{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:48:41Z","timestamp":1790444921954,"version":"4.1.0"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["FRN. 187246"],"award-info":[{"award-number":["FRN. 187246"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"crossref","award":["RGPIN-2023-05100"],"award-info":[{"award-number":["RGPIN-2023-05100"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Ontario, being one of Canada\u2019s largest provinces, has been central to the high incidence of human Mpox. Research is scarce on how socio-environmental factors influence Mpox incidences. This study seeks to explore potential geographical correlations and the relationship between indicators of social marginalization and Mpox incidence rate in Ontario.<\/jats:p>\n <\/jats:sec>\n \n Methodology<\/jats:title>\n We used surveillance data on confirmed human Mpox cases from May 1, 2022, to March 31, 2024, extracted from the Public Health Ontario website for this study. Spatial autocorrelation of Mpox incidence was investigated using spatial methods including Moran\u2019s Index, Getis\u2013Ord Gi*statistic, and spatial Poisson scan statistic. Following this, we adopted a generalized Poisson regression (GPR) model to estimate the incidence rate ratios (IRRs) based on the association between Ontario PHU-level marginalization and Mpox incidence, while adjusting for age and sex. The goodness-of-fit of the models was assessed using the Log Likelihood (LL), Akaike Information Criterion (AIC), Akaike\u2019s Information Criterion corrected (AICc), and the Bayesian Information Criterion (BIC).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Our analysis revealed significant localized spatial heterogeneity in Mpox incidence across Ontario. Statistically significant local clusters of Mpox cases were identified in Toronto (\n \n \n \n \n \n R<\/mml:mi>\n R<\/mml:mi>\n =<\/mml:mo>\n 11.34<\/mml:mn>\n ,<\/mml:mo>\n \n L<\/mml:mi>\n L<\/mml:mi>\n =<\/mml:mo>\n 511.97<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ), Ottawa (\n \n \n \n \n \n R<\/mml:mi>\n R<\/mml:mi>\n =<\/mml:mo>\n 3.21<\/mml:mn>\n ,<\/mml:mo>\n \n L<\/mml:mi>\n L<\/mml:mi>\n =<\/mml:mo>\n 19.88<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ), and a secondary cluster, overlapping Hamilton PHU with nine local districts (\n \n \n \n \n \n R<\/mml:mi>\n R<\/mml:mi>\n =<\/mml:mo>\n 2.07<\/mml:mn>\n ,<\/mml:mo>\n \n L<\/mml:mi>\n L<\/mml:mi>\n =<\/mml:mo>\n 9.64<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ), all with\n \n \n \n \n \n p<\/mml:mi>\n \u2212<\/mml:mo>\n v<\/mml:mi>\n a<\/mml:mi>\n l<\/mml:mi>\n u<\/mml:mi>\n e<\/mml:mi>\n <<\/mml:mo>\n 0.05<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n . The incidence rate of Mpox was statistically significantly associated with a higher proportion of ethnic concentration (racialized groups, migrants, or visible minorities)\n \n \n \n \n \n \n \n I<\/mml:mi>\n R<\/mml:mi>\n R<\/mml:mi>\n =<\/mml:mo>\n \n 9.478<\/mml:mn>\n ;<\/mml:mo>\n 95<\/mml:mn>\n %<\/mml:mi>\n \n C<\/mml:mi>\n I<\/mml:mi>\n =<\/mml:mo>\n 5.062<\/mml:mn>\n \u2212<\/mml:mo>\n 17.747<\/mml:mn>\n <\/mml:mrow>\n <\/mml:mfenced>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n , gender\n \n \n \n \n \n \n \n I<\/mml:mi>\n R<\/mml:mi>\n R<\/mml:mi>\n =<\/mml:mo>\n 5.150<\/mml:mn>\n ;<\/mml:mo>\n 95<\/mml:mn>\n %<\/mml:mi>\n \n C<\/mml:mi>\n I<\/mml:mi>\n =<\/mml:mo>\n 1.159<\/mml:mn>\n \u2212<\/mml:mo>\n 8.324<\/mml:mn>\n <\/mml:mrow>\n <\/mml:mfenced>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n and higher residential instability\n \n \n \n \n \n \n \n I<\/mml:mi>\n R<\/mml:mi>\n R<\/mml:mi>\n =<\/mml:mo>\n 14.112<\/mml:mn>\n ;<\/mml:mo>\n \n 95<\/mml:mn>\n %<\/mml:mi>\n \n C<\/mml:mi>\n I<\/mml:mi>\n =<\/mml:mo>\n 6.596<\/mml:mn>\n \u2212<\/mml:mo>\n 30.189<\/mml:mn>\n <\/mml:mrow>\n <\/mml:mfenced>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n We identified major Mpox hotspots in Toronto. According to our model results, the high incidence rate may be influenced by the greater population of internal migrants and younger individuals. Based on these insights, we recommend targeted interventions in the high-risk neighborhoods. Efforts to improve Mpox diagnosis and promote health equity among socioeconomically vulnerable populations, including racial and ethnic minorities, should be implemented.