Department of Family and Community Medicine, University of Toronto, Toronto, Canada
Mount Sinai Hospital, Sinai Health System, Toronto, Canada.
Ann Fam Med. 2017 Jul;15(4):329-334. doi: 10.1370/afm.2097.
Many chlamydia infections are identified through screening, which is frequently offered to females concomitantly with cervical cancer screening. Recent cervical cancer screening guidelines recommend screening less frequently and starting later. We sought to evaluate the impact of the May 2012 Ontario, Canada, cervical cancer screening guideline change on Papanicolaou (Pap) and chlamydia trachomatis (chlamydia) testing and incidence.
We extracted population-based physician billing claims data to identify Pap and chlamydia tests and public health surveillance data to identify chlamydia cases. We used interrupted time series analysis of quarterly data spanning 2 years before and after the guideline change and fitted segmented linear regression or rational functions to the outcomes using autoregressive integrated moving average models. Outcomes were stratified by sex and age group.
Two years after the guideline change, we observed reduced chlamydia testing in females, with the greatest relative reduction (25.5%) among those aged 15 to 19 years. We also observed decreases in reported chlamydia incidence for females aged 15 to 19 years and 20 to 24 years (relative reductions of 16.8% and 14.4%, respectively). Chlamydia incidence remained the same for males, despite increased chlamydia testing.
Recent cervical cancer screening guideline changes in Ontario were associated with reduced chlamydia testing and reported new cases of chlamydia in females. Females aged 15 to 19 years, who are at high risk for chlamydia if sexually active, and who no longer warrant cervical cancer screening, were disproportionately affected. Females should be tested for chlamydia based on risk, regardless of need for Pap testing.
许多衣原体感染是通过筛查发现的，这种筛查通常与宫颈癌筛查同时提供给女性。最近的宫颈癌筛查指南建议减少筛查频率并推迟开始时间。我们试图评估 2012 年 5 月加拿大安大略省宫颈癌筛查指南变更对巴氏涂片（Pap）和沙眼衣原体（衣原体）检测和发病率的影响。
我们提取了基于人群的医生计费数据，以确定巴氏涂片和衣原体检测，以及公共卫生监测数据，以确定衣原体病例。我们使用了在指南更改前后两年的季度数据进行中断时间序列分析，并使用自回归综合移动平均模型对结果进行分段线性回归或合理函数拟合。结果按性别和年龄组分层。
在指南更改后的两年内，我们观察到女性衣原体检测减少，15 至 19 岁年龄组的相对减少幅度最大（25.5%）。我们还观察到 15 至 19 岁和 20 至 24 岁女性报告的衣原体发病率下降（相对减少分别为 16.8%和 14.4%）。尽管衣原体检测增加，但男性衣原体发病率保持不变。
安大略省最近的宫颈癌筛查指南变化与衣原体检测减少和女性新报告的衣原体病例有关。如果有性行为，15 至 19 岁的女性处于衣原体感染的高风险中，且不再需要进行宫颈癌筛查，她们受到的影响不成比例。无论是否需要巴氏涂片检测，女性都应根据风险进行衣原体检测。
