Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis

Abstract

IntroductionArthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and meta-analysis aims to assess the relationship between markers of socioeconomic position (SEP) and infection due to arboviruses with mosquito vectors.MethodsWe conducted a systematic search on PubMed, Embase, and LILACS databases to identify studies published between 1980 and 2020 that measured the association of SEP markers with arbovirus infection. We included observational studies without geographic location or age restrictions. We excluded studies from grey literature, reviews and ecological studies. Study findings were extracted and summarised, and pooled estimates were obtained using random-effects meta-analyses.ResultsWe identified 36 observational studies using data pertaining to 106 524 study participants in 23 geographic locations that empirically examined the relationship between socioeconomic factors and infections caused by seven arboviruses (dengue, chikungunya, Japanese encephalitis, Rift Valley fever, Sindbis, West Nile and Zika viruses). While results were varied, descriptive synthesis pointed to a higher risk of arbovirus infection associated with markers of lower SEP, including lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, marital status (married, divorced or widowed), non-white ethnicities and migration status. Pooled crude estimates indicated an increased risk of arboviral infection associated with lower education (risk ratio, RR 1.5 95% CI 1.3 to 1.9); I2=83.1%), interruption of water supply (RR 1.2; 95% CI 1.1 to 1.3; I2=0.0%) and having been married (RR 1.5 95% CI 1.1 to 2.1; I2=85.2%).ConclusionEvidence from this systematic review suggests that lower SEP increases the risk of acquiring arboviral infection; however, there was large heterogeneity across studies. Further studies are required to delineate the relationship between specific individual, household and community-level SEP indicators and arbovirus infection risks to help inform targeted public health interventions.PROSPERO registration numberCRD42019158572.

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

“…Our study found markers of social vulnerability, such as living in the Northeast, the mother’s race/ethnicity, years of education and marital status, to be associated with a higher risk of CZS. The findings are broadly consistent with a 2022 systematic review of socioeconomic risk factors for arbovirus infections that found an association between lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, non-white ethnicities and migration status and arbovirus infection 14. Indicators of low socioeconomic position associated with increased CZS risks may be explained, in part, by increased exposure to infected mosquitoes during pregnancy due to community-level environmental factors such as interrupted water supplies/sanitation and inadequate housing conditions.…”

“…The findings are broadly consistent with a 2022 systematic review of socioeconomic risk factors for arbovirus infections that found an association between lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, non-white ethnicities and migration status and arbovirus infection. 14 Indicators of low socioeconomic position associated with increased CZS risks may be explained, in part, by increased exposure to infected mosquitoes during pregnancy due to community-level environmental factors such as interrupted water supplies/sanitation and inadequate housing conditions. A literature review on infectious diseases in Brazil published in 2011, 29 had already stressed the failure of the control of Aedes aegypti in the country, which at that time was responsible for major dengue epidemics in the country and is the main vector of ZIKV.…”

“…Emerging evidence suggests that children with CZS have lifelong health sequelae that can increase mortality risk6 and require costly interventions with widespread social and economic impacts on the affected individual and their family 7. While it is well known that social risk markers at the community (eg, sanitation), household (eg, crowding, housing materials) and individual (eg, education) levels are associated with a higher risk of infectious diseases4 8–13 including arboviruses,14 research on the relationship between socioeconomic factors and CZS remains limited.…”

Seroprevalence of Dengue, Chikungunya and Zika at the epicenter of the congenital microcephaly epidemic in Northeast Brazil: a population-based survey

“…The weighted seroprevalence of dengue, zika and chikungunya was higher in areas classified as low and intermediate socioeconomic levels when compared to the high socioeconomic strata which have greater coverage of sanitation, regular water supply and where most of the population live in apartment buildings. In general, our data also reinforce the role of unplanned urbanization and poverty as one of the factors that influence the incidence and expansion of arboviruses [63, 64].…”

Messaging Should Reflect the Nuanced Relationship between Land Change and Zoonotic Disease Risk

“…Especially on the webpages we sampled, it was not rare for messaging to give the impression that spillover risk is entirely dependent on land change. This could divert attention from other factors that may increase zoonotic disease spillover risk, such as the wildlife trade (Karesh et al 2005 ), wildlife farming (Magouras et al 2020 and the references therein), global travel (Baker et al 2022 ), climate change (Carlson et al 2022 ), socioeconomics (Power et al 2022 ), and transmission to researchers working on ­zoonotic diseases (National Research Council 2012 ).…”