1. 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

2. 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)

3. 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

4. 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.

5. 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…

6. 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

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

8. Results

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

10. 2015 data

11. 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= ,p=0.000).
80% were geocoded

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

13. 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).

14. 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= ; (p= 0.00)) were found as shown in Table 6.8.

15. 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.

16. 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.

17. 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