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美国大都市统计区 2005-2009 年的居住隔离与淋病发病率。

Residential segregation and gonorrhea rates in US metropolitan statistical areas, 2005-2009.

机构信息

Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23218-2448, USA.

出版信息

Sex Transm Dis. 2013 Jun;40(6):439-43. doi: 10.1097/OLQ.0b013e31828c6416.

Abstract

BACKGROUND

The residential segregation of black populations, often in areas of high-economic disadvantage and low social status, may play a crucial role in the observed racial inequities in sexually transmitted disease rates.

METHODS

An ecological analysis of 2005 to 2009 average gonorrhea rates was performed across 277 US metropolitan statistical areas (MSAs). The black isolation index and Gini index of income inequality were used as proxy measures for racial and economic residential segregation respectively, derived from 2005 to 2009 US Census estimates. We used logistic regression modeling to produce estimates of odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the segregation indices, both independently and in combination, on gonorrhea rates in MSAs. Effect measure modification was assessed by calculating the relative excess risk due to interaction between the 2 indices.

RESULTS

Compared with MSAs with low levels of racial segregation, MSAs with high levels of racial segregation had increased odds of high gonorrhea rates (adjusted OR, 3.37; 95% CI, 1.23-9.21). Similarly, higher levels of income inequality predicted higher gonorrhea rates, although this association did not persist after adjustment for potential confounders (adjusted OR, 1.54; 95% CI, 0.74-3.24). In combined models, the influence of racial residential segregation on gonorrhea rates was stronger than that of income inequality-based segregation; there was no evidence of additivity or a multiplicative interaction.

CONCLUSIONS

Residential segregation by race or income equality may be a key component in the perpetuation of high rates of gonorrhea and other sexually transmitted diseases among black populations in the United States.

摘要

背景

黑人聚居区的居住隔离,通常发生在经济劣势和社会地位低下的地区,这可能在观察到的性传播疾病率的种族不平等中起着关键作用。

方法

对 277 个美国大都市统计区(MSA)在 2005 年至 2009 年期间的平均淋病发病率进行了生态分析。黑人群体隔离指数和收入不平等基尼指数分别作为种族和经济居住隔离的代理指标,这些数据来源于 2005 年至 2009 年的美国人口普查数据。我们使用逻辑回归模型,针对隔离指数之间的关联,无论是独立的还是组合的,对 MSA 中的淋病发病率产生比值比(OR)和 95%置信区间(CI)的估计值。通过计算两个指数之间相互作用引起的相对超额风险,评估了效应量修正。

结果

与种族隔离程度较低的 MSA 相比,种族隔离程度较高的 MSA 发生高淋病发病率的可能性更高(调整后的 OR,3.37;95%CI,1.23-9.21)。同样,收入不平等程度较高预测淋病发病率较高,但在调整潜在混杂因素后,这种关联并不存在(调整后的 OR,1.54;95%CI,0.74-3.24)。在组合模型中,种族居住隔离对淋病发病率的影响强于基于收入不平等的隔离;没有证据表明存在附加性或乘法交互作用。

结论

种族或收入平等的居住隔离可能是美国黑人群体中淋病和其他性传播疾病高发病率持续存在的关键因素。

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