Abstract
BackgroundPertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications and death, particularly in infants. Between 2008 and 2011, children less than 3 months old accounted for 83% of the pertussis deaths in the United States. Understanding the geographic disparities in the distribution of pertussis risk and identifying high risk geographic areas is necessary for guiding resource allocation and public health control strategies. Therefore, this study investigated geographic disparities and temporal changes in pertussis risk in Florida from 2010 to 2018. It also investigated socioeconomic and demographic predictors of the identified disparities.MethodsPertussis data covering the time period 2010–2018 were obtained from Florida HealthCHARTS web interface. Spatial patterns and temporal changes in geographic distribution of pertussis risk were assessed using county-level choropleth maps for the time periods 2010–2012, 2013–2015, 2016–2018 and 2010–2018. Tango’s flexible spatial scan statistics were used to identify high-risk spatial clusters which were displayed in maps. Ordinary least squares (OLS) regression was used to identify significant predictors of county-level risk. Residuals of the OLS model were assessed for model assumptions including spatial autocorrelation.ResultsCounty-level pertussis risk varied from 0 to 116.31 cases per 100,000 people during the study period. A total of 11 significant (p < 0.05) spatial clusters were identified with risk ratios ranging from 1.5 to 5.8. Geographic distribution remained relatively consistent over time with areas of high risk persisting in the western panhandle, northeastern coast, and along the western coast. Although county level pertussis risks generally increased from 2010–2012 to 2013–2015, risk tended to be lower during the 2016–2018 time period. Significant predictors of county-level pertussis risk were rurality, percentage of females, and median income. Counties with high pertussis risk tended to be rural (p = 0.021), those with high median incomes (p = 0.039), and those with high percentages of females (p < 0.001).ConclusionThere is evidence that geographic disparities exist and have persisted over time in Florida. This study highlights the application and importance of Geographic Information Systems (GIS) technology and spatial statistical/epidemiological tools in identifying areas of highest disease risk so as to guide resource allocation to reduce health disparities and improve health for all.
Highlights
Pertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications and death, in infants
Pertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications, in infants less than year old (CDC, 2015)
Between 2008 and 2011, children less than 3 months old accounted for 83% of pertussis deaths in the United States
Summary
Pertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications and death, in infants. This study investigated geographic disparities and temporal changes in pertussis risk in Florida from 2010 to 2018 It investigated socioeconomic and demographic predictors of the identified disparities. Spatial patterns and temporal changes in geographic distribution of pertussis risk were assessed using county-level choropleth maps for the time periods 2010–2012, 2013–2015, 2016–2018 and 2010–2018. This study highlights the application and importance of Geographic Information Systems (GIS) technology and spatial statistical/ epidemiological tools in identifying areas of highest disease risk so as to guide resource allocation to reduce health disparities and improve health for all. While the cause(s) of the re-emergence are still unclear (Clark, 2014), the severity of disease in infants makes ensuring high vaccination coverage in all age groups a public health necessity. Since pertussis is a vaccine-preventable disease and demographic and socioeconomic factors influence acceptance and uptake of vaccines, it is important to investigate and identify how these factors impact pertussis vaccination and disease epidemiology
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