Influence of study population on the identification of risk factors for sexually transmitted diseases using a case-control design: The example of gonorrhea
Influence of study population on the identification of risk factors for sexually transmitted diseases using a case-control design: The example of gonorrhea
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DOI：
10.1093/aje/kwh220
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发表时间：
2004-08-15
影响因子：
5
通讯作者：
Foxman, B
中科院分区：
文献类型：
--
作者：
Manhart, LE;Aral, SO;Foxman, B
许多性传播疾病 (STD) 的人口患病率较低。因此，大多数性病流行病学研究都是在性病诊所人群中进行，以最大限度地提高效率。然而，性病门诊患者具有独特的社会行为特征。为了检验研究人群对识别危险因素的潜在影响，作者比较了 1) STD 诊所患者与随机数字拨号电话样本，2) 一般人群病例与随机数字拨号对照，以及 3) STD 诊所病例与 STD 诊所对照（西雅图，华盛顿，1992-1995 年）。在 STD 诊所患者中发现的淋病危险因素构成了在一般人群中发现的危险因素的一部分。在这两个人群中，风险随着年龄的增长而降低（一般人群的优势比（ORGP）= 0.4，95％置信区间（CI）：0.22，0.59；临床人群的优势比（ORclinic）= 0.5，95％CI：0.30，0.81），并且在黑人中风险增加（ORGP=15.5，95％CI：4.93， 49.0；ORclinic = 10.5，95% CI：4.51，24.68）及其伴侣入狱的人（ORGP = 5.4，95% CI：2.07，13.9；ORclinic = 3.1，95% CI：1.32，7.30）。与一般人群中淋病相关的其他因素包括中等教育（OR = 0.3，95% CI：0.11，0.70）、肛交（OR = 10.5，95% CI：2.01、54.7）、性病史（OR = 5.9，95% CI：1.76、19.5）、在结构化环境中会见伴侣（OR = 0.2、 95% CI: 0.09, 0.50)、不使用安全套 (OR = 3.2, 95% CI: 1.30, 7.89) 和离婚 (OR = 3.6, 95% CI: 1.07, 11.9)。可能会被错过。
The population prevalence of many sexually transmitted diseases (STDs) is low. Thus, most epidemiologic studies of STDs are conducted among STD clinic populations to maximize efficiency. However, STD clinic patients have unique sociobehavioral characteristics. To examine the potential effect of study population on identification of risk factors, the authors compared 1) STD clinic patients with a random digit dialing telephone sample, 2) general population cases with random digit dialing controls, and 3) STD clinic cases with STD clinic controls (Seattle, Washington, 1992-1995). Risk factors for gonorrhea identified among STD clinic patients formed a subset of those identified in the general population. In both populations, risk decreased with age (odds ratio for the general population (ORGP) = 0.4, 95% confidence interval (CI): 0.22, 0.59; odds ratio for the clinic population (ORclinic) = 0.5, 95% CI: 0.30, 0.81) and was increased among Blacks (ORGP = 15.5, 95% CI: 4.93, 49.0; ORclinic = 10.5, 95% CI: 4.51, 24.68) and persons whose partner had been jailed (ORGP = 5.4, 95% CI: 2.07, 13.9; ORclinic = 3.1, 95% CI: 1.32, 7.30). Additional factors associated with gonorrhea in the general population included secondary education (OR = 0.3, 95% CI: 0.11, 0.70), anal intercourse (OR = 10.5, 95% CI: 2.01, 54.7, STD history (OR = 5.9, 95% CI: 1.76, 19.5), meeting partners in structured settings (OR = 0.2, 95% CI: 0.09, 0.50), no condom use (OR = 3.2, 95% CI: 1.30, 7.89), and divorce (OR = 3.6, 95% CI: 1.07, 11.9). Risk factors identified in STD clinics will probably be confirmed in a general population sample, despite overcontrolling for shared behaviors; however, factors associated with both disease and STD clinic attendance may be missed.