TP 69 Chlamydia Screening Rates Among Females Enrolled in Medicaid Kansas

Tuesday, June 10, 2014
Exhibit Hall
Jennifer Schwartz, MPH, Bureau of Disease Control and Prevention, Kansas Department of Health and Environment, Topeka, KS

Background: Chlamydia trachomatis is the most commonly reported notifiable disease in the US and is among the most prevalent of all sexually transmitted infections.  Kansas reported over 10,600 cases in 2011.  Rates were highest among young adults and females.  In Kansas, adolescents and young adults (15–24) represented 14% of the population but 76% of reported cases. The U.S. Preventative Services Task Force recommends annual chlamydia screening for all sexually active (SA) non-pregnant women under 25 and non-pregnant women 25 and over who are at increased risk. CDC echoes this with a similar recommendation.

Methods: Kansas Medicaid claims data was analyzed for females 16-24 who were continuously enrolled for 12 months.  Patients were identified as SA if they had claims or encounter data associated with: contraceptives, Pap test, pelvic examination, pregnancy-related, or STI-related services.

Results: Over 80% of females 16-24 enrolled in Medicaid were defined as SA; of which 40% or less received an annual chlamydia screening.  Screening rates varied significantly. Blacks were twice as likely to be screened than Whites.  SA adolescents (16–20) were also less likely to be screened than adults (21–24).  In 2012, 35% of eligible females received an annual screening.  This resulted in potentially under-identification of 625 new cases of chlamydia.

Conclusions: Kansas’ annual screening rate (40%) under performs the national rate by 20 percentage points and Healthy People 2020 (16-20 at 74.4% and 21-24 at 80%).  Whites and adolescents represent a significant proportion of the eligible population but were the lowest screened.  Targeting these groups could significantly impact screening rates. Low screening rates potentially result in not identifying over 600 new cases yearly.  Untreated cases can lead to Pelvic Inflammatory Disease (PID) in 10-40% of women.  Higher screening rates would result in a significant reduction of disease morbidity including PID and infertility.