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Factors Associated with Dengue Mortality in Latin America and the Caribbean, 1995–2009: An Ecological Study

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  • Faculdade de Saúde Pública, University of São Paulo School of Public Health, São Paulo, Brazil; Grupo Latinoamericano de Investigaciones Epidemiológicas, Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Colombia
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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 103 L/m2]); population density (aRR = 2.1 and 3.2 for 20–120 inhabitants/km2 and > 120 inhabitants/km2, 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.

Author Notes

*Address correspondence to Fredi Alexander Díaz-Quijano, Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, CEP 01246-904, São Paulo, SP, Brazil. E-mail: frediazq@msn.com

Financial support: This study was partially supported by a grant from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, National Council for Scientific and Technological Development; grant no. 312131/2006-2) and by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Office for the Advancement of Higher Education) through the Programa de Estudiante-Convênio de Pós-Graduação (PEC-PG, Graduate Student Support Program).

Authors' addresses: Fredi Alexander Díaz-Quijano, Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brazil, E-mail: frediazq@msn.com. Eliseu Alves Waldman, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brazil, E-mail: eawaldma@usp.br.

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