Association of Social Determinants of Health and Incident Gonorrhea and Chlamydia Infection Among the Obstetric Population at a Large, Urban Safety-Net Hospital Open Access
Wichmann, Hannah (Spring 2021)
Abstract
Objective: To determine if social determinant of health (SDH) screening in pregnancy predicts increased risk of gonorrhea (GC) and chlamydia (CT) infection.
Methods: Retrospective cohort study of pregnant women who received antenatal care at a large, urban safety-net hospital in Atlanta, GA between October 15, 2019 and March 12, 2020. We included all women who completed SDH screening at least once during their prenatal visits. Demographic and clinical data were collected from the initiation of prenatal care through 42 days postpartum. We used logistic regression to examine the crude associations between self-reported SDH exposures, other covariates of interest and incident CT/GC infection. Variable multicollinearity was assessed. Remaining covariates were then selected for inclusion into two adjusted models (with and without backward selection) if they were associated with the outcome using a Bonferroni-adjusted p-value to account for multiple comparisons.
Results: Our total study population consisted of 1421 women who had CT/GC test results. In this population, 12.25% were positive for CT/GC. Median age was 27 years, with 81.66% non-Hispanic black, 35.83% nulliparous, and 87.90% publicly-insured. After adjusting for confounders, in our backward selection model age <27 years (aOR 3.83, p-value <0.0001) and asthma (1.914, p-value 0.0004) were statistically associated with increased risk of CT/GC infection. Without backward selection, only age <27 years remained significant (aOR 3.675, p-value <0.0001).
Conclusion: These results highlight the connections between SDH needs and STIs in pregnancy. Though only a few of our covariates were significant, many of the others still hold clinical significance, have implications for future screening recommendations, and emphasize areas for public health interventions aimed at decreasing STIs and subsequent adverse outcomes in pregnancy. Future directions include conducting this analysis on the completed dataset, examining the connection between asthma and STIs more thoroughly, developing a risk prediction score using SDH to determine those at increased risk of CT/GC during pregnancy, and expanding this analysis to evaluate temporality of SDH needs and STIs during pregnancy.
Table of Contents
Distribution Agreement ................................................................................................................................. 1
Approval Sheet .............................................................................................................................................. 2
Abstract Cover Sheet ..................................................................................................................................... 3
Abstract ........................................................................................................................................................ 4
Thesis Cover Sheet ........................................................................................................................................ 5
Introduction ................................................................................................................................................. 6
Background ................................................................................................................................................... 6
Methods ....................................................................................................................................................... 7
Results ........................................................................................................................................................ 10
Discussion .................................................................................................................................................. 12
Conclusion .................................................................................................................................................. 15
Figure 1 ...................................................................................................................................................... 16
Table 1 ........................................................................................................................................................ 17
Table 2 ........................................................................................................................................................ 19
Table 3 ........................................................................................................................................................ 21
References .................................................................................................................................................. 23
Appendix A ................................................................................................................................................. 27
Appendix B ................................................................................................................................................. 28
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Association of Social Determinants of Health and Incident Gonorrhea and Chlamydia Infection Among the Obstetric Population at a Large, Urban Safety-Net Hospital () | 2021-05-03 20:28:40 -0400 |
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