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Socioeconomic disparities in the seroprevalence of cytomegalovirus infection in the US population: NHANES III

  • J. B. DOWD (a1), A. E. AIELLO (a1) and D. E. ALLEY (a2)
  • DOI:
  • Published online: 16 April 2008

There is a strong relationship between socioeconomic status (SES) and health outcomes in the United States, although the mechanisms are poorly understood. Increasing evidence points to links between lifelong exposure to infectious disease and subsequent chronic disease. Exposure and susceptibility to infections may be one way SES affects long-term health, although little population-based research to date has examined social patterning of infections in the United States. This paper tests the relationship between income, education, race/ethnicity and seroprevalence of cytomegalovirus (CMV) infection at different ages in a representative sample of the US population, and tests potential mediators for these relationships. The study finds significant racial and socioeconomic disparities in CMV seroprevalence beginning at early ages and persisting into middle age. Potential exposures do not explain the relationship between SES and CMV positivity. Because reactivation of latent CMV infections may contribute to chronic disease and immune decline later in life, future research should determine the exposure or susceptibility pathways responsible for these disparities in the prevalence of CMV infection.

Corresponding author
*Author for correspondence: J. B. Dowd, Ph.D., Robert Wood Johnson Health and Society Scholar, Center for Social Epidemiology & Population Health, 3634 SPH Tower, 109 Observatory, Ann Arbor, MI 48109-2029, USA. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.NE Adler , Socioeconomic inequalities in health: no easy solution. Journal of the American Medical Association 1993; 269: 31403145.

2.RG Rogers , Demographic, socioeconomic, and behavioral factors affecting ethnic mortality by cause. Social Forces 1996; 74: 14191438.

4.PM Lantz , Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. Journal of the American Medical Association 1998; 279: 17031708.

5.FJ Nieto . Infections and atherosclerosis: new clues from an old hypothesis? American Journal of Epidemiology 1998; 148: 937948.

6.PJ Lindsberg , AJ Grau . Inflammation and infections as risk factors for ischemic stroke. Stroke 2003; 34: 25182532.

7.HN Schmaltz , Chronic cytomegalovirus infection and inflammation are associated with prevalent frailty in community-dwelling older women. Journal of the American Geriatric Society 2005; 53: 747754.

8.S Cohen , Chronic social stress, social status, and susceptibility to upper respiratory infections in nonhuman primates. Psychosomatic Medicine 1997; 59: 213221.

9.S Cohen . Social status and susceptibility to respiratory infections. Annals of the New York Academy of Science 1999; 896: 246253.

10.S Cohen , Childhood socioeconomic status and host resistance to infectious illness in adulthood. Psychosomatic Medicine 2004; 66: 553558.

11.C Soderberg-Naucler . Does cytomegalovirus play a causative role in the development of various inflammatory diseases and cancer? Journal of Internal Medicine 2006; 259: 219246.

12.SAS Staras , Seroprevalence of cytomegalovirus infection in the United States, 1988–1994. Clinical Infectious Diseases 2006; 43: 11431151.

13.FA Colugnati , Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infectious Diseases 2007; 7: 71.

14.MD de Jong , Summary of the II International Symposium on Cytomegalovirus. Antiviral Research 1998; 39: 141162.

15.J Sinclair , P Sissons . Latency and reactivation of human cytomegalovirus. Journal of General Virology 2006; 87: 17631779.

16.R Liu , Presence and severity of chlamydia pneumoniae and cytomegalovirus infection in coronary plaques are associated with acute coronary syndromes. International Heart Journal 2006; 47: 511519.

17.YH Shen , Human cytomegalovirus causes endothelial injury through the ataxia telangiectasia mutant and p53 DNA damage signaling pathways. Circulation Research 2004; 94: 13101317.

18.PD Sorlie , A prospective study of cytomegalovirus, herpes simplex virus 1, and coronary heart disease: The Atherosclerosis Risk in Communities (ARIC) Study. Archives of Internal Medicine 2000; 160: 20272032.

19.RF Itzhaki , Infiltration of the brain by pathogens causes Alzheimer's disease. Neurobiology of Aging 2004; 25: 619627.

20.AE Aiello , The influence of latent viral infection on rate of cognitive decline over 4 years. Journal of the American Geriatrics Society 2006; 54: 10461054.

23.JA Schillinger , National seroprevalence and trends in herpes simplex virus type 1 in the United States, 1976–1994. Sexually Transmitted Diseases 2004; 31: 753760.

24.P Evans , Social class, sex, and age differences in mucosal immunity in a large community sample. Brain, Behavior, and Immunity 2000; 14: 4148.

25.AV Diez Roux . Persistent social patterning of cardiovascular risk: rethinking the familiar. Circulation 2005; 111: 30203021.

26.GA Kaplan , Childhood socioeconomic position and cognitive function in adulthood. International Journal of Epidemiology 2001; 30: 256263.

27.N Ranjit , Socioeconomic differences in progression of carotid intima-media thickness in the Atherosclerosis Risk in Communities Study. Arteriosclerosis, Thrombosis, and Vascular Biology 2006; 26: 411416.

28.RS Wilson , Early life socioeconomic status and late life risk of Alzheimer's disease. Neuroepidemiology 2005; 25: 814.

29.JW KG Lynch , Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? American Journal of Epidemiology 1996; 144: 934942.

30.G Pawelec , Is immunosenescence infectious? Trends in Immunology 2004; 25: 406410.

31.BO Nilsson , Morbidity does not influence the T-cell immune risk phenotype in the elderly: findings in the Swedish NONA Immune Study using sample selection protocols. Mechanisms of Ageing and Development 2003; 124: 469476.

32.G Pawelec , Human immunosenescence: does it have an infectious component? Annals of the New York Academy of Science 2006; 1067: 5665.

33.S Koch , Human cytomegalovirus infection and T cell immunosenescence: a mini review. Mechanisms of Ageing and Development 2006; 127: 538543.

34.R Glaser . Stress-associated immune dysregulation and its importance for human health: a personal history of psychoneuroimmunology. Brain, Behavior, and Immunity 2005; 19: 311.

35.R Glaser , The differential impact of training stress and final examination stress on herpesvirus latency at the United States military academy at West Point. Brain, Behavior, and Immunity 1999; 13: 240251.

36.R Glaser , JK Kiecolt-Glaser . Chronic stress modulates the virus-specific immune response to latent herpes simplex virus type 1. Annals of Behavioral Medicine 1997; 19: 7882.

37.TB Herbert , S Cohen . Stress and immunity in humans: a meta-analytic review. Psychosomatic Medicine 1993; 55: 364379.

38.SK Mehta , Reactivation and shedding of cytomegalovirus in astronauts during spaceflight. Journal of Infectious Diseases 2000; 182: 17611764.

39.TW McDade , Epstein-Barr virus antibodies in whole blood spots: a minimally invasive method for assessing an aspect of cell-mediated immunity. Psychosomatic Medicine 2000; 62: 560568.

40.BA Esterling , Defensiveness, trait anxiety, and Epstein-Barr viral capsid antigen antibody titers in healthy college students. Health Psychology 1993; 12: 132139.

41.S Cohen . The Pittsburgh common cold studies: psychosocial predictors of susceptibility to respiratory infectious illness. International Journal of Behavioral Medicine 2005; 12: 123131.

42.JB Dowd , Socioeconomic gradients in immune response to latent infection. American Journal of Epidemiology 2008; 167: 112120.

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