Socioeconomic status and post-cyclone dengue Vulnerability: The mediating roles of knowledge and risk perception in Southern China

BACKGROUND: Although numerous studies have investigated the link between tropical cyclones and dengue transmission, this body of research is predominantly ecological. How individual-level factors modify vulnerability to this risk remains understudied. We investigated how socioeconomic status, knowledge, attitudes, practices (KAP), and risk perception modulate post-cyclone vulnerability to inform targeted interventions. METHODS: We conducted a 1:1 matched case-control study in Guangzhou, Zhongshan, and Foshan cities between September 14 and October 1, 2024, following the Super Typhoon Yagi on September 7, 2024. Cases were confirmed using the local surveillance system and matched to controls recruited via community sampling by age and sex. Structural equation modeling (SEM) was used to identify the mediating pathways between SES and vulnerability, while multivariable conditional logistic regression was used to identify independent direct predictors of dengue infection. RESULTS: Structural equation modeling identified a significant pathway in which a higher socioeconomic status predicted greater knowledge (β = 0.34, p < 0.01), which in turn was associated with stronger preventive practices. In the final multivariable logistic regression, higher scores for practice (aOR = 0.62, 95 % CI: 0.43, 0.88), environment risk perception (aOR = 0.73, 95 % CI: 0.59, 0.91), and knowledge (aOR = 0.57, 95 % CI: 0.42, 0.77) were significant protective factors against dengue. Conversely, frequent mosquito exposure emerged as the strongest risk factor. Compared to individuals bitten weekly or less often, those experiencing daily bites had more than double the odds of infection (aOR = 2.38, 95 % CI: 1.43, 3.97). CONCLUSION: Individual-level determinants, particularly adaptive practices and environmental risk perception, are critical mediators of post-cyclone dengue risk. Public health interventions should be tailored to bolster these protective behaviors, mitigating outbreak threats in vulnerable populations.