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Ethnic and regional differences in STI clinic use: a Dutch epidemiological study using aggregated STI clinic data combined with population numbers
  1. A A M van Oeffelen1,
  2. I V F van den Broek1,
  3. M Doesburg1,
  4. B Boogmans2,
  5. H M Götz1,3,4,
  6. F A M van Leeuwen-Voerman5,
  7. M G van Veen6,
  8. P J Woestenberg1,
  9. B H B van Benthem1,
  10. J E van Steenbergen1,7
  1. 1Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
  2. 2Municipal Public Health Service Region Utrecht, Utrecht, The Netherlands
  3. 3Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
  4. 4Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
  5. 5Municipal Public Health Service Haaglanden, The Hague, The Netherlands
  6. 6Department of Infectious Diseases, Municipal Public Health Service Amsterdam, Amsterdam, The Netherlands
  7. 7Centre for Infectious Diseases, Leiden University Medical Centre LUMC, Leiden, The Netherlands
  1. Correspondence to Dr Louise van Oeffelen, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; louise.van.oeffelen{at}


Objectives Ethnic minorities (EM) from STI-endemic countries are at increased risk to acquire an STI. The objectives of this study were to investigate the difference in STI clinic consultation and positivity rates between ethnic groups, and compare findings between Dutch cities.

Methods Aggregated population numbers from 2011 to 2013 of 15–44 year-old citizens of Amsterdam, Rotterdam, The Hague and Utrecht extracted from the population register (N=3 129 941 person-years) were combined with aggregated STI clinic consultation data in these cities from the national STI surveillance database (N=113 536). Using negative binomial regression analyses (adjusted for age and gender), we compared STI consultation and positivity rates between ethnic groups and cities.

Results Compared with ethnic Dutch (consultation rate: 40.3/1000 person-years), EM from Eastern Europe, Sub-Sahara Africa, Suriname, the Netherlands Antilles/Aruba and Latin America had higher consultation rates (range relative risk (RR): 1.27–2.26), whereas EM from Turkey, North Africa, Asia and Western countries had lower consultation rates (range RR: 0.29–0.82). Of the consultations among ethnic Dutch, 12.2% was STI positive. Positivity rates were higher among all EM groups (range RR: 1.14–1.81). Consultation rates were highest in Amsterdam and lowest in Utrecht independent of ethnic background (range RR Amsterdam vs Utrecht: 4.30–10.30). Positivity rates differed less between cities.

Conclusions There were substantial differences in STI clinic use between ethnic groups and cities in the Netherlands. Although higher positivity rates among EM suggest that these high-risk individuals reach STI clinics, it remains unknown whether their reach is optimal. Special attention should be given to EM with comparatively low consultation rates.


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  • Handling editor Jackie A Cassell

  • Contributors AAMvO analysed and interpreted the data and drafted the manuscript. JEvS initiated the study, helped interpreting the data and revised the manuscript draft. IVFvdB and BHBvB helped interpreting the findings and revised the manuscript draft. MD performed preliminary data analyses and revised the manuscript draft. BB, HMG, FAMvL-V and MGvV were involved in providing the data, assisted in interpreting the findings and revised the manuscript draft. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Results of sensitivity analyses are available on request from the corresponding author.