Differences in  Chlamydia trachomatis  seroprevalence between ethnic groups cannot be fully explained by socioeconomic status, sexual healthcare seeking behavior or sexual risk behavior: a cross-sectional analysis in the HEalthy LIfe in an Urban Setting (HELIUS) study

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Abstract

Background

In the Netherlands, there are strong disparities in Chlamydia trachomatis (CT) prevalence between ethnic groups. The current study aims to identify whether socioeconomic status, sexual risk behavior and sexual healthcare seeking behavior may explain differences in CT seroprevalence between ethnic groups.

Methods

We used 2011–2014 baseline data of the HELIUS (HEalthy LIfe in an Urban Setting) study, a multi-ethnic population-based cohort study in Amsterdam, the Netherlands, including participants from Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Moroccan and Turkish origin. For this analysis, we selected sexually active, heterosexual participants aged 18–34 years old. CT seroprevalence was determined using a multiplex serology assay. The CT seroprevalence ratios between different ethnicities are calculated and adjusted for potential indicators of socioeconomic status, sexual risk behavior and sexual healthcare seeking behavior.

Results

The study population consisted of 2001 individuals (52.8% female) with a median age of 28 years (IQR 24–31). CT seropositivity differed by ethnicities and ranged from 71.6% (African Surinamese), and 67.9% (Ghanaian) to 31.1% (Turkish). The CT seroprevalence ratio of African Surinamese was 1.72 (95% CI 1.43–2.06) and 1.52 (95% CI 1.16–1.99) of Ghanaian as compared to the Dutch reference group, after adjustment for socioeconomic status, sexual risk behavior and sexual healthcare seeking behavior.

Conclusions

Indicators of socioeconomic status, sexual risk behavior, and sexual health seeking behavior could not explain the higher CT seroprevalence among African Surinamese and Ghanaian residents of Amsterdam.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3533-7) contains supplementary material, which is available to authorized users.

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Most cited references 25

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The Vaginal Microbiota: What Have We Learned after a Decade of Molecular Characterization?

Janneke H. H. M. van de Wijgert, Hanneke Borgdorff, Rita Verhelst … (2014)

We conducted a systematic review of the Medline database (U.S. National Library of Medicine, National Institutes of Health, Bethesda, MD, U.S.A) to determine if consistent molecular vaginal microbiota (VMB) composition patterns can be discerned after a decade of molecular testing, and to evaluate demographic, behavioral and clinical determinants of VMB compositions. Studies were eligible when published between 1 January 2008 and 15 November 2013, and if at least one molecular technique (sequencing, PCR, DNA fingerprinting, or DNA hybridization) was used to characterize the VMB. Sixty three eligible studies were identified. These studies have now conclusively shown that lactobacilli-dominated VMB are associated with a healthy vaginal micro-environment and that bacterial vaginosis (BV) is best described as a polybacterial dysbiosis. The extent of dysbiosis correlates well with Nugent score and vaginal pH but not with the other Amsel criteria. Lactobacillus crispatus is more beneficial than L. iners. Longitudinal studies have shown that a L. crispatus-dominated VMB is more likely to shift to a L. iners-dominated or mixed lactobacilli VMB than to full dysbiosis. Data on VMB determinants are scarce and inconsistent, but dysbiosis is consistently associated with HIV, human papillomavirus (HPV), and Trichomonas vaginalis infection. In contrast, vaginal colonization with Candida spp. is more common in women with a lactobacilli-dominated VMB than in women with dysbiosis. Cervicovaginal mucosal immune responses to molecular VMB compositions have not yet been properly characterized. Molecular techniques have now become more affordable, and we make a case for incorporating them into larger epidemiological studies to address knowledge gaps in etiology and pathogenesis of dysbiosis, associations of different dysbiotic states with clinical outcomes, and to evaluate interventions aimed at restoring and maintaining a lactobacilli-dominated VMB.

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The utility of 'country of birth' for the classification of ethnic groups in health research: the Dutch experience.

Karien Stronks, Isik Kulu-Glasgow, Charles Agyemang (2009)

The relationship between ethnicity and health is attracting increasing attention in international health research. Different measures are used to operationalise the concept of ethnicity. Presently, self-definition of ethnicity seems to gain favour. In contrast, in the Netherlands, the use of country of birth criteria have been widely accepted as a basis for the identification of ethnic groups. In this paper, we will discuss its advantages as well as its limitations and the solutions to these limitations from the Dutch perspective with a special focus on survey studies. The country of birth indicator has the advantage of being objective and stable, allowing for comparisons over time and between studies. Inclusion of parental country of birth provides an additional advantage for identifying the second-generation ethnic groups. The main criticisms of this indicator seem to refer to its validity. The basis for this criticism is, firstly, the argument that people who are born in the same country might have a different ethnic background. In the Dutch context, this limitation can be addressed by the employment of additional indicators such as geographical origin, language, and self-identified ethnic group. Secondly, the country of birth classification has been criticised for not covering all dimensions of ethnicity, such as culture and ethnic identity. We demonstrate in this paper how this criticism can be addressed by the use of additional indicators. In conclusion, in the Dutch context, country of birth can be considered a useful indicator for ethnicity if complemented with additional indicators to, first, compensate for the drawbacks in certain conditions, and second, shed light on the mechanisms underlying the association between ethnicity and health.

