Epidemiology of incident chlamydia and gonorrhoea infections and population attributable fractions associated with living in the inner-core of Winnipeg,Canada

Abstract

Population attributable fractions help to convey public health significance of differential disease risk for chlamydia and gonorrhoea. Geographical residence serves as a useful proxy for complex processes creating ill health. Using population-based data, Poisson regression models were used to examine factors associated with chlamydia and gonorrhoea incidence. Population attributable fractions due to residency in the Winnipeg Health Region’s inner-core were determined for chlamydia/gonorrhoea infections among 15–59-year olds (2005–2013), stratified by age group. For both chlamydia and gonorrhoea, it was found that the 15–24-year old age group had the highest incidence rates. There was also a stronger association between residency in the inner-core and incidence for gonorrhoea, compared to chlamydia. Overall, 24% (95% CI: 12–34%) of chlamydia infections were attributable to residency in the inner-core, compared to 46% (95% CI: 35–54%) for gonorrhoea (p < .05). Within chlamydia/gonorrhoea, no statistically significant differences in population attributable fraction were observed by age group. The conclusion was that a concentration of efforts towards inner-core residents with gonorrhoea infections may result in a relatively larger decrease in incidence.

Keywords

Chlamydia gonorrhoea population attributable fraction

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References

Young

. Population Health: concepts and methods, 2nd ed. London, UK: Oxford University Press, 2004.

Greenland

Gago-Dominguez

Castelao

. The value of risk-factor (“black-box”) epidemiology. Epidemiology 2004; 15: 529–535.

Savitz

. In defense of black box epidemiology. Epidemiology 1994; 5: 550–552.

Bhopal

. Concepts of epidemiology: integrating the ideas, theories, principles and methods of epidemiology, 2nd ed. New York, NY: Oxford University Press, 2008.

Northridge

. Public health methods – attributable risk as a link between causality and public health action. Am J Public Health 1995; 85: 1202–1204.

Levin

. The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 1953; 9: 531–541.

Public Health Agency of Canada. Report on sexually transmitted infections in Canada: 2011. Ottawa, ON: Centre for Communicable Diseases and Infection Control, Infectious Disease Prevention and Control Branch, 2014.

Chesson

Gift

Owusu-Edusei

Jr . A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies. Sex Transm Dis 2011; 38: 889–891.

Blanchard

. Populations, pathogens, and epidemic phases: closing the gap between theory and practice in the prevention of sexually transmitted diseases. Sex Transm Infect 2002; 78(Suppl 1): i183–i188.

10.

Elliott

Blanchard

Beaudoin

. Geographical variations in the epidemiology of bacterial sexually transmitted infections in Manitoba, Canada. Sex Transm Infect 2002; 78(Suppl 1): i139–i144.

11.

Fang

Oliver

Jayaraman

. Trends in age disparities between younger and middle-age adults among reported rates of chlamydia, gonorrhea, and infectious syphilis infections in Canada: findings from 1997 to 2007. Sex Transm Dis 2010; 37: 18–25.

12.

Yorke

Hethcote

Nold

. Dynamics and control of the transmission of gonorrhea. Sex Transm Dis 1978; 5: 51–56.

13.

Zenilman

Ellish

Fresia

. The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system. Sex Transm Dis 1999; 26: 75–81.

14.

Thomas

Tucker

. The development and use of the concept of a sexually transmitted disease core. J Infect Dis 1996; 174(Suppl 2): S134–S143.

15.

Rothenberg

. The geography of gonorrhea. Empirical demonstration of core group transmission. Am J Epidemiol 1983; 117: 688–694.

16.

Jennings

Curriero

Celentano

. Geographic identification of high gonorrhea transmission areas in Baltimore, Maryland. Am J Epidemiol 2005; 161: 73–80.

17.

Haque

Soares Magalhaes

Mitra

. The role of age, ethnicity and environmental factors in modulating malaria risk in Rajasthali, Bangladesh. Malaria J 2011; 10: 367–367.

18.

Norman

Bradshaw

Lewin

. Estimating the burden of disease attributable to four selected environmental risk factors in South Africa. Rev Environ Health 2010; 25: 87–119.

19.

Boyle

Willms

. Place effects for areas defined by administrative boundaries. Am J Epidemiol 1999; 149: 577–585.

20.

Mustard

Frohlich

. Socioeconomic status and the health of the population. Med Care 1995; 33: DS43–DS54.

21.

Diez Roux

. Neighborhoods and health: where are we and were do we go from here? Rev Epidemiol Sante Publique 2007; 55: 13–21.

22.

Diez Roux

Mair

. Neighborhoods and health. Ann New York Acad Sci 2010; 1186: 125–145.

23.

Schwartz

Susser

. A future for epidemiology? Ann Rev Public Health 1999; 20: 15–33.

