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Poster Session I: Congenital Syphilis & Syphilis in Pregnancy

(P5) PREVALENCE AND RISK FACTORS ASSOCIATED WITH SYPHILIS AND CONGENTIAL SYPHILIS IN US COUNTIES 2018

Tuesday, September 17, 2024
4:15 PM - 5:15 PM EST
Background:
Syphilis and congenital syphilis (CS) have long been associated with poverty yet little is known if persistent poverty (counties with a poverty rate of >20% for 30+ years) have higher incidence of syphilis. We investigated the prevalence and the associated risk factors with syphilis and CS in US counties with or without persistent poverty.

Methods:
We used county-level syphilis data from the CDC's NCHHSTP AtlasPlus and the Agency for Healthcare Research and Quality (AHRQ), 2018. We used negative binomial regression models adjusting for age, sex, race/ethnicity, health insurance, geographic area, income, single parent, and rural/urban.

Results:
In counties with persistent poverty, syphilis and CS prevalence was nearly double that of non-persistent poverty counties (11.2/100,000 vs 5.6/100,000 and 134/100,000 vs 60/100,000 respectively). In counties with persistent poverty, syphilis rate ratios were higher in counties with higher populations of Blacks RR 1.01 (95% CI 1.001-1.03) and RR 1.02 (95% CI 1.008-1.04). CS rate ratios in persistent poverty counties were lower among Whites RR 0.93 (95% CI 0.89-0.97) and in the Northeast. Non-persistent poverty counties had higher rate ratios of syphilis associated with single parent households RR 1.01 (95% CI 1.006-1.02), uninsured, the South and West regions. CS rates in non-persistent poverty counties were higher in counties with higher rates of uninsured individuals.

Conclusion:
Persistent poverty counties have significantly higher rates of syphilis and CS compared to counties without persistent poverty but these rates were lower among counties with higher white populations concerning for ongoing racial disparities especially with higher rates of maternal mortality among Black women. More research is needed to better understand the underlying disparities and to initiate strategies to address racial disparities, improve healthcare access, and improve STI health literacy.