The Impact of Social Determinants of Health on Aggregated County-Level STD Rates in Georgia, 2009 - 2010

Background: Social determinants of health (SDH) are economic and social conditions that influence the health of people and communities.  By focusing on local SDH, STD rates of chlamydia, gonorrhea, and syphilis can be addressed.  The SDH constructs examined were occupational status, poverty status, educational attainment, rural-urban location, and median family income. 

Objectives: To examine the relationship between county-level STD rates (chlamydia, gonorrhea, and syphilis) and local measures of SDH in Georgia.

Methods: We conducted a cross-sectional analysis of state surveillance data for STD cases diagnosed between January 1, 2009 and December 31, 2010, and estimated county-level SDH using 5-year estimates from the US Census Bureau American Community Survey (2005-2009).   We examined   correlations among individual SDH and the association between STD rates and SDH using multiple regression analysis.

Results: Analyses indicated statistically-significant correlations between education (low to high, r = -0.78, p – value <.0001) and poverty to median income (r = -0.76, p-value <.0001).   Using these SDH constructs, multiple-regression analysis showed that approximately 40% (r² = 0.44) of the variance in county-level STD incidence in Georgia can be predicted from the predetermined SDH.   Measures of poverty status (percent of population below federal poverty level) and occupational status (percent in white collar occupations) had the highest correlation with STD incidence (r² = 0.37).

Conclusions: Certain SDH constructs (poverty to median income) are closely related and were closely associated with high STD rates. 

Implications for Programs, Policy, and Research: STD programs with limited resources can use these results to implement interventions in targeted areas.  Counties in Georgia with high poverty rates and low percentage of white collar workers have greater need for STD prevention services.