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Abstract
Background The greater Rotterdam area of the Netherlands consists of 15 municipalities. The sole center of sexual health (CSH) plays a crucial role in finding people unaware of their STI/HIV status. We investigated the association between CSH utilization and sociodemographic and geographical factors. The primary focus was on geographical proximity.
Methods We linked CSH consultation data from STI tested heterosexual clients to the population registry for the years 2015–2017. In this analysis, logistic regression was performed to investigate the importance of proximity. We stratified by age (15–24 and 25–44 years) and ethnicity, since CSH access policies may affect utilization. Proximity was operationalised as straight-line distance between centroid address of a 4-digit postal code and CSH address. Distance was divided into six categories: <10th percentile (<1.8 km), 10–25th percentile (1.8–2.9 km), 25–50th percentile (2.9–6.1 km), 50–75th percentile (6.1–9.9 km), 75–90th percentile (9.9–17.3 km) and >90th percentile (>17.3 km).
Results In total, 19,287 out of the 1.5 million inhabitants aged 15–44 utilized the CSH in the study period. Our data suggest that larger distance to the CSH is strongly associated with lower utilization. For instance, the odds ratios for utilization by 15–24-year-old Surinamese, adjusted for sex, were 0.70 (95% CI: 0.59–0.84), 0.61 (0.52–0.71), 0.52 (0.44–0.63), 0.34 (0.28–0.45) and 0.23 (0.13–0.43) for the different percentiles respectively, compared to <10th percentile (overall P<0.001). Although the association was observed for all ethnic groups, including native Dutch, the strength of the association varied by ethnic group.
Conclusion Geographical proximity effects healthcare utilization even in an infrastructure rich country. The extent to which GPs compensate for lower CSH utilization for those further away from the CSH is unclear. Further research will address the role of the GP in STI healthcare to develop an optimal strategy for offering local STI testing services.
Disclosure No significant relationships.