Eating out is associated with self-reported food poisoning: a Western Australia population perspective, 1998 to 2009

Lack of Association of Household Income and Acute Gastroenteritis Disease Severity in Young Children: A Cohort Study

OBJECTIVE

To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE).

METHODS

We conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3 to 48 months and presented for care due to AGE. Income status was defined based on 1) home ZIP Code median annual home income and 2) percentage of home ZIP Code households below the poverty threshold. The primary outcome was moderate-to-severe AGE, defined by a post-ED visit Modified Vesikari Scale (MVS) score ≥9. Secondary outcomes included in-person revisits, revisits with intravenous rehydration, hospitalization, and etiologic pathogens.

RESULTS

About 943 (97%) participants with a median age of 17 months (interquartile range 10, 28) completed follow-up. Post-ED visit MVS scores were lower for the lowest household income group (adjusted: -0.60; 95% confidence interval [CI]: -1.13, -0.07). Odds of experiencing an MVS score ≥9 did not differ between groups (adjusted odds ratio: 0.91; 95% CI: 0.54, 1.52). No difference in the post-ED visit MVS score or the proportion of participants with scores ≥9 was observed using the national poverty threshold definition. For both income definitions, there were no differences in terms of revisits following discharge, hospitalizations, and intravenous rehydration. Bacterial enteropathogens were more commonly identified in the lowest socioeconomic group using both definitions.

CONCLUSIONS

Lower household income was not associated with increased disease severity or resource use. Economic disparities do not appear to result in differences in the disease course of children with AGE seeking ED care.

Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study)

Background

Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID remains unclear. This study aims to investigate the relationship between SES and IID in a large community cohort.

Methods

Longitudinal analysis of a prospective community cohort in the UK following 6836 participants of all ages was undertaken. Hazard ratios for IID by SES were estimated using Cox proportional hazard, adjusting for follow-up time and potential confounding factors.

Results

In the fully adjusted analysis, hazard ratio of IID was significantly lower among routine/manual occupations compared with managerial/professional occupations (HR 0.74, 95% CI 0.61-0.90).

Conclusion

In this large community cohort, lower SES was associated with lower IID risk. This may be partially explained by the low response rate which varied by SES. However, it may be related to differences in exposure or recognition of IID symptoms by SES. Higher hospital admissions associated with lower SES observed in some studies could relate to more severe consequences, rather than increased infection risk.

Relationship between socioeconomic status and gastrointestinal infections in developed countries: A systematic review and meta-analysis

BACKGROUND

The association between socioeconomic status (SES) and health is well-documented; however limited evidence on the relationship between SES and gastrointestinal (GI) infections exists, with published studies producing conflicting results. This systematic review aimed to assess the association between SES and GI infection risk, and explore possible sources of heterogeneity in effect estimates reported in the literature.

METHODS

MEDLINE, Scopus, Web of Science and grey literature were searched from 1980 to October 2015 for studies reporting an association between GI infections and SES in a representative population sample from a member-country of the Organisation for Economic Co-operation and Development. Harvest plots and meta-regression were used to investigate potential sources of heterogeneity such as age; level of SES variable; GI infection measurement; and predominant mode of transmission. The protocol was registered on PROSPERO: CRD42015027231.

RESULTS

In total, 6021 studies were identified; 102 met the inclusion criteria. Age was identified as the only statistically significant potential effect modifier of the association between SES and GI infection risk. For children, GI infection risk was higher for those of lower SES versus high (RR 1.51, 95% CI;1.26-1.83), but there was no association for adults (RR 0.79, 95% CI;0.58-1.06). In univariate analysis, the increased risk comparing low and high SES groups was significantly higher for pathogens spread by person-to-person transmission, but lower for environmental pathogens, as compared to foodborne pathogens.

CONCLUSIONS

Disadvantaged children, but not adults, have greater risk of GI infection compared to their more advantaged counterparts. There was high heterogeneity and many studies were of low quality. More high quality studies are needed to investigate the association between SES and GI infection risk, and future research should stratify analyses by age and pathogen type. Gaining further insight into this relationship will help inform policies to reduce inequalities in GI illness in children.

Food safety knowledge of undergraduate students at a Canadian university: results of an online survey

Background

Foodborne diseases are an important public health issue, and young adults are an important demographic to target with food safety education. Our objective was to assess the food safety knowledge of undergraduate students at a Canadian university, to identify potential areas for such education.

Methods

In February 2015, we conducted an online survey of 485 undergraduate students at a university in Ontario, Canada. We assessed various food-related factors, including cooking frequency and prior food handling or preparation education. We then modeled the relationship between ‘overall knowledge score’ and the demographic and food skills/cooking experience predictors using multivariable log-binomial regression, to determine factors associated with relatively higher proportions of correct responses.

Results

Respondents were, on average, 20.5 years old, and the majority (64.8 %) lived off campus. Students cooked from basic ingredients infrequently, with 3 in 4 doing so a few times a year to never. Students averaged 6.2 correct answers to the 11 knowledge questions. Adjusting for other important covariates, older age and being a current food handler were associated with relatively higher knowledge, whereas working/volunteering in a hospital and infrequent cooking were associated with relatively lower knowledge. Males in the Faculty of Science had relatively higher knowledge than females in the Faculty of Science, both of whom had relatively higher knowledge than all students in other Faculties. Among students who had never taken a food preparation course, knowledge increased with self-reported cooking ability; however, among students who had taken such a course, knowledge was highest among those with low self-reported cooking ability.

Conclusions

Consistent with other similar studies, students in Faculties outside of the Faculty of Science, younger students, and those who cook infrequently could benefit from food safety education. Supporting improved hand hygiene, in particular clarifying hand washing versus hand sanitizing messages, may also be important. Universities can play a role in such education, including as part of preparing students for work or volunteer placements, or as general support for student health and success.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3818-y) contains supplementary material, which is available to authorized users.

Relationship between socioeconomic status and gastrointestinal infections in developed countries: a systematic review protocol

BACKGROUND

The association between low socioeconomic status (SES) and poor health is well documented in the existing literature. Nonetheless, evidence on the relationship between SES and gastrointestinal (GI) infections is limited, and the mechanisms underlying this relationship are not well understood with published studies pointing to conflicting results. This review aims to identify studies that investigate the relationship between SES and GI infections in developed countries, in order to assess the direction of the association and explore possible explanations for any differences in the risk, incidence or prevalence of GI infections across socioeconomic groups.

METHODS

Three systematic methods will be used to identify relevant literature: electronic database, reference list and grey literature searching. The databases MEDLINE, Scopus and Web of Science Core Collection will be searched using a broad range of search terms. Screening of the results will be performed by two reviewers using pre-defined inclusion and exclusion criteria. The reference lists of included studies will be searched, and Google will be used to identify grey literature. Observational studies reporting quantitative results on the prevalence or incidence of any symptomatic GI infections by SES, in a representative population sample from a member country of the Organisation for Economic Co-operation and Development (OECD), will be included. Data will be extracted using a standardised form. Study quality will be assessed using the Liverpool University Quality Assessment Tools (LQAT). A narrative synthesis will be performed including tabulation of studies for comparison.

DISCUSSION

This systematic review will consolidate the existing knowledge on the relationship between SES and GI infections. The results will help to identify gaps in the literature and will therefore provide an evidence base for future empirical studies to deepen the understanding of the relationship, including effective study design and appropriate data analysis methods. Ultimately, gaining insight into this relationship will help to inform policies to reduce any health inequalities identified.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015027231.