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Spatiotemporal distribution and socioeconomic disparities of dengue, chikungunya and Zika in two Latin American cities from 2007 to 2017
Author(s) -
Carabali Mabel,
Harper Sam,
Lima Neto Antonio S.,
Santos de Sousa Geziel,
Caprara Andrea,
Restrepo Berta Nelly,
Kaufman Jay S.
Publication year - 2021
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13530
Subject(s) - socioeconomic status , dengue fever , geography , chikungunya , latin americans , demography , outbreak , index (typography) , distribution (mathematics) , inequality , environmental health , medicine , population , mathematics , political science , virology , sociology , mathematical analysis , world wide web , computer science , law
Objective To assess the presence, pattern and magnitude of socioeconomic inequalities on dengue, chikungunya and Zika in Latin America, accounting for their spatiotemporal distribution. Methods Using longitudinal surveillance data (reported arboviruses) from Fortaleza, Brazil and Medellin, Colombia (2007–2017), we fit Bayesian hierarchical models with structured random effects to estimate: (i) spatiotemporally adjusted incidence rates; (ii) Relative Concentration Index and Absolute Concentration Index of inequality; (iii) temporal trends in RCIs; and (iv) socioeconomic‐specific estimates of disease distribution. The spatial analysis was conducted at the neighbourhood level (urban settings). The socioeconomic measures were the median monthly household income (MMHI) for Brazil and the Socio‐Economic Strata index (SES) in Colombia. Results There were 281 426 notified arboviral cases in Fortaleza and 40 887 in Medellin. We observed greater concentration of dengue among residents of low socioeconomic neighbourhoods in both cities: Relative Concentration Index = −0.12 (95% CI = −0.13, −0.10) in Fortaleza and Relative Concentration Index = −0.04 (95% CI = −0.05, −0.03) in Medellin. The magnitude of inequalities varied over time across sites and was larger during outbreaks. We identified a non‐monotonic association between disease rates and socioeconomic measures, especially for chikungunya, that changed over time. The Relative Concentration Index and Absolute Concentration Index showed few if any inequalities for Zika. The socioeconomic‐specific model showed increased disease rates at MMHI below US$400 in Brazil and at SES‐index below level four, in Colombia. Conclusions We provide robust quantitative estimates of socioeconomic inequalities in arboviruses for two Latin American cities. Our findings could inform policymaking by identifying spatial hotspots for arboviruses and targeting strategies to decrease disparities at the local level.