Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clement, Fay, and Yee); Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT (Dr Clement).
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clement, Fay, and Yee); Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA (Dr Fay).
Am J Obstet Gynecol MFM. 2022 May;4(3):100595. doi: 10.1016/j.ajogmf.2022.100595. Epub 2022 Feb 15.
Since 1999, Illinois has had a legal statute mandating both first-visit and third-trimester syphilis testing in all pregnancies. However, the incidence of syphilis infection is increasing at the national and state level, including among individuals of reproductive age, conferring risk of congenital syphilis. Although state-mandated infectious disease screening is purported to be a strategy to improve equity and quality of care, adherence to such mandates and disparities in adherence are unknown.
We sought to evaluate compliance with state-mandated third-trimester syphilis testing at a single tertiary hospital in Illinois and to identify disparities in testing.
This is a retrospective cohort study of all pregnant individuals who delivered between January 1, 2015 and February 28, 2018 at a large-volume academic center. Patients who delivered after 28 weeks of gestation were included. Frequency of state-mandated first-visit (<28 weeks) and third-trimester (≥28 weeks) syphilis screening was evaluated over the study period. The primary outcome was completion of any third-trimester screening (ie, performed as an initial or repeat test in the third trimester) in accordance with state law. Demographic and clinical factors associated with the primary outcome and with completion of both first-visit and third-trimester screening were evaluated with multivariable logistic regression.
Of the 9048 eligible deliveries, 96.9% (N=8766) of patients had first-visit syphilis screening, whereas only 27.3% (N=2469) had third-trimester screening. Performance of third-trimester syphilis testing increased over time from an average of 5.8% of deliveries during the first 6 months of the study period to 59.8% over the last 6 months of the study period. Non-Hispanic Black or Hispanic race or ethnicity, non-English primary language, public insurance, age <25, multiparity, and greater body mass index were independently associated with increased odds of third-trimester screening.
Despite a decades-old state mandate for third-trimester syphilis screening in this high-prevalence region, third-trimester screening performance was suboptimal. Several demographic characteristics were associated with adherence to screening, suggesting inequity and bias exist in testing practices. It is important to acknowledge that legal statutes do not fully eliminate bias and health disparities.
自 1999 年以来，伊利诺伊州已通过法律规定，所有孕妇在首次就诊和妊娠晚期均需进行梅毒检测。然而，梅毒感染的发生率在全国和州一级都在上升，包括生殖年龄的个体，从而导致先天性梅毒的风险。尽管州政府规定的传染病筛查被认为是提高公平性和护理质量的一种策略，但对这些规定的遵守情况以及遵守情况的差异尚不清楚。
我们旨在评估伊利诺伊州一家三级医院对州政府规定的妊娠晚期梅毒检测的执行情况，并确定检测中的差异。
这是一项回顾性队列研究，纳入了 2015 年 1 月 1 日至 2018 年 2 月 28 日在一家大型学术中心分娩的所有孕妇。纳入了妊娠 28 周后分娩的患者。研究期间评估了州政府规定的首次就诊（<28 周）和妊娠晚期（≥28 周）梅毒筛查的频率。主要结局是根据州法律完成任何妊娠晚期筛查（即作为初始或重复检测在妊娠晚期进行）。使用多变量逻辑回归评估与主要结局相关的以及与首次就诊和妊娠晚期筛查完成相关的人口统计学和临床因素。
在 9048 例符合条件的分娩中，96.9%（N=8766）的患者进行了首次就诊梅毒筛查，而只有 27.3%（N=2469）进行了妊娠晚期筛查。妊娠晚期梅毒检测的实施随着时间的推移而增加，从研究期间前 6 个月的平均 5.8%的分娩量增加到最后 6 个月的 59.8%。非西班牙裔黑人和西班牙裔或拉丁裔、非英语为母语、公共保险、年龄<25 岁、多胎产和更高的体重指数与妊娠晚期筛查的几率增加独立相关。
尽管在这个高患病率地区有几十年的州政府对妊娠晚期梅毒筛查的规定，但妊娠晚期筛查的实施情况并不理想。几个人口统计学特征与筛查的遵守情况相关，这表明在检测实践中存在不公平和偏见。重要的是要认识到，法律规定并不能完全消除偏见和健康差异。
