Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Sex Transm Dis. 2010 Dec;37(12):751-5. doi: 10.1097/OLQ.0b013e3181e50044.
Diagnostic chlamydia testing is recommended for all young women demonstrating sexually transmitted infection (STI) symptoms. Differential testing among symptomatic women may contribute to disparities in chlamydia rates. Our objective was to determine whether providers test young women with STI symptoms for chlamydia differently by age, race/ethnicity, or insurance status, and whether testing patterns differ by documentation of previous STI.
Retrospective cohort analysis using electronic medical records and billing data of women 14 to 25 years old with one or more diagnostic or procedure codes indicative of STI symptoms (N = 61,498 women). Random effects logistic regression analysis was performed to assess the odds of chlamydia testing given a woman presented for a nonpregnancy-related visit with STI symptoms. All analyses controlled for history of STI, setting, and year, and adjusted for within-person correlation.
A chlamydia test was performed in 38% of visits with codes indicating STI symptoms. Women aged <18 or >19 were less likely to be tested than women aged 18 to 19, with young women aged 14 to 15 having the lowest odds of being tested (Odd Ratio [OR]: 0.52). Providers were more likely to test minority (ORblack: 2.87; ORLatina: 2.10) compared with white women. Women were also more likely to be tested if they had public insurance (OR: 2.41) or were self-pay (OR: 2.35) compared with if they had private insurance. Women aged 14 to 15 and 16 to 17 with prior history of STI had increased odds of chlamydia testing (OR: 1.79 and 1.43, respectively) compared with women aged 18 to 19, changing the overall direction of association compared with women with no history of STI. The odds of testing were dramatically reduced for minority and nonprivately insured young women with history of STI, although significant differences persisted.
Provider chlamydia testing differs by age, race/ethnicity, and insurance status when a woman presents with STI symptoms and no prior history of STI. This bias may contribute to higher reported rates of chlamydia among younger, minority, and poor women.
对于表现出性传播感染 (STI) 症状的所有年轻女性，均建议进行诊断性衣原体检测。对有症状的女性进行差异化检测可能导致衣原体检测率的差异。我们的目的是确定提供者是否根据年龄、种族/民族或保险状况对有 STI 症状的年轻女性进行不同的衣原体检测，以及检测模式是否因先前 STI 的记录而有所不同。
使用电子病历和 14 至 25 岁女性的诊断或程序代码（N = 61,498 名女性）的计费数据进行回顾性队列分析。使用随机效应逻辑回归分析评估在出现非妊娠相关 STI 症状就诊时进行衣原体检测的可能性。所有分析均控制了 STI 病史、就诊环境和年份，并对个体内相关性进行了调整。
有诊断性 STI 症状代码的就诊中，有 38%进行了衣原体检测。与 18-19 岁的女性相比，<18 岁或>19 岁的女性进行检测的可能性较小，14-15 岁的年轻女性进行检测的可能性最低（比值比 [OR]：0.52）。与白人女性相比，少数民族（黑人 OR：2.87；拉丁裔 OR：2.10）的女性更有可能接受检测。与拥有私人保险的女性相比，如果女性拥有公共保险（OR：2.41）或自付（OR：2.35），则更有可能接受检测。与 18-19 岁的女性相比，有 STI 既往史的 14-15 岁和 16-17 岁女性进行衣原体检测的可能性增加（OR：1.79 和 1.43），与没有 STI 既往史的女性相比，改变了整体关联方向。尽管仍存在显著差异，但有 STI 既往史的少数民族和非私人保险的年轻女性进行检测的可能性大大降低。
当女性出现 STI 症状且无 STI 既往史时，提供者根据年龄、种族/民族和保险状况进行衣原体检测存在差异。这种偏见可能导致年轻、少数族裔和贫困女性报告的衣原体感染率更高。
