Abstract
Rocky Mountain Spotted Fever (RMSF) is a potentially fatal tick-borne disease historically prevalent in the eastern and southeastern U.S. Since the early 2000s, there has been a notable rise in RMSF cases in the south-western U.S. Despite the documented role of dogs in tick-borne disease transmission, research on the influence of other factors, such as veterinary care access, climatic conditions and landscape characteristics on RMSF incidence is limited. This study investigated the combined impact of these factors on RMSF using county-level temperature, relative humidity, precipitation, land cover, dog populations and veterinary care access in Arizona from 2006 to 2021. Employing a spatial negative binomial regression model, the study revealed significant associations between veterinary care access, precipitation, relative humidity, shrubland, and RMSF incidence across three models incorporating lagged effects (0-month, 1-month, and 2-month) for climatic variables. A key finding was that counties experiencing higher veterinary care access were more likely to report lower RMSF case counts (incidence rate ratio (IRR): 0.9237). The mean precipitation consistently showed the highest positive IRR (1.8137) across all models, indicating its strong influence. In contrast, relative humidity (IRR: 0.9413) and shrubland presence (IRR: 0.9265) demonstrated significant negative associations with RMSF incidence. These findings underscore the importance of veterinary care access, climatic factors, and land cover in shaping RMSF dynamics, particularly in regions with increasing incidence rates.