Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk

摘要: BACKGROUND: Few studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution within small urban areas. This study aimed to examine whether specific an slum community were associated with risk disease. METHODOLOGY/PRINCIPAL FINDINGS: From 01/2009 12/2010, we conducted enhanced, community-based surveillance in only public emergency unit a Salvador, Brazil identify acute febrile illness (AFI) patients laboratory evidence infection. Patient households geocoded census tracts (CTs). Demographic, geographical data obtained from 2010 national census. Associations CTs both non-dengue AFI assessed by Poisson log-normal conditional auto-regressive models (CAR). We identified 651 (22.0%) cases among 2,962 patients. Estimated symptomatic was 21.3 70.2 per 10,000 inhabitants 2009 2010, respectively. All four serotypes identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased poorer (RR: 1.02 for each percent increase frequency families earning ≤1 times minimum wage; 95% CI: 1.01-1.04), decreased located farther health 0.87 100 meter increase; 0.80-0.94). The same also risk. CONCLUSIONS/SIGNIFICANCE: highlights large burden on individuals living slums Brazil. Lower neighborhood socioeconomic status independently dengue, indicating that communities high levels absolute poverty, factors social gradient influence transmission. In addition, poor access services may be barrier identifying cases. Therefore, further should account this potential source bias.