Persistent socioeconomic and racial and ethnic disparities in pathogen burden in the United States, 1999-2014

• Published in: Epidemiology and infection Vol. 147; p. e301
• Main Authors: Stebbins, R C, Noppert, G A, Aiello, A E, Cordoba, E, Ward, J B, Feinstein, L
• Format: Journal Article
• Language: English
• Published: England Cambridge University Press 11.11.2019
• Subjects: Adolescent; Adult; Cost of Illness; Cross-Sectional Studies; Educational Status; Ethnic Groups - education; Ethnic Groups - statistics & numerical data; Female; Health Status Disparities; Health Surveys; Humans; Income; Male; Middle Aged; Original Paper; Poverty; Social Class; Toxoplasmosis - economics; Toxoplasmosis - ethnology; United States - epidemiology; Virus Diseases - economics; Virus Diseases - ethnology; Young Adult; United States; pathogen burden; Herpesviruses; human papilloma virus; socioeconomic status; race/ethnicity
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268819001894

The disproportionate burden of prevalent, persistent pathogens among disadvantaged groups may contribute to socioeconomic and racial/ethnic disparities in long-term health. We assessed if the social patterning of pathogen burden changed over 16 years in a U.S.-representative sample. Data came from 17 660 National Health and Nutrition Examination Survey participants. Pathogen burden was quantified by summing the number of positive serologies for cytomegalovirus, herpes simplex virus-1, HSV-2, human papillomavirus and Toxoplasma gondii and dividing by the number of pathogens tested, giving a percent-seropositive for each participant. We examined sex- and age-adjusted mean pathogen burdens from 1999-2014, stratified by race/ethnicity and SES (poverty-to-income ratio (PIR); educational attainment). Those with a PIR < 1.3 had a mean pathogen burden 1.4-1.8 times those with a PIR > 3.5, with no change over time. Educational disparities were even greater and showed some evidence of increasing over time, with the mean pathogen burden among those with less than a high school education approximately twice that of those who completed more than high school. Non-Hispanic Black, Mexican American and other Hispanic participants had a mean pathogen burden 1.3-1.9 times non-Hispanic Whites. We demonstrate that socioeconomic and racial/ethnic disparities in pathogen burden have persisted across 16 years, with little evidence that the gap is closing.