Last week, the Tulsa Health department released their annual Tulsa County Health Profile for 2015. This report shows important health indicators and their prevalence across Tulsa, separated by zipcode. Separating by location reveals what parts of town are most affected by certain diseases or health choices, allowing healthcare professionals to tailor programs to specific areas.
Since the report spans population demographics and socioeconomic status to mortality and behavioral risk factors, it provides for a wide range of analysis. Perhaps one of the most glaring is sexual health issues, from teen births to sexually transmitted diseases.
In 2013, teen birth rate of girls 15-17 years old in Tulsa was 17.9 live births for every 1,000 females, lower than the state average of 20.5, but higher than the U.S. average of 12.3. About 37 percent of mothers received delayed or no prenatal care, a rate which was similar across most ethnicities.
Prenatal care is important for the health of mother and baby, and the rate of delayed care in Tulsa is higher than state and US rates. Infant mortality rate in the county was 7.2 deaths per 1,000 live births, higher than both the state (6.8) and country (6.0) rates. Disparities in race/ethnicity are reflected in the data, as black infant mortality rate was three times higher than that of whites.
Compared to the national average, rates of sexually transmitted diseases in Tulsa county are also extremely elevated. The chlamydia incidence rate was 545.5 cases per 100,000 in 2013, while in the state the rate was 474.7, and in the US as a whole, 446.6 cases. The highest incidence rates were found in the 74106 and 74126 zip codes. This STD, commonly asymptomatic, can cause short and long-term reproductive problems than can be transmitted during births.
Gonorrhea incidence rates in Tulsa were also double the national average, at 200.5 cases per 100,000 compared to 106.1 cases per 100,000. Syphilis rates, however, were slightly lower than the national average, but higher than the state average.
The locality map, however, showed syphilis incidence rates were not evenly spread across the county; the 74106 district had a rate of 24.7-32.1 cases per 100,000, while some districts had none.
This difference played out repeatedly. New cases of gonorrhea were found at a rate of 464.9-1000.3 in the 74106, 74126, and 74103 areas. This rate was over four times the national average.
The greatest percentages of new chlamydia and gonorrhea cases were found in 20-24 year olds, mostly in females and blacks. For syphilis, the most new cases were reported in 25-29 year olds, and about 80 percent of these new cases were male. The majority of the new cases were in whites, and about half the cases were men who have sex with men.
In new HIV/AIDS cases, the greatest number was in 20-29 year olds, majority male and white. Over half the new cases were in males who have sex with men.
When comparing the sexual health data to other data available, some similarities became apparent. Some of the zipcodes with the lowest life expectancy — around 68 to 72 years, compared to the highest at 78 to 81 years — were those with the highest STD rates.
The median household incomes of some of these areas were also the lowest in the county, around 19,712 – 28,005 dollars, with close to or over 30 percent of the population below poverty. These areas had low population density and ranged from 12,000 to 21,000 people, compared to some regions of 36,000 to 58,000.
The Tulsa Health Department is “currently developing a plan to address” the STD rates in certain high risk areas of Tulsa county, according to Kaitlin Snider, health department spokeswoman. Part of this outreach is Expedited Partner Therapy. In this treatment, a patient with chlamydia or gonorrhea receives prescriptions to give to his/her partner without the health care provider first examining the partner.
Currently, this therapy is potentially allowable in the state, with some administrative regulations authorizing it, but other administrative regulations, statutory authority, case law, and medical board opinions pose legal barriers.
Studies have shown EPT is a cost effective and cost-saving treatment option for these STD forms. While the treatment will not be recommended to every patient, Snider believes it will help decrease rates of infection.
The Tulsa Health department also works with the disease intervention specialists from the state’s Department of Health in notifying hard-to-reach clients with positive test results. The county’s North Regional Health and Wellness Center does offer STD services and education.
Staff work to provide counseling on ways of safer sexual behavior, provide help to sexual partners of those infected, and identify those with infections who are unlikely to seek diagnosis or treatment.
As a state, Oklahoma ranks high in many STD transmission rates. In 2013, the state ranked 14th in chlamydial infections and 10th in gonorrheal infections nationally. For HIV diagnosis, Oklahoma ranked 24th in 2013 nationally.
Sexual health education in Oklahoma may play a role in these rates. State regulations do not require sexuality education, only HIV/AIDS-prevention education. HIV/AIDS discussion must be limited to “discussion of the disease AIDS and its spread and prevention,” according to regulations.
Only AIDS curriculum is mandated to be medically accurate; HB 2721, which required sex education curriculum to include medically accurate, age-appropriate information designed to reduce risk factors and behaviors associated with unintended pregnancy, failed in 2016.
Tulsa Public Schools began offering comprehensive sex education and pregnancy prevention in fall of 2014. Other districts teach nothing past the required HIV/AIDS-prevention courses.