Mapping co-occurrence of infectious disease in New York City to identify geographic areas of priority for service delivery

Objectives: To identify priority neighborhoods for integrated infectious disease screening and linkage to care by mapping zip codes with co-occurring high morbidity for more than one disease. Methods: Using 2009 surveillance data for HIV, chlamydia, gonorrhea, syphilis, TB, hepatitis B and hepatitis C, we identified zip codes in NYC with co-occurring high morbidity. A high morbidity zip code for each disease was defined as a rate per 100,000 in the top quintile (20%) of all zip codes in NYC with a reported case of disease. All zip codes with high morbidity for more than one disease were identified and given a score 2-7, indicating the number of diseases in the top quintile. Census data (Year 2000) was used to examine social characteristics of the high-morbidity zip codes. Maps were created using ArcGIS to visualize the surveillance and census data and to identify priority areas of the city. Results: Zip codes with high morbidity for more than one disease tended to fall into two categories: those with high morbidity for hepatitis C, HIV, gonorrhea and chlamydia; and those with high morbidity for TB and hepatitis B. Zip codes in the first category have high rates of poverty, while those in the second have large immigrant populations. Conclusions: Mapping surveillance and census data provides the opportunity to identify neighborhoods with high rates of co-occurrence of disease and better coordinate health department activities. Next steps include working with providers in identified neighborhoods to improve testing, treatment and linkage to care.