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Concurrent and Time-Lagged Effects of Social Disorganization on Chlamydia Rate Trajectories Among United States Counties and the District of Columbia, 2010–2015

Sheehan, Diana M., PhD*†; Gebrezgi, Merhawi T., BS*; Sanchez, Mariana, PhD†‡; Li, Tan, PhD§; Fennie, Kristopher P., PhD*; Trepka, Mary Jo, MD*

Sexually Transmitted Diseases: June 2019 - Volume 46 - Issue 6 - p 364–369
doi: 10.1097/OLQ.0000000000000982
Original Studies
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SDC

Objective To examine the longitudinal relationship between social disorganization (SD) and genital Chlamydia trachomatis infection.

Methods US county-level data for 2010 to 2015 were used. Reliability and principal component analysis revealed 2 SD factors: socioeconomic deprivation and demographic instability. Growth curve models examined the degree to which SD factors affected chlamydia rates (number of new reported cases per 100,000 population) at baseline and over time adjusting for population percentage aged 15 to 24 years, male to female ratio for population aged 15 to 24 years, and rural percentage. Regression models explored 1- and 3-year time-lagged effects.

Results Among 2961 counties, the average baseline chlamydia rate was 320.3 with an average increase of 7.7 cases per year. Higher baseline deprivation was associated with higher baseline chlamydia rates (P < 0.0001) but lower increases over time (P < 0.0001). Higher demographic instability was associated with lower baseline rates (P < 0.0001) but higher increases over time (P < 0.0001). Deprivation was associated with 1- and 3-year lagged rates (P < 0.0001).

Conclusions On average, chlamydia rates increased across US counties, and more rapidly for counties with the highest demographic instability.

A study of US counties found chlamydia rates are continuing to increase and more rapidly for counties with the highest demographic instability.

From the *Department of Epidemiology, Robert Stempel College of Public Health and Social Work,

Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA),

Department of Health Promotion and Disease Prevention, and

§Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL

Conflicts of Interest: none declared.

Sources of Funding: Support for this research was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Correspondence: Diana M. Sheehan, PhD, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Rm 479, Miami, FL 33199. E-mail: dsheehan@fiu.edu.

Received for publication August 20, 2018, and accepted January 28, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).

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