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  • A risk factor study of coccidioidomycosis by controlling differential misclassifications of exposure and susceptibility using a landscape ecology approach.

    Author(s) : Tabor, J. A.O'Rourke, M. K.

    Author Affiliation : Office of Arid Lands Studies, College of Agriculture and Life Sciences, The University of Arizona, Tucson, AZ 85721, USA.

    Author Email : jatabor@u.arizona.edu

    Journal article : Science of the Total Environment 2010 Vol.408 No.10 pp.2199-2207

    Abstract : State-reported coccidioidomycosis cases in Arizona have dramatically increased since 1997, raising concerns about a possible epidemic, its cause, and associated risk factors, including spatio-temporal differences in susceptibility and exposure. This stratified, two-stage, cross-sectional study evaluates inherent, socio-economic, and environmental risk factors of coccidioidomycosis from information collected during an address-based telephone survey of 5460 households containing 14,105 individuals in greater Tucson, Arizona. Three geomorphic and two demographic strata controlled for differences in group-level exposures and susceptibility, and assured recruitment of a minority population. Logistic regression of self-reported cases indicates that location of residence by geomorphic and demographic strata was a risk factor that confounded the associations of coccidioidomycosis with age, race-ethnicity, and educational attainment. The risk due to age is more evenly distributed across the population than bivariate results when individual- and group-level exposure and susceptibility factors are controlled. Similarly the association for being Hispanic decreased from strong bivariate 0.28 odds ratio to a weak multivariate 0.75. Location of residence confounded the risk due to race-ethnicity and was an effect modifier of risk due to age. Differential misclassification of exposure to Coccidioides spores and susceptibility to coccidioidomycosis was reduced through landscape stratification by demographics and geomorphic types. Landscape epidemiological studies of diseases with strong environmental and demographic determinants can reduce residual confounding and account for spatial and temporal differences between neighborhoods and at broader scales.

    ISSN : 0048-9697

    DOI : 10.1016/j.scitotenv.2010.02.013

    URL : http://www.sciencedirect.com/science?...

    Record Number : 20103118287

    Publisher : Elsevier Ltd

    Location of publication : Oxford

    Country of publication : UK

    Language of text : English

    Language of summary : English

    Indexing terms for this abstract:

    Organism descriptor(s) : Coccidioides

    Descriptor(s) : coccidioidomycosis, demography, ecology, environment, environmental health, epidemics, epidemiology, Hispanics, households, infections, mycoses, neighbourhoods, risk, risk factors

    Identifier(s) : coccidiomycosis, fungus, neighborhoods, telephone surveys, United States of America

    Geographical Location(s) : Arizona, USA

    Broader term(s) : Onygenaceae, Onygenales, Eurotiomycetes, Pezizomycotina, Ascomycota, fungi, eukaryotes, Mountain States of USA, Western States of USA, USA, APEC countries, Developed Countries, North America, America, OECD Countries, Southwestern States of USA