Snakebite epidemiology in the State of Mexico, Mexico 2003-2024

In the State of Mexico, several venomous snakes have low median lethal doses, which therefore pose serious health risks. We anal- ysed the epidemiology of snakebites from 2003 to 2024 and examined their relationship with demographic, socioeconomic, and bio- logical factors. Incidence rates and demographic characteristics were calculated, and Getis-Ord Gi* statistics were used to identify snakebite hotspots. We also applied Non-Metric Multi-Dimensional Scaling (NMDS) to explore associations between hotspot cate- gories and socioeconomic conditions. The potential distribution of 14 venomous snake species was modelled to estimate venomous snake diversity across municipalities. A total of 3,972 cases were reported, with an increasing trend over time. Most bites occurred in summer, affecting mainly males aged 25-44. Hotspot analysis identified 27 municipalities as hotspots, 50 as not significant and 48 as coldspots. Southern municipalities showed higher snakebite incidence. Coldspot areas had higher educational attainment and greater employment in services and tertiary sectors, despite similar snake diversity to hotspots. These findings can guide public health strategies, particularly regarding the allocation of antivenoms in regional hospitals.