Volume 29, Number 6—June 2023
Research
Risk Factors for Non-O157 Shiga Toxin–Producing Escherichia coli Infections, United States
Ellyn P. Marder1
, Zhaohui Cui, Beau B. Bruce, LaTonia Clay Richardson, Michelle M. Boyle, Paul R. Cieslak, Nicole Comstock, Sarah Lathrop, Katie Garman, Suzanne McGuire, Danyel Olson, Duc J. Vugia, Siri Wilson, Patricia M. Griffin, and Carlota Medus
, Zhaohui Cui, Beau B. Bruce, LaTonia Clay Richardson, Michelle M. Boyle, Paul R. Cieslak, Nicole Comstock, Sarah Lathrop, Katie Garman, Suzanne McGuire, Danyel Olson, Duc J. Vugia, Siri Wilson, Patricia M. Griffin, and Carlota Medus
Table 3
Risk factors associated with domestically acquired non-O157 Shiga toxin-producing Escherichia coli infection, FoodNet case–control study, United States, 2012–2015*
| Consumption/exposure*† | Cases,‡ n = 774 | Controls,‡ n = 2,365 | Multivariable analysis |
||
|---|---|---|---|---|---|
| OR (95% CI) | PAF (95% CI) | p value§ | |||
| Fruits and vegetables | |||||
| Lettuce | 288/447 (64) | 710/1,268 (56) | 2.6 (1.8–3.6) | 39.3 (29.2–46.6) | <0.001 |
| Tomatoes | 227/435 (52) | 605/1,265 (48) | 1.7 (1.3–2.3) | 21.3 (10.4–29.4) | 0.03 |
| Prepared outside the home | 101/443 (23) | 175/1,266 (14) | 2.5 (1.8–3.5) | 13.7 (10.0–16.3) | <0.001 |
| Watermelon | 145/448 (32) | 302/1,276 (24) | 2.4 (1.8–3.4) | 19.0 (14.0–22.7) | <0.001 |
| Prepared inside the home | 120/445 (27) | 291/1,274 (23) | 1.7 (1.2–2.3) | 10.9 (5.4–15.0) | 0.03 |
| Exotic fruit such as kiwi, avocado | 140/444 (32) | 336/1,274 (26) | 1.7 (1.3–2.3) | 13.2 (6.7–18.0) | 0.02 |
| Prepared outside the home | 35/449 (8) | 30/1,275 (2) | 3.9 (2.1–7.1) | 5.8 (4.2–6.7) | <0.001 |
| Iceberg lettuce prepared outside the home | 86/415 (21) | 156/1,245 (13) | 2.7 (1.8–3.9) | 12.9 (9.4–15.4) | <0.001 |
| Pineapple | 98/449 (22) | 221/1,279 (17) | 1.8 (1.3–2.6) | 9.9 (5.0–13.3) | 0.02 |
| Prepared outside the home | 23/440 (5) | 29/1,274 (2) | 3.6 (1.8–7.1) | 3.8 (2.3–4.5) | 0.02 |
| Salsa | 71/442 (16) | 137/1,275 (11) | 1.9 (1.3–2.8) | 7.6 (3.7–10.3) | 0.04 |
| Onions other than white or red prepared outside the home | 54/438 (12) | 87/1,260 (7) | 2.5 (1.6–4.0) | 7.4 (4.6–9.2) | 0.006 |
| Romaine lettuce prepared outside the home | 51/431 (12) | 95/1,227 (8) | 2.2 (1.4–3.4) | 6.4 (3.4–8.3) | 0.03 |
| Peppers prepared outside the home | 41/440 (9) | 56/1,274 (4) | 3.0 (1.8–5.0) | 6.2 (4.2–7.5) | 0.002 |
| Raw spinach prepared outside the home | 30/445 (7) | 44/1,286 (3) | 2.9 (1.7–5.2) | 4.4 (2.7–5.4) | 0.02 |
| Cantaloupe prepared outside the home | 18/431 (4) | 22/1,274 (2) | 4.3 (1.9–9.9) | 3.2 (2.0–3.8) | 0.02 |
