It matters what you measure: a systematic literature review examining whether young people in poorer socioeconomic circumstances are more at risk of chlamydia
- 1Department of Applied Health Research, University College London, London, UK
- 2Sexual Health Consultant, King's College Hospital, London, UK
- 3Department of HIV & STI, Health Protection Services, Colindale, Health Protection Agency, London, UK
- 4Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- 5Department of Infection & Population Health, Faculty of Population Health Sciences, Centre for Sexual Health, HIV Research, University College London Mortimer Market Centre, London, UK
- 6Department of Applied Health Research, University College London, London, UK
- Correspondence to Dr Jessica Sheringham, Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, UK;
Contributors JS, the corresponding author, had full access to the data used in this study and had final responsibility for the decision to submit for publication. JS and SM screened all retrieved references and reviewed papers meeting the inclusion criteria. JS, SM, IS, MS, GH and RR collaborated on drafting the inclusion criteria and reviewed the list of included references. JS and RR drafted the paper. All authors contributed to drafts of the paper and approved the final version.
- Accepted 30 June 2012
- Published Online First 11 October 2012
Background England has invested in chlamydia screening interventions for young people. It is not known whether young people in poorer socioeconomic circumstances (SEC) are at greater risk of chlamydia and therefore in greater need of screening.
Objective To conduct a systematic review examining socioeconomic variations in chlamydia prevalence or positivity in young people.
Data sources Eight bibliographic databases using terms related to chlamydia and SEC, supplemented by website and reference searches.
Eligibility Studies published 1999–2011 in North America, Western Europe, Australia or New Zealand, including populations aged 15–24 years, with chlamydia prevalence or positivity diagnosed by nucleic acid amplification testing.
Appraisal and synthesis Two reviewers independently screened references, extracted data, appraised studies meeting inclusion criteria and rated studies as high, medium or low according to their quality and relevance. Socioeconomic variations in chlamydia were synthesised for medium/high-rated studies only.
Results No high-rated studies were identified. Eight medium-rated studies reported variations in chlamydia prevalence by SEC. In 6/8 studies, prevalence was higher in people of poorer SEC. Associations were more often significant when measured by education than when using other indicators. All studies measuring positivity were rated low. Across all studies, methodological limitations in SEC measurement were identified.
Conclusions The current literature is limited in its capacity to describe associations between SEC and chlamydia risk. The choice of SEC measure may explain why some studies find higher chlamydia prevalence in young people in disadvantaged circumstances while others do not. Studies using appropriate SEC indicators (eg, education) are needed to inform decisions about targeting chlamydia screening.
Funding This work was supported by the Medical Research Council (grant number G0701660).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.