Assessing Longitudinal Relationships between County Level Rates of Crime and Chlamydia and Gonorrhea in the United States from 2002-2014

Background: Rates of chlamydia and gonorrhea continue to increase in the United States (US) at unprecedented rates. A growing body of literature points to a relationship between ecological factors including community rates of crime, poverty, geography, racial/ethnic composition and growing rates of Sexually Transmitted Infections (STI). Research is scant despite mounting attention to the importance of social ecology in structuring the production of STI risk in social environments in the US. This analysis examined associations between rates of drug and violent crime and incidence rates of STI after adjusting for percent in poverty, geographic region, and racial/ethnic composition at the county level from 2002-2014. Understanding how rates of crime impact STI at the county level will inform policy and interventions at the interface of the criminal justice system and public health in the US.

Methods: Descriptive analyses were performed on incidence rates of gonorrhea and chlamydia, rates of crime, and sociodemographic data (poverty, racial/ethnic composition and geographic region). All rates were adjusted to per 100,000 of the population. Negative binomial fixed effects regression models with a population offset assessed relationships between rates of violent and drug crimes and rates of gonorrhea and chlamydia after adjusting for percent in poverty, racial/ethnic composition and geographic region for 2942 counties from 2002-2014 amounting to 38205 observations.

Results: From 2002-2014, mean rates of Chlamydia and Gonorrhea were 275.55(SD=239.46) and 65.44(SD=96.41) respectively. Average rates of drug crimes were 456.69 (SD=1049.15) and violent crimes 128.19(SD=111.02). On average, 15.74%(SD=6.31) of the counties were in poverty, 9.63% (SD=14.82) African American, 1.85% (SD=6.43) Native American, 7.91%(SD=13.11) Hispanic and 86.38% (SD=15.86) white. Rates of Chlamydia were highest in the East South Central region (380.37; SD=332.28) and gonorrhea was highest in the South Atlantic region (166.69; SD=118.62). After adjusting for country and year fixed effects and potential confounders, violent crime significantly predicted higher rates of gonorrhea and chlamydia (β=.14, SD=.02, p<.001). Counties with greater percent composition of African Americans and significantly predicted greater rates of chlamydia (β=.06 SD=.003, p<.001) and gonorrhea (β=.05 SD=.004, p<.001). Counties with greater perrcent composition of Native Americans was associated with greater rates of chlamydia (β=.02 SD=.001, p<.001) and gonorrhea (β=.10 SD=.008, p<.001). Compared to the Midwest, counties in the East South Central region were associated with the greatest rates of chlamydia (β=.31, SD=.03, p<.001) and West South Central for rates of gonorrhea (β=.77, SD=.04, p<.001). Counties in the New England region were associated with the lowest rates of chlamydia (β=-.32, SD=.03; p<.001) and gonorrhea (β =-.89, SD = .07, p<.001).

Implications: This research sheds important insights into geographic, racial/ethnic and socioeconomic disparities in rates of chlamydia and gonorrhea in the US. Targeted public health interventions and resources directed to counties with high rates of violent crime and greater racial/ethnic composition of African Americans and Native Americans particularly in Southern regions may attenuate expanding rates of Chlamydia and Gonorrhea in the US.