Biophysical, infrastructural and social heterogeneities explain spatial distribution of waterborne gastrointestinal disease burden in Mexico City

Due to unplanned growth, large extension and limited resources, most megacities in the developing world are vulnerable to hydrological hazards and infectious diseases caused by waterborne pathogens. Here we aim to elucidate the extent of the relation between the spatial heterogeneity of physical and socio-economic factors associated with hydrological hazards (flooding and scarcity) and the spatial distribution of gastrointestinal disease in Mexico City, a megacity with more than 8 million people. We applied spatial statistics and multivariate regression analyses to high resolution records of gastrointestinal diseases during two time frames (2007-2009 and 2010-2014). Results show a pattern of significant association between water flooding events and disease incidence in the city center (lowlands). We also found that in the periphery (highlands), higher incidence is generally associated with household infrastructure deficiency. Our findings suggest the need for integrated and spatially tailored interventions by public works and public health agencies, aimed to manage socio-hydrological vulnerability in Mexico City.