Teng Jennifer, Prabhakar Sarah, Rajnik Michael, Susi Apryl, Hisle-Gorman Elizabeth, Nylund Cade M, Brown Jill
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2025 Feb 27;190(3-4):e845-e850. doi: 10.1093/milmed/usae392.
Congenital syphilis (CS) case rates have increased significantly in the United States over the past 20 years, accelerating during the COVID-19 pandemic. Increasing rates may relate to access to care but have not been evaluated in a fully-insured population, such as the Military Health System.
We performed a repeated monthly cross-sectional study of CS cases and total encounters (care rates) using the queried Military Health System database. We defined CS by International Classifications of Diseases 10th Revision Clinical Modification diagnosis codes in beneficiaries ≤ 2 years old. We evaluated pre-COVID-19 (March 2018 to February 2020), pandemic year 1 (March 2020 to February 2021), and pandemic year 2 (March 2021 to February 2022) periods. We performed change-point and trend analyses and Poisson regression to evaluate differences by sponsor rank, TRICARE region, and pandemic period. The Uniformed Services University Institutional Review Board approved the study.
A total of 69 unique CS cases were identified with a median monthly care rate of 0.90/100,000 eligible beneficiaries. The CS care rate showed a 5.8% average monthly percent increase throughout the study period (P < .001) and a 20.8% average monthly percent increase in year 2 (P < .05). Compared to the pre-pandemic era, CS care rates increased in pandemic years 1 and 2 (adjusted rate ratio [aRR] 2.76 [95% CI: 1.95-3.92], 5.52 [95% CI: 4.05-7.53], respectively). Congenital syphilis care rates were lower in children of senior enlisted sponsors versus junior enlisted, aRR 0.24 (95% CI: 0.17-0.33), and higher in the West and North regions versus South, aRR 2.45 (95% CI: 1.71-3.53) and aRR 2.88 (95% CI: 2.01-4.12), respectively.
Congenital syphilis care rates were substantially lower in this insured group than national rates but increased significantly during the COVID-19 pandemic. Higher care rates were seen in children of military members of lower rank. Regional trends differed from national data. These findings suggest that, even in a fully-insured population, income and regional differences impact CS, and the COVID-19 pandemic may have exacerbated differences in care delivery.
在过去20年里，美国先天性梅毒（CS）的发病率显著上升，在新冠疫情期间加速上升。发病率上升可能与医疗服务的可及性有关，但尚未在诸如军事医疗系统这样的全保人群中进行评估。
我们使用查询到的军事医疗系统数据库，对CS病例和总就诊人次（医疗服务率）进行了每月一次的重复横断面研究。我们根据国际疾病分类第10次修订临床修订版诊断代码，在2岁及以下受益人群中定义CS。我们评估了新冠疫情前（2018年3月至2020年2月）、疫情第1年（2020年3月至2021年2月）和疫情第2年（2021年3月至2022年2月）这几个时期。我们进行了变点和趋势分析以及泊松回归，以评估主办者级别、TRICARE地区和疫情时期之间的差异。美国军医大学机构审查委员会批准了该研究。
共识别出69例独特的CS病例，每月的医疗服务率中位数为0.90/10万符合条件的受益人。在整个研究期间，CS医疗服务率平均每月增长5.8%（P < 0.001）；在第2年平均每月增长20.8%（P < 0.05）。与疫情前时期相比，CS医疗服务率在疫情第1年和第2年有所上升（调整率比[aRR]分别为2.76 [95%置信区间：1.95 - 3.92]和5.52 [95%置信区间：4.05 - 7.53]）。高级士官主办者的子女的先天性梅毒医疗服务率低于初级士官的子女，aRR为0.24（95%置信区间：0.17 - 0.33）；西部地区和北部地区的医疗服务率高于南部地区，aRR分别为2.45（95%置信区间：1.71 - 3.53）和2.88（95%置信区间：2.01 - 4.12）。
在这个参保人群中，先天性梅毒医疗服务率显著低于全国水平，但在新冠疫情期间显著上升。军衔较低的军人的子女的医疗服务率更高。地区趋势与全国数据不同。这些发现表明，即使在全保人群中，收入和地区差异也会影响先天性梅毒，并且新冠疫情可能加剧了医疗服务提供方面的差异。