| Raspberries prepared outside the home |
11/432 (3) |
10/1,270 (1) |
7.7 (2.4–27.5) |
2.2 (1.5–2.5) |
0.03 |
| Other | |||||
| Eat at a fast-food restaurant | 245/434 (56) | 580/1,278 (45) | 1.7 (1.3–2.2) | 22.5 (11.7–30.7) | 0.02 |
| Eat at a table-service restaurant | 207/454 (46) | 425/1,276 (33) | 1.7 (1.3–2.3) | 19.4 (11.5–25.4) | 0.002 |
| Stomach acid–reducing medications in 4 weeks before illness | 93/430 (22) | 174/1,261 (14) | 2.1 (1.5–2.9) | 11.3 (7.3–14.2) | <0.001 |
| Contact with someone with diarrheal illness |
56/408 (14) |
55/1,153 (5) |
3.6 (2.2–5.7) |
9.9 (7.6–11.3) |
<0.001 |
| Meat, poultry, pork, and seafood | |||||
| Chicken prepared outside the home | 203/446 (46) | 465/1,269 (37) | 1.6 (1.2–2.0) | 16.3 (7.6–23.1) | 0.04 |
| Pork prepared outside the home | 71/450 (16) | 86/1,276 (7) | 2.9 (1.9–4.2) | 10.2 (7.6–12.0) | <0.001 |
| Beef prepared at table service restaurant | 85/443 (19) | 135/1,258 (11) | 2.1 (1.5–3.0) | 10.1 (6.2–12.9) | 0.003 |
| Ground beef hamburger prepared at a table service restaurant | 44/445 (10) | 73/1,276 (6) | 2.4 (1.5–3.8) | 5.8 (3.4–7.3) | 0.01 |
| Pink ground beef hamburger prepared at a table service restaurant |
17/443 (4) |
7/1,280 (1) |
9.0 (3.5–24.7) |
3.4 (2.7–3.7) |
<0.001 |
| Environmental | |||||
| Live on, visit, or work on a farm, petting zoo, or fair | 72/430 (17) | 61/1,258 (5) | 8.0(4.7–14.1) | 14.7 (13.1–15.6) | <0.001 |
| With cows or calves present | 42/426 (10) | 29/1,258 (2) | 9.3 (4.7–19.2) | 8.8 (7.8–9.3) | <0.001 |
| With cows present | 40/429 (9) | 29/1,257 (2) | 6.8 (3.5–13.5) | 8.0 (6.7–8.6) | <0.001 |
| With chickens present | 27/430 (6) | 9/1,255 (1) | 26.1 (9.1–87.2) | 6.0 (5.6–6.2) | <0.001 |
| With calves present | 21/424 (5) | 9/1,250 (1) | 23.3 (7.4–88.9) | 4.7 (4.3–4.9) | <0.001 |
| With goats present | 21/435 (5) | 8/1,250 (1) | 15.7 (5.3–52.8) | 4.5 (3.9–4.7) | <0.001 |
| And have contact with cows or calves | 19/423 (4) | 6/1,246 (0) | 18.8 (5.8–70.6) | 4.3 (3.7–4.4) | <0.001 |
| With sheep present | 14/430 (3) | 7/1,249 (1) | 13.2 (3.9–51.4) | 3.0 (2.4–3.2) | 0.002 |
| And have contact with cows | 13/435 (3) | 7/1,244 (1) | 8.7 (2.7–32.9) | 2.6 (1.9–2.9) | 0.01 |
| With pigs present | 12/429 (3) | 6/1,252 (0) | 13.6 (3.5–65.0) | 2.6 (2.0–2.8) | 0.008 |
| And have contact with calves | 9/430 (2) | 4/1,242 (0) | 11.8 (2.9–59.0) | 1.9 (1.4–2.1) | 0.02 |
| Visit a farm | 40/434 (9) | 25/1,271 (2) | 9.0 (4.6–17.9) | 8.2 (7.2–8.7) | <0.001 |
| With cows present | 21/436 (5) | 9/1,262 (1) | 7.7 (3.2–19.5) | 4.2 (3.3–4.6) | <0.001 |
| With chickens present | 12/430 (3) | 5/1,270 (0) | 10.0 (3.4–31.2) | 2.5 (2.0–2.7) | 0.002 |
