The Impact of Poverty on Chlamydia and Gonorrhea Diagnoses Among Teenagers and Young Adults in Virginia

Background:  Historically, chlamydia (CT) and gonorrhea (NG) rates have been particularly high in teenagers and young adults in Virginia and nationwide.  Furthermore, high poverty areas are consistently associated with high incidence rates of CT and NG.

Objectives:  To quantify the association between poverty and incidence rates of CT and NG among 15-19 and 20-24 year old Black, White and Hispanic populations in Virginia.

Methods:  Patient addresses for all CT and NG cases diagnosed between January 1, 2005 and December 31, 2010 who were between the ages 15-24 at the time of diagnosis were geocoded to the census tract level and linked with an area-based measure of poverty (percent of persons living below 150% of the federal poverty level in the patient’s census tract of residence).  Each census tract was categorized into one of four levels of poverty.  Rates of CT and NG were then calculated for each gender, race and age group and for each census tract poverty level.  Incidence rate ratios were calculated both within and between age and race groups.

Results:  Rates of both CT and NG significantly increased as poverty increased across each stratum, and were highest in the poorest census tracts for all groups.  Black teenage and young adult males living in high poverty areas had rates of CT up to 41 times and NG up to 102 times higher than their white counterparts living in the lowest poverty areas.  

Conclusions:  Teenagers and young adults living in high poverty areas are at increased risk of acquiring CT and NG regardless of race.  This impact is greatest among Black youth.

Implications for Programs, Policy, and Research:  This information can be used to target approaches in STD prevention towards areas of high morbidity and poverty.  Enhanced collaboration between the Department of Education and the STD prevention program would also be beneficial to increase testing among high risk populations.