title: Human listeriosis in England, 2001-2007: association with neighbourhood deprivation.
abstract: Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Despite the high mortality rate of the disease, its socio-economic determinants have not been studied in detail, meaning that health inequalities that might exist in relation to this disease are not apparent. Laboratory surveillance data on listeriosis cases reported in England between 2001 and 2007 were linked to indices of deprivation and denominator data using patients' postcodes. Incidence relative to increasing quintiles of deprivation was calculated by fitting generalised linear models while controlling for population size. Patient food purchasing and consumption data were scrutinised and compared with commercial food purchasing denominator data to further quantify the observed differences in disease incidence. For all patient groups, listeriosis incidence was highest in the most deprived areas of England when compared with the most affluent, and cases were more likely to purchase foods from convenience stores or from local services (bakers, butchers, fishmongers and greengrocers) than the general population were. Patients' risk profile also changed with increasing neighbourhood deprivation. With increased life expectancy and rising food prices, food poverty could become an increasingly important driver for foodborne disease in the future. While United Kingdom Government policy should continue to focus on small food businesses to ensure sufficient levels of food hygiene expertise, tailored and targeted food safety advice on the avoidance of listeriosis is required for all vulnerable groups. Failure to do so may enhance health inequality across socio-economic groups.
authors.affiliation: Health Protection Agency, Centre for Infections, London, United Kingdom. iain.gillespie@hpa.org.uk
authors.forename: I A
authors.initials: IA
authors.lastname: Gillespie
authors.forename: P
authors.initials: P
authors.lastname: Mook
authors.forename: C L
authors.initials: CL
authors.lastname: Little
authors.forename: K A
authors.initials: KA
authors.lastname: Grant
authors.forename: J
authors.initials: J
authors.lastname: McLauchlin
mesh_terms: D000328:Adult; D000368:Aged; D003415:Crime; D004522:Educational Status; D004739:England / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005506:Food Contamination / Q000191:economics / Q000706:statistics & numerical data*; D005511:Food Handling / Q000592:standards / Q000706:statistics & numerical data; D005516:Food Microbiology; D006801:Humans; D015994:Incidence; D007182:Income; D007231:Infant, Newborn; D008089:Listeria monocytogenes / Q000302:isolation & purification*; D008088:Listeriosis / Q000191:economics / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011203:Poverty; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000453:epidemiology; D012111:Residence Characteristics; D012189:Retrospective Studies; D035862:Vulnerable Populations