We assessed chlamydia trends, individual-level risk factors, and population-level area-based socioeconomic measures (ABSMs) associated with chlamydia infection in women attending U.S. Public Health Service (PHS) Region X Infertility Prevention Project (IPP) family planning (FP) clinics from 1997-2006. We then explored these measures within racial/ethnic subpopulations.
Using data from 667,223 chlamydia tests obtained from women aged 15-24 years screened in 201 FP clinics, we employed a generalized mixed model with logistic link, incorporating clinic and ZIP code as random effects to adjust for risk of chlamydia associated with individual- and population-level (areal) measures for the overall population and for each racial/ethnic subpopulation.
Significant racial/ethnic differences in chlamydia persisted after adjusting for individual and aggregate factors. Relatively steep chlamydia gradients were found across racial/ethnic ABSM levels. Compared with white women, infection risk was significantly higher for black (adjusted odds ratio [AOR] = 1.93), American Indian/Alaska Native (AOR=1.62), Asian/Pacific Islander (AOR=1.42), and Hispanic (AOR=1.28) women. The impact of population-level ABSMs on chlamydia varied across racial/ethnic groups and was generally modest. Among white women, there was a significant 4% relative annual increase in predicted chlamydia during the 10-year period 1997-2006. Chlamydia positivity over time did not change for racial/ethnic minority groups after adjusting for individual- and population-level factors.
Racial/ethnic differences in chlamydia persisted over time and were not mitigated by adjustment for aggregate socioeconomic position or areal racial/ethnic measures. Changes in project strategies will be needed to address racial/ethnic disparities for chlamydial infection among young female FP clinic clients.
Notes
Cites: Am J Public Health. 2000 Feb;90(2):230-610667184
Cites: Public Health Rep. 2010 Jul-Aug;125 Suppl 4:70-8020626195
Cites: Am J Public Health. 2001 Apr;91(4):632-611291379
Cites: Am J Prev Med. 2001 Apr;20(3 Suppl):90-411306237
Cites: Am J Public Health. 2001 Nov;91(11):1783-911684601
Cites: Am J Gynecol Health. 1992 May-Jun;6(3):80-712319293
Cites: Public Health Rep. 2001 Sep-Oct;116(5):449-6312042609
Cites: Public Health Rep. 2003 May-Jun;118(3):240-6012766219