Article Text

other Versions

Download PDFPDF
It matters what you measure: a systematic literature review examining whether young people in poorer socioeconomic circumstances are more at risk of chlamydia
  1. Jessica Sheringham1,
  2. Sue Mann2,
  3. Ian Simms3,
  4. Mai Stafford4,
  5. Graham J Hart5,
  6. Rosalind Raine6
  1. 1Department of Applied Health Research, University College London, London, UK
  2. 2Sexual Health Consultant, King's College Hospital, London, UK
  3. 3Department of HIV & STI, Health Protection Services, Colindale, Health Protection Agency, London, UK
  4. 4Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
  5. 5Department of Infection & Population Health, Faculty of Population Health Sciences, Centre for Sexual Health, HIV Research, University College London Mortimer Market Centre, London, UK
  6. 6Department of Applied Health Research, University College London, London, UK
  1. Correspondence to Dr Jessica Sheringham, Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; j.sheringham{at}


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.

  • Socioeconomic factors
  • Chlamydia trachomatis
  • chlamydia screening
  • young people
  • epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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.