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. 2018 Nov;146(15):1968-1976.
doi: 10.1017/S095026881800153X. Epub 2018 Jun 14.

Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults

G A Noppert  1 , A E Aiello  2 , A M O'Rand  3 , H J Cohen  1
Affiliations

Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults

G A Noppert et al. Epidemiol Infect. 2018 Nov.

Abstract

Pathogen burden is a construct developed to assess the cumulative effects of multiple, persistent pathogens on morbidity and mortality. Despite the likely biological wear and tear on multiple body systems caused by persistent infections, few studies have examined the impact of total pathogen burden on such outcomes and specifically on preclinical markers of dysfunction. Using data from two waves of the National Health and Nutrition Examination Survey, we compared three alternative methods for measuring pathogen burden, composed of mainly persistent viral infections, using a cumulative deficits index (CDI) as an outcome: single pathogen associations, a pathogen burden summary score and latent class analyses. We found significant heterogeneity in the distribution of the CDI by age, sex, race/ethnicity and education. There was an association between pathogen burden and the CDI by all three metrics. The latent class classification of pathogen burden showed particularly strong associations with the CDI; these associations remained after controlling for age, sex, body mass index, smoking, race/ethnicity and education. Our results suggest that pathogen burden may influence early clinical indicators of poor health as measured by the CDI. Our results are salient since we were able to detect these associations in a relatively young population. These findings suggest that reducing pathogen burden and the specific pathogens that drive the CDI may provide a target for preventing the early development of age-related physiological changes.

Keywords: Epidemiology; herpesviruses; infectious disease epidemiology; social determinants; virus infection.

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Figures

Fig. 1.
Fig. 1.
(a) The conditional probability of each infection given a three class solution for the National Health and Examination Survey, 2003–2004 wave (N = 2168). (b) The conditional probability of each infection given a three class solution for the National Health and Examination Survey, 2009–2010 wave (N = 2546).
See this image and copyright information in PMC

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