title: Geographic Disparities in Cytomegalovirus Infection During Pregnancy.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is the most common infectious cause of fetal malformations and childhood hearing loss. CMV is more common among socially disadvantaged groups, and it clusters geographically in poor communities. We conducted a geospatial analysis of chronic and primary CMV infection among pregnant women around Durham, NC.
  
  
  METHODS
  We performed a geospatial analysis of subjects from an ongoing study of CMV infection among pregnant women using geographic information systems and spatial statistics. Subjects were categorized on the basis of results of their CMV immunoglobulin G avidity testing as seronegative, seropositive, or primary infection. We used generalized additive models to analyze the spatial distributions of individuals who fell into each category and to control for confounders such as race and age. We used a generalized estimating equation to correlate community-level variables with CMV status.
  
  
  RESULTS
  Of 3527 pregnant women aged 15 to 59 years, 93.4% were either white or black. CMV seropositivity was significantly more common among non-Hispanic white subjects than among minority subjects (odds ratio, 3.76 [95% confidence interval, 3.25-4.34]). We identified a cluster in which women had elevated odds of CMV seropositivity in the urban neighborhoods of Durham. Cases of primary CMV infection were more common in areas with higher-than-average CMV seroprevalence. Neighborhood median family income was associated inversely with the prevalence of chronic CMV.
  
  
  CONCLUSIONS
  We found a high prevalence of CMV seropositivity in urban low-income neighborhoods among pregnant women, particularly among racial and ethnic minorities. Seronegative pregnant women from these communities might be at heightened risk for primary CMV infection.
authors.affiliation: Department of Pediatrics, Duke University, Durham, North Carolina.|Department of Internal Medicine, Duke University, Durham, North Carolina.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lantos
authors.affiliation: Nicholas School of the Environment, Duke University, Durham, North Carolina.
authors.forename: Kate
authors.initials: K
authors.lastname: Hoffman
authors.affiliation: Department of Pediatrics, Duke University, Durham, North Carolina.|Human Vaccine Institute, Duke University, Durham, North Carolina.
authors.forename: Sallie R
authors.initials: SR
authors.lastname: Permar
authors.affiliation: Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
authors.forename: Pearce
authors.initials: P
authors.lastname: Jackson
authors.affiliation: Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Hughes
authors.affiliation: Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Swamy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000914:Antibodies, Viral; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D005006:Ethnicity; D005260:Female; D062305:Geographic Mapping; D005843:Geography; D006801:Humans; D007074:Immunoglobulin G; D015994:Incidence; D007182:Income; D008875:Middle Aged; D008913:Minority Groups; D009657:North Carolina; D016017:Odds Ratio; D011203:Poverty; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000208:ethnology; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012698:Serologic Tests; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G
keywords: African American; black; cluster; cytomegalovirus; disparity; epidemiology; generalized additive model; geographic information system (GIS); poverty; segregation; serology; spatial epidemiology