Salmonellosis-related mortality in the United States, 1990-2006

Despite the recognition of nontyphoidal Salmonella as an important foodborne infection, few data exist on salmonellosis as a cause of death in the United States. To provide a quantitative assessment of the burden of Salmonella-related mortality in the United States, we examined national multiple-cause-of-death data for the years 1990-2006. Crude and age-standardized rates of salmonellosis mortality and 95% confidence intervals (CI) were computed for race, sex, age, state of residence, and year. A matched case-control analysis, using non-Salmonella deaths as controls, was conducted to determine whether certain diseases were more likely to be listed as comorbid conditions for Salmonella-related death. Salmonellosis was reported as an underlying or associated cause of death among 1316 persons, with an average annual age-adjusted mortality rate of 0.03 per 100,000 person-years. Salmonellosis mortality rates were higher among blacks and Asian/Pacific Islanders with an age-adjusted rate ratio of 2.61 (95% CI, 2.43-2.81) and 2.48 (95% CI, 2.30-2.67), respectively. Rates were also higher in males with an age-adjusted rate ratio of 1.84 (95% CI, 1.68-2.03). The highest frequency of deaths occurred among adults age 75-84 (n = 329; 25% of all cases). A declining trend in salmonellosis-related deaths was observed over the study period. Several comorbid conditions were associated with Salmonella deaths, including HIV and connective tissue disorders, with matched odds ratios of 7.44 (95% CI, 5.04-10.97) and 3.69 (95% CI, 1.88-7.25), respectively. Despite declining trends, salmonellosis continues to be an important cause of preventable death especially among selected subgroups, underscoring the need for expanded prevention efforts.