| With horses present | 12/434 (3) | 5/1,269 (0) | 12.8 (4.0–46.6) | 2.5 (2.1–2.7) | <0.001 |
| With calves present | 10/436 (2) | 5/1,264 (0) | 9.4 (2.6–38.9) | 2.0 (1.4–2.2) | 0.03 |
| With sheep present | 7/427 (2) | 1/1,262 (0) | 19.7 (3.7–138.7) | 1.6 (1.2–1.6) | 0.02 |
| And have contact with horse feed | 5/438 (1) | 2/1,269 (0) | 20.9 (3.6–185.6) | 1.1 (0.8–1.1) | 0.03 |
| Household member visited/worked on farm with animals | 43/435 (10) | 49/1,254 (4) | 3.5 (2.1–5.9) | 7.1 (5.1–8.2) | <0.001 |
| Live on a farm | 28/444 (6) | 23/1,277 (2) | 5.6 (2.6–12.2) | 5.2 (3.9–5.8) | <0.001 |
| With chickens present | 11/443 (2) | 2/1,274 (0) | 28.1 (6.5–178.6) | 2.4 (2.1–2.5) | <0.001 |
| With pigs present | 3/443 (1) | 0/1,274 (0) | 66.9 (4.7–9,270.2) | 0.7 (0.5–0.7) | 0.05 |
| Camping | 32/441 (7) | 31/1,268 (2) | 3.2 (1.8–5.7) | 5.0 (3.2–6.0) | 0.006 |
| Household member visited/worked on farm with cows | 22/431 (5) | 19/1,248 (2) | 5.1 (2.4–11.3) | 4.1 (3.0–4.7) | 0.002 |
| Contact with wild deer or elk or their droppings | 20/406 (5) | 13/1,214 (1) | 4.7 (2.2–10.4) | 3.9 (2.7–4.5) | 0.006 |
| Contact with goats |
9/438 (2) |
3/1,255 (0) |
21.2 (4.3–145.7) |
2.0 (1.6–2.0) |
0.005 |
| Water | |||||
| Swim or play in lake, river, or stream | 41/432 (9) | 53/1,249 (4) | 2.5 (1.5–4.2) | 5.7 (3.2–7.2) | 0.02 |
| Swallow water from lake | 30/433 (7) | 35/1,238 (3) | 3.0 (1.7–5.3) | 4.6 (2.7–5.6) | 0.02 |
| Drink untreated water such as lake, spring, river | 18/434 (4) | 9/1,252 (1) | 6.6 (2.8–16.1) | 3.5 (2.7–3.9) | 0.001 |
*Values are no. exposures/no. for whom data were available (%) except as indicated. OR, odds ratio; PAF, population attributable fractions. †In the 7 d before illness began unless otherwise specified. Interviewers told respondents to consider foods prepared at any home to be prepared at home and foods prepared at a restaurant or commercial food service establishment to be prepared outside the home. ‡The initial sample for each exposure was 774 noninfant nontraveler cases and 2,365 noninfant nontraveler controls. During nearest-neighbors matching, cases and controls without a match were excluded for the exposure under consideration. Thus, the numbers of cases and controls that were matched and included in the analysis of each exposure is smaller than the total. §Adjusted for multiple testing using the Benjamini-Hochberg-Yekutieli method.
1Current affiliation: Washington State Department of Health, Shoreline, Washington, USA.
Page created: April 21, 2023
Page updated: May 18, 2023
Page reviewed: May 18, 2023
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