Toward a Social Ecology of N. Gonorrhoeae: Association of Incidence in Females with Neighborhood Characteristics in Five Geographically Disparate States, 2006 – 2008

Background: Links between adverse health outcomes and socioeconomic status have been demonstrated using a range of indicators at various geographic levels.  Most previous investigations have focused on contiguous areas within a single jurisdiction.

Objectives: Our objective was to assess associations between socioeconomic and neighborhood characteristics and gonorrhea incidence among females across five geographically disparate sites. 

Methods: Three-year (2006 – 2008) average incidence rates for females  were calculated for 1,542 Census Tracts representing 10 counties in Colorado, Minnesota, Virginia, Washington State, and San Francisco County, California.  Incidence for females was used as a proxy for heterosexuals.  Geocoded morbidity data were collected in these states through the STD Surveillance Network (SSuN).  Mixed regression models incorporating random and fixed effects were used to assess association of poverty, housing and population characteristics with incidence in females at the census tract level.

Results: We found that percent of the population with incomes below 150% of the federal poverty level, percent of households residing in rental units and proportion of the female population that is non-white were independently associated with increased incidence (p<0.001, p<0.03 and p<0.001, respectively). The magnitude of the effect was similar for all three factors with a 10% increase in any one associated with an approximate 10-case per 100,000 increase in incidence. Income inequality, educational attainment, population density and county unemployment rates were not significant in our combined model.

Conclusions: Female GC incidence across disparate regions was independently associated with poverty, housing characteristics and proportion of the female population that is non-white. These findings suggest that neighborhood characteristics influence STD rates.

Implications for Programs, Policy, and Research: If more studies confirm relationships between suboptimal health outcomes and neighborhood social and economic conditions, STD programs will need to develop more holistic interventions and broaden their partnerships to include those engaged in wider community development efforts.