It matters what you measure: a systematic literature review examining whether young people in poorer socioeconomic circumstances are more at risk of chlamydia

Sheringham, Jessica; Mann, Sue; Simms, Ian; Hart, Graham; Raine, Rosalind

doi:10.1136/sextrans-2011-050223

Cited by 18 publications

(22 citation statements)

References 25 publications

(28 reference statements)

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“…Our study provides the strongest evidence to date of social inequalities in the risk of chlamydia [7]. Associations with risk of infection were observed for household-level measures of socioeconomic position collected in early life and educational and neighbourhood deprivation measures taken in early and late teens.…”

Section: Discussionmentioning

confidence: 59%

“…Existing evidence on the association between socioeconomic position and risk of chlamydia is mixed, with most studies finding only weak evidence of an association between increased risk and social disadvantage [7], [8]. The most recent survey in the UK (Natsal-3), undertaken several years after the introduction of screening, found stronger evidence of such health inequality with risk of infection amongst residents of the most disadvantaged areas being around double that of participants from the least disadvantaged areas in both men and women aged 16–44 years.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Chlamydia in Young Adulthood and Association with Life Course Socioeconomic Position: Birth Cohort Study

et al. 2014

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BackgroundFew estimates are available of chlamydia prevalence in the general population. Existing studies have limited scope to explore potential selection bias or associations with socioeconomic position.MethodsWe examined the prevalence of Chlamydia trachomatis infection and associations with life-course socioeconomic position in the Avon Longitudinal Study of Parents and Children in England. Chlamydia infection was measured through nucleic acid amplification test of urine specimens.Results4864 (51%) of those invited attended the clinic (mean age 17.8; SD 0.37 years). (60%) provided a urine specimen. Prevalence was 1.0% (95% CI 0.6 to 1.6) among participants reporting sexual activity. Risk of infection was strongly associated with life course social disadvantage and with recent sexual behaviour. After adjustment for other measures of disadvantage and for sexual behaviour the strongest risk factors for infection were lower maternal educational attainment (OR 9.1 (1.1, 76.7)) and lower participant educational attainment at age 11 (OR 5.0 (1.5, 16.5)). Both clinic attendance and agreement to test were lower amongst the disadvantaged. Adjustment for selective participation based on detailed information on non-participants approximately doubled prevalence estimates. Prevalence was higher in sexually active women (1.4% (0.7 to 2.4) than men (0.5% (0.1 to 1.3)).ConclusionsChlamydia prevalence in this general population sample was low even after adjustment for selective participation in testing. These estimates of prevalence and patterns of association with socioeconomic position may both reflect recent screening efforts. Prevalence was higher amongst the disadvantaged who were also less likely to engage in testing. Our results reveal the importance of monitoring and addressing inequalities in screening programme participation and outcomes.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Prevalence of Chlamydia in Young Adulthood and Association with Life Course Socioeconomic Position: Birth Cohort Study

et al. 2014

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“…Different indicators might result in different findings, as shown in analyses of sexual behaviours and attitudes by area-level deprivation, educational attainment, and National Statistics Socio-economic Classification (NS-SEC) in participants aged 16–74 years in Natsal-3 20 . Similarly, a review examining the association between socioeconomic circumstances and chlamydia prevalence in various countries showed substantial variations, dependent on the measure used 35 . The IMD at small area level has seven domains (income, employment, health, education, housing and services, crime, and living environment) 26 .…”

Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)

