Socioeconomic inequalities in risk of and exposure to gastrointestinal infections in the UK
Natalie completed her PhD in the People Theme entitled ‘Socioeconomic inequalities in risk of and exposure to gastrointestinal infections in the UK’ in 2018, with supervisors Margaret Whitehead, David Taylor-Robinson, Sarah O’Brien and Ben Barr at the University of Liverpool, Jeremy Hawker at Public Health England and Mara Violato at the University of Oxford.
Before starting the PhD she studied Geography and completed a Master of Public Health both at the University of Nottingham. Natalie works as an epidemiologist in the gastrointestinal infections department at Public Health England. Outside of the PhD Natalie enjoys horse riding and running muddy obstacle races.
Gastrointestinal (GI) infections are a significant burden both to the NHS and to society; affecting around a quarter of the UK population each year at an estimated cost of £1.5 billion. Socioeconomic inequalities in health are a serious problem and reducing such inequalities is high on the public health agenda in this country. Many infections are socially patterned but the role of socioeconomic inequalities in the risk of and exposure to GI infections is unclear, with published studies providing conflicting results. My PhD aimed to investigate whether risk of or exposure to GI infections in the UK is socially patterned and if so, which sectors of society experience a greater burden of infection. I undertook novel analyses of existing UK-based high-quality and comprehensive secondary data on GI infections to explore the relationship between GI infections and socioeconomic status (SES) using a variety of analytical techniques.
In high income countries, disadvantaged children but not adults had a significantly higher risk of GI infection compared to less disadvantaged children. In England, odds of calls to NHS helplines about GI infection symptoms in disadvantaged children and adults were significantly higher compared to their less disadvantaged counterparts. Disadvantaged adults were found to have lower risk of GI infections in the community cohort and both children and adults were less likely to be reported as having a severe GI infection (Shiga-toxin producing E.coli, STEC) or developing a severe complication of STEC (haemolytic uraemic syndrome, HUS). Overall, the results provide strong evidence to suggest that risk of GI infection differs by SES across the life course, with disadvantaged children at highest risk of GI infections. Increased risk may relate to differential exposure, vulnerability or healthcare-seeking behaviours, including symptom recognition, across socioeconomic groups.
- Margaret Whitehead – Dept. Public Health & Policy & NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool
- Jeremy Hawker - NIHR Health Protection Research Unit in Gastrointestinal Infections, Public Health England
- David Taylor-Robinson - Dept. Public Health & Policy, University of Liverpool
- Sarah O’Brien – Dept. Public Health & Policy & NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool
- Ben Barr - Dept. Public Health & Policy, University of Liverpool
- Mara Violato - NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Oxford
Adams, N*., Rose, TC*., Taylor-Robinson, D., Barr, B., Hawker, J., O'Brien SJ., Violato, M. & Whitehead, M. Relationship between socioeconomic status and gastrointestinal infections in developed countries: a systematic review and meta-analysis. PLoS ONE. 2018, 13:1.
Adams, N. L., Rose, T. C., Hawker, J., Violato, M., O'Brien S, J., Whitehead, M., Barr, B. & Taylor-Robinson, D. Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study). European Journal of Public Health. 2018, 28:1: 134-138.
Rose, T. C., Adams, N. L., Barr, B., Hawker, J., O'Brien, S. J., Violato, M., Whitehead, M. & Taylor-Robinson, D. Socioeconomic status is associated with symptom severity and sickness absence in people with infectious intestinal disease in the UK. BMC Infectious Diseases. 2017, 17: 447.
Adams, N*., Rose, T.C*., Taylor-Robinson, D., Barr, B., Hawker, J., O'Brien S, J., Violato, M. & Whitehead, M. Relationship between socioeconomic status and gastrointestinal infections in developed countries: a systematic review. PROSPERO International prospective register of systematic reviews. 2016, 5:13.
Adams, N., Byrne, L., Smith, G.A., Elson, R., Harris, J.P., Salmon, R., Smith, R., O'Brien, S.J., Adak, G.K., Jenkins, C. Shiga Toxin-Producing Escherichia coli O157, England and Wales, 1983-2012. Emerging Infectious Diseases. 2016, 22:4.
* Joint first authors