Such relationship shows a declining trend over our study period due to the expansion of city and technological advancement in overland transportation. An increase of 100 m in the width of river and a shortening of 1 km distance between city and river resulted in 9 and 0.96 more plague outbreaks in our study period, respectively. This association remained robust in different regression model specifications.
Besides, the count of plague outbreak was positively correlated with the width of river and negatively correlated with the distance between city and river.
Our results showed that 95.5% of plague happened within 10 km proximity of navigable rivers. In this study, we based on the spatio-temporal information of 5559 plague ( Yersinia pestis) outbreaks in Europe and its neighboring regions in AD1347–1760 to statistically examine the connection between navigable rivers and plague outbreak.
Yet, little is known about the inland transmission of infectious diseases in history. Infectious diseases have become a rising challenge to mankind in a globalizing world.
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