142nd APHA Annual Meeting and Exposition

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Toxoplasmosis Mortality, Associated Medical Conditions, and Productivity Losses in the United States, 2000-2010: A Matched Case-Control Analysis

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Patricia L. Cummings, MPH , Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
Tony Kuo, MD, MSHS , Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA
Marjan Javanbakht, PhD , Department of Epidemiology, Fielding School of Public Health, Los Angeles, CA
Frank Sorvillo, PhD , Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
Background: Toxoplasma gondii is a well-known parasitic infection associated with HIV/AIDS, but its status as the second most common foodborne illness is often overlooked. Few studies have quantified toxoplasmosis mortality burden in the United States.

Methods: We examined national multiple cause-of-death data and estimated lost productivity from this disease for the period 2000-2010. Crude and age-standardized rates of toxoplasmosis-related mortality were computed for sex, race, year, and state of residence. A matched case-control analysis was conducted to examine associations between comorbid conditions and toxoplasmosis deaths. Productivity losses due to premature death were calculated using the human capital approach which estimated the present value of lifetime productivity.

Results: A total of 789 toxoplasmosis deaths were identified as either an underlying or associated cause of death during the study period. The average annual age-adjusted mortality rate was 0.03 per 100,000 population. Poisson trend analysis showed an annual percent change of -11.7% (p<0.0001) over the study period. Blacks and Hispanics had the highest burden of toxoplasmosis-related mortality as compared to whites, with an age-adjusted rate ratio of 8.3 (95% Confidence Interval [CI], 7.3-9.4) and 3.5 (95% CI, 3.1-4.0), respectively. The age-adjusted rate for toxoplasmosis death in males was twice that of females. For the matched case-control analysis, several comorbid conditions were associated with toxoplasmosis deaths, including HIV (OR=27.7; 95% CI, 21.8-35.4), Hodgkin/Non-Hodgkin lymphomas (Odds Ratio [OR]=5.9; 95% CI, 4.0-8.7), leukemia (OR=3.1; 95% CI, 1.95-4.85), and connective tissue disorders (OR=4.4; 95% CI, 2.7-7.2). The total productivity losses were $814.5 million during the 10-year period.

Conclusions: Although trends for this infection have declined in the last decade, toxoplasmosis remains an important cause of preventable death among several subgroups.

Learning Areas:

Chronic disease management and prevention
Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Explain how national multiple cause-of-death data were used to estimate lost productivity from toxoplasmosis for the period 2000-2010. Describe the importance of this predominately recognized HIV/AIDS associated infection among other immune compromised groups.

Keyword(s): Epidemiology, Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Patricia L. Cummings, MPH is an Epidemiologist at the Los Angeles County Department of Public Health and a PhD candidate at the University of California Los Angeles (UCLA) Fielding School of Public Health. She has been the principal or co-principal investigator of multiple research studies focusing on food safety and food quality, including foodborne diseases.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.