Chlamydia screening among young women: individual- and provider-level differences in testing.
OBJECTIVE
We assessed differences in chlamydia screening rates according to race/ethnicity, insurance status, age, and previous sexually transmitted infection (STI) or pregnancy.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Divisions of Children's Health Services Research and dAdolescent Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana 46202, USA. swiehe@iupui.edu
Sarah E
SE
Wiehe
Marc B
MB
Rosenman
Jane
J
Wang
Barry P
BP
Katz
J Dennis
JD
Fortenberry
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology*; D015331:Cohort Studies; D005006:Ethnicity / Q000208:ethnology; D005260:Female; D006282:Health Personnel / Q000191:economics / Q000592:standards*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000592:standards; D008137:Longitudinal Studies; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000191:economics / Q000208:ethnology; D055815:Young Adult
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