Urban wastewater infrastructure gaps for upstream public health risk prevention: provincial panel evidence from the Yellow River Basin, 2010–2024

Introduction Urban wastewater infrastructure supports upstream public health risk prevention, defined here as infrastructure-supported conditions before pollution exposure. This study provides a diagnostic comparison of relative weaknesses across treatment capacity, sewer collection, resource utilization, and sludge disposal over time. Methods This study integrates multiple official statistical sources, including the China Urban Construction Statistical Yearbook, to construct a balanced panel for nine provinces and autonomous regions in the Yellow River Basin from 2010 to 2024, comprising 135 province-year observations. Results The annual mean of the four-dimensional composite index across the nine regions increased from 0.511 in 2010 to 0.747 in 2024. Resource utilization was the lowest-scoring dimension, termed the dominant gap, in 106 of the 135 observations (78.52%). Although treatment capacity and sewer collection improved, marked structural differences persisted across provinces. Discussion The findings indicate overall improvement in wastewater infrastructure alongside persistent weaknesses within the management chain. Provincial panel data can therefore help identify infrastructure priorities for urban public health risk prevention. The study evaluates these infrastructure conditions and does not directly measure individual exposure or disease outcomes.