Epidemic transition of environmental health risk during China's urbanization

China has experienced rapid urbanization in recent decades along with dramatic economic growth. Previous studies have shown that urbanization has both positive and negative effects on health. However, there is a lack of research on the overall effects of urbanization on the epidemic transition of environmental health risks considering various pathways in China. In the present study, we studied the contributions of different aspects of urbanization in China to epidemic transitions using provincial and multi-year (1995, 2000, 2005, and 2010) panel data. Statistical models with fixed and random effects were developed to explore the impacts of different urbanization indicators on the overall epidemic transition of environmental health (general model) and the changes in cause-specific mortality rates of typical diseases (cause-specific models). The results show that the impacts of non-communicable diseases continue to grow during the urbanization process in China. The ratio of communicable disease-related mortality to non-communicable disease-related mortality continues to decrease over time. The general model shows that the improved medical conditions (coefficient=-0.0011, P=0.037), the improved urban infrastructure (e.g., tap water supply) (coefficient=-0.00065, P<0.001), and the rise in income (coefficient=-0.00027, P=0.047) during the urbanization process are important factors that promote this overall epidemic transition. The cause-specific models show that the mechanisms behind the general model are complicated. More attention should be paid to non-communicable diseases in urban health management. Specific health policies for different diseases should incorporate the considerations of different impact pathways of urbanization.