Territorial suitability and human exposure interactions shaping dengue incidence in Mexico (2020-2024)

Dengue remains a major public health concern in tropical and subtropical regions, with spatial patterns shaped by environmental gradients and human population distribution. In Mexico, pronounced geographic heterogeneity complicates prevention and surveillance efforts. This study develops a state-level Territorial Suitability Index (TSI) for dengue during the 2020-2024 period. The framework integrates environmental suitability and human-exposure variables within a spatial analytical approach. Temperature, precipitation, relative humidity, vegetation, elevation, slope, built-up fraction, and population density were used to generate suitability surfaces at 1-km resolution in Google Earth Engine. These surfaces were subsequently aggregated and validated against confirmed dengue incidence from the national epidemiological surveillance system. Results showed moderate and spatially consistent associations between the TSI and state-level dengue incidence, with Spearman correlation coefficients reaching 0.47 and AUC values up to 0.72 for the combined index, reflecting the joint influence of environmental suitability and population exposure. High territorial suitability was concentrated along the Gulf of Mexico and Pacific coastal regions, whereas high-altitude states consistently exhibited low suitability values. The index captures macro-territorial suitability patterns rather than local transmission dynamics, highlighting the importance of spatial scale when linking environmental processes with epidemiological data. The proposed framework demonstrates how multi-source environmental information can be integrated into reproducible territorial indicators that support strategic planning, spatial prioritization, and public health surveillance in vector-borne disease management.