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Examining the role of socioeconomic deprivation in ethnic differences in sexually transmitted infection diagnosis rates in England: evidence from surveillance data

  • M. FUREGATO (a1), Y. CHEN (a2), H. MOHAMMED (a1), C. H. MERCER (a2), E. J. SAVAGE (a1) and G. HUGHES (a1)...

Summary

Differences by ethnic group in STI diagnosis rates have long been recognized in England. We investigated whether these may be explained by ethnic disparities in socioeconomic deprivation (SED). Data on all diagnoses made in sexual health clinics in England in 2013 were obtained from the mandatory STI surveillance system. Poisson regression was used to calculate incidence rate ratios (IRRs) of STIs, by ethnicity, with and without adjustment for index of multiple deprivation (IMD) a measure of area-level deprivation. Unadjusted IRRs (95% confidence intervals) were highest for gonorrhoea [8·18 (7·77–8·61) and 5·76 (5·28–6·29)] and genital herpes [4·24 (3·99–4·51) and 3·58 (3·23–3·98)] for people of black Caribbean and non-Caribbean/non-African black ethnicity and IRRs were highest for syphilis [8·76 (7·97–9·63)] and genital warts [2·23 (2·17–2·29)] for people of non-British/non-Irish white ethnicity compared to white British ethnicity. After adjustment for IMD, IRRs for gonorrhoea [5·76 (5·47–6·07)] and genital herpes [3·73 (3·50–3·97)] declined but remained highest for black Caribbeans and IRRs for syphilis [7·35 (6·68–8·09)] and genital warts [2·10 (2·04–2·16)] declined but remained highest for non-British/non-Irish white compared to white British. In England, ethnic disparities in STI diagnosis rates are partially explained by SED, but behavioural and contextual factors likely contribute. Clinic and community-based interventions should involve social peer networks to ensure they are targeted and culturally sensitive.

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Copyright

Corresponding author

*Author for correspondence: Ms. M. Furegato, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. (Email: Martina.Furegato@phe.gov.uk)

