Monday, July 4, 2011

Catching Chlamydia by Race and Gender

STD Cases for The United States
Disease: Chlamydia, Race/Ethnicity: Black or African American
According to the Center For Disease Control (CDC) 2009 Surveillance Report there is a decline in some sexually transmitted diseases. The CDC reports that "Gonorrhea: The national gonorrhea rate is at the lowest level ever recorded." Also, according to the CDC report, "For the first time in five years, reported syphilis cases did not increase among women overall. Likewise, cases of congenital syphilis (transmitted from mother to infant) did not increase for the first time in four years." Also, good news. But if we left it there, we would have an incomplete picture. The rate of Chlamydia has nearly doubled in some states and is at an increased rate in nearly every state in the U.S. What is more puzzling is that the rates of Gonorrhea for African American women are up to 30X higher for African American women than white women (in 2000). Also, Chlamydia is higher in Native American population over Hispanic and white population, so what gives?

As a general rule, I do not give STD's much thought, particularly since I am in a monogamous relationship, but I am always curious about teen health, so when I checked into teen sexual health, I found some stunning statistics. Starting with a fact from WebMD that "half of all sexually active teens will catch chlamydia, herpes, or another STD by the time they turn 25." That was news to me! But that was merely the tip of the STD iceberg. The CDC has a wealth of data about trends with STD's; some of the news is good, and some is very, very troubling. They also have interactive maps, reports, tables and statistics which can be generated by any computer to calculate the patterns of communicable disease, race, gender, population, region or state.

Let's start with some disparities in difference between common STD's. According to the CDC records:

There were 13,000 cases of Syphilis reported in 2009, (Rate of 4.6 per 100,000 population).


There were 301,000 cases of Gonorrhea reported in 2009, (Rate of 99.1 per 100,000 population).

There were 1,244,000 cases of Chlamydia reported in 2009, (Rate of 409.2 per 100,000 population).

What that means in part, according to CDC analysis that not all STD rates are rising or falling at the same rate. For example, the CDC reports that cases of gonorrhea "have declined steadily in recent years" (CDC.gov). The CDC also says that rates of gonorrhea "are are now at the lowest level since CDC began tracking the disease in 1941"(CDC.gov). Even with that good news, those rates are not falling at the same rate. Rates for African-Americans are down 15% but the rates for the same disease for whites is down 25%. 

The CDC reports that Syphilis rose 5% over a one-year period, and up 39% since 2006, but that "syphilis did not increase among women – there was a 7% decline among women overall over the past year. This follows an 88% increase in syphilis among women from 2004 to 2008" (CDC.gov).

The rates of those STD's are tame compared to the rise of Chlamydia across the board. "From 2000 to 2009, the chlamydia screening rate among young women nearly doubled (from 25% to 47%)" (CDC.gov). The CDC also reports that the rates of Chlamydia are actually quite higher from lack of screening and reporting.
"CDC estimates that there are 2.8 million chlamydia cases annually – more than twice the number actually reported" (CDC.gov).


But the chlamydia facts do not stop there. According to the CDC, African-Americans accounted for 50% of all reports of chlamydia. "Based on case reports, the chlamydia rate among blacks is eight times higher than whites and three times higher than Hispanics" (CDC.gov). What's more, there is a staggering rate of chlamydia amongst young African-American women, aged 15-24. "In 2009, there was one chlamydia case reported for every 10 black women in that age group" (CDC.gov). And, the chlamydia rate amongst Hispanic women, aged 20-24 was more than twice as high as those amongst whites.

If we look at the rates of Chlamydia reported by state, we see that there are disparities here as well. The reported rates in Puerto Rico nearly tripled over a nine year period from 112.5 in 2000 to 308.1 in 2009 (per 100,000 population). But, having said that, only three states: Maine (252.9), New Hampshire (231.3) and West Virginia (289.9)  reported rates lower than the 308.1 benchmark that Puerto Rico set. It should be noted that all three of those states have a majority white population, which would be in keeping with the national trend.

So, some states with a more rural and white population had lower rates of chlamydia, what does that mean? Nothing, if we do not compare those numbers to other states with an elevated African-American or Native-American population. South Carolina had a rate of (919), triple the rate in Maine. Alabama also had an elevated rate of 807, triple the rate in New Hampshire and Louisiana had a reported rate of 912.7, triple the rate in West Virginia. Alabama, Louisiana and South Carolina, with their elevated rates of chlamydia could top Alaska, which reported a rate of 1023.5 (4X higher than the reported rate in Maine). It is important to note that after African-Americans, Native-Americans are the highest reported rate of chlamydia in the country.

The problem does seem significant in the southeastern United States. The state of Mississippi was 2X above national average in their reporting of chlamydia cases in 2000. The national average for Chlamydia in 2000 was 400 (per 100,000 population) and has now doubled to 800 (per 100,000 population). The rate in Mississippi was 800 in 2000 and is now close to 1,200 (per 100,000 population). According to the CDC data, the rate or reporting by gender appears to be 2 to 1, women to men. Looking at the state of Mississippi for example, the rate of reporting by women was 2,189.25, while the rate for reporting by men was only 930.10. Also, the rate of chlamydia for young women (15-19 years) in Mississippi was 2.5X higher then women aged 25-29. 

What can be done to correct this trend? The CDC created a 2-day conference in Atlanta, GA in 2007 to "Address STD Disparities In African-American Communities" (CDC.gov). One of the first things that the CDC report acknowledges is that this problem will have to tackled by several fronts. "The problem’s scope is most fully grasped from multiple perspectives—epidemiological, sociological, and even spiritual. All point in the same direction: STD disparities reflect socioeconomic disparities, which in turn reflect deep-rooted racial inequalities that continue to exist and are metastasized throughout American society" (CDC.gov). And the report does show that the CDC has been taking on the disparities in race with success in other areas. "A national campaign against syphilis launched in 1999 (and updated in 2006) focused on African-American women—who are pivotal to reducing syphilis rates in children. That campaign succeeded in slashing congenital syphilis rates by 44% and cutting disparities for primary and secondary syphilis between African Americans and whites dramatically" (CDC.gov).

And while it would be easy to blame promiscuity for the elevated rates in the African-American population, the CDC data does not support that claim. "African-American women have the highest STD rates in most analyses, but studies show they do not have the highest levels of risk behavior" (CDC.gov). Instead, the 2007 summit pointed toward poverty and lack of sexual education as the provocateurs of elevated rates of STD's in the African-American community.

We have a long way to go in our country in correcting the racial divides, particularly in health and longevity. I wrote a couple of weeks ago about the disproportionate rate of obesity and Type-II diabetes in the same region of the country and in the same ethnicity. There is an unfavorable trend happening in our minority communities, and as U.S. citizens, one and all, we all have to make public health our primary focus for the future.

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