The purpose of this study was to investigate the association between socioeconomic status and salmonellosis outcomes in Georgia from 2010 to 2012 using sociodemographic groups and spatial-temporal analyses.
Poisson regression models were utilized to estimate the incidence, hospitalization, and case fatality rate ratios for all non-typhoidal serotypes of Salmonella enterica, and Salmonella Enteritidis, Typhimurium, Newport, and Javiana. The highest socioeconomic status group (A of A-D) or subgroup (A.1 of A.1-D.7) served as the reference category. Spatial-temporal analyses were conducted to describe the geospatial distribution of Salmonella Newport and Javiana cases.
7,590 cases of salmonellosis were included in the analysis. The incidence rate ratios were generally protective for Salmonella Enteritidis. The highest, significant incidence rate ratios occurred in sociodemographic group C and D for Salmonella Typhimurium (IRR 1.82-2.36), A and C for Salmonella Newport (1.90-2.60), and C for Salmonella Javiana (IRR 1.59-1.79). Significant hospitalization rate ratios above the null were noted among many of the subgroups in A, C, and D for Salmonella Typhimurium, Newport, and Javiana; hospitalization rates were similar to the null for Salmonella Enteritidis. The case fatality rate ratio was significantly greater than the null for group C (RR=2.89, p=0.01). The spatial-temporal analyses identified geospatial clusters in the lower two-thirds and northeastern corner of the state for both Salmonella Newport and Javiana.
These results suggest an increased incidence, hospitalization, and case fatality rate for salmonellosis cases in the lower middle socioeconomic status group (C) relative to those in the highest socioeconomic status group (A). The spatial-temporal analyses further identified geospatial clusters in regions of the state mostly populated by cases in group C.
Table of Contents
Burden of Salmonellosis
National burden of Salmonella enterica
Burden of Salmonella enterica in Georgia
Patterns of illness by serotype
Surveillance and diagnostics
Epidemiology of Salmonella enterica
Organism and nomenclature
Reservoirs and environmental viability
Salmonellosis and Socioeconomic Status
Association between socioeconomic variables and salmonellosis
Hypotheses for the association between higher socioeconomic status and higher incidence
Characteristics of the study population
Rate ratios for incidence by serotype and group
Rate ratios for hospitalization by serotype and group
Rate ratios for case fatality by serotype and group
Spatial-temporal analyses of Salmonella Newport and
Incidence, serotype, and sociodemographic group
Hospitalization, case fatality, serotype, and group
Summary, Public Health Implications, Possible Future Directions
Description of the Sociodemographic Groups and Subgroups
Model Selection Tables
Comparison of the Year of Onset, Outcomes, and Serotypes
for Included and Excluded Cases
Emory University IRB Approval Letter
Georgia Department of Public Health IRB Approval Letter
About this Master's Thesis
|Committee Chair / Thesis Advisor|
|Sociodemographic and Spatial-Temporal Cluster Analyses of Socioeconomic Status and Salmonellosis in Georgia, 2010-2012 ()||2018-08-28||