Multiple imputation of race and Hispanic ethnicity in national surveillance data for chlamydia, gonorrhea, and syphilis.

BACKGROUND: Disease burden of sexually transmitted infections such as chlamydia, gonorrhea, and syphilis is often compared across age categories, sex categories, and race and ethnicity categories. Missing data may prevent researchers from accurately characterizing health disparities between populations. This article describes the methods used to impute race and Hispanic ethnicity in a large national surveillance data set. METHODS: All US cases of chlamydia, gonorrhea, and syphilis (excluding congenital syphilis) reported through the National Notifiable Diseases Surveillance System (NNDSS) from the year 2019 were included in the analyses. We used fully conditional specification to impute missing race and Hispanic ethnicity data. After imputation, reported case rates were calculated, by disease, for each race and Hispanic ethnicity category using Vintage 2019 Population and Housing Unit Estimates from the US Census. We then used case counts from subsets that contained only complete race and Hispanic ethnicity information to investigate if the confidence intervals from the multiply imputed data included the observed number of cases in each race and Hispanic ethnicity category. RESULTS: Among the 2,553,038 cases reported in 2019, race and Hispanic ethnicity were multiply imputed for 9% of syphilis cases, 22% of gonorrhea cases and 33% of chlamydia cases. In the subset analyses, every non-zero rate of reported cases was contained within the confidence intervals that were calculated from multiply imputed data. CONCLUSIONS: Confidence intervals that account for the uncertainty of the predictions are an advantage of multiple imputation over complete-case analysis because a realistic variance estimate allows for valid hypothesis testing results.

Impact of the COVID-19 Pandemic on Centers for Disease Control and Prevention-Funded Sexually Transmitted Disease Programs.

ABSTRACT: The COVID-19 pandemic impacted sexually transmitted disease (STD) services. Of 59 US-funded STD programs, 91% reported a great deal to moderate impact from staff reassignment in April 2020, with 28% of respondents reporting permanent reassignment of disease intervention specialist staff. Telemedicine was implemented in 47%. Decreases in STD case reports were reported by most jurisdictions.

Trends in Nationally Notifiable Sexually Transmitted Disease Case Reports During the US COVID-19 Pandemic, January to December 2020.

BACKGROUND: To describe changes in reported sexually transmitted diseases (STDs) during the US coronavirus disease 2019 pandemic, we compared the weekly number of reported nationally notifiable STDs in 2020 to 2019. METHODS: We reviewed cases of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis reported to the US National Notifiable Disease Surveillance System in 2020. For each STD, we compare the number of 2020 cases reported for a given Morbidity and Mortality Weekly Report (MMWR) week to the number of 2019 cases reported in the same week, expressing 2020 cases as a percentage of 2019 cases. We also calculated the percent difference between 2020 and 2019 cumulative case totals as of MMWR week 50 (week of December 9). RESULTS: During MMWR weeks 1 to 11 (week of December 29, 2019-March 11, 2020), the weekly number of cases of STDs reported in 2020 as a percentage of the cases in the same week in 2019 was similar. However, 2020 numbers were much lower than 2019 numbers in week 15 (week of April 8; chlamydia, 49.8%; gonorrhea, 71.2%; and P&S syphilis, 63.7%). As of week 50, the 2020 cumulative totals compared with 2019 were 14.0% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for P&S syphilis. CONCLUSIONS: During March-April 2020, national case reporting for STDs dramatically decreased compared with 2019. However, resurgence in reported gonorrhea and syphilis cases later in the year suggests STD reporting may have increased in 2020, underscoring the importance of continued STD prevention and care activities.

The Impact of HIV Infection on TB Disparities Among US-Born Black and White Tuberculosis Patients in the United States.

BACKGROUND/OBJECTIVES: US-born non-Hispanic black persons (blacks) (12% of the US population) accounted for 41% of HIV diagnoses during 2008-2014. HIV infection significantly increases TB and TB-related mortality. TB rate ratios were 6 to 7 times as high in blacks versus US-born non-Hispanic whites (whites) during 2013-2016. We analyzed a sample of black and white TB patients to assess the impact of HIV infection on TB racial disparities. METHODS: In total, 552 black and white TB patients with known HIV/AIDS status were recruited from 10 US sites in 2009-2010. We abstracted data from the National TB Surveillance System, medical records, and death certificates and interviewed 477 patients. We estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for associations of TB with HIV infection, late HIV diagnosis (≤3 months before or any time after TB diagnosis), and mortality during TB treatment. RESULTS: Twenty-one percent of the sample had HIV/AIDS infection. Blacks (AOR = 3.4; 95% CI, 1.7-6.8) and persons with recent homelessness (AOR = 2.5; 95% CI, 1.5-4.3) had greater odds of HIV infection than others. The majority of HIV-infected/TB patients were diagnosed with HIV infection 3 months or less before (57%) or after (4%) TB diagnosis. Among HIV-infected/TB patients, blacks had similar percentages to whites (61% vs 57%) of late HIV diagnosis. Twenty-five percent of HIV-infected/TB patients died, 38% prior to TB diagnosis and 62% during TB treatment. Blacks did not have significantly greater odds of TB-related mortality than whites (AOR = 1.1; 95% CI, 0.6-2.1). CONCLUSIONS: Black TB patients had greater HIV prevalence than whites. While mortality was associated with HIV infection, it was not significantly associated with black or white race.

Participation in Community Preparedness Programs in Human Services Organizations and Faith-Based Organizations - New York City, 2018.