24.

Smith

Corvalan

Kjellstrom

. How much global ill health is attributable to environmental factors? Epidemiology 1999; 10: 573–584.

25.

Statistics Canada. Health regions: boundaries and correspondence with census geography, Ottawa, Canada: Statistics Canada, 2007.

26.

Shah

. Public health and preventive medicine in Canada, Toronto: University of Toronto Press, 2003.

27.

WRHA Research & Evaluation Unit. Population distribution by sex Winnipeg community areas and neighbourhood clusters, 2010. http://www.wrha.mb.ca/research/cha/files/PopulationBySex_10.pdf (accessed 6 October 2015).

28.

Fransoo

Martens

Need to Know Team . The 2013 RHA Indicators Atlas, Winnipeg, Manitoba: Manitoba Centre for Health Policy, 2013.

29.

Newson R. Punaf. Population attributable and unattributable fractions for cohort and cross-sectional studies. Program for Stata 13. 2013.

30.

Greenland

Drescher

. Maximum likelihood estimation of the attributable fraction from logistic models. Biometrics 1993; 49: 865–872.

31.

Yorke

Hethcote

Nold

. Dynamics and control of the transmission of gonorrhea. Sex Transm Dis 1978; 5: 51–56.

32.

Wand

Guy

Donovan

. Population attributable risk for chlamydia infection in a cohort of young international travellers (backpackers) and residents in Australia. BMJ Open 2011; 1: e000004–e000004.

33.

Gray

Wawer

Sewankambo

. Relative risks and PAF of incident HIV associated with symptoms of sexually transmitted diseases and treatable symptomatic sexually transmitted diseases in Rakai District, Uganda. Rakai Project Team. AIDS 1999; 13: 2113–2123.

34.

Page-Shafer

Cahoon-Young

Klausner

. Hepatitis C virus infection in young, low-income women: the role of sexually transmitted infection as a potential cofactor for HCV infection. Am J Public Health 2002; 92: 670–676.

35.

Aral

Hughes

Stoner

. Sexual mixing patterns in the spread of gonococcal and chlamydial infections. Am J Public Health 1999; 89: 825–833.

36.

Laumann

Youm

. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis 1999; 26: 250–261.

37.

Potterat

Rothenberg

Woodhouse

. Gonorrhea as a social disease. Sex Transm Dis 1985; 12: 25–32.

38.

City of Winnipeg. City of Winnipeg Census Profiles, http://winnipeg.ca/census/2011/ (2015, accessed 6 October 2015).

39.

Gracey

King

. Indigenous health part 1: determinants and disease patterns. Lancet 2009; 374: 65–75.

40.

King

. An overall approach to health care for indigenous peoples. Pediatr Clin North Am 2009; 56: 1239–1242.

41.

King

Smith

Gracey

. Indigenous health part 2: the underlying causes of the health gap. Lancet 2009; 374: 76–85.

42.

Aral

. Determinants of STD epidemics: implications for phase appropriate intervention strategies. Sex Transm Infect 2002; 78(Suppl 1): i3–i13.

43.

Blanchard

. Populations, pathogens, and epidemic phases: closing the gap between theory and practice in the prevention of sexually transmitted diseases. STI 2002; 78(Suppl 1): i183–i188.

44.

Turner

Garnett

. The impact of the phase of an epidemic of sexually transmitted infection on the evolution of the organism. Sex Transm Infect 2002; 78(Suppl 1): i20–i30.

45.

Jennings

Glass

Parham

. Sex partner concurrency, geographic context, and adolescent sexually transmitted infections. Sex Transm Dis 2004; 31: 734–739.

46.

Robinson

Cohen

Colijn

. The dynamics of sexual contact networks: effects on disease spread and control. Theor Popul Biol 2012; 81: 89–96.

47.

Aral

Lipshutz

Blanchard

. Drivers of STD/HIV epidemiology and the timing and targets of STD/HIV prevention. Sex Transm Infect 2007; 83(Suppl 1): i1–i4.

48.

Corones

Hardy

. En-gendered surveillance: women on the edge of a watched cervix. Surveill Soc 2009; 6: 388–397.

49.

Milloy

Marshall

Kerr

. Social and structural factors associated with HIV disease progression among illicit drug users: a systematic review. AIDS 2012; 26: 1049–1063.

50.

Rhodes

Singer

Bourgois

. The social structural production of HIV risk among injecting drug users. Soc Sci Med 2005; 61: 1026–1044.

51.

Walter

. The estimation and interpretation of attributable risk in health research. Biometrics 1976; 32: 829–849.

52.

Wylie JL and Jolly A. Patterns of chlamydia and gonorrhea infection in sexual networks in Manitoba, Canada. Sex Transm Dis 2001; 28: 14–24.