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Investigating Multiple-Reported Bacterial Sexually Transmitted Infection Hot Spot Counties in the United States

Ordered Spatial Logistic Regression

Owusu-Edusei, Kwame Jr PhD*; Chang, Brian A. MD

doi: 10.1097/OLQ.0000000000001078
Original Study

Purpose To identify and examine the correlates of multiple bacterial sexually transmitted infection (STI) hot spot counties in the United States.

Methods We assembled and analyzed 5 years (2008–2012) of cross-sectional STI morbidity data to identify multiple bacterial STI (chlamydia, gonorrhea, and syphilis) hot spot counties using hot spot analysis. Then, we examined the association between the multi-STI hot spots and select multiyear (2008–2012) sociodemographic factors (data obtained from the American Community Survey) using ordered spatial logistic regression analyses.

Results Of the 2935 counties, the results indicated that 85 counties were hot spots for all 3 STIs (3-STI hot spot counties), 177 were hot spots for 2 STIs (2-STI hot spot counties), and 145 were hot spots for only 1 STI (1-STI hot spot counties). Approximately 93% (79 of 85) of the counties determined to be 3-STI hot spots were found in 4 southern states––Mississippi (n = 25), Arkansas (n = 22), Louisiana (n = 19), and Alabama (n = 13). Counties determined to be 2 STI hot spots were found in 7 southern states––Arkansas, Louisiana, Mississippi, Alabama, Georgia, and North and South Carolina had at least ten 2-STI hot spot counties each. The multi-STI hot spot classes were significantly (P < 0.05) associated with percent black (non-Hispanic), percent Hispanics, percent American Indians, population density, male-female sex ratio, percent aged 25 to 44 years, and violent crime rate.

Conclusions This study provides information on multiple STI hot spot counties in the United States and the associated sociodemographic factors. Such information can be used to assist planning, designing, and implementing effective integrated bacterial STI prevention and control programs/interventions.

Hot spot analyses of county-level reported bacterial STIs indicated that 85 were hot spots for all 3 infections, and over 90% (79 of 85) of them were in 4 southern states.

From the *National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY

Conflict of interest and Sources of Funding: None declared.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the United States Centers for Disease Control and Prevention (CDC). Mention of company names or products does not imply endorsement by CDC.

Correspondence: Kwame Owusu-Edusei Jr., PhD, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, 12 Corp Sq Blvd, MS US12-2, Atlanta, GA 30329. E-mail:

Received for publication July 9, 2019, and accepted September 21, 2019.

Online date: October 31, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association