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Influence of socio-economic status on Shiga toxin-producing Escherichia coli (STEC) infection incidence, risk factors and clinical features

Lookup NU author(s): Professor Sarah O'Brien



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.

Publication metadata

Author(s): Adams NL, Byrne L, Rose TC, Adak GK, Jenkins C, Charlett A, Violato M, O'Brien SJ, Whitehead MM, Barr B, Taylor-Robinson DC, Hawker JI

Publication type: Article

Publication status: Published

Journal: Epidemiology and Infection

Year: 2019

Volume: 147

Online publication date: 13/06/2019

Acceptance date: 23/04/2019

Date deposited: 22/08/2019

ISSN (print): 0950-2688

ISSN (electronic): 1469-4409

Publisher: Cambridge University Press


DOI: 10.1017/S0950268819000864

PubMed id: 31364538


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Funder referenceFunder name
NIHR HPRU 201210,038