Résumé :
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[BDSP. Notice produite par INIST-CNRS 9JmR0xEl. Diffusion soumise à autorisation]. Objectives. We assessed chlamydia trends, individual-level risk factors, and population-level area-based socioeconomic measures (ABSMs) associated with chlamydia infection in women attending U.S. Public Health Service (PHS) Region X Infertility Prevention Project (IPP) family planning (FP) clinics from 1997-2006. We then explored these measures within racial/ethnic subpopulations. Methods. Using data from 667,223 chlamydia tests obtained from women aged 15-24 years screened in 201 FP clinics, we employed a generalized mixed model with logistic link, incorporating clinic and ZIP code as random effects to adjust for risk of chlamydia associated with individual-and population-level (areal) measures for the overall population and for each racial/ethnic subpopulation. Results. Significant racial/ethnic differences in chlamydia persisted after adjusting for individual and aggregate factors. Relatively steep chlamydia gradients were found across racial/ethnic ABSM levels. Compared with white women, infection risk was significantly higher for black (adjusted odds ratio [AOR]=1.93), American Indian/Alaska Native (AOR=1.62), Asian/Pacific Islander (AOR=1.42), and Hispanic (AOR=1.28) women. The impact of population-level ABSMs on chlamydia varied across racial/ethnic groups and was generally modest. Among white women, there was a significant 4% relative annual increase in predicted chlamydia during the 10-year period 1997-2006. Chlamydia positivity over time did not change for racial/ethnic minority groups after adjusting for individual-and population-level factors. Conclusions. Racial/ethnic differences in chlamydia persisted over time and were not mitigated by adjustment for aggregate socioeconomic position or areal racial/ethnic measures. Changes in project strategies will be needed to address racial/ethnic disparities for chlamydial infection among young female FP clinic clients.
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