Since 1999, West Nile virus (WNV) disease has af-fected the northeastern United States. To describe the spa-tial epidemiology and identify risk factors for disease inci-dence, we analyzed 8 years (1999–2006) of county-based human WNV disease surveillance data. Among the 56.6 million residents in 8 northeastern states sharing primary enzootic vectors, we found 977 cases. We controlled for population density and potential bias from surveillance and spatial proximity. Analyses demonstrated signifi cant spatial spreading from 1999 through 2004 (p0.75 cases/100,000 residents) than counties with the most (>70%) forest cover. These results quantify urbanization as a risk factor for WNV disease incidence and are consistent with knowledge of vector species in this area
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