Dengue incidence, mortality, and case-fatality in Brazil: spatial patterns, socioeconomic contrasts, and serotype impact.

BACKGROUND

Despite its burden, dengue remains neglected, with few studies comparing its incidence, mortality, case-fatality, and key variables such as socioeconomic factors, healthcare access, and serotype distribution.

METHODS

This ecological study analyzed dengue cases and deaths (2014-2024) in intermediate regions of Brazil. Covariates included illiteracy rate, hospital bed availability, serotype distribution, and private healthcare coverage. High- and low-risk spatial clusters were identified using the SaTScan Poisson model. Statistical analysis assessed significant covariate differences between risk groups.

RESULTS

High-incidence clusters were found in areas with lower illiteracy rates, whereas high-case fatality clusters were found in areas with higher illiteracy rates. DENV-2 was associated with high-risk case-fatality areas; in contrast, DENV-1 showed the opposite pattern, appearing to be more common but associated with lower severity.

CONCLUSIONS

These findings provide a basis for generating hypotheses for future modeling studies on these associations.