Relationship between socioeconomic status and gastrointestinal infections in developed countries: A systematic review and meta-analysis

Natalie Adams*, Tanith C. Rose, Jeremy Hawker, Mara Violato, Sarah J. O’Brien, Benjamin Barr, Victoria J.K. Howard, Margaret Whitehead, Ross Harris, David C. Taylor-Robinson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

18 Citations (Scopus)


Background The association between socioeconomic status (SES) and health is well-documented; however limited evidence on the relationship between SES and gastrointestinal (GI) infections exists, with published studies producing conflicting results. This systematic review aimed to assess the association between SES and GI infection risk, and explore possible sources of heterogeneity in effect estimates reported in the literature. Methods MEDLINE, Scopus, Web of Science and grey literature were searched from 1980 to October 2015 for studies reporting an association between GI infections and SES in a representative population sample from a member-country of the Organisation for Economic Co-operation and Development. Harvest plots and meta-regression were used to investigate potential sources of heterogeneity such as age; level of SES variable; GI infection measurement; and predominant mode of transmission. The protocol was registered on PROSPERO: CRD42015027231. Results In total, 6021 studies were identified; 102 met the inclusion criteria. Age was identified as the only statistically significant potential effect modifier of the association between SES and GI infection risk. For children, GI infection risk was higher for those of lower SES versus high (RR 1.51, 95% CI;1.26–1.83), but there was no association for adults (RR 0.79, 95% CI;0.58–1.06). In univariate analysis, the increased risk comparing low and high SES groups was significantly higher for pathogens spread by person-to-person transmission, but lower for environmental pathogens, as compared to foodborne pathogens. Conclusions Disadvantaged children, but not adults, have greater risk of GI infection compared to their more advantaged counterparts. There was high heterogeneity and many studies were of low quality. More high quality studies are needed to investigate the association between SES and GI infection risk, and future research should stratify analyses by age and pathogen type. Gaining further insight into this relationship will help inform policies to reduce inequalities in GI illness in children.

Original languageEnglish
Article numbere0191633
JournalPLoS ONE
Issue number1
Publication statusPublished - Jan 2018

Bibliographical note

Funding Information:
This work was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections [grant number NIHR HPRU 2012-10038] at University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Institute of Food Research. Natalie Adams is a PhD student based at the University of Liverpool and Public Health England. Tanith Rose is a PhD student based at the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Publisher Copyright:
© 2018 Adams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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