title: Community-level risk factors for notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008.
abstract: BACKGROUND
  Enteric 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  Significant (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.
  
  
  CONCLUSIONS
  These 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.
authors: Department of Population Medicine, University of Guelph, Guelph, ON, Canada. apardhan@uoguelph.ca
authors: Aliya
authors: A
authors: Pardhan-Ali
authors: Jeff
authors: J
authors: Wilson
authors: Victoria L
authors: VL
authors: Edge
authors: Chris
authors: C
authors: Furgal
authors: Richard
authors: R
authors: Reid-Smith
authors: Maria
authors: M
authors: Santos
authors: Scott A
authors: SA
authors: McEwen
mesh_terms: D016010:Binomial Distribution; D002169:Campylobacter Infections / Q000453:epidemiology*; D003466:Cultural Characteristics; D005247:Feeding Behavior; D005873:Giardiasis / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D015873:Northwest Territories / Q000453:epidemiology; D016012:Poisson Distribution; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012480:Salmonella Infections / Q000453:epidemiology*; D012959:Socioeconomic Factors