256 - The Association Between Childhood Opportunity Index and Rates of Sexually Transmitted Infections by Adolescents Presenting to the Emergency Department

Publication Number: 256.6855

Alicia I. Rolin, Children's National Health System, WASHINGTON, DC, United States; Meleah Boyle, Children's National Health System, Rockville, MD, United States; Jennifer Reed, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Michelle Pickett, Medical College of Wisconsin, Milwaukee, WI, United States; Andrea T. Cruz, Baylor College of Medicine, Houston, TX, United States; Erin Augustine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Cynthia Mollen, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sarah Schmidt, Children's Hospital Colorado, Denver, CO, United States; Kristin S. Stukus, Nationwide Children’s Hospital, Columbus, OH, United States; Charles Casper, University of Utah School of Medicine, Salt Lake City, UT, United States; Monika Goyal, Children's National Health System, Washington, DC, United States

Background: Sexually transmitted infections (STI) disproportionally affect adolescents. While the risk of contracting an STI is dependent on one’s behaviors, an individual’s health outcome is highly dependent on where they live and interact, exerting influence through sexual networks, risk behaviors, and access to healthcare. The Childhood Opportunity Index (COI) is a unique composite index that accounts for community-level factors affecting child development across three domains: education, health and environment, and social and economic. The COI is reported as five categories from “Very High” to “Very Low.” Previous studies have identified COI as a predictor of morbidity related to asthma, diabetes, appendicitis, and firearm injury.

Objective: The objective of this study was to understand the relationship between the COI and adolescent rates of STIs. Understanding the relationship between community-level factors and STI rates may inform and direct public health interventions.

Design/Methods: This is a secondary analysis of a pragmatic trial evaluating broadscale adolescent STI screening strategies across six pediatric EDs through the Pediatric Emergency Care Applied Research Network. Patients were included if they were 15-21 years and underwent testing for Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (GC) from January 2020 - March 2023. Patient addresses were geocoded into census tracts using the US Census Bureau’s Geocoder tool and were linked to the COI 3.0. Multivariable Poisson regression models were used to evaluate the association between COI and STI rates. Statistical analysis was performed using STATA.

Results: There were a total of 8,061 CT/GC tests performed, of which 7,713 (95.7%) had geocoded addresses that were linked with COI. Of these 7,713 visits, there were 1,259 positive tests (16.3%). There was an average of 3.2 GC/CT tests performed per census tract (SD 5.3). Patients living in metropolitan areas (96.7%) comprised the majority of GC/CT testing, with < 1% of tests performed on patients in small town or rural areas. In the overall Poisson multivariable model adjusting for RUCA, positive STI tests were inversely related to the COI (Table 1). Patients living in an area with “Very Low” COI had a significantly higher STI incident rate compared to patients living in an area with “Very High” COI (IRR: 3.12 95% CI [2.45, 3.96]).

Conclusion(s): Patients living in areas with lower COI were more likely to have positive STI tests as compared to individuals in areas with higher COI. More research is needed to identify community and neighborhood level factors that contribute to disparate STI rates.

Table 1: Association between STI Rates and Child Opportunity Index
Poisson model adjusted for level of urbanization