We examined risk factors associated with Necator americanus infection among persons aged > or =50 years in Hainan Province, People's Republic of China. Age and sex made the most important contributions to the variation in infection intensity (28%-30%), with age alone responsible for 27% of this variation. When stratified by 20-year age intervals, the influence of shared residence was 23% for persons aged > or =50 years and 27% for those aged <20 years, who had the highest and lowest levels of infection intensity, respectively. This points to shared residence as a means of capturing the complex relationship between aging and shared socioeconomic, environmental, and behavioral factors that influence transmission of Necator infection. None of the other 26 personal or 32 household risk factors were found to be significant. The importance of aging in Necator infection reveals an emerging public health problem among the elderly population of developing countries.
Hookworm is highly endemic to Hainan Province, an island located in the South China Sea. To investigate the prevalence and intensity of infection in the area, the village of Xiulongkan was surveyed between April and July 1998. A cross-sectional study was conducted in which fecal samples of 80% of the village residents (631 individuals) were tested for the presence of helminth eggs. Hookworm was the predominant intestinal helminth in Xiulongkan, where it was determined that 60% of those tested were infected. Necator americanus was the predominant species of hookworm in this population. The prevalence of hookworm increased with age, and then leveled to a plateau for ages 41 yr and up. This observation was in contrast to infections with Ascaris lumbricoides, where the highest prevalences occurred among school-aged children. Women had a significantly higher prevalence of hookworm than men and this difference emerged in early adulthood. The intensity of hookworm infection also significantly increased with age, with the highest intensity infections occurring among middle-aged and elderly residents. Females were more likely to have moderate or heavy infections, whereas males were more likely to have light infections. The rates of hookworm transmission are particularly high among the middle-aged and elderly residents of Xiulongkan.
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