Chlamydia Screening Among Young Women: Individual- and Provider-Level Differences in Testing

Abstract

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.