BackgroundDebates exist as to whether, as overall population health improves, the absolute and relative magnitude of income- and race/ethnicity-related health disparities necessarily increase—or derease. We accordingly decided to test the hypothesis that health inequities widen—or shrink—in a context of declining mortality rates, by examining annual US mortality data over a 42 year period.Methods and FindingsUsing US county mortality data from 1960–2002 and county median family income data from the 1960–2000 decennial censuses, we analyzed the rates of premature mortality (deaths among persons under age 65) and infant death (deaths among persons under age 1) by quintiles of county median family income weighted by county population size. Between 1960 and 2002, as US premature mortality and infant death rates declined in all county income quintiles, socioeconomic and racial/ethnic inequities in premature mortality and infant death (both relative and absolute) shrank between 1966 and 1980, especially for US populations of color; thereafter, the relative health inequities widened and the absolute differences barely changed in magnitude. Had all persons experienced the same yearly age-specific premature mortality rates as the white population living in the highest income quintile, between 1960 and 2002, 14% of the white premature deaths and 30% of the premature deaths among populations of color would not have occurred.ConclusionsThe observed trends refute arguments that health inequities inevitably widen—or shrink—as population health improves. Instead, the magnitude of health inequalities can fall or rise; it is our job to understand why.

Campylobacter species are a leading cause of foodborne illness in the United States, but few population-based data describing patterns and trends of disease are available. We summarize data on culture-confirmed cases of Campylobacter infection reported during 1996-1999 to the Foodborne Diseases Active Surveillance Network (FoodNet) system. The average annual culture-confirmed incidence was 21.9 cases/100,000 population, with substantial site variation (from 43.8 cases/100,000 population in California to 12.2 cases/100,000 population in Georgia). The incidence among male subjects was consistently higher than that among female subjects in all age groups. The incidence trended downward over the 4 years, with incidences of 23.6, 25.2, 21.4, and 17.5 cases/100,000 population for 1996-1999, respectively--a 26% overall decrease. This trend was sharpest and most consistent in California. Overall, we estimate that ~2 million people were infected with Campylobacter in the United States each year during this time period. Although the number of Campylobacter infections appears to have decreased in the United States during 1996-1999, the disease burden remains significant, which underscores the need to better understand how the disease is transmitted.

To assess trends in the burden of acute diarrheal illness, the Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based telephone survey during 1998-1999, using a random-digit-dialing, single-stage Genesys-ID sampling method. During the 12-month study period, 12,755 persons were interviewed; after the exclusion of persons with chronic diarrheal illnesses, 12,075 persons were included in the analysis; 6% (n=645) reported having experienced an acute diarrheal illness at some point during the 4 weeks preceding the interview (annualized rate, 0.72 episodes per person-year). Rates of diarrheal illness were highest among children aged <5 years (1.1 episodes per person-year) and were lowest in persons aged > or =65 years (0.32 episodes per person-year). Twenty-one percent of persons with acute diarrheal illness sought medical care as a result of their illness. Diarrheal illness imposes a considerable burden on the US population and health care system.