The ecologic relationship between the incidence of reactive serologic tests for
syphilis among 2,229 newborns and diagnoses that included
cocaine dependence among 17,219 hospitalized women ages 15-44 in New York City was investigated. Citywide, race-specific and zip code-specific annual rates were computed. The residential zip codes were grouped into quartiles by cumulative level of diagnoses that included
cocaine dependence, and citywide and race-specific annual rates of
congenital syphilis were computed in each quartile. From 1982 to 1988, the citywide rate of
congenital syphilis for all races increased from 1.2 to 5.8 per 1,000 live births, while rates of
cocaine dependence discharges increased from 23.3 to 423.3 per 100,000 women of all races during the same period. For African American infants, citywide rates of
congenital syphilis increased from 1.8 to 10.6 per 1,000 live births. In quartile-specific analyses of African American women and newborns, rates of
congenital syphilis increased from 1.9 to 14.6 in the highest
cocaine-exposure quartile; from 2.1 to 12.4 in the third; from 1.5 to 7.6 in the second; and, from 1.6 to 2.8 in the lowest
cocaine-exposure quartile. This study provides support for the hypothesis that
cocaine dependence in women may be associated with
congenital syphilis infection.