title: Neighborhoods at risk: estimating risk of higher Neisseria gonorrhoeae incidence among women at the census tract level.
abstract: BACKGROUND
  The association between area-based social factors and sexually transmitted diseases has been demonstrated in numerous studies. Such associations have not previously been explored for their potential to quantify likelihood of higher transmission of gonorrhea in small geographic areas.
  
  
  METHODS
  Aggregate census tract-level sociodemographic factors in 4 domains (demographics, educational attainment, household income, and housing characteristics) were merged with female gonorrhea incidence data from 113 counties in 10 US states. Multivariate models were constructed, and a tract-level composite gonorrhea risk index was calculated. This composite risk index was validated against gonorrhea incidence among women from 2 independent states.
  
  
  RESULTS
  Seven tract-level factors were found to be most strongly correlated with female gonorrhea incidence: educational attainment, proportion of female headed households, annual household income below US $20,000, proportion of population non-Hispanic black, proportion of housing units currently vacant, proportion of population reporting moving in last year, and proportion of households that are nonfamily units. Composite index was highly correlated with female gonorrhea in the study area and validated with independent data.
  
  
  CONCLUSIONS
  Social factors predict gonorrhea incidence at the census tract level and identify small areas at risk for higher morbidity. These data may be used by health departments and health care practices to develop geographically based disease prevention and control efforts. This is especially useful because gonorrhea incidence data are not routinely available below the county level in many states.
authors.affiliation: From the *Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †California Department of Public Health, Sacramento, CA; ‡Philadelphia Department of Public Health, Philadelphia, PA; §Virginia Department of Health, Richmond, VA; ¶Chicago Department of Public Health, Chicago, IL; ∥New York City Department of Health and Mental Hygiene, New York, NY; **Colorado Department of Public Health and Environment, Denver, CO; ††Johns Hopkins University School of Medicine/Baltimore City Health Department, Baltimore, MD; and ‡‡Washington State Department of Health, Tumwater, WA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Stenger
authors.forename: Michael C
authors.initials: MC
authors.lastname: Samuel
authors.forename: Greta L
authors.initials: GL
authors.lastname: Anschuetz
authors.forename: River
authors.initials: R
authors.lastname: Pugsley
authors.forename: Margaret
authors.initials: M
authors.lastname: Eaglin
authors.forename: Ellen
authors.initials: E
authors.lastname: Klingler
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.forename: Christina M
authors.initials: CM
authors.lastname: Schumacher
authors.forename: Julie
authors.initials: J
authors.lastname: Simon
authors.forename: Hillard
authors.initials: H
authors.lastname: Weinstock
mesh_terms: D019352:Censuses; D004522:Educational Status; D005260:Female; D006069:Gonorrhea / Q000517:prevention & control / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009344:Neisseria gonorrhoeae / Q000472:pathogenicity*; D011203:Poverty; D012111:Residence Characteristics; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology