Socioeconomic disparities and dog rabies: a retrospective analysis of high-spatial-resolution surveillance data from a Latin American city.

Background: Dog-mediated human rabies is intuitively linked to poverty, but few studies have formally investigated the relationship between local socioeconomic disadvantage and dog rabies incidence. Methods: We leveraged a unique, high-spatial-resolution surveillance database from the rabies-endemic city of Arequipa, Peru to probe the relationship between neighbourhood socioeconomic status (SES) and dog rabies risk in 2015-2022. Rabies cases and samples were assigned to the SES level of their block or locality of origin, respectively. We tested the hypothesis that lower SES is associated with increased case positivity and used a spatial statistical model to understand how sample positivity varied spatially. Findings: Rabies cases were concentrated in socioeconomically disadvantaged blocks (p < 0.001), and sample positivity had a significant and positive association with neighbourhood disadvantage (p < 0.05 for all periods), suggesting that surveillance effort was low relative to case incidence in disadvantaged areas. Stratifying samples by those collected via active vs. passive surveillance revealed that active surveillance reduced disparities in surveillance effort and sample positivity. Spatial analysis identified a sample positivity hotspot in a socioeconomically disadvantaged region with low access to health facilities. Interpretation: Dog-mediated rabies is known to impact the poorest regions globally. We found similar patterns mirrored on a much smaller spatial scale-within a single city's limits. A balanced approach combining spatially-targeted ("active") and community-based ("passive") surveillance can help reduce rabies disparities. Mass dog vaccination and surveillance programs could target disadvantaged neighbourhoods to allocate resources to the most impacted areas and more effectively control dog rabies epidemics. Funding: US National Institutes of Health.