SOCIODEMOGRAPHIC FACTORS AND THE VARIATION IN SYPHILIS RATES AMONG USCOUNTIES, 1984 THROUGH 1993 - AN ECOLOGICAL ANALYSIS

Objectives. Syphilis: in the United States is focally distributed, wit h high incidence rates in the South and in metropolitan areas nationwi de. In this study an ecological analysis, using-the county as the unit of analysis, was performed; to generate hypotheses about community-le vel determinants of syphilis rates. Methods. Bivariate rank correlatio ns and multivariate, backward stepwise elimination linear regressions were performed. Mean annual incidence of primary- and secondary-stage syphilis in a county was the dependent variable, and county sociodemog raphic characteristics (from census data) were the independent variabl es. Results. In the multivariate recession model, sociodemographic cha racteristics accounted for 71% of the variation in syphilis rates amon g counties. With other factors accounted for, the most highly correlat ed characteristics were percentage non-Hispanic Black population, coun ty location in the South, percentage of the population that was urban, percentage Hispanic population, and percentage of births to women you nger than 20 years. Conclusions. Most of the variation in syphilis rat es among counties is accounted for by sociodemographic characteristics . Identification and remediation of modifiable health determinants for which these factors are markers are needed to improve the health stat us of these populations.