Spatial ecological determinants of infectious diseases using National Health Insurance data: A multivariate canonical correlation analysis

Uncertain climate change and population growth, which increase every year, constitute a varied lifestyle that can escalate the incidence of some infectious diseases. In West Java, the incident of dengue hemorrhagic fever (DHF), malaria, and pneumonia, along with the number of claims under National Health Insurance (BPJS) for these diseases, increased in 2022. This research aims to explore the relationship between ecological factors and the incidence of infectious diseases using multivariate canonical correlation analysis. The response variables are the incidence of DHF, malaria, and pneumonia based on disease-related visits to healthcare facilities captured in the BPJS data sample. The ecological factors used as explanatory variables include population size, average humidity, average rainfall, average temperature, the amount of waste transported to landfills per ton, and the percentage of households with access to adequate sanitation. The results showed a high correlation between ecology and disease incidence. Based on canonical loading and cross loading, the ecological factors that significantly contribute to disease incidence are population, average rainfall, average temperature, and the amount of waste transported to landfills per ton. Statistically, reduction in waste sent to landfills can decrease the incidence of DHF, malaria, and pneumonia. Reduction in population can reduce disease incidence, and decrease in temperature can lower disease incidence. Meanwhile, increase in rainfall can also reduce disease incidence. Therefore, efforts to control population growth, improve access to proper sanitation, and implement effective waste management can have a positive impact on reducing the incidence of infectious diseases in West Java. Therefore, efforts to control the population, improve access to proper sanitation, and effective waste management can have a positive impact on reducing infectious disease incidence in West Java.