Efforts to decrease the burden of disease among adults and children have focused on immunization and judicious use of antibiotics to minimize development of drug-resistant strains of Streptococcus pneumoniae. Certain communities, particularly those that are socioeconomically disadvantaged, may be at increased risk for transmission of S. pneumoniae among young children, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS10247) through the Centers for Education and Research on Therapeutics (CERTs) initiative.
Certain community characteristics increase the odds of carriage of disease-causing strains two- to three-fold. The presence of these characteristics could be used to identify communities that should be targeted for interventions to decrease carriage, according to Jonathan Finkelstein, M.D., M.P.H., of the HMO Research Network CERT in Boston.
Based on U.S. census data, the researchers calculated that living in census tracts with an average household size of more than 2.9 predicted a three-fold increase in the odds of S. pneumoniae carriage, and living in socioeconomically disadvantaged census tracts conferred an additional two- to three-fold increase in the odds of carriage (equal to that of a child attending child care).
The predictive value of a low-income census tract (median household income less than $35,000) was interchangeable with any of several socioeconomic measures, including poverty, unemployment, low educational attainment, and low owner occupancy, in addition to high density of children and limited household plumbing facilities. Furthermore, living in census tracts where residents had low educational attainment predicted a four-fold risk of carriage of antibiotic-resistant S. pneumoniae. The authors geocoded addresses from a multi-community sample of 710 Massachusetts children previously swabbed for pneumococcal carriage in 2001. They used mathematical models to evaluate associations between census tract measures and pneumococcal carriage.
See "Community-level predictors of pneumococcal carriage and resistance in young children," by Susan S. Huang, M.D., M.P.H., Jonathan A. Finkelstein, M.D., M.P.H., Sheryl L. Rifas-Shiman, M.P.H., and others, in the American Journal of Epidemiology 159(7), pp. 645-654, 2004.
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