坦桑尼亚老年人中自我报告的性传播感染的高流行率：一项基于代表性人群调查的清单实验结果。
High prevalence of self-reported sexually transmitted infections among older adults in Tanzania: results from a list experiment in a population-representative survey.
机构信息
Department of Population Health, New York University Grossman School of Medicine, New York; Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Center for Population and Development Studies, Harvard University TH Chan School of Public Health, Cambridge, MA.
出版信息
Ann Epidemiol. 2023 Aug;84:48-53. doi: 10.1016/j.annepidem.2023.05.001. Epub 2023 May 16.
PURPOSE
Self-report of sensitive or stigmatized health states is often subject to social desirability and interviewer biases. To reduce such biases, we estimated the rate of sexually transmitted infections (STIs) using a list experiment.
METHODS
This population-representative study was nested within the Dar es Salaam Urban Cohort Study, a Health and Demographic Surveillance System (HDSS) in the Ukonga ward of Dar es Salaam, Tanzania. Men and women aged ≥40years were randomly assigned to receive a list of either four control items (i.e., the control group) or four control items plus an additional item on having had a disease through sexual contacts in the past 12months (i.e., the treatment group). We calculated the mean difference in the total number of items to which respondents answered "yes" in the treatment versus control group and compared this prevalence estimate to the one measured by the direct question.
RESULTS
A total of 2310 adults aged ≥40years were enrolled in the study: 32% were male and 48% were aged 40-49years. The estimated prevalence of having STIs in the past 12months was 17.8% (95% confidence interval [CI] 12.3-23.3) in the list experiment, almost 10 times higher than the estimated prevalence of 1.8% (95%CI 1.3-2.4) based on the direct question (P < .001). STI prevalence remained high after adjusting for age, the number of lifetime sex partners, alcohol consumption and smoking in multivariate linear regression (15.6%; 95% CI 7.3-23.9).
CONCLUSIONS
We found a substantially higher prevalence of STIs among older adults in urban Tanzania when we based our estimation on a list experiment rather than a direct question in a population-representative survey. List experiments should be considered to elimnate social desirability and interviewer biases in surveys of sensitive or stigmatized health states. The very high prevalence of STIs highlights the need for improved access to STI screening, prevention and treatment for older adults in urban Africa.
目的
敏感或污名化的健康状况的自我报告通常受到社会期望和访谈者偏见的影响。为了减少这种偏见，我们使用列表实验来估计性传播感染（STI）的发生率。
方法
这项基于人群的研究嵌套在达累斯萨拉姆城市队列研究中，该研究是坦桑尼亚 Ukonga 区的一个健康和人口监测系统（HDSS）。年龄≥40 岁的男性和女性被随机分配接受一个包含四个对照项目的列表（即对照组）或一个包含四个对照项目和一个过去 12 个月中通过性接触感染疾病的额外项目的列表（即治疗组）。我们计算了治疗组和对照组中回答“是”的项目总数的平均差异，并将该患病率估计值与直接问题测量的患病率进行了比较。
结果
共有 2310 名年龄≥40 岁的成年人参加了这项研究：32%为男性，48%年龄在 40-49 岁之间。在列表实验中，过去 12 个月 STI 的估计患病率为 17.8%（95%置信区间[CI] 12.3-23.3），几乎是直接问题估计的 1.8%（95%CI 1.3-2.4）的 10 倍（P<0.001）。在多元线性回归中，调整年龄、终生性伴侣数量、饮酒和吸烟因素后，STI 的患病率仍然很高（15.6%；95%CI 7.3-23.9）。
结论
我们发现，在坦桑尼亚城市的老年人中，基于列表实验而非代表性调查中的直接问题进行估计时，STI 的患病率要高得多。在调查敏感或污名化的健康状况时，应该考虑使用列表实验来消除社会期望和访谈者偏见。STI 的高患病率突出表明需要改善城市非洲老年人获得 STI 筛查、预防和治疗的机会。
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