American Journal of Epidemiology Vol. 148, No. 12: 1212-1218
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Geocoding and Linking Data from Population-based Surveillance and the US Census to Evaluate the Impact of Median Household Income on the Epidemiology of Invasive Streptococcus pneumoniae Infections
1Childwood and Respiratory Disease Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention Atlanta, GA
2Emory University School of Medicine, VA Medical Center Atlanta, GA
Reprint requests to Dr. Martin S. Cetron, Surveillance and Epidemiology Branch, Division of Quarantine, National Center for Infectious Diseases, Mailstop E-03, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.
The emergence of drug-resistant Streptococcus pneumoniae poses new clinical challenges and may also reflect a change in the epidemiology of S. pneumoniae infections. A variety of studies have shown that drug-resistant S. pneumoniae infections are linked to antimicrobial use. It has been hypothesized that persons of high socioeconomic status are at increased risk for a drug-resistant infection because of greater access to antimicrobial drugs. To assess whether median household income is associated with increased risk of penicillin- nonsusceptible S. pneumoniae infections, the authors geocoded and linked data from population-based surveillance for invasive pneumococcal disease with data from the 1990 US Census. Among invasive pneumococcal isolates from Atlanta, Georgia, in 1994, increasing proportions of penicillin-nonsusceptible isolates were associated with higher median household incomes (x2 for trend, 15. 17; p = 0.002). Despite higher rates of invasive pneumococcal disease among blacks and persons who resided within lower median household income areas, white patients in areas with higher median household income had a higher risk of being infected with strains that were not susceptible to penicillin (Wilcoxon rank sum, Z = 2.66, p = 0.008). These findings demonstrated the utility of geocoding and US Census data in describing the epidemiology of drug-resistant S. pneumoniae and also provided more evidence that socioeconomic factors may influence the development of drug resistance. Am J Epidemiol 1998; 148: 1212–18.
censuses; drug resistance; socioeconomic status; Streptococcus pneumoniae
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