Dengue-Associated Mortality, Climate Anomalies, and Geographic Emergence in Peru, 2017–2024: A Spatiotemporal Study Triangulating Death Records and Epidemiological Surveillance

Dengue transmission has expanded across the Americas, but the spatiotemporal distribution of mortality recorded in death certificates and its ecological relationship with climate remain insufficiently characterized. Objective: To evaluate dengue-associated mortality recorded in Peruvian death certificates during 2017–2024, characterize geographic emergence across fixed provinces, estimate associations with local climate anomalies, and triangulate findings with epidemiological surveillance. Methods: We conducted a retrospective ecological spatiotemporal study combining the National Death Information System, national dengue surveillance, official population projections, gridded climate data, and a fixed 196-province framework. The primary outcome was an A90 or A91 code in any certificate position; province-month was the principal unit. Poisson models included a population offset, provincial fixed effects, calendar month, linear time, a 2020–2021 indicator, and temperature and precipitation anomalies at lags 0–3 months. Results: The updated snapshot contained 987 certificates with A90/A91 during 2017–2024; 968 were territorially eligible. Thirty-six provinces were classified as emergent. Surveillance contributed 772,387 notified cases, and department-year deaths and cases were correlated (Spearman ρ = 0.772). In the corrected primary model, the cumulative ecological mortality rate ratio comparing the 90th with the 50th percentile was 1.75 (95% CI: 1.41–2.17) for mean-temperature anomalies and 2.69 (95% CI: 1.97–3.67) for precipitation anomalies. Estimates remained positive under position-A, code-specific, syndromic, and temporal sensitivity definitions. Conclusions: Recorded dengue-associated mortality was concentrated during recent outbreaks and appeared in provinces without baseline-period mortality. Local climate anomalies preceded higher province-month mortality rates, but these ecological associations are compatible with indirect transmission and health-system pathways and do not establish direct individual-level effects.