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Unravelling the impact of ethnicity on health in Europe: the HELIUS study

Karien Stronks, Marieke Snijder, Ron JG Peters … (2013)

Background Populations in Europe are becoming increasingly ethnically diverse, and health risks differ between ethnic groups. The aim of the HELIUS (HEalthy LIfe in an Urban Setting) study is to unravel the mechanisms underlying the impact of ethnicity on communicable and non-communicable diseases. Methods/design HELIUS is a large-scale prospective cohort study being carried out in Amsterdam, the Netherlands. The sample is made up of Amsterdam residents of Surinamese (with Afro-Caribbean Surinamese and South Asian-Surinamese as the main ethnic groups), Turkish, Moroccan, Ghanaian, and ethnic Dutch origin. HELIUS focuses on three disease categories: cardiovascular disease (including diabetes), mental health (depressive disorders and substance use disorders), and infectious diseases. The explanatory mechanisms being studied include genetic profile, culture, migration history, ethnic identity, socio-economic factors and discrimination. These might affect disease risks through specific risk factors including health-related behaviour and living and working conditions. Every five years, participants complete a standardized questionnaire and undergo a medical examination. Biological samples are obtained for diagnostic tests and storage. Participants’ data are linked to morbidity and mortality registries. The aim is to recruit a minimum of 5,000 respondents per ethnic group, to a total of 30,000 participants. Discussion This paper describes the rationale, conceptual framework, and design and methods of the HELIUS study. HELIUS will contribute to an understanding of inequalities in health between ethnic groups and the mechanisms that link ethnicity to health in Europe.

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Author and article information

Contributors

Sebastiaan H. Hulstein:

ORCID: http://orcid.org/0000-0003-3328-3062

bhulstein@ggd.amsterdam.nl , s.h.hulstein@amc.nl

Amy Matser: amatser@ggd.amsterdam.nl

Catharina J. Alberts: catharina.j.alberts@gmail.com

Marieke B. Snijder: m.b.snijder@amc.nl

Martina Willhauck-Fleckenstein: mwf-kg@willhauck.de

Katrin Hufnagel: k.hufnagel@Dkfz-Heidelberg.de

Maria Prins: mprins@ggd.amsterdam.nl

Henry J. C. de Vries: h.j.devries@amc.nl

Maarten F. Schim van der Loeff: mschim@ggd.amsterdam.nl

Tim Waterboer: T.Waterboer@dkfz-heidelberg.de

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 3 December 2018

Publication date PMC-release: 3 December 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 612

Affiliations

[1 ]ISNI 0000 0000 9418 9094, GRID grid.413928.5, Department of Infectious Diseases, , Public Health Service of Amsterdam (GGD Amsterdam), ; Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands

[2 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Internal Medicine, , Amsterdam Institute for Infection and Immunity (AI&II), Academic Medical Center, ; Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

[3 ]Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

[4 ]Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

[5 ]ISNI 0000 0004 0492 0584, GRID grid.7497.d, Molecular Diagnostics of Oncogenic Infections Division, German Cancer Research Center (Deutsches Krebsforschungszentrum DKFZ), ; Im Neuenheimer Feld 280, 69120 Heidelberg, Germany

[6 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Dermatology, , Academic Medical Center, ; Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Author information

Sebastiaan H. Hulstein http://orcid.org/0000-0003-3328-3062

Article

Publisher ID: 3533

DOI: 10.1186/s12879-018-3533-7

PMC ID: 6278015

PubMed ID: 30509189

SO-VID: 98bbb1ca-98a4-4cae-9856-41fae8c42d72

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 May 2018

Date accepted : 20 November 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002996, Hartstichting;

Award ID: 2010T084

Funded by: FundRef http://dx.doi.org/10.13039/501100001826, ZonMw;

Award ID: 200500003

Funded by: European Integration Fund

Award ID: 2013EIF013

Funded by: FP7 Ideas: European Research Council ()

Award ID: 278901

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: ethnicity,chlamydia trachomatis,sexual healthcare seeking behavior,socioeconomic status,sexual risk behavior

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: ethnicity, chlamydia trachomatis, sexual healthcare seeking behavior, socioeconomic status, sexual risk behavior

Differences in Chlamydia trachomatis seroprevalence between ethnic groups cannot be fully explained by socioeconomic status, sexual healthcare seeking behavior or sexual risk behavior: a cross-sectional analysis in the HEalthy LIfe in an Urban Setting (HELIUS) study

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Point-Of-Care Testing for STIs

Most cited references 25

The Vaginal Microbiota: What Have We Learned after a Decade of Molecular Characterization?

The utility of 'country of birth' for the classification of ethnic groups in health research: the Dutch experience.

Unravelling the impact of ethnicity on health in Europe: the HELIUS study

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