Geographic Disparities in Cytomegalovirus Infection During Pregnancy

• Published in: Journal of the Pediatric Infectious Diseases Society Vol. 6; no. 3; pp. e55 - e61
• Main Authors: Lantos, Paul M, Hoffman, Kate, Permar, Sallie R, Jackson, Pearce, Hughes, Brenna L, Swamy, Geeta K
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.09.2017
• Subjects: Adolescent; Adult; Age Factors; Antibodies, Viral; Case-Control Studies; Cross-Sectional Studies; Cytomegalovirus - immunology; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - ethnology; Cytomegalovirus Infections - immunology; Electronic; Ethnicity; Female; Geographic Mapping; Geography; Humans; Immunoglobulin G; Incidence; Income; Middle Aged; Minority Groups; North Carolina; Odds Ratio; Poverty; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - ethnology; Prevalence; Risk Factors; Seroepidemiologic Studies; Serologic Tests; Young Adult; North Carolina; cluster; epidemiology; geographic information system (GIS); cytomegalovirus; disparity; generalized additive model; serology; black; spatial epidemiology; poverty; segregation; African American
• ISSN: 2048-7193; 2048-7207
• DOI: 10.1093/jpids/piw088

Abstract Background Cytomegalovirus (CMV) is the most common infectious cause of fetal malformations and childhood hearing loss. CMV is more common among socially disadvantaged groups, and it clusters geographically in poor communities. We conducted a geospatial analysis of chronic and primary CMV infection among pregnant women around Durham, NC. Methods We performed a geospatial analysis of subjects from an ongoing study of CMV infection among pregnant women using geographic information systems and spatial statistics. Subjects were categorized on the basis of results of their CMV immunoglobulin G avidity testing as seronegative, seropositive, or primary infection. We used generalized additive models to analyze the spatial distributions of individuals who fell into each category and to control for confounders such as race and age. We used a generalized estimating equation to correlate community-level variables with CMV status. Results Of 3527 pregnant women aged 15 to 59 years, 93.4% were either white or black. CMV seropositivity was significantly more common among non-Hispanic white subjects than among minority subjects (odds ratio, 3.76 [95% confidence interval, 3.25–4.34]). We identified a cluster in which women had elevated odds of CMV seropositivity in the urban neighborhoods of Durham. Cases of primary CMV infection were more common in areas with higher-than-average CMV seroprevalence. Neighborhood median family income was associated inversely with the prevalence of chronic CMV. Conclusions We found a high prevalence of CMV seropositivity in urban low-income neighborhoods among pregnant women, particularly among racial and ethnic minorities. Seronegative pregnant women from these communities might be at heightened risk for primary CMV infection.