Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Ann Epidemiol. 2019 Apr;32:14-19.e1. doi: 10.1016/j.annepidem.2019.01.013. Epub 2019 Feb 5.
Primary and secondary (P&S) syphilis in men who have sex with men (MSM) has been increasing; however, there is a lack of research on geographic factors associated with MSM P&S syphilis.
We used multiple data sources to examine associations between social and environmental factors and MSM P&S syphilis rates at the state- and county-level in 2014 and 2015, separately. General linear models were used for state-level analyses, and hurdle models were used for county-level models. Bivariate analyses (P < .25) were used to select variables for adjusted models.
In 2014 and 2015 state models, a higher percentage of impoverished persons (2014 β = 1.24, 95% confidence interval, 0.28-2.20; 2015 β = 1.19; 95% confidence interval, 0.42-1.97) was significantly associated with higher MSM P&S syphilis rates. In the 2015 county model, policies related to sexual orientation (marriage, housing, hate crimes) were significant correlates of MSM P&S syphilis rates (P < .05).
Our state-level findings that poverty is associated with MSM P&S syphilis are consistent with research at the individual level across different subpopulations and various sexually transmitted diseases. Our findings also suggest that more research is needed to further evaluate potential associations between policies and sexually transmitted diseases. Geographic-level interventions to address these determinants may help curtail the rising syphilis rates and their sequelae in MSM.
男男性行为者（MSM）的原发性和继发性（P&S）梅毒一直在增加；然而，关于与 MSM P&S 梅毒相关的地理因素的研究还很缺乏。
我们使用多个数据源，分别在 2014 年和 2015 年，在州和县两级检查社会和环境因素与 MSM P&S 梅毒率之间的关联。使用一般线性模型进行州一级的分析，使用障碍模型进行县一级的模型。使用双变量分析（P<.25）选择调整模型的变量。
在 2014 年和 2015 年的州模型中，贫困人口比例较高（2014 年β=1.24，95%置信区间，0.28-2.20；2015 年β=1.19；95%置信区间，0.42-1.97）与 MSM P&S 梅毒率较高显著相关。在 2015 年的县模型中，与性取向相关的政策（婚姻、住房、仇恨犯罪）是 MSM P&S 梅毒率的显著相关因素（P<.05）。
我们在州一级的研究结果表明，贫困与 MSM P&S 梅毒有关，这与不同亚人群和各种性传播疾病的个体水平研究结果一致。我们的研究结果还表明，需要进一步研究以进一步评估政策与性传播疾病之间的潜在关联。针对这些决定因素的地理层面干预措施可能有助于遏制 MSM 梅毒率及其后果的上升。
