Risk Factors for Alveolar Echinococcosis, Appendix

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Vol. 10, No. 12
December 2004

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•	Appendix Table 1
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Research

Risk Factors for Alveolar Echinococcosis in Humans

Petra Kern,* Andrea Ammon,† Martina Kron,* Gabriele Sinn,†‡ Silvia Sander,* Lyle R. Petersen,†§ Wilhelm Gaus,* and Peter Kern*
*University of Ulm, Ulm, Germany; †Robert Koch-Institut, Berlin, Germany; ‡Health Authorities (Gesundheitsamt) of Charlottenburg-Wilmersdorf, Berlin, Germany; and §Centers for Disease Control and Prevention, Fort Collins, Colorado; USA

Appendix

Table 1. Association between exposure factors and alveolar echinococcosis^a,b,c

Risk factor	Patients		Controls		Crude	95% CI	p value	AR (%)

	+	–	+	–	OR

Contact with definitive hosts
Foxes
Went hunting	1	39	5	111	0.6	0.1–5.1	0.641
Shot and skinned foxes	1	39	1	115	–	–	–
Saw a fox in the garden	8	32	14	102	2.0	0.7–5.4	0.181
Saw a fox at the hen coop	8	28	23	76	1.0	0.4–2.3	0.941
Dogs
Dog ownership (owned dogs or cared for others' dogs)	21	19	31	89	4.2	1.7–9.9	0.001	40.0
Allowed dog into the house	17	23	30	89	2.5	1.1–5.7	0.028	25.5
Allowed dog into bedroom	3	37	5	113	1.8	0.4–7.5	0.421
Was licked by dog	11	27	22	91	1.8	0.7–4.5	0.196
Played with the dog	16	24	29	90	2.6	1.1–6.2	0.037	24.6
Brushed the dog's fur	13	27	24	95	2.3	0.9–5.5	0.076
Left dog in garden unattended^d	20	20	23	96	6.1	2.4–15.8	< 0.001	41.8
Walked dog without leash	15	25	18	101	4.2	1.7–10.8	0.003	28.6
Walked dog without leash in forest	7	31	10	100	2.3	0.8–6.8	0.129
Dog killed game^d	6	34	1	117	18.0	2.2–149.5	0.008	14.2
Dog ate mice	7	22	7	77	3.1	1.0–9.5	0.043	16.4
Dog had worms	3	35	4	104	2.1	0.5–9.5	0.326
Had dog dewormed infrequently or never	20	19	25	87	5.6	2.1–14.6	< 0.001	42.1
Dog defecated in the house	3	36	13	102	0.7	0.2–2.5	0.540
Cats
Cat ownership (owned cats or cared for others' cats)	18	22	34	86	2.1	1.0–4.5	0.051
Allowed cat into the house	14	26	31	89	1.6	0.7–3.4	0.262
Allowed cat into the bed	3	37	17	103	0.5	0.1–1.8	0.276
Was licked by the cat	4	36	20	98	0.5	0.2–1.7	0.307
Fed the cat	10	30	26	93	1.2	0.5–2.8	0.683
Brushed the cat's fur	2	37	8	107	0.7	0.1–3.9	0.684
Left cat unattended outdoors^d	18	22	33	87	2.3	1.0–4.8	0.038	25.4
Cat ate mice	16	22	27	84	2.3	1.0–5.2	0.038	23.8
Had a cat toilet in the house	5	33	19	93	0.7	0.2–2.3	0.601
Cleaned cat toilet	5	33	16	96	0.9	0.3–2.9	0.886
Cat had worms	4	34	7	105	2.0	0.5–8.5	0.363
Had cat dewormed infrequently or never	16	22	30	82	2.1	0.9–4.6	0.068
Cat defecated in the house	6	31	18	91	1.0	0.3–2.8	0.929
Contact with contaminated soil or dust
Farming, living conditions
