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

Abstract

Introduction: Arthropod-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.

Methods: We 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.

Results: We 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%).

Conclusion: Evidence 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 number: CRD42019158572.

Keywords: arboviruses; epidemiology; public health; systematic review.

Figure 1

PRISMA flow chart illustrating selection of studies. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SEP, socioeconomic position.

Figure 2

Geographic distribution of studies included in the systematic review. (A) All countries reporting SEP and arboviral infections, (B) Countries reporting SEP and Dengue virus (DENV) infections, (C) Countries reporting SEP and Chikungunya virus infections, (D) Countries reporting on SEP and Japanese encephalitis virus (JEV), Rift Valley fever virus (RVFV), Sindbis virus (SINV), West Nile virus (WNV), Zika virus (ZIKV) or multiple arboviral infections. SEP, socioeconomic position.

Figure 3

Meta-analysis for the association between socioeconomic risk markers and arboviral infections. Pooled estimates using random-effects meta-analyses are calculated by subgroups of socioeconomic markers, sex (A), education (B), employment (C), water supply (D) and marital status (E). Subgroups of arboviruses are additionally presented per risk marker. Error bars show the point RR with their 95% CIs on the log scale for each study. Diamonds show the combined point estimate. I² statistics and Q-test p values are reported. *Indicates cohort study, whereas all others are cross-sectional studies.