References

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1. Millett, GA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet 2012; 380: 341348.
2. Woestenberg, PJ, et al. Comparison of STI-related consultations among ethnic groups in the Netherlands: an epidemiologic study using electronic records from general practices. BMC Family Practice 2015; 16: 18.
3. The UK Collaborative Group for HIV and STI Surveillance. Sexually transmitted infections in black African and black Caribbean communities in the UK: 2008 report: Health Protection Agency, Centre for Infections; 2008.
4. Fenton, KA, et al. Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey. Lancet 2005; 365: 12461255.
5. Hughes, G, et al. Comparison of risk factors for four sexually transmitted infections: results from a study of attenders at three genitourinary medicine clinics in England. Sexually Transmitted Infections 2000; 76: 262267.
6. GOV.UK. Sexually transmitted infections (STIs): annual data tables (https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables). Accessed 16 March 2016.
7. Savage, EJ, et al. Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011. Eurosurveillance 2012; 17: 195196.
8. Marmot, M. Social determinants of health inequalities. Lancet 2005; 365: 10991104.
9. Shavers, VL. Measurement of socioeconomic status in health disparities research. Journal of the National Medical Association 2007; 99: 10131023.
10. Butler, DC, et al. Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery. Health Services Research 2013; 48: 539559.
11. Kershaw, KN, Albrecht, SS, Carnethon, MR. Racial and ethnic residential segregation, the neighborhood socioeconomic environment, and obesity among blacks and Mexican Americans. American Journal of Epidemiology 2013; 177: 299309.
12. White, K, et al. Racial/ethnic residential segregation and self-reported hypertension among US- and foreign-born blacks in New York City. American Journal of Hypertension 2011; 24: 904910.
13. Krieger, J, Higgins, DL. Housing and health: time again for public health action. American Journal of Public Health 2002; 92: 758768.
14. Newton, JN, et al. Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386: 22572274.
15. Moonesinghe, R, et al. Linear and non-linear associations of gonorrhea diagnosis rates with social determinants of health. International Journal of Environmental Research and Public Health 2012; 9: 31493165.
16. Hughes, GJ, Gorton, R. Inequalities in the incidence of infectious disease in the North East of England: a population-based study. Epidemiology & Infection 2015; 143: 189201.
17. Pound, P, Campbell, R. Exploring the feasibility of theory synthesis: A worked example in the field of health related risk-taking. Social Science & Medicine 2015; 124: 5765.
18. Gupta, GR, et al. Structural approaches to HIV prevention. Lancet 2008; 372: 764775.
19. Nazroo, J, et al. The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference? Sociology of Health & Illness 2007; 29: 811830.
20. Savage, EJ, et al. Assessing the relationship between sexually transmitted infection rates, ethnic group and socio-economic deprivation in England. Sexually Transmitted Infections 2011; 87: A195A196.
22. Savage, EJ, et al. Improving surveillance of sexually transmitted infections using mandatory electronic clinical reporting: the genitourinary medicine clinic activity dataset, England, 2009 to 2013. Eurosurveillance 2014; 19: 20981.
23. GOV.UK. English indices of deprivation 2010 (https://www.gov.uk/government/statistics/english-indices-of-deprivation-2010). Accessed 16 March 2016.
24. Payne, R, Abel, G. UK indices of multiple deprivation – a way to make comparisons across constituent countries easier. Health Statistics Quarterly 2012; 53: 2237.
25. Office for National Statistics. Population estimates (http://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates). Accessed 16 March 2016.
26. StataCorp. Stata Statistical Software: Release 13.College Station, TX: StataCorp LP, 2013.
27. GOV.UK. Genitourinary medicine clinic activity dataset (GUMCADv3) pilot (https://www.gov.uk/guidance/genitourinary-medicine-clinic-activity-dataset-gumcadv3-pilot). Accessed 16 March 2016.
28. Public Health England. Sexually transmitted infections and chlamydia screening in England, 2014. Health Protection Report (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/437433/hpr2215_STI_NCSP_v6.pdf). Accessed 16 March 2016.
29. GOV.UK. Chlamydia Testing Activity Dataset (CTAD): specification and technical guidance (https://www.gov.uk/government/publications/chlamydia-testing-activity-dataset-ctad-specification-and-technical-guidance). Accessed 16 March 2016.
30. Hughes, G, Field, N. The epidemiology of sexually transmitted infections in the UK: impact of behavior, services and interventions. Future Microbiology 2015; 10: 3551.
31. Wetten, S, et al. Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000–2011: a population-based study using data from the UK Clinical Practice Research Datalink. BMJ Open 2015; 5: e007776.
32. Zhang, X, et al. The effects of deprivation and relative deprivation on self-reported morbidity in England: an area-level ecological study. International Journal of Health Geographics 2013; 12: 111.
33. Mazur, J, et al. Subjective health of adolescents from families in receipt of social assistance. Public Health.
34. Dean, HD, Fenton, KA. Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis. Public Health Reports 2012; 372: 125132.
35. Gerver, SM, et al. Sexual risk behaviours and sexual health outcomes among heterosexual black Caribbeans: comparing sexually transmitted infection clinic attendees and national probability survey respondents. International Journal of STD & AIDS 2011; 22: 8590.
36. Gerressu, M, et al. The importance of distinguishing between black Caribbeans and Africans in understanding sexual risk and care-seeking behaviours for sexually transmitted infections: evidence from a large survey of people attending genitourinary medicine clinics in England. Journal of Public Health 2012; 34: 411420.
37. Beyrer, C, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet 2012; 380: 367377.
38. Hogben, M, Leichliter, JS. Social determinants and sexually transmitted disease disparities. Sexually Transmitted Diseases 2008; 35: S1318.
39. Bowleg, L, et al. Racial discrimination, social support, and sexual HIV risk among Black heterosexual men. AIDS and Behavior 2013; 17: 407418.
40. Westercamp, N, et al. Spatial distribution and cluster analysis of sexual risk behaviors reported by young men in Kisumu, Kenya. International Journal of Health Geographics 2010; 9: 24.

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