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Background: Measuring health disparities is a public health priority. Racial/ethnic (R/E) disparities in gonorrhea (GC) rates are extreme.
Objectives: Assess to what degree observed disparities are confounded by demographic/risk groups.
Methods: We used 1990–2010 California (CA) GC case data to describe GC R/E rate ratios (RR) by time, gender and county. Enhanced 2007-2010 sample-based GC data and population-based MSM estimates were used to model rates by sexual orientation (SO) and R/E.
Results: Rates decreased from 181.3/100,000 in 1990 (N=54076) to a nadir of 55.8 in 1999, increased through 2005 then decreased to 69.1 in 2010 (N=26840). This pattern was seen in all groups. Black rates were higher than other races in all years (up to 31.7 times higher than whites). Decreases were seen in the black:white (B:W) RR for males 1990–2003, followed by steady RRs through 2010; there was no trend in the B:W RR for females. Among the 15 largest CA counties, the B:W RR varied substantially and the % change in the B:W RR 1990-2010 also varied substantially and differed by gender. The MSM proportion among male cases increased from 44% to 60% 2007-2010 and differed by R/E; in 2010, 84% of white males with GC were MSM compared to 22% of black males. Based on gender only, in 2010 the B:W RR for females (17.5) was >2 times larger than for males (7.7); however, when considering SO, the B:W RR was >2 times larger for heterosexual males (38.1) than for females (17.5) and >19 times larger than MSM (2.0).
Conclusions: Black GC R/E disparities are large and vary by gender, county and SO. A large proportion of GC cases are MSM, and this varies by R/E. GC R/E disparities are much larger for heterosexuals than MSM.
Implications for Programs, Policy, and Research: Controlling for confounders is critical to accurately measure, and ultimately reduce, GC disparities.