Examining socioeconomic inequalities in chlamydia screening and disease in young people
Lead Research Organisation:
University College London
Department Name: Epidemiology and Public Health
Abstract
Chlamydia is a common sexually transmitted infection, which can cause infertility in later life. Most people with chlamydia do not know they are infected – they experience no symptoms. Screening can detect chlamydia in a urine sample or swab, so those infected can be treated.
In England, the National Chlamydia Screening Programme (NCSP) offers screening to sexually active people under 25. To be most effective, the NCSP needs to screen people most at risk of chlamydia. Although we do not know which young people are at greatest risk, in general people in deprived circumstances often suffer poorer health than affluent groups, so the NCSP need to make sure screening is offered to these people. Researchers measure deprivation in many ways, e.g. using income, education, characteristics of the local area. However, we do not know which measures are most relevant for young people at risk of chlamydia.
I plan to improve how we measure deprivation in young people, in order to investigate inequalities associated with chlamydia and screening. The findings of this study will help the NCSP to monitor service use and to identify those at high risk of chlamydia. It should also help other services to reduce inequalities in young people.
In England, the National Chlamydia Screening Programme (NCSP) offers screening to sexually active people under 25. To be most effective, the NCSP needs to screen people most at risk of chlamydia. Although we do not know which young people are at greatest risk, in general people in deprived circumstances often suffer poorer health than affluent groups, so the NCSP need to make sure screening is offered to these people. Researchers measure deprivation in many ways, e.g. using income, education, characteristics of the local area. However, we do not know which measures are most relevant for young people at risk of chlamydia.
I plan to improve how we measure deprivation in young people, in order to investigate inequalities associated with chlamydia and screening. The findings of this study will help the NCSP to monitor service use and to identify those at high risk of chlamydia. It should also help other services to reduce inequalities in young people.
Technical Summary
Background: Chlamydia trachomatis is a significant public health problem. It affects up to one in 10 young people in England, increasing their risk of ectopic pregnancy and infertility, and may be more common in deprived groups. Screening has been developed using reliable diagnostic techniques to detect the high proportion of asymptomatic infections. The National Chlamydia Screening Programme (NCSP) in England offers screening to sexually active people under the age of 25 regardless of socioeconomic status.
However, the Inverse Care Law - The availability of good medical care tends to vary inversely with the need for it in the population served - has been demonstrated across NHS services including screening programmes. Initial analysis, based on routine area deprivation indicators, suggested the Law may not apply to chlamydia screening, but it did highlight two methodological problems:
a) it is not clear which indicators should be selected to investigate associations between deprivation and sexually transmitted infections (STIs);
b) commonly used deprivation measures may not be appropriately applied to young people.
Aims: This project will
- identify the most appropriate indicators of deprivation to use in young people;
- apply these indicators to the NCSP dataset to examine socioeconomic inequalities in chlamydia positivity and screening, to assess progress towards reducing inequalities.
Design: a mixed methods approach will be employed, combining a qualitative study in young people to inform a cross-sectional, quantitative analysis of chlamydia positivity and screening.
Methodology
Study 1: a systematic literature review will explore advantages and limitations of using different deprivation measures in STI research in young people, and will bring together existing theory and empirical literature to develop a theoretical model linking deprivation and chlamydia. This will be tested in study 3;
Study 2: focus groups with young people will be conducted to understand how geographical contexts influence risk behaviours, networks and service use that impact on STIs, in order to select appropriate areas for deprivation analysis;
Study 3: NCSP will collect further individual and area deprivation data, informed by studies 1 and 2, from screening providers. This multilevel dataset will be analysed to examine associations between deprivation, chlamydia screening coverage and positivity in young people.
Scientific and medical opportunities: This study will enable NCSP to monitor service use and to identify groups at higher risk of chlamydia. The identification of appropriate deprivation indicators for young people will also be of generalisable significance for analyses of social variations in healthcare use.
However, the Inverse Care Law - The availability of good medical care tends to vary inversely with the need for it in the population served - has been demonstrated across NHS services including screening programmes. Initial analysis, based on routine area deprivation indicators, suggested the Law may not apply to chlamydia screening, but it did highlight two methodological problems:
a) it is not clear which indicators should be selected to investigate associations between deprivation and sexually transmitted infections (STIs);
b) commonly used deprivation measures may not be appropriately applied to young people.
Aims: This project will
- identify the most appropriate indicators of deprivation to use in young people;
- apply these indicators to the NCSP dataset to examine socioeconomic inequalities in chlamydia positivity and screening, to assess progress towards reducing inequalities.
Design: a mixed methods approach will be employed, combining a qualitative study in young people to inform a cross-sectional, quantitative analysis of chlamydia positivity and screening.
Methodology
Study 1: a systematic literature review will explore advantages and limitations of using different deprivation measures in STI research in young people, and will bring together existing theory and empirical literature to develop a theoretical model linking deprivation and chlamydia. This will be tested in study 3;
Study 2: focus groups with young people will be conducted to understand how geographical contexts influence risk behaviours, networks and service use that impact on STIs, in order to select appropriate areas for deprivation analysis;
Study 3: NCSP will collect further individual and area deprivation data, informed by studies 1 and 2, from screening providers. This multilevel dataset will be analysed to examine associations between deprivation, chlamydia screening coverage and positivity in young people.
Scientific and medical opportunities: This study will enable NCSP to monitor service use and to identify groups at higher risk of chlamydia. The identification of appropriate deprivation indicators for young people will also be of generalisable significance for analyses of social variations in healthcare use.