Factors associated with dengue mortality in Latin America and the Caribbean, 1995-2009: an ecological study.
In this study, we aimed to estimate the effect that environmental, demographic, and socioeconomic factors have on dengue mortality in Latin America and the Caribbean. To that end, we conducted an observational ecological study, analyzing data collected between 1995 and 2009. Dengue mortality rates were highest in the Caribbean (Spanish-speaking and non-Spanish-speaking). Multivariate analysis through Poisson regression revealed that the following factors were independently associated with dengue mortality: time since identification of endemicity (adjusted rate ratio [aRR] = 3.2 [for each 10 years]); annual rainfall (aRR = 1.5 [for each 10(3) L/m(2)]); population density (aRR = 2.1 and 3.2 for 20-120 inhabitants/km(2) and > 120 inhabitants/km(2), respectively); Human Development Index > 0.83 (aRR = 0.4); and circulation of the dengue 2 serotype (aRR = 1.7). These results highlight the important role that environmental, demographic, socioeconomic, and biological factors have played in increasing the severity of dengue in recent decades.
Faculdade de Saúde Pública, University of São Paulo School of Public Health, São Paulo, Brazil. frediazq@msn.com
Fredi Alexander
FA
Díaz-Quijano
Eliseu Alves
EA
Waldman
D017691:Caribbean Region / Q000453:epidemiology; D003715:Dengue / Q000401:mortality*; D003906:Developing Countries; D004777:Environment; D005006:Ethnicity; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D011156:Population Density; D011158:Population Growth; D012959:Socioeconomic Factors