(P12) ASSESSING THE RELATIONSHIP BETWEEN COUNTY-LEVEL MATERNITY CARE ACCESS AND CONGENITAL SYPHILIS AND SYPHILIS CASE RATES

Background:
Primary and secondary (P&S) and congenital syphilis (CS) rates in the U.S. have rapidly increased in recent years. Numerous individual factors contribute to rising syphilis rates, but important structural factors are less often described. We explored how access to maternity care may contribute to rising syphilis and CS rates.

Methods:
We conducted an ecological study examining trends in syphilis and CS rates by maternity care access (MCA) over time using Area Health Resource Files data and criteria outlined by March of Dimes (access to hospitals with obstetric beds and obstetric providers) to define four categories of county-level MCA from 2016—2021: deserts, low, moderate, and high. CS rates and P&S syphilis rates among women of reproductive age (WRA), 15-44 years, were extracted from the National Notifiable Diseases Surveillance System. Rates are reported as cases per 100,000 live births for CS or cases per 100,000 WRA for P&S.

Results:
Access to maternity care remained consistent from 2016—2021. Most counties were classified as deserts (42%) or high access (40%); few were low (10%) or moderate access (8%). Rates of CS and P&S were generally highest in high MCA and low MCA counties throughout the study period.

CS rates increased over time for all MCA levels, and the largest absolute increase was in low MCA counties (low: 10.5 to 88.2, high: 17.2 to 79.3; desert: 10.2 to 62.0; moderate: 7.2 to 43.0). P&S syphilis rates followed a similar pattern; rates increased across all MCA levels and the largest increase was in low MCA counties (low: 3.3 to 22.1; high: 4.4 to 16.0; desert: 2.4 to 18.7; moderate: 2.4 to 14.4).

Conclusion:
Both CS and P&S case rates increased across all levels of MCA. Further research into structural barriers to syphilis and CS prevention, care, and treatment are needed to address the continued rise in cases.