Was a farmer (fulltime or parttime)^d	33	7	65	55	4.7	1.8–12.1	0.001	64.9
Worked in pastures	30	8	52	59	5.7	2.1–15.7	< 0.001	65.1
Worked in fields	29	9	53	59	6.1	2.0–18.4	0.002	63.8
Worked in grain fields	25	12	48	59	3.0	1.3–7.3	0.013	45.0
Did haymaking
In meadows not adjacent to water	10	16	14	95	5.9	1.9–18.8
In meadows adjacent to water	14	16	11	95	12.9	3.6;46.2	< 0.001	52.9^e
Lived in a farmhouse^d	17	23	14	106	6.4	2.5–16.5	< 0.001	35.9
Dwelling was adjacent to a forest	9	30	43	73	0.4	0.2–1.1	0.077
Dwelling was adjacent to meadows	33	6	101	15	0.8	0.3–2.2	0.697
Dwelling was adjacent to fields^d	28	11	55	62	3.0	1.3–6.7	0.009	47.9
Owned a hen coop	26	13	66	47	1.6	0.7–3.6	0.277
Gardening
Owned or had access to a garden	37	3	109	11	1.2	0.3–4.7	0.746
Garden was close to a forest, meadows, or water	28	10	67	45	1.9	0.8–4.3	0.132
Worked in the garden
Frequently	20	9	74	22	0.6	0.2–1.7
Occasionally	11	9	22	22	1.2	0.4–3.6	0.315
Grew herbs	33	6	90	27	1.7	0.6–4.6	0.296
Grew salad vegetables	32	8	78	42	2.4	1.0–6.1	0.060
Grew strawberries	25	15	61	59	1.7	0.8–3.6	0.185
Grew root or leaf vegetables^d	32	8	77	43	2.5	1.0–6.4	0.049	48.0
Did haymaking in the garden	28	12	84	35	1.0	0.4–2.2	0.972
Raked up leaves in the garden	23	11	66	35	1.2	0.5–2.7	0.745
Picked up windfalls	24	16	62	54	1.3	0.6–2.8	0.461
Activities in forests
Went into the forests	39	1	108	12	4.4	0.6–35.4	0.161
Went into forests for vocational reasons^d	9	31	11	109	2.8	1.1–7.4	0.036	14.5
Went for a walk	28	9	91	18	0.6	0.3–1.6	0.316
Collected wood^d	24	16	28	90	4.7	2.1–10.4	< 0.001	47.2
Picked mushrooms	7	31	34	78	0.5	0.2–1.3	0.146
Went jogging	6	31	16	86	1.1	0.4–3.1	0.825
Picked low growing berries	10	28	27	84	1.2	0.5–2.7	0.742
Picked high growing berries	13	25	30	83	1.4	0.7–3.0	0.372
Cleaned berries	23	14	60	38	1.0	0.5–2.3	0.921
"Food" factors
Ate unwashed herbs	6	34	15	104	1.2	0.4–3.5	0.681
Ate unwashed lettuce	0	40	1	119	Undef.
Ate unwashed vegetables	4	36	5	115	2.4	0.6–8.9	0.192
Ate unwashed strawberries^d	19	20	34	82	2.2	1.1–4.7	0.034	26.6
Ate sorrel (Rumex sp.)	6	32	10	103	1.9	0.7–5.3	0.245
Chewed grass^d	14	25	14	101	4.4	1.7–11.2	0.002	27.7
Ate raw berries	30	10	70	37	1.6	0.7–3.6	0.296
Washed berries before eating	27	12	61	42	1.5	0.7–3.4	0.325
Ate raw mushrooms	1	37	2	107	1.5	0.1–16.5	0.740
Drank water from springs	11	29	23	91	1.4	0.6–3.2	0.391

^aCrude odds ratios (OR) based on simple conditional logistic regression analyses.
^bCI, confidence intervals; AR, attributable risk. Factors with p < 0.05 are indicated in boldface.
^cExposure versus reference: +, number of persons exposed; –, number of pesons unexposed.
^dFactors included in the risk score.
^eAR was calculated from OR by using the exposure variable with two categories ("yes" and "no"; OR = 8.5; 24/40 cases were exposed).

