Divisions of Children's Health Services Research and dAdolescent Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana 46202, USA.
Pediatrics. 2011 Feb;127(2):e336-44. doi: 10.1542/peds.2010-0967. Epub 2011 Jan 24.
We assessed differences in chlamydia screening rates according to race/ethnicity, insurance status, age, and previous sexually transmitted infection (STI) or pregnancy.
A retrospective cohort study was performed using electronic medical record and billing data for women 14 to 25 years of age in 2002-2007, assessing differences in the odds of a chlamydia test being performed at that visit.
Adjusted odds of a chlamydia test being performed were lower among women 14 to 15 years of age (odds ratio: 0.83 [95% confidence interval: 0.70-1.00]) and 20 to 25 years of age (20-21 years, odds ratio: 0.78 [95% confidence interval: 0.70-0.89]; 22-23 years, odds ratio: 0.76 [95% confidence interval: 0.67-0.87]; 24-25 years, odds ratio: 0.64 [95% confidence interval: 0.57-0.73]), compared with women 18 to 19 years of age. Black women had 3 times increased odds (odds ratio: 2.96 [95% confidence interval: 2.66-3.28]) and Hispanic women nearly 13 times increased odds (odds ratio: 12.89 [95% confidence interval: 10.85-15.30]) of testing, compared with white women. Women with public (odds ratio: 1.74 [95% confidence interval: 1.58-1.91]) and public pending (odds ratio: 6.85 [95% confidence interval: 5.13-9.15]) insurance had increased odds of testing, compared with women with private insurance. After first STI diagnosis, differences according to race/ethnicity persisted but were smaller; after first pregnancy, differences persisted.
Despite recommendations to screen all sexually active young women for chlamydia, providers screened women differently according to age, race/ethnicity, and insurance status, although differences were reduced after first STI or pregnancy.
本研究评估了根据种族/民族、保险状况、年龄以及既往性传播感染（STI）或妊娠情况，衣原体筛查率的差异。
本研究使用电子病历和 2002-2007 年期间 14 至 25 岁女性的计费数据进行回顾性队列研究，评估了本次就诊时进行衣原体检测的可能性差异。
与 18-19 岁女性相比，14-15 岁（优势比：0.83[95%置信区间：0.70-1.00]）和 20-25 岁（20-21 岁，优势比：0.78[95%置信区间：0.70-0.89]；22-23 岁，优势比：0.76[95%置信区间：0.67-0.87]；24-25 岁，优势比：0.64[95%置信区间：0.57-0.73]）的女性进行衣原体检测的可能性较低。与白人女性相比，黑人女性检测的可能性增加了 3 倍（优势比：2.96[95%置信区间：2.66-3.28]），西班牙裔女性的可能性增加了近 13 倍（优势比：12.89[95%置信区间：10.85-15.30]）。与拥有私人保险的女性相比，拥有公共保险（优势比：1.74[95%置信区间：1.58-1.91]）和公共待决保险（优势比：6.85[95%置信区间：5.13-9.15]）的女性进行衣原体检测的可能性更高。首次诊断 STI 后，种族/民族的差异仍然存在，但有所缩小；首次妊娠后，差异仍然存在。
尽管建议对所有有性行为的年轻女性进行衣原体筛查，但提供者根据年龄、种族/民族和保险状况对女性进行不同的筛查，尽管首次 STI 或妊娠后差异有所减少。
