Overutilization of Chlamydia Testing by Privately Insured Women Aged 26-44 Years in 2008

Background:   CDC recommends annual chlamydia screening of all sexually active women aged 25 years and younger, and studies have found that chlamydia testing rates have been increasing in young women.  A few studies in public-funded clinics have found high testing rates of older women, in whom risk-based testing is recommended.

Objectives:  We estimated chlamydia testing coverage of privately-insured women aged 15-44 years by age.  To better understand reasons for chlamydia testing of older women, we assessed types of reproductive healthcare service performed at a visit with a chlamydia test.

Methods:   We analyzed data in a large commercial claims database to estimate chlamydia testing among women who had reproductive healthcare visits in 2008.  Reproductive healthcare visits were identified using diagnostic or procedural codes for gynecologic examination, contraception, cervical cancer screening, STD diagnostic or treatment services, pregnancy, and infertility diagnostic or treatment.

Results:   Among 3.2 million women aged 15-44 years who had a  reproductive healthcare visit in 2008, 22% had chlamydia testing. The testing rate peaked in women aged 19-24 years, and then steadily declined.  Among those 0.7 million women who had a chlamydia test, 65% were in older women aged 26-44 years.  Among older women tested for chlamydia in 2008, about 70% were at visits for reasons other than an STD diagnosis.

Conclusions:  Our findings suggest that too few young women and too many older women were tested for chlamydia, and many asymptomatic older women were inappropriately tested.  

Implications for Programs, Policy, and Research:  Most of the 62 million U.S. women aged 15–44 years have an annual visit to a healthcare provider for reproductive healthcare.  It might be better to use limited resources to increase chlamydia screening of younger women who have a greater burden of infection.