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Epidemiology poster session 5: Transmission dynamic: Income disparities
P1-S5.46 Assessing the relationship between sexually transmitted infection rates, ethnic group and socio-economic deprivation in England
  1. E Savage,
  2. G Leong,
  3. L Peters,
  4. S Duffell,
  5. G Hughes
  1. Health Protection Agency, London, UK


Background Disparities in the distribution of sexually transmitted infections (STIs), especially gonorrhoea, across ethnic groups in England are well recognised. Socio-economic deprivation (SED) is also a known determinant of poor health outcomes and is often more common in ethnic minorities, but it has not previously been possible to assess the relationship between ethnic group, SED and STI rates at the national level. We used data from a new national patient-level STI surveillance system to investigate the interplay between SED and ethnicity on population-level rates of STIs in England.

Methods Data on patients diagnosed with syphilis, gonorrhoea, genital herpes and genital warts from all genitourinary medicine (GUM) clinics in England in 2009 were obtained through the GUM Clinic Activity Dataset (GUMCAD). Rates of STI diagnoses by ethnic group and deprivation quintile were calculated. Deprivation was measured using the Index of Multiple Deprivation for England for each lower-level super output area of residence.

Results In England in 2009 the rate of syphilis and gonorrhoea was over five times higher (7.7/100 000 vs 1.4/100 000 and 42.8/100 000 vs 8.0/100 000 respectively) in the most deprived areas than in the least deprived areas but there was less difference for genital herpes (49.4/100\000 vs 26.8/100\000) and warts (131.1/100 000 vs 79.0/100 000) (see Abstract P1-S5.46 figure 1). The highest crude rates of acute STI diagnoses were among black ethnic communities although the magnitude varied by STI. The rate of gonorrhoea in black communities was over eight times higher than in white ethnic groups (171/100 000 vs 20/100 000), however, for genital warts rates in black ethnic communities were only 1.5 times higher than those in white ethnic groups (194.5/100 000 vs 130/100 000). Asians had the lowest rates for all four infections.

Abstract P1-S5.46 Figure 1

Rates of diagnoses of STIs by deprivation quintile using the Index of Multiple Deprivation, England, 2009.

Conclusions Rates of STIs are strongly associated with deprivation. Presentation of STI rates by ethnic categories should be adjusted to take into account the strong interaction between ethnicity and SED. While SED is a key determinant of ill health other cultural influences on sexual behaviour may contribute to STI risk exposure among ethnic groups. The high STI rates seen among black ethnic communities are likely to be the consequence of a complex interplay of cultural, economic and behavioural factors.

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