Chesson Harrell W, Patel Chirag G, Gift Thomas L, Bernstein Kyle T, Aral Sevgi O
From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Sex Transm Dis. 2017 Sep;44(9):513-518. doi: 10.1097/OLQ.0000000000000646.
Racial disparities in the burden of sexually transmitted diseases (STDs) have been documented and described for decades. Similarly, methodological issues and limitations in the use of disparity measures to quantify disparities in health have also been well documented. The purpose of this study was to use historic STD surveillance data to illustrate four of the most well-known methodological issues associated with the use of disparity measures.
We manually searched STD surveillance reports to find examples of racial/ethnic distributions of reported STDs that illustrate key methodological issues in the use of disparity measures. The disparity measures we calculated included the black-white rate ratio, the Index of Disparity (weighted and unweighted by subgroup population), and the Gini coefficient.
The 4 examples we developed included illustrations of potential differences in relative and absolute disparity measures, potential differences in weighted and nonweighted disparity measures, the importance of the reference point when calculating disparities, and differences in disparity measures in the assessment of trends in disparities over time. For example, the gonorrhea rate increased for all minority groups (relative to whites) from 1992 to 1993, yet the Index of Disparity suggested that racial/ethnic disparities had decreased.
Although imperfect, disparity measures can be useful to quantify racial/ethnic disparities in STDs, to assess trends in these disparities, and to inform interventions to reduce these disparities. Our study uses reported STD rates to illustrate potential methodological issues with these disparity measures and highlights key considerations when selecting disparity measures for quantifying disparities in STDs.
几十年来，性传播疾病（STD）负担方面的种族差异已有文献记载和描述。同样，在使用差异衡量指标来量化健康差异方面的方法学问题和局限性也有充分的文献记录。本研究的目的是利用历史性的性传播疾病监测数据来说明与使用差异衡量指标相关的四个最著名的方法学问题。
我们手动搜索性传播疾病监测报告，以找到报告的性传播疾病种族/族裔分布的例子，这些例子说明了使用差异衡量指标时的关键方法学问题。我们计算的差异衡量指标包括黑白发病率比、差异指数（按亚组人群加权和未加权）以及基尼系数。
我们给出的4个例子包括相对和绝对差异衡量指标的潜在差异、加权和未加权差异衡量指标的潜在差异、计算差异时参考点的重要性以及在评估差异随时间变化趋势时差异衡量指标的差异。例如，从1992年到1993年，所有少数族裔群体（相对于白人）的淋病发病率都有所上升，但差异指数表明种族/族裔差异有所下降。
尽管存在缺陷，但差异衡量指标可用于量化性传播疾病中的种族/族裔差异、评估这些差异的趋势以及为减少这些差异的干预措施提供信息。我们的研究利用报告的性传播疾病发病率来说明这些差异衡量指标潜在的方法学问题，并强调在选择用于量化性传播疾病差异的差异衡量指标时的关键考虑因素。
