Impact of Chlamydia & Gonorrhea in Georgia: An Urban/Rural Comparison (2000-2004)

Abstract

Background: In 2005, 33,562 cases of chlamydia and 15,860 cases of gonorrhea were reported in the State of Georgia, respectively corresponding to 3.4% and 4.7% of all cases reported nationally (CDC, 2005). Disparities of infection with respect to race and gender are evident for both diseases. The objective of this study was to determine the magnitude of chlamydia and gonorrhea in rural Georgia compared to urban areas of the state. Methods: County level data necessary for analysis were acquired using the Georgia Division of Public Health’s Online Analytical Statistical Information System database (GDHR, 2007). Rates of infection by gender and race (black vs. white) were aggregated over a five year period (2000 – 2004) and indirectly adjusted using Georgia as the standard. Rates for rural counties, defined as populations less than 35,000, were statistically compared to urban rates using a test of proportions (α = 0.05). Additionally, rate ratios and 95% confidence intervals were calculated to further quantify risk. Results: Although variation exists, data suggest infection of both diseases in Georgia is an urban problem, disproportionately impacting black residents. For chlamydia, adjusted rates for white males (21.0/100,000) and black males (313.9/100,000) were significantly higher in urban counties. Quantified risk as indicated by rate ratios [RR] and 95% confidence intervals [95%CI] suggest an 18% increase of risk among white males (RR = 1.18; 95%CI = 1.07, 1.30) and 33% increase of risk among black males (RR = 1.33; 95%CI = 1.27, 1.38). Among females, rates in rural areas of the state were higher for whites (121.9/100,000) and blacks (1,045.5/100,000). However, these differences were not significant. For gonorrhea, rates in urban areas were significantly higher among white males (15.5/100,000), black males (519.6/100,000), and black females (414.2/100,000) as compared to rural populations. Additionally, elevated risk of gonorrhea among these groups ranged from a 10% increase among black females (RR = 1.10; 95%CI = 1.07, 1.14) in urban areas to a 65% increase among white males (RR = 1.64; 95%CI = 1.43, 1.85) in urban areas. Conclusions: The State of Georgia continues to report two of the most common sexually transmitted infections at an alarming rate. The disproportionate impact of minorities is evident, although further assessment of the variation between urban and rural areas is warranted to more fully explain risk of infection.