-ray screening results. The detected cases were mainly in the 13-18 years old (69.26%), 42.76% of cases were pathogen-positive, and 2.83% of cases were rifampicin-resistant. Conclusion The screening rate of tuberculosis for freshmen in Anhui Province from 2022 to 2024 is relatively high, but the abnormal screening rate shows an increasing trend year by year, and there are population and regional differences in screening results. Chest X-ray screening has a prominent case detection efficiency. Detected cases are mainly freshmen in middle school and junior college/university and above, and some cases exist drug resistance. It is necessary to optimize screening strategies for key populations and regions, and to strengthen pathogenic detection and drug resistance monitoring.

Objective To predict the incidence trend of tuberculosis in Huangshan and to provide a basis for optimizing tuberculosis prevention and control strategies. Methods Tuberculosis incidence data from 2015 to 2024 in Huangshan were collected from the Tuberculosis Management Information System. Seasonal autoregressive integrated moving average (SARIMA) model, Holt-winters exponential smoothing model, Gray Prediction GM (1, 1) model, and Prophet model were constructed. The predicted incidence for 2024 from each model was validated against the actual reported incidence. Root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) were used as evaluation indicators to select the optimal model for predicting tuberculosis incidence from 2025 to 2026 in Huangshan. Results The registered tuberculosis incidence in Huangshan from 2015 to 2024 showed a fluctuating downward trend with distinct seasonality, peaked in summer, and reached a trough in winter. All four models demonstrated good fitting performance. Validation results revealed that the Prophet model achieved the best predictive performance (RMSE=5.03, MAE=4.17, MAPE=10.28%). All models predicted a continued decline in tuberculosis incidence in Huangshan for 2025-2026. The Prophet model predicted 462 and 432 registered tuberculosis cases in 2025 and 2026, respectively, corresponding to registered incidence rates of 35.08/100 000 and 32.80/100 000. Conclusion The Prophet model exhibits the best fitting performance and can be used to predict the trend of tuberculosis incidence in Huangshan.

Objective To describe the epidemiological characteristics of extrapulmonary tuberculosis (EPTB) in Wuhu City in 2024 and to explore factors associated with concurrent pulmonary tuberculosis (PTB). Methods Case data for this study were obtained from the Multi-Point Trigger Early Warning System for Public Health Emergencies in Wuhu City and the China Information System for Disease Control and Prevention. A descriptive analysis was conducted on the diagnosed cases of EPTB, and the factors associated with concurrent PTB were analyzed using logistic regression. Results A total of 199 cases of EPTB were included, with a registered incidence rate of 5.30 per 100 000. There were more males than females (52.76% vs. 47.24%), and the median age was 54 (41, 70) years. Lymph node tuberculosis was the most common type of EPTB (27.14%). Overall, 58.29% of the cases were distributed in the urban area, and 85.43% of the cases were diagnosed in only one medical institution, mainly provincial hospitals and municipal tuberculosis-designated hospitals. Multivariate logistic regression analysis showed that age (OR=0.979, 95%CI: 0.962-0.996), being male (OR=2.048, 95%CI: 1.100-3.888), and other types of EPTB (OR=3.753, 95%CI: 1.428-10.341) were associated with concurrent PTB in EPTB patients. Conclusion Lymph node tuberculosis is the most common type of EPTB in Wuhu City in 2024, with population and regional differences in incidence, and diagnoses are concentrated in a limited number of institutions. Age, gender, and disease type are relevant factors for concurrent EPTB and PTB. It is recommended to strengthen grassroots diagnostic capabilities and carry out collaborative screening for high-risk populations.

