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Relationship between socioeconomic status and gastrointestinal infections in developed countries: A systematic review and meta-analysis

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  • Natalie L Adams
  • Tanith C Rose
  • Jeremy Hawker
  • Mara Violato
  • Sarah J O’Brien
  • Benjamin Barr
  • Victoria J K Howard
  • Margaret Whitehead
  • Ross Harris
  • David C Taylor-Robinson

Abstract

Background: The association between socioeconomic status (SES) and health is well-documented; however limited evidence on the relationship between SES and gastrointestinal (GI) infections exists, with published studies producing conflicting results. This systematic review aimed to assess the association between SES and GI infection risk, and explore possible sources of heterogeneity in effect estimates reported in the literature. Methods: MEDLINE, Scopus, Web of Science and grey literature were searched from 1980 to October 2015 for studies reporting an association between GI infections and SES in a representative population sample from a member-country of the Organisation for Economic Co-operation and Development. Harvest plots and meta-regression were used to investigate potential sources of heterogeneity such as age; level of SES variable; GI infection measurement; and predominant mode of transmission. The protocol was registered on PROSPERO: CRD42015027231. Results: In total, 6021 studies were identified; 102 met the inclusion criteria. Age was identified as the only statistically significant potential effect modifier of the association between SES and GI infection risk. For children, GI infection risk was higher for those of lower SES versus high (RR 1.51, 95% CI;1.26–1.83), but there was no association for adults (RR 0.79, 95% CI;0.58–1.06). In univariate analysis, the increased risk comparing low and high SES groups was significantly higher for pathogens spread by person-to-person transmission, but lower for environmental pathogens, as compared to foodborne pathogens. Conclusions: Disadvantaged children, but not adults, have greater risk of GI infection compared to their more advantaged counterparts. There was high heterogeneity and many studies were of low quality. More high quality studies are needed to investigate the association between SES and GI infection risk, and future research should stratify analyses by age and pathogen type. Gaining further insight into this relationship will help inform policies to reduce inequalities in GI illness in children.

Suggested Citation

  • Natalie L Adams & Tanith C Rose & Jeremy Hawker & Mara Violato & Sarah J O’Brien & Benjamin Barr & Victoria J K Howard & Margaret Whitehead & Ross Harris & David C Taylor-Robinson, 2018. "Relationship between socioeconomic status and gastrointestinal infections in developed countries: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-16, January.
    • Handle: RePEc:plo:pone00:0191633
    DOI: 10.1371/journal.pone.0191633
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    References listed on IDEAS

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    1. Lina Schollin Ask & Can Liu & Karl Gauffin & Anders Hjern, 2019. "The Effect of Rotavirus Vaccine on Socioeconomic Differentials of Paediatric Care Due to Gastroenteritis in Swedish Infants," IJERPH, MDPI, vol. 16(7), pages 1-10, March.
    2. Rotheram, Suzanne & Cooper, Jessie & Barr, Ben & Whitehead, Margaret, 2021. "How are inequalities generated in the management and consequences of gastrointestinal infections in the UK? An ethnographic study," Social Science & Medicine, Elsevier, vol. 282(C).
    3. Jong-Myong Park & Joong-Hee Cho & Nam-Soo Jun & Ki-In Bang & Ji-Won Hong, 2022. "Worker Protection Scenarios for General Analytical Testing Facility under Several Infection Propagation Risks: Scoping Review, Epidemiological Model and ISO 31000," IJERPH, MDPI, vol. 19(19), pages 1-16, September.

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