Socioeconomic and racial disparities in invasive pneumococcal disease among children less than five years of age in the post-pneumococcal conjugate vaccine era Pubblico
Spicer, Jennifer Oliver (2012)
Abstract
Objective: This study analyzed the independent effect of census
tract-level socioeconomic
characteristics on rates of IPD in children less than five years of
age in addition to race-stratified
estimates.
Methods: Socioeconomic and racial trends in IPD incidence in
the post-heptavalent
pneumococcal conjugate vaccine (PCV7) era were examined for 905
children less than five years
of age. Data were obtained through active laboratory- and
population-based surveillance from the
Centers for Disease Control and Prevention-sponsored Georgia
Emerging Infections Program for
the 20-county Metropolitan Atlanta region in Georgia for the time
period of 2001 through 2009.
Incidence rates were calculated by race and socioeconomic
characteristics using data from the
2000 US Census. Trends in IPD were determined by chi-squared tests
for trend, and rate ratios
(RRs) and 95% confidence intervals (CIs) were estimated using
Poisson regression.
Results: For 2001 through 2009, the average annual incidence of
invasive pneumococcal disease
was 46.1 cases per 100,000 in black children and 28.9 cases per
100,000 in white children
(RR=1.60; 95% CI 1.49, 1.71). Race-stratified incidence rates
demonstrated statistically
significant linear trends between IPD rates and some census
tract-level socioeconomic factors. In
white children, there were trends of increasing IPD incidence as
the percentage of low-income
houses increased (p = 0.007). In black children, trends of
increasing IPD incidence were observed
as median household increased (p = 0.005), as census tract poverty
decreased (p = 0.009), and as
crowding decreased (p < 0.001). After adjusting for sex and
race, only three socioeconomic
measures showed significant associations with IPD incidence in at
least one of their strata:
percentage household crowding (RR=0.75; 95% CI 0.59, 0.96),
percentage low-income
households (RR=1.38; 95% CI 1.03, 1.84), and census tract median
household income (RR=1.34;
95% CI 1.07, 1.69). Race was still a significant predictor of
disease even after controlling for sex
and socioeconomic characteristics.
Discussion: The estimated effect of socioeconomic
characteristics on IPD rates differs by race.
Although crowding, percentage low-income households, and median
household income account
for some health disparities in IPD rates in children, race remains
an independent risk factor for
IPD in children in the post-PCV7 era.
Table of Contents
Table of Contents
Background and Literature Review...1
Introduction...1
Epidemiology of S, pneumoniae...1
Racial Disparities in Invasive Pneumococcal Disease...3
Socioeconomic Health Disparities...4
Geocoding and Area-based Socioeconomic Measures...4
Socioeconomic Measures and S. pneumoniae Infection...6
Thesis Rationale and Objective...7
Methods...9
Study Population...9
Geocoding and US Census Data...10
Socioeconomic Variables...10
Case Variables...11
Statistical Analysis...13
Results....15
Discussion...19
Strengths and Limitations...22
Public Health Implications and Future Directions...23
References...24
Tables...28
Figures...55
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