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Socioeconomic Status and Foodborne Pathogens in Connecticut, USA, 2000–20111 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC


Socioeconomic Status and Foodborne Pathogens in Connecticut, USA, 2000–20111 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
Emerging Infections Program

Emerging Infections Program

Socioeconomic Status and Foodborne Pathogens in Connecticut, USA, 2000–20111

Bridget M. WhitneyComments to Author , Christina Mainero, Elizabeth Humes, Sharon Hurd, Linda Niccolai, and James L. Hadler
Author affiliations: Yale School of Public Health, New Haven, Connecticut, USA


Foodborne pathogens cause >9 million illnesses annually. Food safety efforts address the entire food chain, but an essential strategy for preventing foodborne disease is educating consumers and food preparers. To better understand the epidemiology of foodborne disease and to direct prevention efforts, we examined incidence of Salmonella infection, Shiga toxin–producing Escherichia coli infection, and hemolytic uremic syndrome by census tract–level socioeconomic status (SES) in the Connecticut Foodborne Diseases Active Surveillance Network site for 2000–2011. Addresses of case-patients were geocoded to census tracts and linked to census tract–level SES data. Higher census tract–level SES was associated with Shiga toxin–producing Escherichia coli, regardless of serotype; hemolytic uremic syndrome; salmonellosis in persons ≥5 years of age; and some Salmonella serotypes. A reverse association was found for salmonellosis in children <5 years of age and for 1 Salmonella serotype. These findings will inform education and prevention efforts as well as further research.
Foodborne diseases cause considerable illness, hospitalization, and death in the United States. Each year, an estimated 9.4 million illnesses, 56,000 hospitalizations, and 1,351 deaths can be attributed to the consumption of food products contaminated by 31 major pathogens (1). Salmonella and Shiga toxin–producing Escherichia coli(STEC) are leading bacterial causes of foodborne illness in the United States and result in a combined estimated 1.2 million cases of gastrointestinal illness, ≈22,000 hospitalizations, and 400 deaths per year (1).
Food safety is a high priority in the United States (2). Although food safety efforts address the entire food chain from production to the retail level (3), these processes do not guarantee that food products, especially uncooked fresh foods, are free from potentially pathogenic bacteria. Therefore, an essential strategy for preventing foodborne disease involves educating food preparers and consumers about preventive measures that can be taken in food handling, cooking, and selection of foods to eat (4).
Despite regulatory efforts to improve food supply safety, the incidence of illnesses caused by some foodborne pathogens, including Salmonella, has changed little in recent years (5). Other than what is known about foodborne illness in younger and older age groups, little is known about which demographic groups in the United States are at highest risk for Salmonella or STEC infection and which groups should be targeted for educational efforts. Demographic data other than age and sex, such as income and education level, are not usually available through routine surveillance of illnesses from these infections.
An approach rarely used to identify demographic groups at high risk for bacterial foodborne infections is to examine incidence by area-based socioeconomic status (ABSES) measures. Surveillance data usually include street addresses of residences of persons diagnosed with foodborne infections, making use of ABSES possible. Census tract–level poverty, in particular, is a validated ABSES measure recommended by the Public Health Disparities Geocoding Project on the basis of a series of exhaustive studies (6). A previous Connecticut study assessing incident Campylobacter data that used census tract–level poverty found that adults and children >10 years of age who lived in census tracts where <5% of residents lived below the federal poverty level had twice the risk for campylobacteriosis of those living in census tracts where >20% lived below the federal poverty level (7). By contrast, children <10 years of age who lived in the lowest SES census tracts had a 1.4-fold higher risk for campylobacteriosis than those living in the highest SES census tracts (7). A study in Denmark, where individual SES data were available, found that Campylobacter and Salmonella enterica serotype Enteritidis were associated with high SES but found no association with S. enterica ser. Typhimurium or STEC (8). A study that used ABSES to examine Salmonella incidence in Michigan, USA, found that persons living in census block groups with high education levels had a higher incidence of Salmonella infection than persons living in block groups with lower education levels (9).
Our study sought to describe the incidence of Salmonella (in general and for leading serotypes) and of STEC (O157, non-O157, and hemolytic uremic syndrome [HUS]) for 2000–2011 by census tract–level SES and to assess whether findings changed over time. Our goal was to help direct public health educational efforts to decrease illness from these foodborne pathogens.

Ms. Whitney worked at the Connecticut Emerging Infections Program while earning her MPH at Yale School of Public Health and is currently a Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Fellow with the New York State Department of Health. Her research interests include foodborne disease, vaccine-preventable disease, and disease modeling.


We thank James Meek, Paula Clogher, and Danyel Olson for their support, expertise, and commitment to the Foodborne Diseases Active Surveillance Network in Connecticut.
This work was supported by Cooperative Agreement 5U50-CK000195 from the Centers for Disease Control and Prevention.


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Suggested citation for this article: Whitney BM, Mainero C, Humes E, Hurd S, Niccolai L, Hadler JL, Socioeconomic status and foodborne pathogens in Connecticut, USA, 2000–2011. Emerg Infect Dis. 2015 Sept [date cited]. http://dx.doi.org/10.3201/eid2109.150277
DOI: 10.3201/eid2109.150277
1Preliminary results from this study were presented at the 2014 Annual Conference of the Council of State and Territorial Epidemiologists; June 23–25, 2014; Nashville, Tennessee, USA.

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