Ethnic and regional differences in STI clinic use: a Dutch epidemiological study using aggregated STI clinic data combined with population numbers.
OBJECTIVE
Ethnic minorities (EM) from STI-endemic countries are at increased risk to acquire an STI. The objectives of this study were to investigate the difference in STI clinic consultation and positivity rates between ethnic groups, and compare findings between Dutch cities.


METHODS
Aggregated population numbers from 2011 to 2013 of 15-44 year-old citizens of Amsterdam, Rotterdam, The Hague and Utrecht extracted from the population register (N=3 129 941 person-years) were combined with aggregated STI clinic consultation data in these cities from the national STI surveillance database (N=113 536). Using negative binomial regression analyses (adjusted for age and gender), we compared STI consultation and positivity rates between ethnic groups and cities.


RESULTS
Compared with ethnic Dutch (consultation rate: 40.3/1000 person-years), EM from Eastern Europe, Sub-Sahara Africa, Suriname, the Netherlands Antilles/Aruba and Latin America had higher consultation rates (range relative risk (RR): 1.27-2.26), whereas EM from Turkey, North Africa, Asia and Western countries had lower consultation rates (range RR: 0.29-0.82). Of the consultations among ethnic Dutch, 12.2% was STI positive. Positivity rates were higher among all EM groups (range RR: 1.14-1.81). Consultation rates were highest in Amsterdam and lowest in Utrecht independent of ethnic background (range RR Amsterdam vs Utrecht: 4.30-10.30). Positivity rates differed less between cities.


CONCLUSIONS
There were substantial differences in STI clinic use between ethnic groups and cities in the Netherlands. Although higher positivity rates among EM suggest that these high-risk individuals reach STI clinics, it remains unknown whether their reach is optimal. Special attention should be given to EM with comparatively low consultation rates.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
A A M
AA
van Oeffelen
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
I V F
IV
van den Broek
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
M
M
Doesburg
Municipal Public Health Service Region Utrecht, Utrecht, The Netherlands.
B
B
Boogmans
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.|Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.|Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
H M
HM
Götz
Municipal Public Health Service Haaglanden, The Hague, The Netherlands.
F A M
FA
van Leeuwen-Voerman
Department of Infectious Diseases, Municipal Public Health Service Amsterdam, Amsterdam, The Netherlands.
M G
MG
van Veen
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
P J
PJ
Woestenberg
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
B H B
BH
van Benthem
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.|Centre for Infectious Diseases, Leiden University Medical Centre LUMC, Leiden, The Netherlands.
J E
JE
van Steenbergen
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology*; D014505:Urban Population; D055815:Young Adult
DIAGNOSIS; EPIDEMIOLOGY (GENERAL); ETHNICITY; GENITOURINARY MEDICINE SERVICES