The geographic relationship between sexual health deprivation and the Index of Multiple Deprivation 2010: a comparison of two indices.

OBJECTIVES: To construct an Index of Sexual Health Deprivation (ISHD), examine its sensitivity, investigate the association between the ISHD and the Index of Multiple Deprivation 2010 (IMD2010), and interpret the observed geographic variation. METHODS: The modified IMD method was informed by the IMD2010. Thirteen profiles relating to sexual health were selected and grouped into four domains. The observed profile values for each primary care trust (PCT) were smoothed and converted to a normal distribution before principal component analysis. Loadings were used to calculate profile weights. Domain scores were calculated by combining weighted profiles, which were combined to create the ISHD. A Bayesian approach acted as a comparator for the ISHD. RESULTS: Substantial variation in sexual health deprivation was seen across strategic health authorities (SHA). The London SHA had the highest proportion of PCTs (61%) among the most deprived quartile, followed by North-West SHA (29%). More than half of PCTs in East of England (71%), South Central (56%) and South-West (50%) SHAs fell into the least deprived quartile. No PCTs within the East of England, South Central and South-West SHAs were in the most deprived quartile. Only 57% of PCTs were attributed to the same quartile of the ISHD as the IMD2010. The modified IMD method and the Bayesian approach produced consistent results. CONCLUSIONS: The ISHD provides a robust picture of the geography of sexual health and shows a weak association with the IMD2010. It can be used to guide public health action to reduce the geographical gradient in sexual health inequality.

What can be gained from comprehensive disaggregate surveillance? The Avon Surveillance System for Sexually Transmitted Infections.

OBJECTIVE: To describe a new disaggregate surveillance system covering key diagnosed sexually transmitted infections in a UK locality. METHODS: The Avon System for Surveillance of Sexually Transmitted Infections (ASSIST) collects computerised person- and episode-based information about laboratory-diagnosed sexually transmitted infections from genitourinary medicine (GUM) clinics, the Avon Brook Clinic, and the Health Protection Agency and trust laboratories in primary care trusts in Avon. The features of the system are illustrated here, by describing chlamydia-testing patterns according to the source of test, age and sex, and by mapping the distribution of chlamydia across Bristol, UK. RESULTS: Between 2000 and 2004, there were 821,685 records of tests for sexually transmitted infections, with 23,542 positive results. The proportion of tests and positive results for chlamydia and gonorrhoea sent from general practice increased over time. Most chlamydia tests in both GUM and non-specialist settings were performed on women aged >25 years, but positivity rates were highest in women aged <25 years. The positivity rate remained stable between 2000 and 2004. Including data from all diagnostic settings, chlamydia rates were about twice as high as those estimated only from genitourinary clinic cases. CONCLUSIONS: The ASSIST model could be a promising new tool for planning and measuring sexual health services in England if it can become sustainable and provide more timely data using fewer resources. Collecting denominator data and including infections diagnosed in primary care are essential for meaningful surveillance.