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Lines LM, Fowler CI, Kaganova Y, Peacock K. Development and validation of a community risk score for sexual and reproductive health in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae048. [PMID: 39071108 PMCID: PMC11282459 DOI: 10.1093/haschl/qxae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 07/30/2024]
Abstract
Equitable access to sexual and reproductive health (SRH) care is key to reducing inequities in SRH outcomes. Publicly funded family-planning services are an important source of SRH care for people with social risk factors that impede their access. This study aimed to create a new index (Local Social Inequity in SRH [LSI-SRH]) to measure community-level risk of adverse SRH outcomes based on social determinants of health (SDoH). We evaluated the validity of the LSI-SRH scores in predicting adverse SRH outcomes and the need for publicly funded services. The data were drawn from more than 200 publicly available SDoH and SRH measures, including availability and potential need for publicly supported family planning from the Guttmacher Institute. The sample included 72 999 Census tracts (99.9%) in the 50 states and the District of Columbia. We used random forest regression to predict the LSI-SRH scores; 42 indicators were retained in the final model. The LSI-SRH model explained 81% of variance in the composite SRH outcome, outperforming 3 general SDoH indices. LSI-SRH scores could be a useful for measuring community-level SRH risk and guiding site placement and resource allocation.
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Affiliation(s)
- Lisa M Lines
- Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States
- Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Christina I Fowler
- Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States
| | - Yevgeniya Kaganova
- Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States
| | - Karen Peacock
- Research and Evaluation, Essential Access Health, Los Angeles, CA 90025, United States
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Johnson KA, Snyder RE, Tang EC, de Guzman NS, Plotzker RE, Murphy R, Jacobson K. Geospatial Social Determinants of Health Correlate with Disparities in Syphilis and Congenital Syphilis Cases in California. Pathogens 2022; 11:pathogens11050547. [PMID: 35631068 PMCID: PMC9146036 DOI: 10.3390/pathogens11050547] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
Syphilis and congenital syphilis (CS) are increasing in California (CA). From 2015 through 2019, for example, CA cases of early syphilis among reproductive-age females (15−44) and CS each increased by >200%. Certain populations—including people experiencing homelessness, using drugs, and/or belonging to certain racial/ethnic groups—have been disproportionately impacted. We hypothesized that geospatial social determinants of health (SDH) contribute to such health inequities. To demonstrate this, we geospatially described syphilis in CA using the Healthy Places Index (HPI). The HPI is a composite index that assigns a score to each CA census tract based on eight socioeconomic characteristics associated with health (education, housing, transportation, neighborhood conditions, clean environment, and healthcare access as well as economic and social resources). We divided CA census tracts into four quartiles based on HPI scores (with the lowest quartile having the least healthy socioeconomic and environmental conditions), then used 2013−2020 CA sexually transmitted diseases surveillance data to compare overall syphilis (among adults and adolescents) and CS case counts, incidence rates (per 100,000 population or live births), and incidence rate ratios (IRRs) among these quartiles. From 2013 to 2020, across all stages of syphilis and CS, disease burden was greatest in the lowest HPI quartile and smallest in the highest quartile (8308 cases (representing 33.2% of all incidents) versus 3768 (15.1%) for primary and secondary (P&S) syphilis; 5724 (31.6%) versus 2936 (16.2%) for early non-primary non-secondary (NPNS) syphilis; 11,736 (41.9%) versus 3026 (10.8%) for late/unknown duration syphilis; and 849 (61.9%) versus 57 (4.2%) for CS; all with p < 0.001). Using the highest HPI quartile as a reference, the IRRs in the lowest quartile were 17 for CS, 4.5 for late/unknown duration syphilis, 2.6 for P&S syphilis, and 2.3 for early NPNS syphilis. We thus observed a direct relationship between less healthy conditions (per HPI) and syphilis/CS in California, supporting our hypothesis that SDH correlate with disparities in syphilis, especially CS. HPI could inform allocation of resources to: (1) support communities most in need of assistance in preventing syphilis/CS cases and (2) reduce health disparities.
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Affiliation(s)
- Kelly A. Johnson
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-757-725-3254
| | - Robert E. Snyder
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
| | - Eric C. Tang
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
| | - Natalie S. de Guzman
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
| | - Rosalyn E. Plotzker
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Ryan Murphy
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
| | - Kathleen Jacobson
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA; (R.E.S.); (E.C.T.); (N.S.d.G.); (R.E.P.); (R.M.); (K.J.)
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