Examining the role of socioeconomic deprivation in ethnic differences in sexually transmitted infection diagnosis rates in England: evidence from surveillance data

Abstract

Differences by ethnic group in STI diagnosis rates have long been recognized in England. We investigated whether these may be explained by ethnic disparities in socioeconomic deprivation (SED). Data on all diagnoses made in sexual health clinics in England in 2013 were obtained from the mandatory STI surveillance system. Poisson regression was used to calculate incidence rate ratios (IRRs) of STIs, by ethnicity, with and without adjustment for index of multiple deprivation (IMD) a measure of area-level deprivation. Unadjusted IRRs (95% confidence intervals) were highest for gonorrhoea [8·18 (7·77-8·61) and 5·76 (5·28-6·29)] and genital herpes [4·24 (3·99-4·51) and 3·58 (3·23-3·98)] for people of black Caribbean and non-Caribbean/non-African black ethnicity and IRRs were highest for syphilis [8·76 (7·97-9·63)] and genital warts [2·23 (2·17-2·29)] for people of non-British/non-Irish white ethnicity compared to white British ethnicity. After adjustment for IMD, IRRs for gonorrhoea [5·76 (5·47-6·07)] and genital herpes [3·73 (3·50-3·97)] declined but remained highest for black Caribbeans and IRRs for syphilis [7·35 (6·68-8·09)] and genital warts [2·10 (2·04-2·16)] declined but remained highest for non-British/non-Irish white compared to white British. In England, ethnic disparities in STI diagnosis rates are partially explained by SED, but behavioural and contextual factors likely contribute. Clinic and community-based interventions should involve social peer networks to ensure they are targeted and culturally sensitive.

100 years of STIs in the UK: a review of national surveillance data

“…w17 w18 An objective of a new service model for London residents is to direct patients to online services rather than attending terrestrial STI clinics. w18 This has the potential to increase access to testing, w19 but care must be taken to avoid exacerbating sexual health inequality through the digital divide; w20-22 this is of particular concern for BME people from socioeconomically deprived areas, who experience disproportionate sexual ill-health 42. It is vital that STI surveillance systems continue to adapt to capture this shift in service provision and thereby enable evaluation of its real-life impact.…”

“…Since the mass wave of migration of people from the Caribbean and elsewhere in the British Commonwealth to the UK after the British Nationality Act of 1948,48 most black Caribbean and other BME people have resided in the most deprived urban areas of England 42. There is an inextricable link between the socioeconomic context of neighbourhoods and the health outcomes of their residents 49.…”

“…There is an inextricable link between the socioeconomic context of neighbourhoods and the health outcomes of their residents 49. Sexual health is no exception, and evidence suggests that socioeconomic deprivation plays a role in ethnic disparities in STI diagnosis rates, although it does not fully explain it 42. Behavioural factors, which are themselves influenced by socioeconomic environment, likely contribute.…”

Meeting Sexual Partners Through Internet Sites and Smartphone Apps in Australia: National Representative Study (Preprint)

“…[21] In women, low annual household income was associated with meeting partners online. Socioeconomic deprivation has been linked with poor health outcomes including STI acquisition [22][23][24], and other reports from ASHR2 found lower income was related to multiple sexual partners. [25] Aside from age and income level for women other sociodemographic factors, smoking and high alcohol consumption and injecting drug use were not associated with having sex with someone met online.…”

Ethnic variations in sexual partnerships and mixing, and their association with STI diagnosis: findings from a cross-sectional biobehavioural survey of attendees of sexual health clinics across England

“…Ethnic inequalities in STI have been repeatedly observed in Britain [1][2][3] (and elsewhere 4 5 ) but their causes remain unclear. In the general population, and among sexual health clinic (SHC) attendees, STI diagnoses are more common among people of Black ethnicities, 1 6-8 particularly bacterial STI 9 and trichomoniasis 10 diagnosis rates among Black Caribbean (BC) people, 3 for example, 378 gonorrhoea and 224 trichomoniasis diagnoses per 100 000, 11 vs 67 and 8 respectively among people of White ethnicity, in England. 12 1.1% of England and Wales' population self-defines as BC (n=594 825).…”