Community-based organizations have a long history of engagement with public health issues; these relationships can contribute to disaster preparedness (1,2). Preparedness training improves response capacity and strengthens overall resilience (1). Recognizing the importance of community-based organizations in community preparedness, the Office of Emergency Preparedness and Response in New York City's (NYC's) Department of Health and Mental Hygiene (DOHMH) launched a community preparedness program in 2016 (3), which engaged two community sectors (human services and faith-based). To strengthen community preparedness for public health emergencies in human services organizations and faith-based organizations, the community preparedness program conducted eight in-person preparedness trainings. Each training focused on preparedness topics, including developing plans for 1) continuity of operations, 2) emergency management, 3) volunteer management, 4) emergency communications, 5) emergency notification systems, 6) communication with persons at risk, 7) assessing emergency resources, and 8) establishing dedicated emergency funds (2,3). To evaluate training effectiveness, data obtained through online surveys administered during June-September 2018 were analyzed using multivariate logistic regression. Previously described preparedness indicators among trained human services organizations and faith-based organizations were compared with those of organizations that were not trained (3). Participation in the community preparedness program training was associated with increased odds of meeting preparedness indicators. NYC's community preparedness program can serve as a model for other health departments seeking to build community preparedness through partnership with community-based organizations.

Preassessment of Community-Based Organization Preparedness in Two Sectors, Human Services and Faith Based: New York City, 2016.

Objectives. To determine the level of preparedness among New York City community-based organizations by using a needs assessment.Methods. We distributed online surveys to 582 human services and 6017 faith-based organizations in New York City from March 17, 2016 through May 11, 2016. We calculated minimal indicators of preparedness to determine the proportion of organizations with preparedness indicators. We used bivariate analyses to examine associations between agency characteristics and minimal preparedness indicators.Results. Among the 210 human service sector respondents, 61.9% reported emergency management plans and 51.9% emergency communications systems in place. Among the 223 faith-based respondents, 23.9% reported emergency management plans and 92.4% emergency communications systems in place. Only 10.0% of human services and 18.8% of faith-based organizations reported having funds allocated for emergency response. Only 2.9% of human services sector and 39.5% of faith-based sector respondents reported practicing emergency communication alerts.Conclusions. New York City human service and faith-based sector organizations are striving to address emergency preparedness concerns, although notable gaps are evident.Public Health Implications. Our results can inform the development of metrics for community-based organizational readiness.

Performance of Point of Dispensing Setup Drills for Distribution of Medical Countermeasures: United States and Territories, 2012-2016.

OBJECTIVES: To describe results of points of dispensing (POD) medical countermeasure drill performance among local jurisdictions. METHODS: To compare POD setup times for each year, we calculated descriptive statistics of annual jurisdictional POD setup data submitted by over 400 local jurisdictions across 50 states and 8 US territories to a Centers for Disease Control and Prevention (CDC) program monitoring database from July 2012 to June 2016. RESULTS: In data collected from July 2012 to June 2015, fewer than 5% of PODs required more than 240 minutes to set up, although the proportion increased from July 2015 to June 2016 to almost 12%. From July 2012 to June 2016, more than 60% of PODs were set up in less than 90 minutes, with 60 minutes as the median setup time during the period. CONCLUSIONS: Our results yield evidence of national progress for response to a mass medical emergency. Technical assistance may be required to aid certain jurisdictions for improvement. Public Health Implications. The results of this study may inform future target times for performance on POD setup activities and highlight jurisdictions in need of technical assistance.

Mortality hazard and survival after tuberculosis treatment.

OBJECTIVES: We compared mortality among tuberculosis (TB) survivors and a similar population. METHODS: We used local health authority records from 3 US sites to identify 3853 persons who completed adequate treatment of TB and 7282 individuals diagnosed with latent TB infection 1993 to 2002. We then retrospectively observed mortality after 6 to 16 years of observation. We ascertained vital status as of December 31, 2008, using the Centers for Disease Control and Prevention's National Death Index. We analyzed mortality rates, hazards, and associations using Cox regression. RESULTS: We traced 11 135 individuals over 119 772 person-years of observation. We found more all-cause deaths (20.7% vs 3.1%) among posttreatment TB patients than among the comparison group, an adjusted average excess of 7.6 deaths per 1000 person-years (8.8 vs 1.2; P < .001). Mortality among posttreatment TB patients varied with observable factors such as race, site of disease, HIV status, and birth country. CONCLUSIONS: Fully treated TB is still associated with substantial mortality risk. Cure as currently understood may be insufficient protection against TB-associated mortality in the years after treatment, and TB prevention may be a valuable opportunity to modify this risk.

Associations between vaccination and childhood cancers in Texas regions.

OBJECTIVES: To determine whether children born in Texas regions with higher vaccination coverage had reduced risk of childhood cancer. STUDY DESIGN: The Texas Cancer Registry identified 2800 cases diagnosed from 1995 to 2006 who were (1) born in Texas and (2) diagnosed at ages 2 to 17 years. The state birth certificate data were used to identify 11 200 age- and sex-matched control subjects. A multilevel mixed-effects regression model compared vaccination rates among cases and control subjects at the public health region and county level. RESULTS: Children born in counties with higher hepatitis B vaccine coverage had lower odds of all cancers combined (OR = 0.81, 95% CI: 0.67 to 0.98) and acute lymphoblastic leukemia (ALL) specifically (OR = 0.63, 95% CI: 0.46 to 0.88). A decreased odds for ALL also was associated at the county level with higher rates of the inactivated poliovirus vaccine (OR = 0.67, 95% CI: 0.49 to 0.92) and 4-3-1-3-3 vaccination series (OR = 0.62, 95% CI: 0.44 to 0.87). Children born in public health regions with higher coverage levels of the Haemophilus influenzae type b-conjugate vaccine had lower odds of ALL (OR: 0.58; 95% CI: 0.42 to 0.82). CONCLUSIONS: Some common childhood vaccines appear to be protective against ALL at the population level.