Community-level risk factors for notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008

Abstract

BackgroundEnteric pathogens are an important cause of illness, however, little is known about their community-level risk factors (e.g., socioeconomic, cultural and physical environmental conditions) in the Northwest Territories (NWT) of Canada. The objective of this study was to undertake ecological (group-level) analyses by combining two existing data sources to examine potential community-level risk factors for campylobacteriosis, giardiasis and salmonellosis, which are three notifiable (mandatory reporting to public health authorities at the time of diagnosis) enteric infections.MethodsThe rate of campylobacteriosis was modeled using a Poisson distribution while rates of giardiasis and salmonellosis were modeled using a Negative Binomial distribution. Rate ratios (the ratio of the incidence of disease in the exposed group to the incidence of disease in the non-exposed group) were estimated for infections by the three major pathogens with potential community-level risk factors.ResultsSignificant (p≤0.05) associations varied by etiology. There was increased risk of infection with Salmonella for communities with higher proportions of ‘households in core need’ (unsuitable, inadequate, and/or unaffordable housing) up to 42% after which the rate started to decrease with increasing core need. The risk of giardiasis was significantly higher both with increased ‘internal mobility’ (population moving between communities), and also where the community’s primary health facility was a health center rather than a full-service hospital. Communities with higher health expenditures had a significantly decreased risk of giardiasis. Results of modeling that focused on each of Giardia and Salmonella infections separately supported and expanded upon previous research outcomes that suggested health disparities are often associated with socioeconomic status, geographical and social mobility, as well as access to health care (e.g. facilities, services and professionals). In the campylobacteriosis model, a negative association was found between food prices in communities and risk of infection. There was also a significant interaction between trapping and consumption of traditional foods in communities. Higher rates of community participation in both activities appeared to have a protective effect against campylobacteriosis.ConclusionsThese results raise very interesting questions about the role that traditional activities might play in infectious enteric disease incidence in the NWT, but should be interpreted with caution, recognizing database limitations in collection of case data and risk factor information (e.g. missing data). Given the cultural, socioeconomic, and nutritional benefits associated with traditional food practices, targeted community-based collaborative research is necessary to more fully investigate the statistical correlations identified in this exploratory research. This study demonstrates the value of examining the role of social determinants in the transmission and risk of infectious diseases.

Presence of animal feeding operations and community socioeconomic factors impact salmonellosis incidence rates: An ecological analysis using data from the Foodborne Diseases Active Surveillance Network (FoodNet), 2004–2010

“…Chang et al (2009) previously identified a positive association between poverty levels and salmonellosis incidence rates at the county-level (Chang et al, 2009). More recently, in a Canadian study, Pardhan-Ali et al (2013) showed that rates of Salmonella infection were positively associated with the number of "households in core need" (homes that fall below defined standards and have low household incomes) (Pardhan-Ali et al, 2013). These findings may be influenced by a lack of safe food handling knowledge and behaviors among lowincome groups (Quinlan, 2013).…”

Acute gastrointestinal illness in two Inuit communities: burden of illness in Rigolet and Iqaluit, Canada

“…While research on the burden of AGI is burgeoning, there is still a limited understanding of enteric illness in subsets of populations, including populations who could be the most vulnerable to enteric illness [13][14][15][16]. For instance, although high-quality data are not currently available to accurately estimate the burden of AGI in Indigenous communities, research has documented environmental conditions that could increase the risk of AGI (e.g.…”

The need for community-led, integrated and innovative monitoring programmes when responding to the health impacts of climate change

“…This is particularly important for Indigenous communities, who are often inadequately engaged in monitoring programmes [63][64][65]. Although public health monitoring is strong in many Circumpolar nations, 2 there is a continued need to adequately use Indigenous Knowledge in these programmes in a meaningful way; failure to do so has led to various gaps and challenges in coverage, data quality and relevance [4,[10][11][12]21,26,27,[29][30][31]65].…”