Low N, Egger M, Sterne J A C, Harbord R M, Ibrahim F, Lindblom B, Herrmann B
Department of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, CH-3012, Switzerland.
Sex Transm Infect. 2006 Jun;82(3):212-8. doi: 10.1136/sti.2005.017186.
To estimate the cumulative incidence of severe complications associated with genital chlamydia infection in the general female population.
The Uppsala Women's Cohort Study was a retrospective population based cohort study in Sweden, linking laboratory, hospital, and population registers. We estimated the cumulative incidence of hospital diagnosed pelvic inflammatory disease, ectopic pregnancy, and infertility, and used multivariable regression models to estimate hazard ratios according to screening status.
We analysed complete data from 43 715 women in Uppsala aged 15-24 years between January 1985 and December 1989. Follow up until the end of 1999 included 709 000 woman years and 3025 events. The cumulative incidence of pelvic inflammatory disease by age 35 years was 3.9% (95% CI 3.7% to 4.0%) overall: 5.6% (4.7% to 6.7%) in women who ever tested positive for chlamydia, 4.0% (3.7% to 4.4%) in those with negative tests, and 2.9% (2.7% to 3.2%) in those who were never screened. The corresponding figures were: for ectopic pregnancy, 2.3% (2.2% to 2.5%) overall, 2.7% (2.1% to 3.5%), 2.0% (1.8% to 2.3%), and 1.9% (1.7% to 2.1%); and for infertility, 4.1% (3.9% to 4.3%) overall, 6.7% (5.7% to 7.9%), 4.7% (4.4% to 5.1%), and 3.1% (2.8% to 3.3%). Low educational attainment was strongly associated with the development of all outcomes.
The incidence of severe chlamydia associated complications estimated from ours, and other population based studies, was lower than expected. Studies that incorporate data about pelvic inflammatory disease diagnosed in primary care and behavioural risk factors would further improve our understanding of the natural history of chlamydia. Our results provide reassurance for patients, but mean that the benefits of chlamydia screening programmes might have been overestimated.
评估普通女性人群中与生殖道衣原体感染相关的严重并发症的累积发病率。
乌普萨拉女性队列研究是瑞典一项基于人群的回顾性队列研究，将实验室、医院和人口登记数据相联系。我们估算了医院诊断的盆腔炎、异位妊娠和不孕症的累积发病率，并使用多变量回归模型根据筛查状态估算风险比。
我们分析了1985年1月至1989年12月期间乌普萨拉43715名年龄在15 - 24岁女性的完整数据。随访至1999年底，共计709000人年，发生3025起事件。35岁时盆腔炎的总体累积发病率为3.9%（95%置信区间3.7%至4.0%）：衣原体检测曾呈阳性的女性为5.6%（4.7%至6.7%），检测呈阴性的女性为4.0%（3.7%至4.4%），从未接受筛查的女性为2.9%（2.7%至3.2%）。异位妊娠的相应数据为：总体2.3%（2.2%至2.5%），衣原体检测曾呈阳性的女性为2.7%（2.1%至3.5%），检测呈阴性的女性为2.0%（1.8%至2.3%），从未接受筛查的女性为1.9%（1.7%至2.1%）；不孕症的相应数据为：总体4.1%（3.9%至4.3%），衣原体检测曾呈阳性的女性为6.7%（5.7%至7.9%），检测呈阴性的女性为4.7%（4.4%至5.1%），从未接受筛查的女性为3.1%（2.8%至3.3%）。低教育程度与所有结局的发生密切相关。
根据我们的研究以及其他基于人群的研究估算的衣原体相关严重并发症的发病率低于预期。纳入初级保健中诊断的盆腔炎数据和行为风险因素的研究将进一步增进我们对衣原体自然史的理解。我们的结果为患者提供了安心的依据，但意味着衣原体筛查项目的益处可能被高估了。
