Influence of socioeconomic, geographic, climatic, and infrastructure factors with dengue fever in Colombia from 2015 to 2020: A Spatial Generalized Additive Mixed Model

BackgroundDengue virus infection remains among the most prevalent infectious diseases globally, with an estimate of 100-400 million cases occurring each year. Prior ecological studies have documented spatial and temporal correlations between dengue occurrence and either socioeconomic or climatic conditions independently. The aim of this study was to analyze the association between multidimensional typologies, including socioeconomic, geographic, climatic, and infrastructure factors and the rate of dengue cases in Colombia. MethodsAn analytical, observational, ecological study with repeated measures that included six years of aggregated quantitative data study from 2015 to 2020, based on national registry data from several sources. A spatial Generalized Additive Mixed Model (GAMM) was used to identify the probable factors associated with the frequency of dengue in Colombia. Socioeconomic, infrastructure, geographic, and climatic factors included Multidimensional Poverty Index (MPI), altitude, population density, road density, education and public services coverage, altitude, temperature, precipitation, relative humidity, and presence of El Nino-Southern Oscillation (ENSO) in the period of analysis. ResultsDuring the study period, 448,774 cases of dengue fever were reported in Colombia, with overall monthly median of 6280 cases (IQR: 2842-9278). The highest number of cases was reported in 2019 with 118,956 cases. Higher levels of drinkable water service coverage, education access coverage, and relative humidity were negatively associated with dengue frequency, showing lower case frequency. While higher GDP per capita and greater participation in the subsidized health system were associated with higher incidence of dengue, although the latter showed substantial variability in extreme values. Precipitation and maximum and minimum temperatures showed unimodal associations, with risk concentrated at intermediate values, while altitude and population density revealed complex multimodal patterns. Municipal performance, a composite index that assesses the efficiency and management capacity of local governments, showed a negative association with dengue occurrence, indicating lower risk in better-performing municipalities. ConclusionsA complex interaction was found between socioeconomic, geographic, climatic, and infrastructure factors. These findings may highlight the need for multidimensional approaches in dengue prevention and control policies, that consider the specific conditions of each community. Research is required to better understand the factors that affect the dynamics of dengue. Factors identified at this local level may be useful in different geographical regions, especially in the context of climate change related vulnerabilities. Author summaryDengue fever affects millions worldwide, with Colombia reporting over 150,000 cases in 2023. Understanding what drives dengue transmission is crucial for prevention, but most studies focus on either climate or social factors alone. We studied how multiple factors such as poverty, access to services, climate conditions, and government capacity relate to dengue patterns across Colombian municipalities from 2015-2020. We found that dengue occurrence is associated with a complex mix of factors. Warmer temperatures and moderate rainfall were associated with more cases, but so were factors like limited access to clean water and education. Surprisingly, areas with higher economic development also reported more cases, possibly explained by better disease detection and diagnosis due to better healthcare access. Well-performing local governments were associated with lower disease frequency. These findings suggest that fighting dengue requires comprehensive approaches that go beyond mosquito control. Communities need improved water access, better education, and strong local governance. As climate change progresses, understanding these multiple vulnerabilities becomes even more important to protect vulnerable populations, particularly in tropical regions where dengue is endemic.