Table 2. Association between exposure factors (Cramer's V)^a

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22

1 Owned dogs / cared for others' dogs	1.00	0.94	0.91	0.89	0.74	0.32	0.66	1.00	0.13	0.12	-0.05	-0.01	-0.04	-0.04	0.15	0.23	0.04	0.05	0.22	0.21	-0.10	0.07
2 Allowed the dog into the house		1.00	0.88	0.82	0.69	0.27	0.62	0.95	0.15	0.14	-0.06	-0.03	-0.05	-0.04	0.11	0.20	0.00	0.02	0.21	0.20	-0.14	0.07
3 Played with dog			1.00	0.81	0.71	0.21	0.62	0.92	0.14	0.13	-0.08	-0.05	-0.08	-0.08	0.08	0.15	0.03	0.00	0.27	0.19	-0.14	0.12
4 Left dog in garden unattended				1.00	0.67	0.36	0.70	0.89	0.22	0.21	-0.01	0.01	0.04	0.03	0.17	0.24	0.03	0.08	0.28	0.22	-0.08	0.13
5 Walked dog without leash					1.00	0.27	0.59	0.78	0.11	0.11	-0.01	0.03	0.00	0.01	0.11	0.10	0.01	-0.09	0.23	0.20	-0.03	0.08
6 Dog killed game						1.00	0.29	0.31	0.12	0.14	0.04	0.07	0.07	0.07	0.17	0.13	0.02	0.08	0.30	0.25	0.10	0.14
7 Dog ate mice							1.00	0.66	0.27	0.28	0.11	0.20	0.15	0.13	0.26	0.34	0.19	-0.04	0.35	0.43	0.00	0.09
8 Had dog dewormed infrequently or never								1.00	0.11	0.10	-0.04	-0.01	-0.04	-0.03	0.14	0.21	0.04	0.03	0.23	0.24	-0.07	0.10
9 Left cat outdoors unattended									1.00	0.97	0.19	0.23	0.26	0.21	0.37	0.41	0.08	0.15	0.19	0.24	0.09	0.07
10 Cat ate mice										1.00	0.22	0.26	0.30	0.24	0.38	0.38	0.10	0.15	0.22	0.18	0.11	0.08
11 Was a farmer											1.00	0.88	0.87	0.83	0.42	0.33	0.18	0.17	0.18	0.31	0.30	0.06
12 Worked in pastures												1.00	0.88	0.83	0.46	0.40	0.25	0.17	0.24	0.40	0.33	0.02
13 Worked in fields													1.00	0.90	0.43	0.37	0.24	0.22	0.24	0.32	0.36	0.09
14 Worked in grain fields														1.00	0.38	0.33	0.17	0.22	0.28	0.30	0.36	0.07
15 Did haymaking															1.00	0.57	0.21	0.25	0.40	0.37	0.20	0.13
16 Lived in a farmhouse																1.00	0.16	0.20	0.39	0.40	0.01	0.02
17 Dwelling was adjacent to fields																	1.00	0.15	0.06	0.20	-0.03	0.10
18 Grew root or leaf vegetables																		1.00	0.14	0.24	0.36	0.21
19 Went to forests for vocational reasons																			1.00	0.38	0.01	0.07
20 Collected wood																				1.00	0.24	0.10
21 Ate unwashed strawberries																					1.00	0.17
22 Chewed grass																						1.00

^aCells in bold mark Cramer's V > 0.5. High values mark strong associations.

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Petra Kern, Department for Biometry and Medical Documentation, University of Ulm, Schwabstr. 13, D - 89075 Ulm, Germany; fax: 0049-731-502-6902; email: echinoreg@medizin.uni-ulm.de

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