#88 Racial and ethnic differences among three enteric agents: The third national health and nutrition examination survey (Nhanes III)

PURPOSE: To examine differences in the presence of antibody to three enteric pathogens (Toxoplasma gondii, Helicobacter pylori, and Hepatitis A virus) among adults age 20 years and older in a representative sample of the U.S. to determine if racial/ethnic differences remain after accounting for socio-demographic factors through adjustment and stratification. METHODS: Sera from participants in NHANES III, conducted from 1988–1994, were tested for the presence of antibody to Toxoplasma gondii (n = 14332), Helicobacter pylori (Phase 1 1988–1991 only, N = 7225), and Hepatitis A virus (n = 14960). RESULTS: Multivariate logistic modeling adjusting for all significant socio-demographic cofactors as compared to adjustment for age alone reduced the race/ethnic odds of being infected for both non-Hispanic blacks and Mexican Americans (as compared to non-Hispanic whites). Variables that had a differential effect on the race/ethnic odds (age, gender, education, foreign birth, metropolitan residence, poverty, and household crowding) were grouped in various combinations (depending on the enteric pathogen) to form subgroups at high and low risk for infection. In general, after adjustment for the remaining cofactors, the effect of race/ethnicity was strongest among those within the lowest risk (more socially advantaged) subgroup. Race/ethnicity had less impact on individuals who were in the highest risk category. CONCLUSION: Racial/ethnic differences are almost always evident in looking at national infectious disease prevalence. Stratification by risk categories demonstrates that the effect of race/ethnicity continues to remain important for most pathogens among the more socially advantaged subgroups, but is diminished among those less socially advantaged.