Association Between Socio-Environmental Factors, Coverage by Family Health Teams, and Rainfall in the Spatial Distribution of Zika Virus Infection in the City of Rio de Janeiro, Brazil, in 2015 and 2016

Abstract Background: Zika virus (ZIKV) infection caused outbreak in Brazil, in 2015 and 2016. Disorganized urban growth, facilitates the concentration of numerous susceptible and infected individuals. It is useful to understand the mechanisms that can favor the increase in ZIKV incidence, such as areas with wide socioeconomic and environmental diversity. Therefore, the study analyzed the spatial distribution of ZIKV in the city of Rio de Janeiro, Brazil, in 2015 and 2016, and associations between the incidence per 1,000 inhabitants and socio-environmental factors. Methods: The census tracts were used as the analytical units reported ZIKV cases among the city’s inhabitants. Local Empirical Bayesian method was used to control the incidence rates’ instability effect. The spatial autocorrelation was verified with Moran’s Index and local indicators of spatial association (LISA). Spearman correlation matrix was used to indicate possible collinearity. The Ordinary Least Squares (OLS), Spatial Lag Model (SAR), and Spatial Error Model (CAR) were used to analyze the relationship between ZIKV and socio-environmental factors.Results: The SAR model exhibited the best parameters: R2 = 0.44, Log-likelihood= -7482, Akaike Information Criterion (AIC) = 14980. In this model, mean income between 1 and 2 minimum wages was possible risk factors for Zika occurrence in the localities. Household conditions related to adequate water supply and the existence of public sewage disposal were associated with lower ZIKV incidence rates, suggesting possible protective factors against the occurrence of ZIKV in the localities. The presence of the Family Health Strategy in the census tracts was positively associated with the ZIKV incidence rate. However, the results show that mean income less than 1 minimum wage were negatively associated with higher ZIKV incidence rates. Discussion: The results demonstrate the importance of socio-environmental variables in the dynamics of ZIKV transmission and the relevance for the development of control strategies.