The social determinants of health of dengue seroprevalence: A systematic review & meta-analysis Open Access

Abstract

Background: Social determinants are integral in health outcomes associated with dengue. A systematic review of the literature and meta-analysis was conducted to determine what social determinants are associated with dengue virus (DENV) seroprevalence. 

Methods: A systematic review was conducted following PRISMA guidelines in Embase, PubMed, and Web of Science. We used the following search strategy, “(Dengue) AND ("risk factors" or "Social Determinants of Health" or "health disparities")” to gather relevant research. Studies with an observational design on risk factors of dengue seroprevalence, confirmed by IgG serology, were included. Covidence was used in the screening and data collection process. A random-effects meta-analysis was conducted to estimate the pooled odds ratio (OR) for each variable with sufficient data. 

Results: The initial search of studies resulted in a total of 4,373 published manuscripts, 203 of which were included after screening by title abstract and duplicates removed. A total of 41 manuscripts with complete raw data from 24 countries were included. The following social determinants had sufficient data to be included in the meta-analysis: gender (n=36), education (n=6), employment (n=4), income (n=5), urban-rural status (n=13), presence of stagnant water (n=5), use of bed net (n=9), spraying insecticides (n=4), and marital status (n=5). Most studies yielded no statistical associations between DENV seropositivity and several of these social determinants. Urban-rural status was statistically associated with DENV seropositivity, with a rural residence as protective (OR 1.54; 95% CI=1.14-2.07). Similarly, insecticide spraying significantly correlated with DENV seropositivity (OR 1.31; 95% CI=1.05-1.64). Gender was not statistically associated with DENV seropositivity. 

Discussion: Dengue virus is the most common arbovirus globally, posing a significant health and economic burden. This systematic review and meta-analysis revealed a relative paucity of data on social determinants of DENV seroprevalence. Further research to explore the role of social risk factors of DENV must include more rigorous assessments correlated with serosurvey data to better inform the nature of comprehensive risk-based prevention and control interventions. 

Table of Contents

1. INTRODUCTION ............................................................................................................................................1 

Problem statement ....................................................................................................................................................3 

Purpose statement ....................................................................................................................................................3 

Research question......................................................................................................................................................3 

Significance statement ..............................................................................................................................................3 

2. LITERATURE REVIEW .....................................................................................................................................4 

Introduction ...............................................................................................................................................................4 

Structural Determinants ............................................................................................................................................5 

Socioeconomic and Political Context ....................................................................................................................6 

Socioeconomic Position ........................................................................................................................................8 

Intermediary Determinants .....................................................................................................................................12 

Biological Factors & Behaviors ............................................................................................................................12 

Psychosocial Factors ...........................................................................................................................................16 

Material Circumstances ......................................................................................................................................17 

Health Systems ...................................................................................................................................................19 

Conclusion................................................................................................................................................................21 

3. METHODS ..................................................................................................................................................21 

Selection criteria ......................................................................................................................................................21 

Search Strategy........................................................................................................................................................22 

Data collection and analysis ....................................................................................................................................22 

Study quality and risk of bias...................................................................................................................................24 

4. RESULTS .....................................................................................................................................................25 

Structural Determinants ..........................................................................................................................................30 

Socioeconomic and Political Context ..................................................................................................................30 

Socioeconomic Position ......................................................................................................................................31 

Intermediary Determinants .....................................................................................................................................36 

Material Circumstances ......................................................................................................................................36 

Behaviors and Biological Factors ........................................................................................................................38 

Psychosocial Factors ...........................................................................................................................................41 

Health System .....................................................................................................................................................42 

6. DISCUSSION & CONCLUSION .......................................................................................................................42 

7. REFERENCES ...............................................................................................................................................48 

8. APPENDIX A ..............................................................................................................................................52 

Forest plots of the sensitivity analysis of variables of interest ................................................................................52 

9. APPENDIX B ...............................................................................................................................................57 

Funnel plots of the random-effects meta-analysis of all variables of interest ........................................................57 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	risk factors social determinants of health DENV seroprevalence dengue
Committee Chair / Thesis Advisor	Castro, Kenneth, Emory University
Committee Members	Collins, Matthew, Emory University Cardona-Ospina, Jaime, Fundación Universitaria Autónoma de las Américas

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