title: Socioeconomic and environmental determinants of dengue transmission in an urban setting: An ecological study in Nouméa, New Caledonia.
abstract: Dengue is a mosquito-borne virus that causes extensive morbidity and economic loss in many tropical and subtropical regions of the world. Often present in cities, dengue virus is rapidly spreading due to urbanization, climate change and increased human movements. Dengue cases are often heterogeneously distributed throughout cities, suggesting that small-scale determinants influence dengue urban transmission. A better understanding of these determinants is crucial to efficiently target prevention measures such as vector control and education. The aim of this study was to determine which socioeconomic and environmental determinants were associated with dengue incidence in an urban setting in the Pacific.
  
  
  
  An ecological study was performed using data summarized by neighborhood (i.e. the neighborhood is the unit of analysis) from two dengue epidemics (2008-2009 and 2012-2013) in the city of Nouméa, the capital of New Caledonia. Spatial patterns and hotspots of dengue transmission were assessed using global and local Moran's I statistics. Multivariable negative binomial regression models were used to investigate the association between dengue incidence and various socioeconomic and environmental factors throughout the city.
  
  
  
  The 2008-2009 epidemic was spatially structured, with clusters of high and low incidence neighborhoods. In 2012-2013, dengue incidence rates were more homogeneous throughout the city. In all models tested, higher dengue incidence rates were consistently associated with lower socioeconomic status (higher unemployment, lower revenue or higher percentage of population born in the Pacific, which are interrelated). A higher percentage of apartments was associated with lower dengue incidence rates during both epidemics in all models but one. A link between vegetation coverage and dengue incidence rates was also detected, but the link varied depending on the model used.
  
  
  
  This study demonstrates a robust spatial association between dengue incidence rates and socioeconomic status across the different neighborhoods of the city of Nouméa. Our findings provide useful information to guide policy and help target dengue prevention efforts where they are needed most.
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.|Epidemiology of Infectious Diseases Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia.
authors.forename: Raphaël M
authors.initials: RM
authors.lastname: Zellweger
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cano
authors.affiliation: IRD, UMR ESPACE-DEV (UR/UA/UG/UM/IRD), Nouméa, New Caledonia.
authors.forename: Morgan
authors.initials: M
authors.lastname: Mangeas
authors.affiliation: University of Reunion Island, UMR Prodig/OIES (Cregur), Reunion Island, France.
authors.forename: François
authors.initials: F
authors.lastname: Taglioni
authors.affiliation: IRD, UMR ESPACE-DEV (UR/UA/UG/UM/IRD), Nouméa, New Caledonia.|CIRAD/INRA, UMR Contrôle des Maladies Animales Exotiques et Emergentes (CMAEE), Montpellier, France.
authors.forename: Alizé
authors.initials: A
authors.lastname: Mercier
authors.affiliation: IRD, UMR ESPACE-DEV (UR/UA/UG/UM/IRD), Nouméa, New Caledonia.
authors.forename: Marc
authors.initials: M
authors.lastname: Despinoy
authors.affiliation: IRD / Sorbonne Universités (UPMC, Université Paris 06) / CNRS / MNHN, LOCEAN - UMR 7159, Nouméa, New Caledonia.
authors.forename: Christophe E
authors.initials: CE
authors.lastname: Menkès
authors.affiliation: Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Noumea, New Caledonia.
authors.forename: Myrielle
authors.initials: M
authors.lastname: Dupont-Rouzeyrol
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.|Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France.|CNRS, URA3012, Paris, France.|Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France.
authors.forename: Birgit
authors.initials: B
authors.lastname: Nikolay
authors.affiliation: Epidemiology of Infectious Diseases Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia.
authors.forename: Magali
authors.initials: M
authors.lastname: Teurlai
mesh_terms: D000328:Adult; D002947:Cities / Q000453:epidemiology; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission*; D018562:Disease Transmission, Infectious; D004777:Environment; D006801:Humans; D015994:Incidence; D009510:New Caledonia / Q000453:epidemiology; D012959:Socioeconomic Factors; D019371:Topography, Medical