Background: Since 2013, national trends in behavioral factors that increase sexually transmitted infection risk among adolescent and young adult (A/YA) females have been mixed (e.g., fewer sex partners, lower condom use). We used data from a national sample of A/YA females to examine racial disparities in Chlamydia trachomatis (CT) prevalence considering these trends.
Methods: Using 2011-March 2020 National Health and Nutrition Examination Survey data, we estimated the prevalence, and unadjusted and adjusted prevalence ratios of a positive CT urine test result among sexually experienced non-Hispanic Black (Black), Hispanic, non-Hispanic Other race (NHO), and non-Hispanic White (White) A/YA females. Percentages were categorized by race/ethnicity, and each was compared with the average of the other race/ethnic groups (e.g., Black vs. Hispanic, NHO, and White). Covariates included age group, health insurance coverage, number of sex partners, and condom use (both past year).
Results: Overall, the prevalence of CT infection among A/YA females was 5.8% (95% confidence interval [CI], 4.5%-7.3%). The prevalence of CT was higher among Black females (vs. Hispanic, NHO, and White; 11.7%; 95% CI, 8.7%-15.2%) and lower among White females (vs. Black, Hispanic, and NHO; 3.2%; 95% CI, 1.7%-5.5%). Compared with the average CT prevalence for Hispanic, NHO, and White females, Black females had a higher adjusted CT prevalence (adjusted prevalence ratio, 2.48; 95% CI, 1.63-3.75).
Conclusions: Nationally, CT prevalence was 2.5 times as high among Black A/YA females than the average prevalence for Hispanic, NHO, and White females. Inclusion of behavioral sexually transmitted infection risk factors did not attenuate this association. Research incorporating sexual network-level factors associated with CT transmission may provide additional insights.
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