Cluster of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.
PLoS One. 2013 Jun 14;8(6):e67287. doi: 10.1371/journal.pone.0067287. Print 2013.
In affluent countries, the prevalence of Chlamydia trachomatis (CT) is often higher in certain ethnic minorities than in the majority population. In The Netherlands, we examined why CT prevalence is higher in Surinamese/Antilleans, the largest minority in the country.
Heterosexuals were recruited for a cross-sectional survey from May through August 2010 at the sexually transmitted infections (STI) clinic in Amsterdam. Participants completed a questionnaire and were tested for STI. A causal directed acyclic graph was assumed to investigate whether the association between ethnicity and CT could be explained by differences in sexual risk behaviour and socio-economic status.
Subjects included 1044 with Dutch background and 335 with Surinamese/Antillean background. Median age for the combined population was 25 (IQR 22-30) years, and 55.4% was female. Sexual risk behaviour did not differ significantly between the two groups. CT was diagnosed in 17.9% of Surinamese/Antilleans and in 11.4% of Dutch. Surinamese/Antilleans were significantly more likely to have CT (OR 1.70; 95% CI 1.21-2.38). The association between ethnicity and CT remained statistically significant after adjusting for sexual risk behaviour, age, sex, and ethnic mixing (aOR 1.48; 95% CI 1.00-2.18), but not after adjusting for education and neighbourhood, markers of socio-economic status (aOR 1.08; 95% CI 0.71-1.64).
The difference in CT prevalence between the minority and majority groups was not explained by differences in sexual risk behaviour. The higher CT prevalence found among Surinamese/Antilleans appeared to reflect their lower educational level and neighbourhood, two markers of lower socio-economic status. We hypothesise that the effect results from lower health-seeking behaviour.
在富裕国家，某些少数族裔的沙眼衣原体（CT）患病率往往高于多数人群。在荷兰，我们研究了为什么该国最大的少数族裔苏里南/荷属安的列斯人（Surinamese/Antilleans）的 CT 患病率较高。
2010 年 5 月至 8 月，在阿姆斯特丹的性传播感染（STI）诊所，我们招募了异性恋者进行横断面调查。参与者完成了一份问卷并接受了 STI 检测。假设因果有向无环图（causal directed acyclic graph）来研究族裔与 CT 之间的关联是否可以用性行为风险和社会经济地位的差异来解释。
受试者包括 1044 名荷兰背景和 335 名苏里南/荷属安的列斯背景的人。合并人群的中位年龄为 25（IQR 22-30）岁，55.4%为女性。两组之间的性行为风险行为没有显著差异。17.9%的苏里南/荷属安的列斯人被诊断患有 CT，11.4%的荷兰人被诊断患有 CT。苏里南/荷属安的列斯人感染 CT 的风险显著更高（OR 1.70；95%CI 1.21-2.38）。在调整性行为风险、年龄、性别和族裔混合（aOR 1.48；95%CI 1.00-2.18）后，族裔与 CT 之间的关联仍然具有统计学意义，但在调整教育和邻里（社会经济地位的标志）后则没有（aOR 1.08；95%CI 0.71-1.64）。
少数族裔和多数族裔群体之间 CT 患病率的差异不能用性行为风险行为的差异来解释。在苏里南/荷属安的列斯人中间发现的较高 CT 患病率似乎反映了他们较低的教育水平和邻里关系，这是社会经济地位较低的两个标志。我们假设这种效果是由于较低的健康寻求行为所致。
