(P359) County-level persistent poverty as a predictor of gonorrhea and chlamydia incidence

Background: Poverty and rural residency status have long been associated with higher rates of sexually transmitted infections (STI) due to fewer sexual health and medical resources. The continuing increase in STIs across the nation requires nuanced understanding of interacting or compounding roles of these disparities. Persistent poverty counties, those counties who have had >20% of the population at or below the national poverty level for at least 30 consecutive years, are predominately rural, and have higher rates of poor outcomes from other health conditions such as cancer. Despite this evidence, no published literature exists that examines the association between these persistent poverty counties and STI rates in the US.

Methods: Drawing on data from the National Electronic Database Surveillance System (NEDSS), American Community Survey (ACS), and County Health Rankings we conducted unadjusted and adjusted binomial regressions, including generalized estimating equations, to examine potential relationships between persistent poverty, as defined by the U.S. Department of Agriculture Economic Research, and STI rates.

Results: Of the 3,143 counties or county-level equivalents in the US, 353 (11.2%) are designated as persistent poverty, of which 63.5% are rural. Positive relationships between persistent poverty and gonorrhea (p=0.0023) and chlamydia (p< 0.001) incidence at the county level were observed. When controlling for rurality, sex education policies, and other factors, persistent poverty remained positively associated with STI incidence.

Conclusion: These findings provide a more nuanced understanding of the growing literature surrounding the relationship between poverty and negative sexual health outcomes by demonstrating a positive relationship between county-level persistent poverty status with gonorrhea and chlamydia incidence. Negative social determinants may be exacerbated within these communities, which warrants further exploration to help inform community-based interventions.