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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on February 4, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/gln012
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Socioeconomic and Race/Ethnic Patterns in Persistent Infection Burden Among U.S. Adults

Anna Zajacova, Jennifer B. Dowd and Allison E. Aiello

Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor

Address correspondence to Allison E. Aiello, PhD, MS, Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1214 S University Ave, Ann Arbor, MI 48104-2548. Email: aielloa{at}umich.edu


  Abstract

Background.: The pathophysiological mechanisms that underlie health disparities by socioeconomic status and race/ethnicity are poorly understood. Promising new research suggests that the burden of persistent infection may influence adult disease risk and mortality. This article examines how multiple persistent infections cluster within individuals and how this clustering varies by socioeconomic position and race/ethnicity in U.S. adults.

Methods.: We analyze data from the National Health and Nutrition Examination Survey III (N = 19,275) for adults aged 17–90 years. The clustering of infections within individuals is studied using tetrachoric correlations. Multiple indicator multiple cause models are used to analyze the infection burden construct as measured by seropositivity to Helicobacter pylori, cytomegalovirus, herpes simplex virus-1, and hepatitis B, focusing on the burden's distribution by socioeconomic position and race/ethnicity. The results are corroborated using ordered logistic regression for a commonly used count index of individual infections.

Results.: Seroprevalence of individual persistent infections is positively correlated, suggesting common factors related to exposure or susceptibility. Education, income, and race/ethnicity are strong and significant independent predictors of infection burden in U.S. adults in all models.

Conclusion.: The disproportionate burden of persistent infections among disadvantaged groups across all ages may be one biologic pathway by which low socioeconomic position is related to increased rates of morbidity and mortality in the United States.

Keywords Socioeconomic; Race; Ethnic; United states; Adults; Infection; Biomarkers

Received: November 6, 2007; Accepted: May 5, 2008

Decision Editor: Luigi Ferrucci, MD, PhD


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