Neighborhood Disadvantage is Associated with High Cytomegalovirus Seroprevalence in Pregnancy

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

Abstract

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.

Keywords

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

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)

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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

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