Objective To analyze the epidemiological characteristics of hepatitis B in Yichun from 2014 to 2024, so as to provide scientific basis for the formulation of hepatitis B prevention and control strategies. Methods The incidence data of hepatitis B in Yichun from 2014 to 2024 were collected from the China Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the distribution characteristics of hepatitis B. The Joinpoint regression model was employed to calculate the annual percentage change (APC) and average annual percent change (AAPC) to analyze the incidence trend of hepatitis B. Results A total of 64 745 hepatitis B cases were reported in Yichun City from 2014 to 2024, with an average annual reported incidence rate of 110.44/100 000. The overall reported incidence rates of hepatitis B and chronic hepatitis B showed an upward trend from 2014 to 2024 (AAPC=3.92%, P<0.001; AAPC=3.59%, P=0.022). The reported incidence rate of acute hepatitis B increased rapidly from 2020 to 2024 (APC=43.72%, P=0.003). There are reports of hepatitis B cases every month throughout the year without obvious seasonality. The top three regions with the highest reported incidence rates were Yuanzhou District (179.90/100 000), Shanggao County (156.16/100 000), and Wanzai County (123.40/100 000). The ratio of male to female reported cases was 2.32∶1, and the reported incidence rate was higher in males than in females. The age of the cases was mainly concentrated between 20 and 74 years old (accounting for 94.46%). The age group of 40 to 59 had the highest number of reported cases and the highest incidence rate, while the age group of 0 to 14 had the lowest number of reported cases and the lowest incidence rate. Farmers accounted for the majority of all cases (45 011 cases, accounting for 69.52%). Conclusion From 2014 to 2024, the reported incidence rate of hepatitis B in Yichun City showed an upward trend. It is recommended to further promote adult hepatitis B vaccination on the basis of continuing to consolidate the interruption of mother-to-child transmission and childhood hepatitis B vaccination. Additionally, health education and health promotion should be strengthened in key areas and among key populations to enhance immunization levels and disease prevention awareness.

Objective To analyze the epidemiological characteristics of mumps in Lu'an City from 2005 to 2024, and to provide a scientific basis for optimizing prevention and control measures and immunization strategies. Methods Mumps case data in Lu'an City from 2005 to 2024 were collected. Joinpoint regression model was used to analyze the incidence trend of mumps, while an age-period-cohort model was applied to evaluate the effects of age, period, and birth cohort. Results From 2005 to 2024, a total of 22 868 cases of mumps were reported in Lu'an City, corresponding to an average annual incidence rate of 24.16/100 000. Cases were mainly concentrated in the age group of 0-19 years old, and the reported incidence rate in males was higher than that in females. The reported incidence rate of mumps in the general population showed an initial upward trend followed by a decline from 2005 to 2024, with 2011 identified as the turning point (2005-2011: APC=39.92%, 95%CI: 15.75% to 69.14%, t=3.780, P=0.002; 2011-2024: APC=-14.20%, 95%CI: -19.50% to -8.54%, t=-5.110, P<0.001). There was no statistically significant trend in reported incidence among 0-19 years old (AAPC=-0.62%, 95%CI: -7.21% to 6.43%, t=-0.180, P=0.859), while the incidence rate in individuals aged 20 years and older showed an overall upward trend (AAPC=6.88%, 95%CI: 1.16% to 12.93%, t=2.370, P=0.018). Analysis using the age-period-cohort model showed that the reported incidence rate increased from 5.73/100 000 at age 0 to 135.84/100 000 at age 10, and then decreased to 7.25/100 000 at age 19. The 5-11-year age group exhibited the highest reported incidence rate. In 2011, 2012, and 2015 did the risk of mumps infection exceed that of the reference period (2014), while in all other years it remained lower. Moreover, after 2020, the relative risk (RR) showed a consistent year-on-year declining trend. The RR of the 1995 birth cohort was the highest (RR=2.181, 95%CI: 1.740-2.734). Conclusion The reported incidence rate of mumps in Lu'an City from 2005 to 2024 showed a trend of first rising and then declining. After the inclusion of the measles, mumps and rubella combined attenuated live vaccine (MMR) vaccine in the immunization program in 2008, the reported incidence rate decreased. It is essential to maintain high coverage of the two-dose MMR vaccine and enhance surveillance among individuals aged 20 years and older to further control mumps transmission.

