# Noncommunicable diseases associated with bleeding disorders, hospitalization, and mortality in patients with dengue in Mexico: A national analysis of confirmed cases in 2024

## TL;DR

This study finds that noncommunicable diseases like diabetes and kidney disease are linked to worse outcomes in dengue patients in Mexico, including hospitalization, bleeding, and death.

## Contribution

The study provides new evidence on how noncommunicable diseases worsen dengue outcomes in Mexico, highlighting a growing syndemic.

## Key findings

- Chronic kidney disease had the strongest association with hospitalization in dengue patients.
- Diabetes, hypertension, and chronic kidney disease were linked to increased odds of death in dengue cases.
- Bleeding disorders in dengue patients were significantly associated with several noncommunicable diseases.

## Abstract

In Mexico, some of the most prevalent noncommunicable diseases (NCDs) among adults are diabetes, hypertension, and chronic kidney disease (CKD). Mexico is currently facing a syndemic characterized by the convergence of dengue and NCDs. This study aims to describe and analyze the association between the prevalence of NCDs and hospitalization, the presence of hemorrhagic disorders, and death in all officially confirmed cases of dengue in Mexico during 2024.

This cross-sectional study was carried out through a secondary analysis of the confirmed cases of dengue reported in 2024. We assessed the associations between NCDs and the probability of hospitalization, bleeding disorders, and death, using one logistic regression model for each clinical outcome. We adjusted the three models for age, sex, social security affiliation, ethnicity and for each of the NCDs (diabetes, hypertension, chronic kidney disease, immunosuppression, cirrhosis, and peptic ulcer disease). The most common noncommunicable diseases were diabetes, hypertension, CKD, and immunosuppression. For hospitalization, CKD had the strongest association (OR 5.74), followed by immunosuppression (OR 2.84), peptic ulcer disease (OR 2.33), and diabetes (OR 2.10). We found significant associations between bleeding disorders and several NCDs (diabetes, peptic ulcer disease, immunosuppression, cirrhosis, and hypertension) compared to people without these conditions. People with CKD, peptic ulcer disease and diabetes, had more odds for death compared to those without these comorbidities.

We found a significant association between several comorbidities and worse clinical outcomes in patients with dengue, such as hospitalization, bleeding disorders, or death. The syndemic of NCDs and dengue in Mexico has been rapidly increasing, and this problem needs to be addressed. This work confirms and extends the findings of previous studies and suggests that patients with these comorbidities have worse clinical outcomes.

Dengue infection has shown a significant increase over the last decade, with 2024 marking a record number of cases across Latin America. Although dengue is considered an endemic disease in the region, the magnitude of reported infections in recent years is unprecedented. In Mexico, this trend reflects the regional surge reporting an unprecedentedly elevated number of cases for 2024. Despite typically having low rates of severe illness and case fatality, dengue outcomes can be exacerbated by the presence of underlying noncommunicable diseases. Furthermore, Mexico is facing growing prevalences of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease. Having a noncommunicable disease as an underlying condition triggers severe illness, including bleeding disorders and higher mortality. This study provides information about the association between the prevalence of noncommunicable diseases and the presence of three different clinical outcomes in dengue-confirmed cases. These findings emphasize the critical necessity of addressing the syndemic interplay between dengue and noncommunicable diseases in Mexico.