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. 2020 Jan 31;7(2):ofaa030.
doi: 10.1093/ofid/ofaa030. eCollection 2020 Feb.

Disparities in Shigellosis Incidence by Census Tract Poverty, Crowding, and Race/Ethnicity in the United States, FoodNet, 2004-2014

Tanya Libby  1 , Paula Clogher  2 , Elisha Wilson  3 , Nadine Oosmanally  4 , Michelle Boyle  5 , Dana Eikmeier  6 , Cynthia Nicholson  7 , Suzanne McGuire  8 , Paul Cieslak  9 , Mugdha Golwalkar  10 , Aimee Geissler  11 , Duc Vugia  12
Affiliations

Disparities in Shigellosis Incidence by Census Tract Poverty, Crowding, and Race/Ethnicity in the United States, FoodNet, 2004-2014

Tanya Libby et al. Open Forum Infect Dis. .

Abstract

Background: Shigella causes an estimated 500 000 enteric illnesses in the United States annually, but the association with socioeconomic factors is unclear.

Methods: We examined possible epidemiologic associations between shigellosis and poverty using 2004-2014 Foodborne Diseases Active Surveillance Network (FoodNet) data. Shigella cases (n = 21 246) were geocoded, linked to Census tract data from the American Community Survey, and categorized into 4 poverty and 4 crowding strata. For each stratum, we calculated incidence by sex, age, race/ethnicity, and FoodNet site. Using negative binomial regression, we estimated incidence rate ratios (IRRs) comparing the highest to lowest stratum.

Results: Annual FoodNet Shigella incidence per 100 000 population was higher among children <5 years old (19.0), blacks (7.2), and Hispanics (5.6) and was associated with Census tract poverty (incidence rate ratio [IRR], 3.6; 95% confidence interval [CI], 3.5-3.8) and household crowding (IRR, 1.8; 95% CI, 1.7-1.9). The association with poverty was strongest among children and persisted regardless of sex, race/ethnicity, or geographic location. After controlling for demographic variables, the association between shigellosis and poverty remained significant (IRR, 2.3; 95% CI, 2.0-2.6).

Conclusions: In the United States, Shigella infections are epidemiologically associated with poverty, and increased incidence rates are observed among young children, blacks, and Hispanics.

Keywords: Census tract; FoodNet; Shigella; diarrheal disease; poverty.

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Figures

Figure 1.
Figure 1.
Age-adjusted shigellosis incidence by Census tract poverty level and FoodNet site, 2004–2014. Poverty level was determined by the percentage of households in each Census tract living below the federal poverty line. *In California, Colorado, and New York, the FoodNet surveillance catchment area includes only selected counties [16].
See this image and copyright information in PMC

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