Changes in community socioeconomic status and racial distribution associated with gonorrhea rates: an analysis at the community level.

BACKGROUND: Gonorrhea persists despite nationwide disease control measures. Research has not focused on the longitudinal impact of community characteristics on gonorrhea. The authors assessed the association between community demographic and socioeconomic changes and gonorrhea rates.
METHODS: Gonorrhea incident cases reported in 1992-1993 and 2001-2002 were aggregated at the census tract level in New York State exclusive of New York City and then matched to the census data. Census tract characteristics were obtained from the 1990 and 2000 decennial censuses and adjusted for changes in geographic boundaries.
RESULTS: Gonorrhea incidence declined considerably between 2 study periods (1992-1993 and 2001-2002) among urban census tracts, but gradually increased in suburbs and rural areas. Changes in community socioeconomic status (SES) were significantly associated with change in gonorrhea rates (e.g., gonorrhea rate ratio given a 5% increase in household poverty rate = 1.08; 95% confidence interval: 1.02-1.14), independent of changes in community demographics. Increases in gonorrhea rates related to the proportion of non-Hispanic black population within urban census tracts persisted after multiple SES variables were controlled (rate ratio = 1.20; 95% confidence interval: 1.16-1.24). DISCUSSION: This study found that temporal changes in community SES and demographic characteristics were associated with changes in gonorrhea rates.