Chlamydia and Gonorrhea Incidence and Residential Segregation: US Spatiotemporal Patterns (2013-2021)

ABSTRACT

Objective Investigate how residential segregation is associated with chlamydia and gonorrhea incidence between 2013 and 2021.

Methods National-level secondary US data from 2013-2021 from the Centers for Diseases Control and Prevention Sexually Transmitted Infection surveillance dataset, American Community Survey, and Racial Segregation Index were analyzed using the Generalized Estimating Equation, and spatial regression. Analysis was divided into two periods (2013–2019; 2020–2021) to account for COVID-19 disruptions. Residential segregation was measured by dissimilarity index categorized into reference (<□0.25), moderate (0.26–0.50), high (0.51–0.75), and extreme (>□0.75) levels. Primary outcome measures were chlamydia and gonorrhea incidence rates. Residential segregation was the key independent variable with other social determinants of health covariates. 3058 counties within the contiguous United States were included within this study. Counties with missing data, and not within the contiguous United States were excluded.

Results For chlamydia, from 2013–2019, segregation coefficients (i.e.,13.77 and 15.84 for moderate and high segregation) indicate that greater residential segregation is associated with higher chlamydia incidence rates (P<.0001). From 2020–2021, these coefficients increased (from 13 and 15 to 28.25 and 34.16), suggesting growing segregation-driven disparities. Gonorrhea followed a similar trend, with the coefficients increasing from 0.47 and 0.55 (P < .001) to 1.53 and 1.62 (P < .05), respectively. Spatial variation in the association between segregation and chlamydia incidence remained consistent, with stronger associations in the Southeastern, Midwest, and Western regions. Spatial variation in the association between segregation and gonorrhea incidence was more pronounced in the South and parts of the Midwest, with weaker associations in some Northern and Western regions.

Conclusions Residential segregation remained a substantial driver of chlamydia and gonorrhea transmission. The spatial patterns varied over time for both diseases. Further research should extend post-COVID-19 analysis to assess evolving relationships between residential segregation and STI incidence across U.S. regions.

Key points What is already known on this topic: Chlamydia and gonorrhea in 2023 were the most reported sexually transmitted infections in the United States, disproportionately affecting Black Americans.

What this study adds: This study found that racial residential segregation was a substantial driver of chlamydia and gonorrhea transmission, especially during the COVID-19 pandemic.

How this study might affect research, practice or policy: Study findings suggest that interventions aiming to reduce chlamydia and gonorrhea incidence rates in the United States should also include intervention activities that address adversities associated with racial residential segregation.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was supported by NIH grants: R01AI174892 and R56AI17489601A1

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data used within this study were obtained from publicly available secondary data sources. Therefore, no new data were generated by the authors for the present study.

Comments (0)

No login
gif