title: Occurrence of severe dengue in Rio de Janeiro: an ecological study.
abstract: BACKGROUND
  This study aimed to analyze the relationship between the incidence of severe dengue during the 2008 epidemic in Rio de Janeiro, Brazil, and socioeconomic indicators, as well as indicators of health service availability and previous circulation of the dengue virus serotype-3 (DENV-3).
  
  
  METHODS
  In this ecological study, the units of analysis were the districts of Rio de Janeiro. The data were incorporated into generalized linear models, and the incidence of severe dengue in each district was the outcome variable.
  
  
  RESULTS
  The districts with more cases of dengue fever in the 2001 epidemic and a higher percentage of residents who declared their skin color or race as black had higher incidence rates of severe dengue in the 2008 epidemic [incidence rate ratio (IRR)= 1.21; 95% confidence interval (95%CI)= 1.05-1.40 and IRR= 1.34; 95%CI= 1.16-1.54, respectively]. In contrast, the districts with Family Health Strategy (FHS) clinics were more likely to have lower incidence rates of severe dengue in the 2008 epidemic (IRR= 0.81; 95%CI= 0.70-0.93).
  
  
  CONCLUSIONS
  At the ecological level, our findings suggest the persistence of health inequalities in this region of Brazil that are possibly due to greater social vulnerability among the self-declared black population. Additionally, the protective effect of FHS clinics may be due to the ease of access to other levels of care in the health system or to a reduced vulnerability to dengue transmission that is afforded by local practices to promote health.
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors: Gerusa
authors: G
authors: Gibson
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors: Reinaldo
authors: R
authors: Souza-Santos
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors: Alexandre San
authors: AS
authors: Pedro
authors: Laboratório de Transmissores de Hematozoários, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors: Nildimar Alves
authors: NA
authors: Honório
authors: Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors: Marilia
authors: M
authors: Sá Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012307:Risk Factors; D019595:Severe Dengue / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult