Obesity, Diabetes, and the Risk of Invasive Group B Streptococcal Disease in Nonpregnant Adults in the United States

• Authors: Samantha I Pitts, Johns Hopkins University; Nisa M Maruthur, Johns Hopkins University; Gayle E Langley, Centers for Disease Control and Prevention; Tracy Pondo, Centers for Disease Control and Prevention; Kathleen A Shutt, University of Pittsburgh; Rosemary Hollick, Johns Hopkins University; Stephanie J Schrag, Centers for Disease Control and Prevention; Ann Thomas, Oregon Public Health Division; Megin Nichols, New Mexico Department of Public Health; Monica Farley, Emory University; James P Watt, California Department of Public Health; Lisa Miller, University of Colorado; William Schaffner, Vanderbilt University; Corinne Holtzman, Minnesota Department of Health; Lee H Harrison, University of Pittsburgh
• Journal Title: Open Forum Infectious Diseases
• Volume: Volume 5, Number 6
• Publisher: Oxford University Press (OUP) | 2018-06-01, Pages 1-7
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/ofid/ofy030
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; behavioral risk factor surveillance system; diabetes; epidemiology; obesity; streptococcal infections; PREGNANT-WOMEN; WEIGHT-LOSS; BODY-COMPOSITION; COLONIZATION; MANIFESTATIONS; INFECTIONS; PREVALENCE; PHYSIOLOGY; VACCINE

Abstract

Background. Rates of invasive group B Streptococcus (GBS) disease, obesity, and diabetes have increased in US adults. We hypothesized that obesity would be independently associated with an increased risk of invasive GBS disease. Methods. We identified adults with invasive GBS disease within Active Bacterial Core surveillance during 2010-2012 and used population estimates from the Behavioral Risk Factor Surveillance System to calculate invasive GBS incidence rates. We estimated relative risks (RRs) of invasive GBS using Poisson analysis with offset denominators, with obesity categorized as class I/II (body mass index [BMI] = 30-39.9 kg/m2) and class III (BMI ≥ 40.0 kg/m2). Results. In multivariable analysis of 4281 cases, the adjusted RRs of invasive GBS disease were increased for obesity (class I/ II: RR, 1.52; 95% confidence interval [CI], 1.14-2.02; and class III: RR, 4.87; 95% CI, 3.50-6.77; reference overweight) and diabetes (RR, 6.04; 95% CI, 4.77-7.65). The adjusted RR associated with class III obesity was 3-fold among persons with diabetes (95% CI, 1.38-6.61) and nearly 9-fold among persons without diabetes (95% CI, 6.41-12.46), compared with overweight. The adjusted RRs associated with diabetes varied by age and BMI, with the highest RR in young populations without obesity. Population attributable risks of invasive GBS disease were 27.2% for obesity and 40.1% for diabetes. Conclusions. Obesity and diabetes were associated with substantially increased risk of infection from invasive GBS. Given the population attributable risks of obesity and diabetes, interventions that reduce the prevalence of these conditions would likely reduce the burden of invasive GBS infection.