Objective The epidemiological characteristics of hemorrhagic fever with renal syndrome (HFRS) in Ji'an City from 2005 to 2024 and the monitoring situation of host animals in Ji'an City from 2016 to 2024 were analyzed to provide a scientific basis for formulating targeted prevention and control measures. Methods Descriptive epidemiological methods were used to analyze HFRS cases in Ji'an City from 2005 to 2024.The night trapping method was employed to investigate rodent density at monitoring sites from 2016 to 2024, and the composition of rodent species was analyzed. Results A total of 421 HFRS cases were reported in Ji'an City from 2005 to 2024, with an average annual reported incidence rate of 0.44 per 100 000 population and 2 deaths, with a case fatality rate (CFR) of 0.48%. The incidence peak occurred from November to January each year (51.54%). Among cases, the 50-59 age group accounted for 28.98%, males accounted for 67.93%, and farmers accounted for 69.60%. Xin'gan County reported the largest number of cases, accounting for 56.77% of all reported cases. Rodent density in rural residential areas (0.73%) of Jizhou District and Xiajiang County was higher than that in urban residential areas (0.26%) and key occupational sites (0.35%). Rattus norvegicus (43.75%) and Mus musculus (42.76%) were the dominant rodent species. Conclusion The overall epidemic situation of HFRS in Ji'an City is stable and maintains a low incidence level, with a seasonal epidemic peak occurring in winter and spring. Cases display differentiated clustering features in population and regional distribution. The main affected groups include men, middle-aged and elderly people, and farmers. Xingan County is the high-incidence county in the city. Comprehensive prevention and control measures should be further strengthened, including enhanced surveillance of HFRS and host animals, rodent control, health education, and vaccination.

Objective To investigate the current infection status and epidemiological trends of soil-transmitted nematodes in Jingdezhen City and to provide evidence for developing control strategies. Methods From 2016 to 2024, at each monitoring site, 3-year-old and above permanent residents were randomly selected from the entire population as the monitoring subjects. Their fecal samples were collected. The modified Kato-Katz thick smear method (two tests per stool) was used to examine the eggs of soil-transmitted nematodes. For children aged 3 to 9 years old, the transparent tape anal swab method was additionally used to detect the eggs of pinworms. An analysis was conducted on the influencing factors of soil-borne nematode infections and the temporal trend of infection rates. Results A total of 19 305 individuals were examined, of whom 56 were positive for soil-transmitted nematodes. The total infection rate was 0.29% (56/19 305). By the modified Kato-Katz method, the infection rates for roundworm, whipworm, hookworm and pinworms were 0.19% (37/19 305), 0.04% (8/19 305), 0.03% (6/19 305 ) and 0.03% (6/19 305), respectively. The infection rate of soil-transmitted nematodes varied significantly among years (χ²=25.021, P=0.002), and the overall infection rate showed a significant decreasing trend, with an average annual decrease of 12.47% (AAPC=-12.47%, 95%CI: -23.19% to -0.96%, t=-2.145, P=0.035). The infection rates of soil-transmitted nematodes were 0.37% (37/9 937) in males and 0.20% (19/9 368) in females, and were higher in males than in females (χ²=4.791, P=0.029). By age, the infection rate was the highest in the 60-69-year age group (0.57%，15/2 640) (χ²=22.932, P=0.002). By occupation, it was the highest among farmers (0.45%，46/10 299) (χ²=21.275, P<0.001). Logistic regression analysis showed that gender and occupation were risk factors for soil-transmitted nematode infection. The infection risk in males was 1.900 times that of females, while the infection risk of farmers was 10.402 times that of preschool and scattered children. A total of 1 344 children aged 3-9 years were tested for Enterobius vermicularis infection by anal swab method, and the infection rate was 5.21% (70/1 344), with the highest rate in kindergarten children. The differences in infection rates among different groups of children were statistically significant (χ²=7.252, P=0.027). Conclusion Soil-transmitted nematode infections in Jingdezhen City remained at a low endemic level with a declining trend. However, the men and farmers have a higher risk of infection, and pinworm infection remained relatively high in children aged 3-9 years. These populations should be prioritized for enhanced prevention and control measures.

