Sexually Transmitted Infections in females in the HSE East region Is there a link to deprivation? SSSTDI Autumn Meeting 25th Nov 2016 Presented by Fionnuala Cooney on behalf of Fiona Cianci F.Cianci1, F. Cooney2, A. O’Farrell1, P. Downes2, O. Ennis2, M. Fitzgerald2, H. Johnson1 1. Health Information Unit, 2. Dept of Public Health HSE-East, both at Dr Steevens’ Hosp, Dublin

Background In 2015, there were 9751 notifications of STIs in Ireland. Of these, 4776 (49%) were in females Socio-economic deprivation is a known risk factor for poor sexual health outcomes Mapping STI notification by deprivation area would be very useful for local needs assessment work Idea was to explore possibility of using routine data to map distribution of certain STI notifications in HSE-East area (Dublin, Wicklow and Kildare)

Aim and objectives Identify factors which can be used to further inform STI prevention and control activities in females in the HSE East: Identify geographical areas of high incidence Explore the association between STIs and deprivation in our region Explore differences between older and younger women

Data collection Computerised Infectious Disease Reporting (CIDR) notifications for 2015 were exported to Excel Data was anonymised and password protected 40% of the 2015 routine notifications were missing address information Providers were contacted to collect address information where available-clinics and GPs  increased to 80% Some clinics gave us addresses other didn’t collect them or werent happy to share.

Areas & Haase Pratschke Index SA are areas of population that comprise between 50 and 200 dwellings and must nest within electoral division (ED) boundaries[26] 3,440 EDs and these are the smallest legally defined administrative areas in the state. PCTS are multi-disciplinary teams of professionals that provide health and social care services to a defined population of between 7,000 and 10,000 people HP index has three dimensions:demographic profile, social class composition and labour market situation each is composed of a set of indicators…

Analysis 2015 data was mapped using Health Atlas Ireland to Small Area where possible, or Electoral Division Crude incidence rate per 100,000 population (CIR) was calculated at ED level and PCT level Ranked by ‘High’, ‘Medium’ or ‘Low’ using median and 75th percentile PCTs are multi-disciplinary teams of professionals that provide health and social care services to a defined population of between 7,000 and 10,000 people. HP index at PCT is not as granular because it’s an average aggregate measure of loads of SA

Analysis-continued Data exported to SPSS for further analysis Age categories: ‘ Older’ = >35 years ‘Younger’= <34 years Services: ‘Free of charge’ ‘Fees’ ‘GP’

Results

CIR per 100,000 population 2003-2015 The total STI notification rate for the five infections examined increased from 121.2 per 100,000 in 2003 female to 278.77 per 100,000 in 2015. Mainly driven by chlamydia

2015 data

Seventeen entries were deleted from the database because they had the same CIDR event ID, disease and clinical notifier and the event notification dates were within one day of each other. If the same disease was notified in the same patient within a three month time period, the records were given the same event ID. Thus, the patient may have presented with the same condition more than once and at more than one clinical location. Any records that matched by date of birth, patient name and address were also assigned the same patient ID. There was no difference in age between the two groups or in disease distribution. There were significant difference between mapped and unmapped events in terms of county of residence(χ2=42.164, p=0.000) and clinic attended (χ2= 47.109,p=0.000). 80% were geocoded

Primary Care Teams CIR High =>75th percentile Med=75-50th percentile Low =<50th percentile

Electoral Division ED HIGH CIR MEDIUM CIR Affluent 15 (16%) 34 (37%) Deprived 2 (2%) 5 (5%) Total 92 Ninety-two EDs had high CIR, of these, 15 (16%) were affluent EDs while only two (2%) were deprived. Of the 92 EDs that had medium CIR, 34 (37%) were affluent and 5 (5%) were deprived (Figure 6.15).

OLDER YOUNGER Odds Ratio (95% CI; p value) Chlamydia 3.63 (35 years>) YOUNGER (<34 years) Pearson-Chi square test (p value) Odds Ratio (95% CI; p value) N % Chlamydia 126 44.8% 1476 74.7% 146.61; (p=0.00) 3.63 (2.81, 4.69; p=0.00) Gonorrhoea 13 4.6% 101 5.1% 1.11 (0.63, 2.00; p=0.73) 0.31 (0.24, 0.40; p=0.00) Herpes 122 43.4% 378 19.1% 0.16 (0.07, 0.34; p=0.00) Trichomoniasis 15 0.8% Syphilis 7 2.5% 6 0.3% 0.12 (0.04, 0.36; p=0.00) Dublin 241 86.4% 1664 87.3% 0.488; (p=0.08) Wicklow 16 5.7% 114 6.0% Kildare 22 7.9% 129 6.8% Very deprived 2 0.9% 67 4.5% 13.627; (p= 0.00) 5.54 (1.26, 24.34;p=0.02) Deprived 9.9% 247 15.7% 1.87 (0.98, 3.50; p=0.06) Neither 51.1% 776 49.2% 1.13 (0.68, 1.86; p=0.64) Affluent 64 28.7% 359 22.8% 0.93 (0.54, 1.58; p=0.78) Very affluent 21 9.4% 127 8.1% Reference Fees 72 25.6% 534 27.0% 0.535; (p=0.91) Free 88 31.3% 604 30.6% GP 111 39.5% 756 38.3% Missing 10 3.6% 82 4.1% significant differences in disease distribution (χ2=146.61; (p=0.000)) and deprivation (χ2= 13.627; (p= 0.00)) were found as shown in Table 6.8.

Recommendations Women’s sexual health must remain a priority on the National Sexual Strategy plan. The findings are being used in the current national sexual health needs assessment Young, very deprived women should be targeted with tailored prevention campaigns. Routine surveillance data should be geo-coded to enhance and assist epidemiological investigations and health service planning. Information on testing rates is being sought to investigate possible differences in testing by age and area of deprivation.

Conclusion First report to use available surveillance data to describe the geographical distribution and to link individual cases to area-based measures of deprivation. The findings are being used to inform service planning in relation to health promotion and STI service provision.

Acknowledgements Eugene Boyle, Anne O’Farrell and Brian O’Boyce at the Health Information Unit All health care providers who provided the required information for this work, especially personnel at: GUIDE Rotunda Hospital Well Woman Clinic and GP practices