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. 2015 Nov 20;2(4):ofv180.
doi: 10.1093/ofid/ofv180. eCollection 2015 Dec.

The Excess Burden of Cytomegalovirus in African American Communities: A Geospatial Analysis

Paul M Lantos  1 , Sallie R Permar  2 , Kate Hoffman  3 , Geeta K Swamy  4
Affiliations

The Excess Burden of Cytomegalovirus in African American Communities: A Geospatial Analysis

Paul M Lantos et al. Open Forum Infect Dis. .

Abstract

Background. Cytomegalovirus (CMV) is a common cause of birth defects and hearing loss in infants and opportunistic infections in the immunocompromised. Previous studies have found higher CMV seroprevalence rates among minorities and among persons with lower socioeconomic status. No studies have investigated the geographic distribution of CMV and its relationship to age, race, and poverty in the community. Methods. We identified patients from 6 North Carolina counties who were tested in the Duke University Health System for CMV immunoglobulin G. We performed spatial statistical analyses to analyze the distributions of seropositive and seronegative individuals. Results. Of 1884 subjects, 90% were either white or African American. Cytomegalovirus seropositivity was significantly more common among African Americans (73% vs 42%; odds ratio, 3.31; 95% confidence interval, 2.7-4.1), and this disparity persisted across the life span. We identified clusters of high and low CMV odds, both of which were largely explained by race. Clusters of high CMV odds were found in communities with high proportions of African Americans. Conclusions. Cytomegalovirus seropositivity is geographically clustered, and its distribution is strongly determined by a community's racial composition. African American communities have high prevalence rates of CMV infection, and there may be a disparate burden of CMV-associated morbidity in these communities.

Keywords: African American; cytomegalovirus; disparity; epidemiology; geographic information system.

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Figures

Figure 1.
Figure 1.
Age distribution of cytomegalovirus (CMV) seropositive and seronegative individuals. Both African American and white children had similar rates of CMV seropositivity. Beyond age 10, however, African Americans had a seroprevalence approximately twice that of whites. Only among the older age cohorts did the CMV seroprevalence among whites approach that of African Americans.
Figure 2.
Figure 2.
Spatial distribution of patients tested for cytomegalovirus (CMV). Ellipses contain 1 standard deviation of both seropositive and seronegative African Americans and whites. Patients are represented by dots placed randomly within their census block group (the boundaries of which are not shown). Although there is considerable overlap of all ellipses, the spatial distribution is more closely aligned with race than with test result.
Figure 3.
Figure 3.
Ripley's cross-L function: seropositive versus seronegative point pattern analysis. This statistical test determines whether 2 point patterns are independent or clustered compared with complete spatial randomness. The “Expected” line is that which would be observed under conditions of complete spatial randomness, and the envelope is its 95% confidence interval. The horizontal axis represents distance between any 2 points. The vertical axis represents the calculated L function; values above the spatial randomness envelope represent significant clustering (ie, spatial association). In this case, the relationship between seropositive and seronegative spatial patterns significantly departed from complete spatial randomness (maximum absolute deviation from complete spatial randomness test and Diggle-Gressie-Loosmore-Ford test, both P < .001). This suggests that at a global level seropositive and seronegative individuals do not have significantly different spatial patterns from one another.
Figure 4.
Figure 4.
Generalized additive model. This analysis is a logistic regression with a 2-dimensional spatial smoothing function, resulting in a continuous odds ratio (OR) surface. The response variable in this model was the binary result of cytomegalovirus (CMV) testing. Significant deviations from an OR of 1 are encircled with a contour, representing a 2-tailed P value of .05. (A) An unadjusted model identified clusters with significantly high and significantly low odds of CMV seropositivity. The OR range was 0.4–3.2. (B) Adjusting for race diminished the OR range, eliminated all but one of the low risk clusters, and diminished the size of the remaining ones. This indicates that race is a key predictor of local odds of CMV seropositivity. (C) Superimposing the contours on a census map shows that areas of significantly high CMV risk are those with a high proportion of African Americans. By contrast, areas of significantly low CMV risk have a low proportion of African Americans. The 2 high odds clusters surround the cities of Durham and Raleigh, North Carolina.
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