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0306681","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T13:33:18Z","timestamp":1741699998000},"page":"e0306681","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Geographical distribution and the impact of socio-environmental indicators on incidence of Mpox in Ontario, Canada"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5013-2253","authenticated-orcid":true,"given":"Chigozie Louisa J.","family":"Ugwu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Asgary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jude Dzevela","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola Luigi","family":"Bragazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Orbinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0336-7831","authenticated-orcid":true,"given":"Woldegebriel Assefa","family":"Woldegerima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"pone.0306681.ref001","author":"WHO","year":"2022"},{"key":"pone.0306681.ref002","author":"PublicHealthAgencyofCanada","year":"2022"},{"issue":"3","key":"pone.0306681.ref003","first-page":"160","article-title":"Analysis of the epidemiological dynamic of monkeypox from 15th May to 31st August 2022","volume":"21","author":"A Perramon Malavez","year":"2022","journal-title":"Enfermedades emergentes"},{"key":"pone.0306681.ref004","article-title":"Mapping spatio-temporal distribution of monkeypox disease incidence: A global hotspot analysis","author":"MM Patwary","year":"2023","journal-title":"New Microbes and New Infections"},{"issue":"1","key":"pone.0306681.ref005","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s40249-022-01004-9","article-title":"Combating the global spread of poverty-related Monkeypox outbreaks and beyond","volume":"11","author":"E Tambo","year":"2022","journal-title":"Infect Dis Poverty"},{"key":"pone.0306681.ref006","doi-asserted-by":"crossref","first-page":"102517","DOI":"10.1016\/j.tmaid.2022.102517","article-title":"Incidence, geographic distribution, clinical characteristics, and socioeconomic and demographic determinants of monkeypox in Brazil: A nationwide population-based ecological study","volume":"52","author":"PR Martins-Filho","year":"2023","journal-title":"Travel Med Infect Dis"},{"issue":"29","key":"pone.0306681.ref007","doi-asserted-by":"crossref","first-page":"E1031","DOI":"10.1503\/cmaj.220886","article-title":"A case of human monkeypox in Canada","volume":"194","author":"SS Sukhdeo","year":"2022","journal-title":"CMAJ"},{"key":"pone.0306681.ref008","author":"GovernmentofCanada"},{"key":"pone.0306681.ref009","author":"PHOntario"},{"key":"pone.0306681.ref010","volume-title":"Enhanced epidemiological summary: Mpox in Ontario: January 1, 2023 to March 31, 2024","year":"2024"},{"key":"pone.0306681.ref011","volume-title":"Ontario Agency for Health Protection and Promotion (Public Health Ontario)","author":"iPHIS-PHOntario","year":"2022"},{"issue":"6","key":"pone.0306681.ref012","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/PHH.0000000000001565","article-title":"COVID-19 vaccine uptake in southeastern Ontario, Canada: monitoring and addressing health inequities","volume":"28","author":"MA Carter","year":"2022","journal-title":"J Public Health Manag Pract"},{"key":"pone.0306681.ref013","article-title":"Effects of socio-economic factors on elementary school student COVID-19 infections in Ontario, Canada.","author":"P Srivastava","year":"2022","journal-title":"medRxiv"},{"key":"pone.0306681.ref014","first-page":"ofac690","article-title":"Which curve are we flattening? 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