Foodborne diseases remain a persistent threat to global health. The World Health Organization (WHO) estimated that 31 foodborne hazards caused 600 million foodborne cases and 420,000 deaths annually (Havelaar et al., 2015). Among various hazards, foodborne pathogens are the leading contributors to the global burden of foodborne diseases. Pathogen transmission is profoundly shaped by environmental factors throughout the food supply chain, highlighting the need for comprehensive risk assessment (Kniel et al., 2018). As the final and critical stage of the farm-to-fork chain, the household serves as the point where environmental hygiene and consumer practices converge, underscoring its pivotal role in precise risk characterization and the implementation of effective interventions. In the European Union (EU), the European Food Safety Authority (EFSA) estimated that 39.1% of notified foodborne outbreaks occurred in domestic settings (EFSA, 2021), and in China, 34%–60% of outbreaks originated in households (Li et al., 2024). It should be noted that these figures are based on reported outbreaks, which may be biased, as people are more likely to attribute illness to meals consumed at a restaurant rather than those prepared at home, and outbreaks originating within households are less likely to be detected and reported. This highlights households as a critical setting where food handling practices directly influence foodborne disease risk (Zhao et al., 2022b). Inappropriate household handling practices, such as temperature abuse, inadequate cooking, and cross-contamination, can facilitate the survival and spread of foodborne pathogens, potentially resulting in illness (Taché and Carpentier, 2014). Therefore, household food handling practices should be taken into account as a key component for comprehensive food safety risk assessments.

Nontyphoidal Salmonella (NTS) is one of the leading foodborne pathogens and accounts for the highest burden of foodborne disease worldwide (Havelaar et al., 2015). NTS is also a significant foodborne pathogen in China. Although it ranks second to norovirus in sporadic foodborne disease cases (Fan et al., 2024), it is the predominant cause of foodborne outbreaks (Fan et al., 2025), underscoring its critical role in China's food safety landscape. NTS also exhibits notable environmental resilience, such as growth during transport and storage, transferring via food-contact surfaces, and surviving due to insufficient cooking. Meanwhile, the emergence and spread of antimicrobial resistance (AMR) in NTS pose a serious threat to human health (Sati et al., 2025). Studies have shown that infections caused by multidrug resistant (MDR) NTS are associated with a higher risk of bloodstream infections and longer hospital stays, potentially increasing the overall disease burden (Liang et al., 2019; Parisi et al., 2018). Epidemiological studies have also shown that MDR NTS infections are associated with a significantly higher risk of developing invasive disease and death (Hengkrawit and Tangjade, 2022; Akullian et al., 2018). Thus, integrating AMR profiles into the quantitative microbiological risk assessment (QMRA) framework is essential for quantifying the health burden of NTS.

In foodborne disease outbreaks in China, livestock meat has been identified as the predominant implicated food vehicle (Zhao et al., 2022b). Meanwhile, evidence from a source attribution study indicates that pork is the main contributor to sporadic NTS infections (Zhang, 2025). This can be attributed to multiple factors, particularly the high prevalence of NTS contamination in pork products and the high level of pork consumption in China. A meta-analysis conducted in China from 2000 to 2020 reported an NTS pooled prevalence of 17% in retail pork, with provincial estimates ranging from 7% to 46% (Shen et al., 2022). On the other hand, pork is also the staple meat in China, and pork handling practices reflect typical food consumption patterns in Chinese households. Furthermore, as the world's largest pork producer and consumer, China faces an elevated risk of NTS infection. Although a study analysis indicated that Chinese consumers exhibit poor hygienic practices in household pork handling (Zhang et al., 2024), the public health risk and disease burden associated with pork-derived NTS remain insufficiently characterized.

The dynamics of NTS in pork are highly dependent on household handling practices. Haque et al. (2024) concluded that the theoretical minimum growth temperatures for NTS range from 5 to 6 °C, indicating that temperature abuse scenarios, such as inadequate refrigeration or prolonged exposure to room temperature, can promote NTS proliferation. Research by Kirchner et al. (2023) indicated that proper handwashing during meal preparation could significantly reduce the risk of cross-contamination. A QMRA study incorporated provincial handling practices identified cross-contamination as the leading contributor to household pork-related salmonellosis in China (Bai et al., 2022). Meanwhile, the recent national survey analysis suggested that the risk of undercooking should not be overlooked (Zhang et al., 2024). However, the relative contribution of the two primary exposure pathways—cross-contamination and undercooking—to quantitative risk remains unclear.

While previous risk assessment studies have primarily adopted a farm-to-fork approach, simplifications across food chain stages have introduced considerable uncertainty, particularly in quantifying risks at the household level—the critical final stage directly influencing food safety (Zhong et al., 2024; Vigre et al., 2016). Therefore, the present study aims to 1) propose a retail-to-fork QMRA model based on the national handling practices data to quantify the risk of pork-derived NTS via two exposure pathways—cross-contamination and undercooking—in mainland China, and 2) integrate the AMR profiles of NTS to estimate the disease burden attributable to MDR and non-MDR strains in terms of disability-adjusted life years (DALYs). Enhanced knowledge may provide a more comprehensive understanding of the NTS risk associated with household pork consumption and support the development of more effective risk management strategies in mainland China.