title: Syphilis in the South: rural rates surpass urban rates in North Carolina.
abstract: We studied primary and secondary syphilis rates in North Carolina for 1985 through 1993 to elucidate demographic trends and the role of rurality in the state's high rates. Each of the state's 100 counties was classified by rural-urban character; and county-level rates, adjusted for gender, race, and age group, were compared. Syphilis rates rose dramatically during the 9-year period, with most of the increase occurring among women, non-Whites, and rural counties. The rural rates recently surpassed urban rates, with the greatest increase experienced by non-White rural women. The exchange of sex for drugs and characteristics of rural poverty may be fueling these trends.
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Thomas
authors.forename: A L
authors.initials: AL
authors.lastname: Kulik
authors.forename: V J
authors.initials: VJ
authors.lastname: Schoenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D012423:Rural Health / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013587:Syphilis / Q000453:epidemiology*; D013590:Syphilis, Congenital / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data