Socioenvironmental, socioeconomic, and public management indicators as predictors of scorpionism in Brazil

Scorpionism is an increasing public health problem in tropical countries, particularly in Brazil, where social inequality, environmental degradation, and unplanned urbanization favor the proliferation of scorpions and human-scorpion encounters. In this study, we investigated the association between scorpion sting notifications and hospitalizations and a set of socioeconomic, socioenvironmental, environmental, and public management indicators related to sustainability across all Brazilian municipalities. We used secondary data from national health information systems and indicators from the Sustainable Development Index of Cities - Brazil (IDSC-BR). Spatial analyses were conducted to describe geographic patterns, followed by Principal Component Analysis (PCA) to identify groups of correlated predictors. We then fitted generalized linear models, selecting negative binomial regression based on model fit and overdispersion tests. Our results showed that 71.2% of Brazilian municipalities exhibit low sustainability scores, predominantly in the North and Northeast regions, which also present higher numbers of notifications and hospitalizations. The socioeconomic component showed a significant effect only on notifications, reducing expected rates by 15% (IRR = 0.85), suggesting that social vulnerability acts primarily as a case-concealing factor (underreporting), with no statistical association with hospitalization volume (IRR = 1.01; p = 0.844). In contrast, the environmental component acted as a strong predictor of clinical severity, increasing hospitalization rates by 36.5% (IRR = 1.37). Public investment demonstrated limited or inconsistent effects. Overall, our findings quantify the multifactorial nature of scorpionism and emphasize the need for integrated public policies that address infrastructure and health determinants to mitigate the burden of this neglected condition.