ARE THERE NATIONAL RISK-FACTORS FOR EPIDEMIC CHOLERA - THE CORRELATION BETWEEN SOCIOECONOMIC AND DEMOGRAPHIC INDEXES AND CHOLERA INCIDENCE IN LATIN-AMERICA

Background From 1991 through 1995, all Latin American countries mainta ined cholera surveillance systems to track the epidemic that entered t he region through Peru in January 1991. These data were used to assess correlations between socioeconomic and demographic indices that might serve as national risk predictors for epidemic cholera in Latin Ameri ca. Methods Correlations between country-specific cumulative cholera i ncidence rates from 1991 through 1995 and infant mortality, the Human Development Index ([HDI] a numerical value based on life expectancy, e ducation, and income), gross national product (GNP) per capita, and fe male literacy were tested using the Pearson correlation coefficient. R esults A total of 1 339 834 cholera cases with a cumulative incidence rate of 183 per 100 000 population were reported from affected Western Hemisphere countries from 1991 through 1995. Infant mortality rates w ere the most strongly correlated with cumulative cholera incidence bas ed on the Pearson correlation coefficient. The HDI had a less strong n egative correlation with cumulative cholera incidence. The GNP per cap ita and female literacy rates were weakly and negatively correlated wi th cholera cumulative incidence rates. Conclusions Infant mortality an d possibly the HDI may be useful indirect indices of the risk of susta ined transmission of cholera within a Latin American country. Cumulati ve cholera incidence is decreased particularly in countries with infan t mortality below 40 per 1000 live births. The lack of reported choler a cases in Uruguay and the Caribbean may reflect a low risk for ongoin g transmission, consistent with socioeconomic and demographic indices. Cholera surveillance remains an important instrument for determining cholera trends within individual countries and regions.