ArticleEpidemiology and infection2015
Unpacking the 'black box' of total pathogen burden: is number or type of pathogens most predictive of all-cause mortality in the United States?
Article in Epidemiology and infection, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sero-epidemiological studies of pathogen burden: A scoping review.Wellcome open research · 2026Pooled it
- Life Course Socioeconomic Disadvantage and the Aging Immune System: Findings From the Health and Retirement Study.The journals of gerontology. Series B, Psychological sciences and social sciences · 2021Article
- Associations of exposure to perfluoroalkyl substances individually and in mixtures with persistent infections: Recent findings from NHANES 1999-2016.Environmental pollution (Barking, Essex : 1987) · 2021Article
- Pathogen burden and leukocyte telomere length in the United States.Immunity & ageing : I & A · 2020Article
- Article
- Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index.Journal of racial and ethnic health disparities · 2020Article
- Persistent socioeconomic and racial and ethnic disparities in pathogen burden in the United States, 1999-2014.Epidemiology and infection · 2019Article
- Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults.Epidemiology and infection · 2018Article
- Early life socioeconomic position and immune response to persistent infections among elderly Latinos.Social science & medicine (1982) · 2016Article
- Does cytomegalovirus infection contribute to socioeconomic disparities in all-cause mortality?Mechanisms of ageing and development · 2016Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
A 'black box' paradigm has prevailed in which researchers have focused on the association between the total number of pathogens for which individuals are seropositive (i.e. total pathogen burden) and various chronic diseases, while largely ignoring the role that seropositivity for specific combinations of pathogens may play in the aetiology of such outcomes and consequently mortality. We examined the association between total pathogen burden as well as specific pathogen combinations and all-cause mortality in the United States. Data were from individuals aged ⩾25 years tested for cytomegalovirus (CMV), herpes simplex virus (HSV)-1, HSV-2 and Helicobacter pylori, with mortality follow-up to 31 December 2006 in the National Health and Nutrition Examination Survey (NHANES) III (N = 6522). We did not observe a statistically significant graded relationship between total pathogen burden level and all-cause mortality. Furthermore, compared to those seronegative for all four pathogens, the greatest statistically significant rate of all-cause mortality was for those CMV+/HSV-2+ (hazard ratio 1·95, 95% confidence interval 1·13-3·35) adjusting for age, gender, race/ethnicity, education level, body mass index (kg/m2) and smoking status. Interventions targeting prevention or treatment of particular pathogens may be more effective for reducing mortality than those focused solely on reducing overall pathogen burden.
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