et al. 2013

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SummaryBackgroundPopulation-based estimates of prevalence, risk distribution, and intervention uptake inform delivery of control programmes for sexually transmitted infections (STIs). We undertook the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) after implementation of national sexual health strategies, and describe the epidemiology of four STIs in Britain (England, Scotland, and Wales) and the uptake of interventions.MethodsBetween Sept 6, 2010 and Aug 31, 2012, we did a probability sample survey of 15 162 women and men aged 16–74 years in Britain. Participants were interviewed with computer-assisted face-to-face and self-completion questionnaires. Urine from a sample of participants aged 16–44 years who reported at least one sexual partner over the lifetime was tested for the presence of Chlamydia trachomatis, type-specific human papillomavirus (HPV), Neisseria gonorrhoeae, and HIV antibody. We describe age-specific and sex-specific prevalences of infection and intervention uptake, in relation to demographic and behavioural factors, and explore changes since Natsal-1 (1990–91) and Natsal-2 (1999–2001).FindingsOf 8047 eligible participants invited to provide a urine sample, 4828 (60%) agreed. We excluded 278 samples, leaving 4550 (94%) participants with STI test results. Chlamydia prevalence was 1·5% (95% CI 1·1–2·0) in women and 1·1% (0·7–1·6) in men. Prevalences in individuals aged 16–24 years were 3·1% (2·2–4·3) in women and 2·3% (1·5–3·4) in men. Area-level deprivation and higher numbers of partners, especially without use of condoms, were risk factors. However, 60·4% (45·5–73·7) of chlamydia in women and 43·3% (25·9–62·5) in men was in individuals who had had one partner in the past year. Among sexually active 16–24-year-olds, 54·2% (51·4–56·9) of women and 34·6% (31·8–37·4) of men reported testing for chlamydia in the past year, with testing higher in those with more partners. High-risk HPV was detected in 15·9% (14·4–17·5) of women, similar to in Natsal-2. Coverage of HPV catch-up vaccination was 61·5% (58·2–64·7). Prevalence of HPV types 16 and 18 in women aged 18–20 years was lower in Natsal-3 than Natsal-2 (5·8% [3·9–8·6] vs 11·3% [6·8–18·2]; age-adjusted odds ratio 0·44 [0·21–0·94]). Gonorrhoea (<0·1% prevalence in women and men) and HIV (0·1% prevalence in women and 0·2% in men) were uncommon and restricted to participants with recognised high-risk factors. Since Natsal-2, substantial increases were noted in attendance at sexual health clinics (from 6·7% to 21·4% in women and from 7·7% to 19·6% in men) and HIV testing (from 8·7% to 27·6% in women and from 9·2% to 16·9% in men) in the past 5 years.InterpretationSTIs were distributed heterogeneously, requiring general and infection-specific interventions. Increases in testing and attendance at sexual health clinics, especially in people at highest risk, are encouraging. However, STIs persist both in individuals accessing and those not accessing services. Our findings provide empirical evidence to inform future sexual health inter...

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“…As well as addressing some of the broader critiques of contemporary social epidemiological practice, critical epidemiology has the potential to improve our understanding of specific health issues, and to re-politicise epidemiology as a moral force for good. Notably, the nature and reasons for socioeconomic disparities in sexual health remain poorly understood (Sheringham et al, 2013). Critical epidemiology may provide a useful approach for improving our understanding of these associations, and for countering the focus on the individual's behaviour and beliefs which dominate sexual health epidemiology.…”

Section: Resultsmentioning

confidence: 99%

Towards a critical epidemiology approach for applied sexual health research

Edelman¹

2017

J Health Psychol

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Critical approaches may benefit epidemiological studies of sexual health. This paper proposes a critical approach, reconcilable with social epidemiological enquiry. Key aims of critical epidemiology for sexual health are identified, from which three criticisms of practice emerge: 1. Lack of attention to socio-cultural contexts; 2.Construction of 'risk' as residing in the individual; 3. Enactment of public health agendas which privilege and pathologise certain behaviours. These reflect and construct an apolitical understanding of population health. This paper proposes features of a critical epidemiology that represent a morally driven re-envisioning of the focus, analysis, and interpretation of epidemiological studies of sexual health.

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It matters what you measure: a systematic literature review examining whether young people in poorer socioeconomic circumstances are more at risk of chlamydia

Cited by 18 publications

References 25 publications

Prevalence of Chlamydia in Young Adulthood and Association with Life Course Socioeconomic Position: Birth Cohort Study

Prevalence of Chlamydia in Young Adulthood and Association with Life Course Socioeconomic Position: Birth Cohort Study

Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)

Towards a critical epidemiology approach for applied sexual health research

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