The annual healthcare cost for Campylobacter infections in Scotland is £3 million ($3.9 million), according to recently released research by Health Protection Scotland.

The study on Campylobacter, which is the main cause of bacterial food poisoning in the country, provides evidence on those at greater risk of infection, factors influencing severity of illness and the estimated healthcare cost of infection for 2013 to 2017.

Costs vary depending on the treatment required, with the highest attributed to those patients older than 65. This group has the top incidence of Campylobacter infection, a greater risk of being hospitalized and a longer duration of stay, although this may be partly due to underlying health conditions.

Study data for 2013 to 2017 included 30,032 cases of Campylobacter, of whom 14 percent were hospitalized. Of these, 3,783 had at least one overnight stay and 410 were admitted and discharged on the same day.

More than 70 percent of the overall cost of almost £15 million ($19.4 million) was attributable to hospital stays plus same-day discharge cases which accounted for 2 percent. Those hospitalized cost an average of £2,612 ($3,400) per case, while those not hospitalized incurred an average cost of £148 ($191) per case.

Differences between affluent and deprived areas
Public health authorities estimated there are 6,000 cases reported per year. There has been a 75 percent increase in infections between 1990 and 2012 in Scotland. Hospitalization rates of campylobacteriosis have tripled for people aged older than 65 years since 2005.

Research, conducted between 2013 and 2019 by Health Protection Scotland and the University of Aberdeen on behalf of Food Standards Scotland (FSS), found a higher number of infections are reported in more affluent areas, with those living in the most deprived areas at increased risk of developing serious illness and being hospitalized.

The study found 19 percent more campylobacteriosis cases were reported in the less deprived areas and there was a 9 percent higher hospitalization rate for people in more deprived areas.

The higher infections in more affluent areas is partly associated with foreign travel which is more common in this group of the population. Other reasons could be the type of food eaten and the way it is prepared. Some of the excess hospitalizations for poorer people may be explained by areas closer to a hospital tending to be more deprived.

Risk factors
Eating chicken liver pâté prepared at home was a significant risk factor and having chicken outside the home was an important risk factor. Foreign travel is a risk factor for campylobacteriosis, mainly for those going to Asia including Turkey.

Results showed about 14 percent of Campylobacter cases lead to hospitalization, with admissions more likely to have one or more risk factors such as being 65 years or older, having an underlying medical condition, or being prescribed with a proton pump inhibitor to reduce stomach acid production in the 90 days prior to infection. Hospitalization was more common among more deprived cases, older age groups and females.

From 2013 to 2017, 12 people died with Campylobacter enteritis recorded as main cause of death. Another 62 cases died within 30 days of their Campylobacter report but Campylobacter enteritis was not the cause of death. There were 10 cases of Guillain-Barre Syndrome.

Incidence is 11.5 percent higher in rural compared with urban areas. However there are more cases in urban compared with rural areas because more people live in the former. Potential reasons for this are environmental exposure such as contact with farm or wild animals and their feces and drinking water from private supplies.

Jacqui McElhiney, FSS’s head of food protection science and surveillance, said reducing the number of people becoming infected from Campylobacter is a top food safety priority for the agency.

“These research projects help us better understand who is most at risk of developing severe infection, which will be used for future activity to support the reduction of the overall burden of Campylobacter on individuals and our health service. We are currently exploring opportunities for engaging with the older population to highlight the risks of infection from Campylobacter and steps they can take to protect themselves from illness,” she said.