Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kimberly Yousey-Hindes

Second Advisor

Robert Heimer


BACKGROUND: The relationship between socioeconomic status and CA-CDI incidence has not been examined. I hypothesize that there will be higher incidence rates of CA-CDI in areas of higher socioeconomic status, where individuals are more likely to have health insurance, better access to care and are more educated.

METHODS: Community onset (CO) cases from Emerging Infections program surveillance were defined as those with a CDI positive specimen sample less than four days after admission to a health care facility. Community associated CO cases were defined as those that did not have a healthcare exposure in the prior three months. Unadjusted CA-CDI incidence rates by sex, race, spatial location, and poverty rate were calculated. A spatial analysis of CA-CDI was conducted in SatScan 9.3. Using Epi Info 7, chi-square test for trend was conducted to assess the relationship between CDI incidence and percent below poverty by census tract.

RESULTS: 1106 cases of CA-CDI occurred in New Haven County from 2011 to 2013. CA-CDI incidence was between 44 and 50 cases per 100,000 population for these three years. When cases for all three years were aggregated, a significant trend was revealed, where CA-CDI incidence increased as census tract poverty decreased. Similarly, age 5-17 CA-CDI incidence decreased as census tract poverty increased, but age 45-64 CA-CDI incidence increased as census tract poverty increased. A significant spatial cluster was revealed near Wallingford.

CONCLUSIONS: Incidence appears to be highest in the census tracts with the highest socioeconomic status, but data were inconclusive. Adjusted rates as well as additional surveillance data will help reveal the true relationship between socioeconomic status and CA-CDI. Spatial clusters will help direct future interventions that aim to reduce CA-CDI incidence.


This is an Open Access Thesis.

Open Access

This Article is Open Access