Use of Administrative Health Care Data for Sexually Transmitted Disease Surveillance

Background:  Surveillance for sexually transmitted diseases (STDs) in the United States relies primarily on case reports from clinicians and laboratories and sentinel surveillance; however, nationwide reporting is not required for viral STDs and clinical sequelae of STDs.   We evaluated the potential usefulness of three sources of administrative health care data for STD surveillance. 

Methods:  The Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) has been used to estimate national and regional incidence of neonatal herpes simplex virus infection.  The MarketScan Commercial Claims and Encounters (CCAE) data, containing records from employee-sponsored private insurance plans, were used to examine trends in anogenital wart prevalence by gender and age group.  Access to national Medicaid Analytic Extract (MAX) data for 2003-2009 has recently been acquired. 

Results: Strengths of all these sources included availability of diagnosis and procedure codes for large numbers of records: KID – 3.4 million birth and hospitalization discharge records for children/adolescents through age 20 in 2009; CCAE – 1.1 billion inpatient and outpatient claims records for employees and their dependents in 2011; MAX – 2.3 billion inpatient and outpatient claims records for child and adult beneficiaries in 2009.  The relatively low cost of these standardized data sources is also beneficial.  None of the sources included laboratory results or inpatient medication data, although CCAE and MAX contain outpatient prescription claims.  Access to these data is not timely; currently, KID and MAX are available through 2009 and CCAE through 2011.  Race/ethnicity information is available in only KID and MAX.  However, this information is incomplete; in 2009, 15% of race/ethnicity values were missing for KID and 28% for MAX.

Conclusions:  Administrative health care data provide new opportunities for STD surveillance among large numbers of health care consumers, despite limitations.  These sources will be particularly useful for non-reportable STDs and clinical sequelae of STDs.