Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016-2019

Abstract

Background: In the United States, ∼179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated vs non-norovirus AGE, and severe vs mild/moderate AGE among hospitalized adults.

Methods: We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016, to November 30, 2019, at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using the BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size.

Results: Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio [aOR], 5.6; 95% CI, 2.7-11.7), HIV infection (aOR, 3.9; 95% CI, 1.8-8.5), severe renal disease (aOR, 3.1; 95% CI, 1.8-5.2), and household contact with a person with AGE (aOR, 2.9; 95% CI, 1.3-6.7). Household (OR, 4.4; 95% CI, 1.6-12.0) and non-household contact (OR, 5.0; 95% CI, 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR, 3.4; 95% CI, 1.3-8.8) was significantly associated with severe AGE.

Conclusions: Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions, such as norovirus vaccines, to specific high-risk populations.

Keywords: acute gastroenteritis; hospitalized; norovirus; risk factors; severe gastroenteritis.

Figure 1.

Prevalence of underlying medical conditions among AGE cases (n = 690) and non-AGE controls (n = 440)^a. ^aUnderlying medical conditions data available from October 2017 to December 2019. Mild renal disease: mild to moderate chronic kidney disease (stages 1–3, GFR ≥30 mL/min/1.73 m²); severe renal disease: severe kidney disease or kidney failure (stage 4, GFR 15–29 mL/min/1.73 m², or stage 5, GFR <15 mL/min/1.73 m², or requiring dialysis). Abbreviations: AGE, acute gastroenteritis; GFR, glomerular filtration rate.

Figure 2.

Risk factors^b,c for acute gastroenteritis among participants enrolled at 5 VA Medical Centers from December 2016 to November 2019. ^aOther includes race reported as Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, multiple races, and “other.” ^bAGE cases = 690, non-AGE controls = 440 (underlying medical conditions data available from October 2017 to November 2019). ^cMultivariate logistic regression analysis showing odds ratios with 95% CI obtained using manual backward elimination method with a P value of .05. Abbreviations: AGE, acute gastroenteritis; VA, Veterans Affairs.

Figure 3.

Risk factors^b for norovirus-associated acute gastroenteritis among participants enrolled at 5 VA Medical Centers from December 2016 to November 2019. ^aOther includes Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, multiple races, other races. ^bUnivariate logistic regression analysis showing odds ratios with 95% CI: norovirus-positive AGE = 44; norovirus-negative AGE = 985 (underlying medical conditions data available from October 2017 to November 2019). Abbreviations: AGE, acute gastroenteritis; VA, Veterans Affairs.

Figure 4.

Risk factors^c,d for severe AGE among participants enrolled at 5 VA Medical Centers from December 2016 to November 2019. ^aAdenovirus F40/41, astrovirus, rotavirus A, and sapovirus (I, II, IV, and V). ^bOther includes Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, multiple races, other races. ^cSevere AGE = 373, norovirus-negative AGE = 317 (underlying medical conditions data available from October 2017 to November 2019). ^dMultivariate logistic regression analysis showing odds ratios with 95% CI obtained using manual backward elimination method with a P value of .05. Abbreviations: AGE, acute gastroenteritis; OR, odds ratio; VA, Veterans Affairs.