title: The Impact of Obesity and Diabetes on the Risk of Disease and Death due to Invasive Group A Streptococcus Infections in Adults.
abstract: BACKGROUND
  Invasive group A Streptococcus (iGAS) infections cause significant morbidity and mortality worldwide. We analyzed whether obesity and diabetes were associated with iGAS infections and worse outcomes among an adult US population.
  
  
  METHODS
  We determined the incidence of iGAS infections using 2010-2012 cases in adults aged ≥ 18 years from Active Bacterial Core surveillance (ABCs), a population-based surveillance system, as the numerator. For the denominator, we used ABCs catchment area population estimates from the 2011 to 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. The relative risk (RR) of iGAS was determined by obesity and diabetes status after adjusting for age group, gender, race, and other underlying conditions through binomial logistic regression. Multivariable logistic regression was used to determine whether obesity or diabetes was associated with increased odds of death due to iGAS compared to normal weight and nondiabetic patients, respectively.
  
  
  RESULTS
  Between 2010 and 2012, 2927 iGAS cases were identified. Diabetes was associated with an increased risk of iGAS in all racial groups (adjusted risk ratio [aRR] ranged from 2.71 to 5.08). Grade 3 obesity (body mass index [BMI] ≥ 40) was associated with an increased risk of iGAS for whites (aRR = 3.47; 95% confidence interval [CI], 3.00-4.01). Grades 1-2 (BMI = 30.0-<40.0) and grade 3 obesity were associated with an increased odds of death (odds ratio [OR] = 1.55, [95% CI, 1.05, 2.29] and OR = 1.62 [95% CI, 1.01, 2.61], respectively) when compared to normal weight patients.
  
  
  CONCLUSIONS
  These results may help target vaccines against GAS that are currently under development. Efforts to develop enhanced treatment regimens for iGAS may improve prognoses for obese patients.
authors.affiliation: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Gayle
authors.initials: G
authors.lastname: Langley
authors.affiliation: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Tracy
authors.initials: T
authors.lastname: Pondo
authors.affiliation: Colorado Department of Public Health and Environment, Denver.
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.affiliation: Connecticut Department of Public Health, Hartford.
authors.forename: Susan
authors.initials: S
authors.lastname: Petit
authors.affiliation: Oregon Department of Human Services, Portland.
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Mary Louise
authors.initials: ML
authors.lastname: Lindegren
authors.affiliation: Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.affiliation: University of Rochester, New York.
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
authors.affiliation: Minnesota Department of Health, St. Paul.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Como-Sabetti
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.affiliation: New Mexico Department of Health, Santa Fe.
authors.forename: Joan
authors.initials: J
authors.lastname: Baumbach
authors.affiliation: California Department of Public Health, Richmond.
authors.forename: James
authors.initials: J
authors.lastname: Watt
authors.affiliation: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Chris
authors.initials: C
authors.lastname: Van Beneden
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D011159:Population Surveillance; D012307:Risk Factors; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D013297:Streptococcus pyogenes; D055815:Young Adult
keywords: diabetes; group A Streptococcus infections; obesity