Analysis of the spatial distribution of cryptosporidiosis in AIDS patients in San Francisco using density equalizing map projections (DEMP)

Environmental transmission of cryptosporidiosis has occurred repeatedly in defined spatial areas during outbreaks of disease attributed, for example, to drinking water contamination. Little work has been done to investigate the possibility of cryptosporicliosis infection in defined spatial areas in non-outbreak (i.e., endemic) settings. This study applies a novel approach to the investigation of the spatial distribution of cryptosporicliosis in AIDS patients in San Francisco. Density equalizing map projection (DEMP) maps were created for nine race/ethnicity-age groups of AIDS patients based on census tract of residence. Additionally, census tracts with a "high density" of cryptosporicliosis cases were identified by applying smoothing techniques to the DEMP maps, and included as a covariate in multivariate Poisson regression analyses of other known risk factors for cryptosporidiosis. These analyses suggest: (1) cases of cryptosporidiosis among Black and Hispanic AIDS patients, but not among Whites, show a statistically significant non-random spatial distribution (p < 0.05) even after adjustment for the underlying spatial distribution of AIDS patients for these demographic groups, and (2) the risk of residence in these high density census tracts, adjusted for other known risk factors, was not statistically significant (relative risk = 1.27, 95% confidence interval 0.15, 10.53). These results do not support an independent effect of spatial distribution on the transmission of cryptosporicliosis among AIDS patients.