期刊
JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES
卷 5, 期 4, 页码 782-786出版社
SPRINGER INTERNATIONAL PUBLISHING AG
DOI: 10.1007/s40615-017-0423-4
关键词
Cytomegalovirus; Health disparities; Poverty; Geographic information system; Spatial epidemiology; Generalized additive model; Pregnancy
资金
- National Center for Advancing Translational Sciences of the NIH [KL2 TR001115]
- NIH Director's New Innovator Award DP2 grant [HD075699]
- National Institute of Child Health and Human Development, Maternal Fetal Medicine Units Network [HD068258]
- National Institute on Minority Health and Health Disparities of the National Institutes of Health [R01MD010243]
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 geographically clusters in poor communities. The Area Deprivation Index (ADI) is a neighborhood-level index derived from census data that reflects material disadvantage. Methods We performed a geospatial analysis to determine if ADI predicts the local odds of CMV seropositivity. We analyzed a dataset of 3527 women who had been tested for CMV antibodies during pregnancy. We used generalized additive models to analyze the spatial distribution of CMV seropositivity. Adjusted models included individual-level age and race and neighborhood-level ADI. Results Our dataset included 1955 CMV seropositive women, 1549 who were seronegative, and 23 with recent CMV infection based on low avidity CMV antibodies. High ADI percentiles, representing greater neighborhood poverty, were significantly associated with the nonwhite race (48 vs. 22, p < 0.001) and CMV seropositivity (39 vs. 28, p < 0.001). Our unadjusted spatial models identified clustering of high CMV odds in poor, urban neighborhoods and clustering of low CMV odds in more affluent suburbs (local odds ratio 0.41 to 1.90). Adjustment for both individual race and neighborhood ADI largely eliminated this spatial variability. ADI remained a significant predictor of local CMV seroprevalence even after adjusting for individual race. Conclusions Neighborhood-level poverty as measured by the ADI is a race-independent predictor of local CMV seroprevalence among pregnant women.
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