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China tends to have a bunch of people that live in very close proximity to each other and the lower classes tend to live with their animals especially pigs. Pigs are close enough to us that we can infect each other. Pig gets sick, human gets sick from the pig who then gets sick from the human next thing you know you have a pandemic. In the west pigs were kept outside, many times out in the woods. The chance that you would catch something was much lower.

The poor tend not to have cats to keep the rodent population down which is the vector for many diseases.

Fuel is in short supply so they tend to cook their food for short periods of time which tends not to kill any bacteria. That is also why the poor live with their animals in the house. It keeps the house warmer and the animals alive during the winter.

There is the fact that the Chinese tend to eat "wild meat". While in the West eating a reptile means that you are down to your last options in China it is actually a symbol of status. This was because of the restrictions on hunting. There is also the idea that eating the parts of certain animals, the rarer the better, will cure what ails you. The guys eat a bunch of crap to improve their bed room antics.

Beef and lamb which are probably the safest foods to eat were rarely eaten by the Chinese as cows and sheep were in short supply.

The Chinese also did not have a tradition of charity. The poor were left to rot. It was their fate to suffer and die so they could be re-born in better circumstances or they were being punished for bad behavior in a past life. In either case you did not want to interfere.

Lack of soap. Soap was not popular in China. They preferred creams to soap to clean the skin. Left your skin nice and soft but did not kill any bacteria.

So you have a bunch of people and animals crowded together, a lack of totally cooked food, lack of rodent control and the eating of foods that are disease reservoirs, a lack of any charity and a lack of cleanliness.

The end results are generally not good.