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Open Forum Infect Dis. 2018 Jul 3;5(7):ofy148. doi: 10.1093/ofid/ofy148. eCollection 2018 Jul.

The Relationship Between Census Tract Poverty and Shiga Toxin-Producing E. coli Risk, Analysis of FoodNet Data, 2010-2014.

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Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut.
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
California Emerging Infections Program, Oakland, California.
Emerging Infections Program, Colorado Department of Public Health and Environment, Denver, Colorado.
Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia.
Emerging Infections Program, Maryland Department of Health, Baltimore, Maryland.
Emerging Infections Program, Minnesota Department of Health, St Paul, Minnesota.
Emerging Infections Program, New Mexico Department of Health, Santa Fe, New Mexico.
Emerging Infections Program, New York State Department of Health, Albany, New York.
Emerging Infections Program, Oregon Health Authority, Portland, Oregon.
Emerging Infections Program, Tennessee Department of Health, Nashville, Tennessee.



The relationship between socioeconomic status and Shiga toxin-producing Escherichia coli (STEC) is not well understood. However, recent studies in Connecticut and New York City found that as census tract poverty (CTP) decreased, rates of STEC increased. To explore this nationally, we analyzed surveillance data from laboratory-confirmed cases of STEC from 2010-2014 for all Foodborne Disease Active Surveillance Network (FoodNet) sites, population 47.9 million.


Case residential data were geocoded and linked to CTP level (2010-2014 American Community Survey). Relative rates were calculated comparing incidence in census tracts with <20% of residents below poverty with those with ≥20%. Relative rates of age-adjusted 5-year incidence per 100 000 population were determined for all STEC, hospitalized only and hemolytic-uremic syndrome (HUS) cases overall, by demographic features, FoodNet site, and surveillance year.


There were 5234 cases of STEC; 26.3% were hospitalized, and 5.9% had HUS. Five-year incidence was 10.9/100 000 population. Relative STEC rates for the <20% compared with the ≥20% CTP group were >1.0 for each age group, FoodNet site, surveillance year, and race/ethnic group except Asian. Relative hospitalization and HUS rates tended to be higher than their respective STEC relative rates.


Persons living in lower CTP were at higher risk of STEC than those in the highest poverty census tracts. This is unlikely to be due to health care-seeking or diagnostic bias as it applies to analysis limited to hospitalized and HUS cases. Research is needed to better understand exposure differences between people living in the lower vs highest poverty-level census tracts to help direct prevention efforts.


E. coli; Shiga toxin; census tract; incidence; poverty

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