Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Daniel Weinberger


Background: Clostridioides difficile infection (CDI) is classified as an urgent threat to public health and has been increasing in incidence and severity. CDI is commonly considered hospital- acquired; however, rates of community-associated CDI (CA-CDI) have been increasing and now make up more than 50% of cases reported. Risk factors for CA-CDI exposure are poorly understood and inadequately studied. This study uses regression to evaluate if community characteristics are associated with CA-CDI incidence at the census tract level in New Haven County. The goal is to determine if where someone lives in proximity to these potential risk factors may contribute to their risk of community-associated C. difficile infection.Methods: Potential risk factors were included as census tract level covariates in a negative binomial regression model. The model was fit to CA-CDI incident case data, obtained from the existing ongoing surveillance database of laboratory-confirmed CDI cases in New Haven County. Stepwise model selection by Akaike Information Criterion (AIC) was used to evaluate which covariates best predicted CA-CDI case counts. Results: Older age and female sex were the only significant risk factors for CA-CDI. Number of hospitals, nursing facilities, livestock farms, and sewage treatment facilities per census tract, as well as crowding and urban/rural census tract indicators were not found to be significant risk factors for CA-CDI. Conclusion: The findings suggest that where someone lives may not be a good predictor of risk of community-associated C. difficile infection. Age and sex were the only significant risk factors. Further studies focused more on individual behaviors and contact with environmental and human sources are needed to continue research on potential unknown risk factors for CA-CDI.


This is an Open Access Thesis.

Open Access

This Article is Open Access