Table 1.
Summary of sociodemographic and lifestyle factors associated with EBV serostatus in the literature*
| Risk factor for EBV serostatus | Summary of results |
|---|---|
| Age |
Seronegativity decreased with age: 28 studies [8,17-44] |
| Seronegativity decreased with age after 6 months: 3 studies [45-47] | |
| Seronegativity decreased with age after 18 months: 1 study [48] | |
| No association (children included): 4 studies [49-52] | |
| No association (all/vast majority adults): 12 studies [10,53-63] | |
| Sex/gender |
Women were more likely to be seronegative: 8 studies [22,49,57,59,62,64-66] |
| Men were more likely to be seronegative: 6 studies [18,30,32,34,50,51] | |
| No association in children, but adult women were less likely to be seronegative: 1 study [26] | |
| Differences by sex interacted with marital status: 1 study [67] | |
| No association: 20 studies [8,17,19,20,23,29,42-44,54-56,60,61,63,68-72] | |
| Ethnicity |
Seroprevalence was lower for white participants than those of other ethnicities: 3 studies [20,43,71] |
| EBV seronegativity was higher in people of Han ethnicity than other Chinese ethnicities: 1 study [57] | |
| No association: 7 studies [31,34,53,69,73-75] | |
| Year of participation in study |
No association: 2 studies [28,76] |
| Country of study |
No difference between Japan and Jamaica: 1 study [77] |
| Higher EBV seroprevalence in Mexico than Papua New Guinea, Columbia, Italy, Netherlands and Israel: 1 study [78] | |
| Place of birth |
EBV seronegativity was higher in central/Eastern China than Western China: 1 study [57] |
| EBV seronegativity was higher among people of European/North American origin than other world regions: 2 studies [10,79] | |
| No association: 5 studies [19,20,36,37,55] | |
| Socioeconomic status (SES) |
EBV seronegativity was associated with higher SES: 1 study [10] |
| No association between EBV and SES: 1 study [73] | |
| No association with occupational/social class: 3 studies [57,60,69] | |
| Higher household income was associated with EBV seronegativity: 2 studies [43,71] | |
| No association with household income: 1 study [20] | |
| EBV seronegativity was associated with having medical insurance for non-white participants: 1 study [43] | |
| No association with having private medical insurance: 1 study [75] | |
| Level of education |
Seronegativity increased with higher levels of education: 5 studies [10,19,20,43,57] |
| No association with level of education of study participant: 2 studies [34,75] | |
| EBV seronegativity was higher among those whose parents had been in education for longer: 2 studies [10,71] | |
| No association with parental education: 1 study [8] | |
| Anthroposophic lifestyle |
No association: 1 study [24] |
| Urban/rural setting |
EBV seronegativity lower in urban areas than rural areas: 1 study [10]
No association: 1 study [21] |
| Household size/structure |
Number of siblings |
| EBV seroprevalence increased with number of siblings: 3 studies [10,66,71] | |
| No association between number of siblings and EBV seropositivity: 2 studies [8,55] | |
|
Birth order | |
| No association with birth order: 2 studies [25,55] | |
|
Number of people in household | |
| Adults with more children in the house were more likely to be EBV seropositive: 1 study [69] | |
| No association between number of adults in the house and EBV serostatus: 1 study [69] | |
| EBV seroprevalence increased with household size: 1 study [79] | |
| No association with household size: 1 study [53] | |
| Crowding of home |
No association: 4 studies [20,25,43,69] |
| Housing type (flat/house) |
No association: 1 study [66] |
| Marital status |
EBV seronegativity higher in unmarried women than married women, but lower in unmarried men than married men: 1 study [67] |
| No association: 3 studies [19,53,57] | |
| Sexual behaviour |
EBV seroconversion was associated with deep kissing: 1 study [55] |
| Smoking status |
Smoking |
| Smoking associated with EBV seropositivity: 3 studies [10,39,79] | |
| Increased association with greater exposure: 1 study [39] | |
| No association: 6 studies [19,56,60,61,64,75] | |
|
Passive smoking | |
| Mother smoking associated with lower EBV seronegativity: 1 study [66] | |
| No association: 1 study [25] | |
| Weight/body mass index (BMI) |
Increased BMI was associated with lower rates of seroprevalence: 4 studies [64,79-81] |
| No association: 2 studies [71,75] | |
| Diet |
General dietary factors |
| No association with diet: 1 study [55] | |
| No association with eating sufficient food: 1 study [82] | |
| No association with eating balanced meals: 1 study [82] | |
| No association with a reliance on low-cost food: 1 study [82] | |
|
Specific foods | |
| No association with salted fish consumption: 3 studies [39,56,61] | |
| No association with frequency of fruit and vegetable consumption: 2 studies [56,82] | |
| No association with frequency of eating leafy salad: 1 study [82] | |
| No association with frequency of eating wholegrain bread: 1 study [82] | |
| No association with frequency of eating beans: 1 study [82] | |
| No association with frequency of eating red meat: 1 study [82] | |
| No association with betel nut consumption: 1 study [56] | |
| No association with slow-cooked soup consumption: 1 study [39] | |
| No association with preserved vegetable consumption: 1 study [39] | |
|
Specific drinks | |
| No association with frequency of drinking milk: 1 study [82] | |
| No association with frequency of drinking juice: 1 study [82] | |
| No association with tea consumption: 1 study [39] | |
| No association with herbal tea consumption: 2 study [39] | |
| Alcohol consumption |
No association: 3 studies [19,39,56] |
| Formaldehyde/solvent exposure |
No association: 1 study [56] |
| Exercise |
No association: 1 study [55] |
| Height |
No association: 2 studies [60,64] |
| Birth factors (baby) |
Vaginal vs caesarean delivery |
| No association: 3 studies [25,66,71] | |
|
Premature birth | |
| No association: 3 studies [25,66,71] | |
|
Birth weight | |
| No association: 3 studies [8,66,71] | |
| Maternal characteristics |
Maternal parity |
| No association: 1 study [53] | |
|
Maternal age | |
| No association: 2 studies [8,71] | |
|
Maternal smoking/alcohol use during pregnancy | |
| No association: 1 study [71] | |
|
Maternal BMI prior to pregnancy | |
| No association: 1 study [71] | |
|
Maternal fever during third trimester | |
| No association: 1 study [71] | |
| Stress |
No association with stress: 1 study [55] |
| No association with parental stress: 1 study [25] | |
| Attended daycare |
Attendance |
| Attending daycare was associated with higher EBV seropositivity: 1 study [66] | |
| No association: 2 studies [20,71] | |
|
Age of starting daycare | |
| Daycare attendance at a younger age was associated with greater EBV seropositivity: 1 study [25] | |
| No association: 1 study [66] | |
| Hygiene practices |
No association with frequency of house cleaning: 1 study [25]
No association with frequency of handwashing: 1 study [25]
No association with having pets in the house: 2 studies [25,66] |
| Swimming |
No association with attending a swimming pool: 1 study [25] |
| Duration of watching television | No association with daily duration of watching television: 1 study [25] |
BMI – body mass index, SES – socio-economic status, EBV – Epstein-Barr virus
*Adjusted results are presented where they were available, otherwise unadjusted associations are reported. There was some overlap in the data used by five studies based on data from the US National Health and Nutrition Examination Surveys [43,76,79,82,83]. To avoid over-representing the findings from this population, for each risk factor we have only included the findings of the largest study in this table.