Does core area theory apply to sexually transmitted diseases in rural environments?
Does core area theory apply to sexually transmitted diseases in rural environments?
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DOI：
10.1097/olq.0b013e3182762524
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发表时间：
2013-01
影响因子：
3.1
通讯作者：
Miller WC
中科院分区：
文献类型：
--
作者：
Gesink DC;Sullivan AB;Norwood TA;Serre ML;Miller WC
我们的目标是确定淋病和梅毒的地理核心区在农村地区与城市地区相比的程度。淋病发病率（2005年1月1日至2010年12月31日）和梅毒发病率（1999年1月1日至2010年12月31日）按人口普查区域和季度进行估计和绘制。乡村性是用农村和城乡通勤区（RUCA;农村、小城镇、小都市或城市）的百分比来衡量的。SaTScan用于识别感染率显著升高的时空集群。持续五年或更长时间的集群被认为是核心地区;持续时间较短的集群被认为是爆发。聚类覆盖在乡村地图上，并定性评估相关性。确定了20个淋病核心区; 65%在城市中心，25%在小都市地区，其余10%在地理上是城市、小都市、小城镇和农村环境的大捕获组合。确定了10个梅毒核心区，其中80%在城市中心，20%捕获两个或更多RUCA。10个梅毒核心区（100%）与淋病核心区重叠。北卡罗来纳州农村地区的淋病和梅毒发病率很高;然而，没有专门为小城镇或农村地区确定的核心地区。农村性传播感染的主要传播途径可能是通过城市、小都市、小城镇和农村地区的相互联系。直接解决城市和小城市社区的性传播感染问题也可能间接有助于解决农村和小城镇社区的性传播感染率问题。
Our objective was to determine the extent to which geographical core areas for gonorrhea and syphilis are located in rural areas, as compared to urban areas. Incident gonorrhea (January 1, 2005 to December 31, 2010) and syphilis (January 1, 1999 to December 31, 2010) rates were estimated and mapped by census tract and quarter. Rurality was measured using percent rural and rural-urban commuting area (RUCA; rural, small town, micropolitan, or urban). SaTScan was used to identify spatiotemporal clusters of significantly elevated rates of infection. Clusters lasting five years or longer were considered core areas; clusters of shorter duration were considered outbreaks. Clusters were overlaid on maps of rurality and qualitatively assessed for correlation. Twenty gonorrhea core areas were identified; 65% in urban centers, 25% in micropolitan areas, and the remaining 10% were geographically large capturing combinations of urban, micropolitan, small town and rural environments. Ten syphilis core areas were identified with 80% in urban centers and 20% capturing two or more RUCAs. All ten of the syphilis core areas (100%) overlapped with gonorrhea core areas. Gonorrhea and syphilis rates were high for rural parts of North Carolina; however, no core areas were identified exclusively for small towns or rural areas. The main pathway of rural STI transmission may be through the interconnectedness of urban, micropolitan, small town and rural areas. Directly addressing STIs in urban and micropolitan communities may also indirectly help address STI rates in rural and small town communities.