The Association Between Social Determinants of Health and Case Rates of Sexually Transmitted Infections at the County-level in the U. S. from 2000-2019.

Introduction: Sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis, remain a serious public health concern in the United States. Social determinants of health (SDOH), such as local social capital, eviction rate, and prison incarceration rate, impact health outcomes and potentially influence risk of STI acquisition and transmission. This study investigated longitudinal associations between SDOH and STI case rates at the county-level in the U.S. over 20-years from 2000 to 2019.

Methods: We compiled data on SDOH and annual STI case rates (chlamydia, gonorrhea, and syphilis) for all U.S. counties over the 20-year period. Panel regression models were employed to examine associations between SDOH and STI case rates, controlling for confounders.

Results: We found significant links between social capital, eviction rate, prison incarceration rate and STI case rates. Higher social capital was associated with lower chlamydia (β=-6.77, p<.05) and gonorrhea rates (β=-7.22, p<.01), while higher eviction rates were associated with higher rates of all three STIs (β=9.71, p<.001 for chlamydia, β=7.32, p<.001 for gonorrhea, and β=.15, p<.001 for P&S syphilis, respectively) and higher prison incarceration rates were associated with higher gonorrhea rates (β=.13, p<.05).

Conclusions: This study provides valuable insights into the annual associations of social determinants on STI rates over 20 years. These findings inform the development of effective interventions and policies to address rising STI case rates and promote health equity across diverse communities.