title: The SEEDs of two gastrointestinal diseases: socioeconomic, environmental, and demographic factors related to cryptosporidiosis and giardiasis in Massachusetts.
abstract: OBJECTIVE
  We assessed associations between community-level socioeconomic, demographic, and environmental characteristics, and the presence of two potentially waterborne infectious diseases, cryptosporidiosis and giardiasis, as reported to the Massachusetts Department of Public Health.
  
  
  METHODS
  We created a series of maps showing the spatial distribution of cryptosporidiosis and giardiasis in Massachusetts (1993-2002) overall and by age, using logistic regression to analyze associations between community-level characteristics and the presence of at least one reported case of each disease. This analysis was repeated for communities with predominantly private water supplies.
  
  
  RESULTS
  After adjusting for population size, higher population density and larger than average household sizes were associated with increased odds of reported cases of cryptosporidiosis. Giardiasis was also associated with high population density, but was not associated with household size. In the elderly, income was positively associated with the presence of giardiasis.
  
  
  CONCLUSIONS
  These findings suggest that greater population density and larger household sizes may increase the likelihood of protozoan gastrointestinal infection. The results emphasize the necessity to account for distal factors, such as demographic characteristics, that may ultimately play a role in the transmission or reporting of disease.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, MD, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Andrey I
authors.initials: AI
authors.lastname: Egorov
authors.forename: Jyotsna S
authors.initials: JS
authors.lastname: Jagai
authors.forename: Bela T
authors.initials: BT
authors.lastname: Matyas
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
authors.forename: Kenneth K H
authors.initials: KK
authors.lastname: Chui
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
authors.forename: Elena N
authors.initials: EN
authors.lastname: Naumova
mesh_terms: D003457:Cryptosporidiosis / Q000453:epidemiology / Q000209:etiology*; D003710:Demography; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005873:Giardiasis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D012959:Socioeconomic Factors; D014871:Water Microbiology / Q000592:standards; D014873:Water Pollutants / Q000032:analysis*; D014881:Water Supply / Q000032:analysis / Q000592:standards
chemical_list: D014873:Water Pollutants