Objective To investigate and analyze an outbreak of acute gastroenteritis that occurred in a company in 2025, identify the causative pathogen, explore its transmission characteristics and risk factors, and provide a scientific basis for the prevention and control of acute gastroenteritis outbreaks. Methods A combination of on-site epidemiological investigation and a case-control study was used to analyze risk factors. Case samples, environmental samples, and retained food samples were collected for culture of common pathogenic bacteria and real-time fluorescence quantitative PCR (RT-qPCR) detection of norovirus. Positive samples were sequenced and classified for homology analysis. Results A total of 374 individuals were investigated in the outbreak, among which 147 were cases, with an incidence rate of 39.30%. The main clinical manifestations were diarrhea (87.07%, 128/147). The distribution of cases showed spatial clustering.The attack rate of the department where the first case was found (55.26%) was significantly higher than that of other departments (χ²=20.295, P=0.028). The case-control study showed that the dinner on the evening of February 11th had no statistical association with the disease onset, and foodborne transmission was excluded.Molecular tracing revealed that the norovirus detected in the anal swabs from eight cases was of the same GⅡ.17[P17] type as that detected on the water faucet of the drinking dispenser, with a high homology of 99.45% to 100.00% in nucleotide sequence. Conclusion This epidemic was caused by norovirus GⅡ.17[P17] and was an outbreak of acute gastroenteritis mainly transmitted through person-to-person contact. It is recommended that collective units establish a symptom monitoring mechanism, strengthen disinfection of high-touch surfaces and improve employee health monitoring systems.

Objective To investigate the survival outcomes of patients diagnosed with cervical cancer or precancerous lesions through cervical cancer screening in rural areas of Anhui Province, and to provide a basis for further improving the cervical cancer screening project in Anhui Province. Methods Data were collected from the free screening program for breast and cervical cancer among rural women age in Anhui Province from 2010 to 2021. Patients who were ultimately diagnosed with cervical cancer or precancerous lesions through cervical cytology, visual inspection with acetic acid/iodine, colposcopy, and pathological biopsy were enrolled. Their survival outcomes were followed up through the total population information platform, telephone interviews, and household surveys. The 5‑year survival rate of patients with cervical cancer was calculated using the life‑table method. Survival analysis was performed using the Kaplan‑Meier method and log‑rank test. Results A total of 16 163 patients with cervical cancer and precancerous lesions were screened and diagnosed. Among them, 15 552 patients had survival data, including 14 523 cases (93.38%) of cervical precancerous lesions and 1 029 cases (6.62%) of cervical cancer, with 149 deaths (0.96%). The 5‑year survival rate of patients with cervical cancer was 94.81%. No statistically significant differences in survival rate were observed among cervical cancer patients with different age, educational level, previous cervical cancer screening history, status of microinvasive cervical cancer, and region (P>0.05). Conclusion The survival rate of patients diagnosed with cervical cancer through screening in rural areas of Anhui Province is relatively high. It is necessary to further expand the coverage of cervical cancer screening to the early detection of cervical cancer and precancerous lesions.

Objective To analyze the pathological detection results of opportunistic screening for upper gastrointestinal cancer (UGIC) in Ma'anshan from 2020 to 2023, and to compare the differences in cumulative survival rates among patients with positive lesions of different characteristics. Methods Pathological data from opportunistic screening for UGIC in Ma'anshan from 2020 to 2023 were obtained from the Information Management Platform for Early Cancer Diagnosis and Treatment Project (Rural Areas) to analyze the detection of lesions at different stages. Survival outcomes of patients with positive lesions were obtained by matching with the Ma'anshan Population Death Information Registration and Management System, with the follow-up deadline set as December 31, 2024. Results From 2020 to 2023, a total of 179 560 individuals underwent endoscopic screening for UGIC in Ma'anshan, among whom 76 527 patients received pathological biopsy. A total of 3 942 cases of precancerous lesions, 4 029 cases of early-stage cancer, 2 164 cases of advanced-stage cancer, and 6 193 cases of positive lesions were detected. The detection rates were 2.20% (3 942/179 560), 2.24% (4 029/179 560), 1.21% (2 164/179 560), and 3.45% (6 193/179 560), respectively, with an early diagnosis rate of 65.06% (4 029/6 193). The detection rate of total positive lesions was higher in males than in females (χ²=113.698, P<0.001), while the early diagnosis rate was lower in males than in females (χ²=579.083, P<0.001). The detection rate of total positive lesions was relatively high in the ≥70 years age group (7.63%), and the early diagnosis rate was highest in the <40 years age group (92.06%). Both the detection rate of total positive lesions (5.18%) and the early diagnosis rate (77.88%) were relatively high in the People's Hospital of Dangtu County. The 1, 2, 3, and 4 years old cumulative survival rates for patients with positive lesions were 80.09%, 77.61%, 75.93%, and 75.09%, respectively. The results of multivariate Cox regression analysis showed that age groups of 50-59 years, 60-69 years, and ≥70 years, as well as the presence of multiple lesions, were risk factors affecting patient survival time. Conclusion The detection rate and early diagnosis rate of upper gastrointestinal lesions in Ma'anshan City are higher than those in multiple regions. It is recommended to further strengthen health education for male populations and elderly groups to reduce the economic burden of upper gastrointestinal cancers in our city.

