We report on the first case-control study to investigate the role of wider environmental and socioeconomic factors upon human cryptosporidiosis. Using GIS the detailed locations of 3368 laboratory-confirmed cases were compared to the locations of an equal number of controls. All cases were genotyped enabling Cryptosporidium hominis and Cryptosporidium parvum to be examined separately. When all cryptosporidiosis cases were analyzed, several location variables were strongly associated with illness: areas with many higher socioeconomic status individuals, many individuals aged less than 4 years, areas with a high estimate of Cryptosporidium applied to land from manure, and areas with poorer water treatment. For C. hominis cases, the strongly significant risk factors were areas with many higher socioeconomic status individuals, areas with many young children and urban areas. Socioeconomic status and areas with many individuals aged less then 4 years had a greater impact for infection with C. hominis than for C. parvum. Policy implications are discussed.
Bibliographical noteFunding Information:
Acknowledgements This work was funded by the Wellcome Trust. We would also like to acknowledge Kristin Elwin and Anne Thomas for maintaining the national collection of Cryptosporidium oocysts and Iain Gillespie for the provision of data to validate the formation of laboratory catchment areas. Finally we would like to acknowledge the work of Steve Anthony, Hester Lyons and Chris Proctor at ADAS for developing the animal manure distribution database.
- Environment and public health
- Social class