Neighborhood Disadvantage is Associated with High Cytomegalovirus Seroprevalence in Pregnancy

  • Paul M. LantosEmail author
  • Kate Hoffman
  • Sallie R. Permar
  • Pearce Jackson
  • Brenna L. Hughes
  • Amy Kind
  • Geeta Swamy



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.


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.


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.


Neighborhood-level poverty as measured by the ADI is a race-independent predictor of local CMV seroprevalence among pregnant women.


Cytomegalovirus Health disparities Poverty Geographic information system Spatial epidemiology Generalized additive model Pregnancy 



Dr. Lantos was supported by the National Center for Advancing Translational Sciences of the NIH under award number KL2 TR001115.

Dr. Permar was supported by the NIH Director’s New Innovator Award DP2 grant, number HD075699.

Dr. Swamy was supported by the National Institute of Child Health and Human Development, Maternal Fetal Medicine Units Network, award number HD068258

Dr. Kind was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number R01MD010243.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Duke University Institutional Review Board. A waiver of Informed consent was granted for this retrospective study. Measures were taken to secure confidential subject data in compliance with HIPAA and with standards for confidential patient data by Duke University School of Medicine and Duke Health Technology Solutions.

Supplementary material

40615_2017_423_MOESM1_ESM.pdf (193 kb)
ESM 1 (PDF 193 kb)
40615_2017_423_MOESM2_ESM.pdf (1.3 mb)
ESM 2 (PDF 1313 kb)


  1. 1.
    Cannon MJ, Davis KF. Washing our hands of the congenital cytomegalovirus disease epidemic. BMC Public Health. 2005;5:70.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Colugnati FA, Staras SA, Dollard SC, Cannon MJ. Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect Dis. 2007;7:71.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Stadler LP, Bernstein DI, Callahan ST, Turley CB, Munoz FM, Ferreira J, et al. Seroprevalence and risk factors for cytomegalovirus infections in adolescent females. J Pediatr Infect Dis Soc. 2013;2(1):7–14.CrossRefGoogle Scholar
  4. 4.
    Stadler LP, Bernstein DI, Callahan ST, Ferreira J, Gorgone Simone GA, Edwards KM, et al. Seroprevalence of cytomegalovirus (CMV) and risk factors for infection in adolescent males. Clin Infect Dis. 2010;51(10):e76–81.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sohn YM, Oh MK, Balcarek KB, Cloud GA, Pass RF. Cytomegalovirus infection in sexually active adolescents. J Infect Dis. 1991;163(3):460–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Gaffey MJ, Tucker RM, Fisch MJ, Normansell DE. The seroprevalence of cytomegalovirus among Virginia State prisoners. Public Health. 1989;103(4):303–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis. 2010;50(11):1439–47.CrossRefPubMedGoogle Scholar
  8. 8.
    Bristow BN, O’Keefe KA, Shafir SC, Sorvillo FJ. Congenital cytomegalovirus mortality in the United States, 1990-2006. PLoS Negl Trop Dis. 2011;5(4):e1140.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dowd JB, Palermo TM, Aiello AE. Family poverty is associated with cytomegalovirus antibody titers in U.S. children. Health Psychol. 2012;31(1):5–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Griffiths P, Baboonian C, Ashby D. The demographic characteristics of pregnant women infected with cytomegalovirus. Int J Epidemiol. 1985;14(3):447–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Lantos PM, Permar SR, Hoffman K, Swamy GK. The Excess Burden of Cytomegalovirus in African American Communities: A Geospatial Analysis. Open Forum Infect Dis. 2015;2(4):ofv180.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lantos PM, Hoffman K, Permar SR. Jackson P. Swamy GK. Geographic Disparities in Cytomegalovirus Infection During Pregnancy. J Pediatric Infect Dis Soc: Hughes BL; 2017.Google Scholar
  13. 13.
    The ADI is freely available through the University of Wisconsin by emailing Scholar
  14. 14.
    Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161(11):765–74.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wood SN. Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models. J Royal Stat Soc (B). 2011;73(1):3–36.CrossRefGoogle Scholar
  16. 16.
    Staras SA, Flanders WD, Dollard SC, Pass RF, McGowan JE Jr, Cannon MJ. Influence of sexual activity on cytomegalovirus seroprevalence in the United States, 1988-1994. Sex Transm Dis. 2008;35(5):472–9.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2017

Authors and Affiliations

  1. 1.Department of MedicineDuke UniversityDurhamUSA
  2. 2.Department of PediatricsDuke UniversityDurhamUSA
  3. 3.Global Health InstituteDuke UniversityDurhamUSA
  4. 4.Nicholas School of the EnvironmentDuke UniversityDurhamUSA
  5. 5.Human Vaccine InstituteDuke UniversityDurhamUSA
  6. 6.Department of Obstetrics and GynecologyDuke UniversityDurhamUSA
  7. 7.Department of MedicineUniversity of WisconsinMadisonUSA

Personalised recommendations