Objective To analyze the incidence and mortality of thyroid cancer and their temporal trends in the cancer registry areas of Ganzhou City, Jiangxi Province from 2017 to 2022. Methods Data on thyroid cancer cases with ICD-10 code C73, reported by cancer registries in Ganzhou City and approved through quality control, were collected. Incidence (mortality) rates, age-standardized rates (standardized to the Chinese standard population), cumulative rates (0-74 years), and truncated rates (35-64 years) were calculated by sex, age group, and area (urban/rural areas). Joinpoint software was used to calculate the average annual percentage change (AAPC) and analyze the trends from 2017 to 2022. Results From 2017 to 2022, the crude incidence rate of thyroid cancer in the Ganzhou City cancer registry areas was 9.84/100 000 [age-standardized incidence rate by Chinese standard population (ASIRC)=10.42/100 000]. The cumulative incidence rate of 0-74 years old was 0.74%, and the truncated incidence rate of 35-64 years old was 16.39/100 000. The incidence rate among women was significantly higher than that among men (χ²=749.061, P<0.001), and the incidence rate in urban areas was higher than that in rural areas (χ²=424.870, P<0.001). The crude mortality rate of thyroid cancer was 0.55/100 000 [age-standardized mortality rate by Chinese standard population (ASMRC)= 0.50/100 000]. The cumulative mortality rate of 0-74 years old was 0.04%, and the truncated mortality rate of 35-64 years old was 0.63/100 000. The incidence and mortality rates increased substantially starting at the 25-29 and 55-59 age groups, respectively, with peaks concentrated in the 50-54 age group (18.86/100 000) and the ≥85 age group (5.06/100 000). Thyroid cancer incidence showed an upward trend (AAPC=41.41%, 95%CI: 25.53%-70.01%, t=3.649, P<0.001), with both crude and age-standardized incidence rates increasing among males, females, urban and rural populations (all P<0.05). Thyroid cancer mortality showed an upward trend (AAPC=27.05%, 95%CI: 4.94%-66.13%, t=1.733, P=0.010), with both the crude mortality rate and the ASMRC rising among males and in rural areas (all P<0.05). Conclusion The incidence and mortality of thyroid cancer in Ganzhou City increased rapidly. The incidence was higher in women than in men, and higher in urban areas than in rural areas. Tailored prevention and control measures should be developed according to local conditions to reduce the burden of thyroid cancer.

Objective To investigate the nutritional status and it's association with dietary behaviors among primary and secondary school students in Bozhou City, and to provide scientific basis for improving students' nutritional status. Methods From September 2024 to November 2024, primary and secondary school students in Bozhou were selected by multistage stratified cluster sampling method for questionnaire survey and physical examination. The nutritional status of the students and its influencing factors were analyzed. Results In 2024, a total of 6 583 primary and secondary school students in Bozhou City were surveyed. The detection rate of undernutrition was 3.11%，overweight and obesity was 38.78%. Boys had higher detection rates of undernutrition, overweight and obesity compared to girls (χ²=12.866, 132.713, both P<0.001)，the detection rates of undernutrition (χ²_trend=4.215, P=0.040), overweight and obesity (χ²_trend=8.509, P=0.004) showed a decreasing trend with increasing of grade level. Multivariate logistic regression analysis revealed that， boys were at a higher risk of undernutrition than girls (OR=1.714, 95%CI: 1.274-2.306), senior high school (OR=0.655, 95%CI: 0.442-0.971), never or sometimes eating breakfast (OR=0.617, 95%CI: 0.448-0.850) were associated with lower risk of undernutrition. The boys (OR=1.856, 95%CI: 1.675-2.056), consuming fresh fruit once or more daily (OR=1.143, 95%CI: 1.027-1.272), consuming vegetables once or more daily (OR=1.177, 95%CI: 1.051-1.319), never or sometimes eating breakfast (OR=1.222, 95%CI: 1.099-1.360) were associated with higher risk of overweight and obesity. Junior (OR=0.880, 95%CI: 0.782-0.989) and senior (OR=0.811, 95%CI: 0.709-0.928) high school students had a lower risk of overweight and obesity than primary school students in grades 4 to 6. Conclusion Both undernutrition and overnutrition coexist among primary and secondary school students in Bozhou City, with overnutrition being the more prominent issue. Boys have a higher risk of both undernutrition and overnutrition than girls, never or sometimes eating breakfast was associated with a higher risk of overweight and obesity among primary and secondary school students.

