Secular trends in New York City hospital discharge diagnoses of congenital syphilis and cocaine dependence, 1982-88.

The ecologic relationship between the incidence of reactive serologic tests for syphilis among 2,229 newborns and diagnoses that included cocaine dependence among 17,219 hospitalized women ages 15-44 in New York City was investigated. Citywide, race-specific and zip code-specific annual rates were computed. The residential zip codes were grouped into quartiles by cumulative level of diagnoses that included cocaine dependence, and citywide and race-specific annual rates of congenital syphilis were computed in each quartile. From 1982 to 1988, the citywide rate of congenital syphilis for all races increased from 1.2 to 5.8 per 1,000 live births, while rates of cocaine dependence discharges increased from 23.3 to 423.3 per 100,000 women of all races during the same period. For African American infants, citywide rates of congenital syphilis increased from 1.8 to 10.6 per 1,000 live births. In quartile-specific analyses of African American women and newborns, rates of congenital syphilis increased from 1.9 to 14.6 in the highest cocaine-exposure quartile; from 2.1 to 12.4 in the third; from 1.5 to 7.6 in the second; and, from 1.6 to 2.8 in the lowest cocaine-exposure quartile. This study provides support for the hypothesis that cocaine dependence in women may be associated with congenital syphilis infection.