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The Influences of Climatic and Socioeconomic Variables on Cholera Incidence in India During the Seventh Pandemic, 1961-2008

Background: Cholera outbreaks result in significant morbidity worldwide. Transmission of the disease may be influenced by weather fluctuations, such as El Nino-Southern Oscillation (ENSO) and excessive rainfall, and socioeconomic status (SES), including income and education. El Nino events may influence many aspects of the climate, including the amount of rainfall occurring in a given year and surface water temperature. This study aimed to assess the influences of extreme weather and SES factors on cholera incidence in India during the seventh cholera pandemic (1961-2008). Methods: Data for all variables were obtained for 1961-2008. Indian population estimates and cholera incidence (IR) were obtained from the World Bank and World Health Organization (WHO). Data for climatic variables were obtained from Indian and US climate agencies. SES measures, gross national income (GNI), Human Development Index (HDI), and infant mortality rate (IMR), were collected from the World Bank, WHO, and United Nations Development Programme. Spearman Correlations, t-tests, ANOVA, and linear regressions were carried out using SPSS. Results: There was no significant difference between cholera IR during ENSO and non-ENSO years using ANOVA (F=0.478, p=0.623). GNI, HDI, and IMR were significant in all linear regression models. Significant associations were observed between IR and GNI (R=0.37, p<0.001), IMR (R=0.62, p<0.001), and HDI (R=0.43, p<0.001). Rainfall and ENSO events were not significant (α<0.05) in any model. Conclusion: While weather fluctuations did not influence cholera incidence, SES measures were significantly associated with cholera IR, suggesting that economic development is important to address in cholera control.