A recent study, funded by the U.S. Department of Agriculture’s National Institute of Food and Agriculture (USDA’s NIFA), has estimated the economic burden of foodborne illnesses linked to flour and flour-based food products in the U.S. from 2001–2021 to be as high as $258 million.

According to the study, which was conducted by researchers at Michigan State University (MSU) and Ohio State University (OSU), the total economic burden of foodborne illnesses in the U.S. could be as high as $97.4 billion, annually. However, incidence and cost estimates have limited use with regards to food safety controls if they cannot be attributed to specific foods; therefore, the study focused on wheat flour and flour-based foods to fill an existing knowledge gap, due to the commodity’s association with foodborne illness cases. The study had two main objectives:

1. Identify the pathogens responsible for causing outbreaks and identify the main vehicle of contamination to better understand why consumers are contracting illnesses from flour and flour-based foods that are intended to undergo a final kill-step by the consumer
2. Characterize the public health and economic burdens associated with the outbreaks by combining original outbreak-based estimates of health burden with existing economic burden estimates from literature.

To identify and critically analyze all incidences of foodborne illness outbreaks associated with flour and flour-based foods, the researchers reviewed scientific literature and collected data from government reports. The researchers defined “outbreaks” as any two or more similar illnesses resulting from the consumption of a common flour-based food product. The researchers then estimated the total health burden by combining annualized outbreak case counts with U.S. Centers for Disease Control and Prevention (CDC) multipliers, and used that value to estimate the total economic burden using two different models.

A total of nine outbreaks associated with flour and flour-based products occurred in the U.S. from 2001–2021. A variety of foods were implicated in the outbreaks, including wheat flour, pot pies, breakfast cereal, prepared cookie dough and cake batters, and ice cream containing cake batter. Salmonella, Escherichia coli O157:H7, and E. coli O121 caused all of the outbreaks, which were laboratory or culture-confirmed. The outbreaks were associated with 752 cases of illness, 223 hospitalizations, and 0 deaths. Of the nine outbreaks, four were caused by Salmonella, representing 75 percent of total cases. The remaining outbreaks and cases were caused by E. coli.

The study produced two separate estimates for the economic burden of foodborne illnesses associated with flour and flour-based products in the U.S. during the reporting period: $108 million using the basic model, and $258 million using the advanced model (using the value of the July 2022 U.S. dollar). Salmonella caused the greatest economic loss ($90 or $225 million), followed by E. coli O157:H7 ($11 or $15 million) and E. coli o121 ($7 or $18 million).

In the outbreaks, most patients who reported their consumption practices admitted to tasting or eating a raw or insufficiently cooked flour or flour-based product. The researchers state that this finding points to the need for better public awareness through education and behavioral interventions.

The study was limited in that only consumer health costs (medical costs, productivity loss, lost life expectancy, and quality-adjusted life year loss, also known as QALY loss) were considered. The basic model for estimating economic burden did not include QUALY loss, whereas the enhanced model did consider QUALY loss. Industry and government costs associated with foodborne illnesses were not included in the analysis.