Objective To analysis the status and influencing factors of health literacy among elderly individuals aged 60-69 in poverty-alleviated areas of Anhui Province, and to provide a basis for formulating targeted health education policies and measures for the elderly in these areas. Methods Stratified multi-stage probability proportional to size sampling was used to select the elderly aged 60-69 in poverty-alleviated areas of Anhui Province in 2024. Household surveys were carried out with the National Resident Health Literacy Monitoring Questionnaire, and multi-level on-site quality control was implemented. Chi-square test and multivariate logistic regression analysis were performed on weighted monitoring data to investigate the current status and relevant influencing factors of health literacy in this population. Results The overall health literacy level of the surveyed population was 10.91%. The health literacy levels in the three dimensions were as follows: basic knowledge and concepts, 16.99%; healthy lifestyles and behaviors, 15.15%; and basic skills, 13.67%. The literacy levels for the six categories of health issues in descending order were: safety and first aid (33.82%), scientific health perspectives (32.22%), health information (26.45%), chronic disease prevention (18.94%), basic medical care (17.47%), and infectious disease prevention (11.72%). Multivariable logistic regression analysis showed that, compared to the 60-64 age group and the never smoking group, the 65-69 age group (OR=0.684, 95%CI: 0.485-0.966) and the smoking group (OR=0.605, 95%CI: 0.380-0.962) were associated with lower health literacy levels, Using illiteracy or minimal literacy as the reference, whereas participants with primary school education (OR=3.313, 95%CI: 1.970-5.572), junior high school education (OR=3.959, 95%CI: 2.330-6.729), and senior high school or above (OR=13.919, 95%CI: 7.720-25.094) were associated with higher health literacy levels. Conclusion The health literacy level among elderly individuals aged 60-69 in poverty-alleviated areas of Anhui Province was relatively low. Targeted health education should focus on those with low educational attainment, smoking and those aged 65-69, with particular emphasis on strengthening education on chronic disease prevention and control, basic medical care, and infectious disease prevention and control, in order to improve basic health skills.

Objective To assess clustering effects in routine swimming pool water quality surveillance data from Bozhou, and to evaluate the screening utility of the cyanuric acid/free chlorine (CYA/FC) ratio and oxidation-reduction potential (ORP) for heterotrophic plate count (HPC) exceedance after adjustment for clustering using generalized estimating equations (GEE). Methods The water samples were collected from swimming facilities in Bozhou in July 2024 and June-July 2025. Intraclass correlation coefficients (ICCs) were estimated using a linear mixed model. Associations of the CYA/FC ratio and ORP with HPC exceedance were assessed using GEE, and cluster-level bootstrap (1 000 replications) was applied to estimate 95% confidence interval (CI) for odds ratio (OR) and area under the receiver operating characteristic curve (AUC). Results A total of 231 water samples were collected from 40 swimming facilities. ICCs ranged from 0.191 to 0.780 (all P<0.05), with an ICC of 0.297 for HPC, indicating notable clustering. FC compliance rate was only 21.65%, with 66.67% exceeding the upper limit. GEE analysis showed that a CYA/FC ratio >20 was positively associated with HPC exceedance (OR=2.690, 95%CI: 1.348-10.283) and demonstrated the best screening performance in the high-FC group (>1.0 mg/L) (AUC=0.918, NPV=0.974). Cluster-bootstrap 95%CI for ORP crossed 1.0 at both cutoffs, indicating no statistical significance. Conclusion Swimming pool surveillance data exhibited notable clustering; cluster-level bootstrap may enhance inference robustness under small-cluster conditions. A CYA/FC ratio >20 was associated with HPC exceedance risk and showed promising rule-out screening potential, particularly in the high-FC group. ORP did not demonstrate statistically significant screening utility. These findings warrant validation in studies with larger sample sizes.