Short and long term mortality associated with foodborne bacterial gastrointestinal infections: registry based study * Commentary: matched cohorts can be useful

doi:10.1136/bmj.326.7385.357

BMJ 2003;326:357 ( 15 February )

Papers

Short and long term mortality associated with foodborne bacterial gastrointestinal infections: registry based study

Morten Helms, research fellow, ^a Pernille Vastrup, statistician, ^a Peter Gerner-Smidt, consultant, ^b Kåre Mølbak, staff specialist. ^b

^a Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, DK-2300 Copenhagen S, Denmark, ^b Department of Gastrointestinal Infections, Statens Serum Institut

Correspondence to: K Mølbak krm{at}ssi.dk

Objectives: To determine the excess mortality associatedwith infections with Salmonella, Campylobacter, Yersinia enterocolitica,and Shigella and to examine the effect of pre-existingillness.
Design: Registry based, matched cohortstudy.
Setting: Denmark.
Participants: 48 857 people with gastrointestinal infectionsplus 487 138 controls from the generalpopulation.
Main outcome measure: One year mortality among patients with gastrointestinalinfections compared with controls after adjustment forcomorbidity.
Results: 1071 (2.2%) people with gastrointestinal infectionsdied within one year after infection compared with 3636 (0.7%)controls. The relative mortality within one year was 3.1 timeshigher in patients than in controls. The relative mortality within30 days of infection was high in all four bacterial groups. Furthermore,there was excess mortality one to six months after infection withYersinia enterocolitica (relative risk 2.53, 95% confidence interval1.38 to 4.62) and from six months to one year after infectionwith Campylobacter (1.35, 1.02 to 1.80) and Salmonella (1.53,1.31 to 1.79).
Conclusions: Infections with all these bacteria were associatedwith an increased short term risk of death, even after pre-existingillnesses were taken into account. Salmonella, Campylobacter,and Yersinia enterocolitica infections were also associated withincreased long termmortality.

What is already known on this topic
Foodborne bacterial infections have a major effect on the public health and economy of industrialised countries

Most estimates of mortality are short term and do not take into account coexisting illnesses

What this study adds
Patients infected with Salmonella, Campylobacter, Yersinia, and Shigella had higher 30 day mortality than controls after comorbidity was taken into account

Salmonella, Campylobacter, and Yersinia infections were also associated with increased long term mortality

The number of deaths from foodborne diseases is likely to be underestimated

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Mortality associated with foodborne bacterial gastrointestinal infections: Mechanism needs to be explained: Philip P Mortimer
BMJ 2003 326: 1265-1266. [Extract] [Full Text]

Mortality associated with foodborne bacterial gastrointestinal infections: Case selection and clinical data are important: Sarah J O'Brien and Roger A Feldman
BMJ 2003 326: 1265. [Extract] [Full Text]

Mortality associated with foodborne bacterial gastrointestinal infections: Statistical method is worth examining: Louis Anthony Cox, Jr
BMJ 2003 326: 1265. [Extract] [Full Text] [PDF]

Stomach bugs kill more than estimated
BMJ 2003 326: 0. [Full Text] [PDF]

This article has been cited by other articles:

Hanley, J. A, Dendukuri, N. (2009). Efficient sampling approaches to address confounding in database studies. Stat Methods Med Res 18: 81-105 [Abstract]
Foley, S. L., Lynne, A. M. (2008). Food animal-associated Salmonella challenges: Pathogenicity and antimicrobial resistance. J ANIM SCI 86: E173-E187 [Abstract] [Full text]
Nielsen, L. R., Warnick, L. D., Greiner, M. (2007). Risk Factors for Changing Test Classification in the Danish Surveillance Program for Salmonella in Dairy Herds. J DAIRY SCI 90: 2815-2825 [Abstract] [Full text]
Zou, G. Y. (2007). One relative risk versus two odds ratios: implications for meta-analyses involving paired and unpaired binary data. Clin Trials 4: 25-31 [Abstract]
Smeeth, L., Douglas, I., Hubbard, R. (2006). Commentary: We still need observational studies of drugs--they just need to be better.. Int J Epidemiol 35: 1310-1311 [Full text]
Gibreel, A., Taylor, D. E. (2006). Macrolide resistance in Campylobacter jejuni and Campylobacter coli. J Antimicrob Chemother 58: 243-255 [Abstract] [Full text]
Rivoal, K., Ragimbeau, C., Salvat, G., Colin, P., Ermel, G. (2005). Genomic Diversity of Campylobacter coli and Campylobacter jejuni Isolates Recovered from Free-Range Broiler Farms and Comparison with Isolates of Various Origins. Appl. Environ. Microbiol. 71: 6216-6227 [Abstract] [Full text]
Scallan, E., Majowicz, S. E, Hall, G., Banerjee, A., Bowman, C. L, Daly, L., Jones, T., Kirk, M. D, Fitzgerald, M., Angulo, F. J (2005). Prevalence of diarrhoea in the community in Australia, Canada, Ireland, and the United States. Int J Epidemiol 34: 454-460 [Abstract] [Full text]
O'Halloran, F., Lucey, B., Cryan, B., Buckley, T., Fanning, S. (2004). Molecular characterization of class 1 integrons from Irish thermophilic Campylobacter spp.. J Antimicrob Chemother 53: 952-957 [Abstract] [Full text]
Leatherbarrow, A. J. H., Hart, C. A., Kemp, R., Williams, N. J., Ridley, A., Sharma, M., Diggle, P. J., Wright, E. J., Sutherst, J., French, N. P. (2004). Genotypic and Antibiotic Susceptibility Characteristics of a Campylobacter coli Population Isolated from Dairy Farmland in the United Kingdom. Appl. Environ. Microbiol. 70: 822-830 [Abstract] [Full text]
(2003). Gastrointestinal Infection Associated with Increased Mortality. JWatch Infect. Diseases 2003: 11-11 [Full text]
(2003). Foodborne Illness: Worse for Us Than We Thought. JWatch General 2003: 5-5 [Full text]

Rapid Responses:

Read all Rapid Responses

Should the system of death certification be changed?: Arpan Dutta
bmj.com, 17 Feb 2003 [Full text]
Was the result specific to gastrointestinal infections?: Adam Jacobs
bmj.com, 18 Feb 2003 [Full text]
Mortality associated with foodborne bacterial gastrointestinal infections reexamined: Louis A. Cox
bmj.com, 19 Feb 2003 [Full text]
Reply to Lewis A. Cox and Adam Jacobs: K�re M�lbak, et al.
bmj.com, 21 Feb 2003 [Full text]
Re: matched cohorts can be useful: Darren C Greenwood
bmj.com, 4 Mar 2003 [Full text]
About case selection and clinical data: Sarah J. O�Brien, et al.
bmj.com, 7 Mar 2003 [Full text]
Re: About case selection and clinical data: K�re M�lbak, et al.
bmj.com, 12 Mar 2003 [Full text]
Over estimation of mortality rates in cases with foodborne bacterial infections: Phillippa M Cumberland, et al.
bmj.com, 18 Mar 2003 [Full text]
Re: Over estimation of mortality rates in cases with foodborne bacterial infections: K�re M�lbak, et al.
bmj.com, 28 Mar 2003 [Full text]