Climate and socioeconomic factors drive heterogeneous dengue risk escalation in the Chinese population

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Dengue risk is increasingly shaped by climate change and rapid urbanization, yet comprehensive, multidimensional risk assessments grounded in a One Health perspective remain scare. We develop a geographically eXplainable artificial intelligence (GeoXAI) model to estimate dengue hazard across China in 2024 (current), 2050, and 2100 under different shared socioeconomic pathway (SSP) scenarios. A hazard-exposure-vulnerability framework is then used to assess dengue risk by integrating dengue hazard, human exposure, and social vulnerability. Here we show a northward expansion of high-hazard areas, with the minimum temperature in the coldest month being the dominant driver (27.2% contribution). Moreover, socioeconomic factors such as population density (3.8%) and urbanization level (2.7%) will further amplify dengue hazard. Current dengue risk assessments reveal high-risk clusters in Southwest China and megacities. Dengue risk exhibits spatially heterogeneous escalation in the future, with Southwest and Southeast China facing the steepest growth and Northwest China experiencing disproportionate increases. Compared to the current, dengue risk in SSP585—a high greenhouse gas emission scenario and limited climate policy interventions—increases by 6.01% (2050) and 8.21% (2100), representing the largest escalation among the three SSPs. Despite ongoing disease control efforts, our findings underscore the need to intensify integrated surveillance and multidimensional intervention strategies against escalating dengue risk in China, and offers lessons for other prevalent Aedes-borne diseases (e.g., chikungunya). Dengue is a vector-borne infectious disease mainly transmitted by mosquitoes, which poses a growing public health concern in China. Understanding where and why this risk is growing is essential for effective prevention. In this study, we developed a multi-dimensional risk assessment framework that combines three key factors: dengue hazard, human exposure, and social vulnerability. Our findings show that high-risk areas are mainly concentrated in southern and southwestern China, with clear spatial differences in risk distribution. We found that increased contact between humans and mosquitoes and rapid urbanization are driving dengue risk across urbanized regions under climate change. In the future, the overall risk intensity is expected to increase unevenly. While high-risk clusters will remain stable in the south, new risk hotspots are likely to emerge in northern areas. Our results show that fighting dengue requires strategies that combine climate adaptation with improved urban planning. Guang, He, et al. establish a multi-dimensional dengue risk assessment framework that combines hazard, human exposure, and social vulnerability under climate change and rapid urbanization. They find a northward expansion of high-risk areas and identify integrated climate adaptation and urban planning as key for prevention.

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