Chlamydia Screening Coverage Estimates Among Insured and Uninsured Female Patients Attending Two New York City Health Centers Serving Neighborhoods with High Rates of Chlamydia Trachomatis, 2015

Background:  Guidelines recommend annual Chlamydia trachomatis (Ct) screening for women aged <25 years. Ct screening coverage estimates using administrative data for Medicaid recipients and privately insured populations have been found to be suboptimal, at approximately 50% nationwide and 60% in New York State. Estimates of Ct screening coverage among uninsured young women are lacking. We assessed clinic Ct screening coverage (CCSC) among insured and uninsured patients attending two organizations serving patients in high-Ct morbidity New York City (NYC) neighborhoods.

Methods:  We analyzed data from one large sexual and reproductive healthcare organization with 3 sites, and one adolescent health center with a focus on runaway/homeless youth. Between June-December 2015, organizations provided aggregated CCSC data, overall and stratified by patient insurance as: uninsured/self-pay, privately insured, or Medicaid. CCSC was defined as the proportion of 15-25 year old sexually active female patients seen in the period with at least one Ct screening within a year of their last visit. We compared CCSC proportions by patient insurance status. 

Results:  In total, 10,631/13,340 patients (CCSC=79.7%) were tested for Ct. By patient insurance status, CCSC was as follows: 69.2% (2,066/2,987) among uninsured patients; 78.0% (1,920/2,463) among privately insured patients; and 84.2% (6,710/7,970) among Medicaid enrollees. CCSC was significantly lower among uninsured patients (69.2% (2,066/2,987)) vs. all insured patients (82.3% (8,630/10,433); p<0.001).  

Conclusions:  While overall CCSC was high in these organizations, uninsured female patients were significantly less likely than insured patients to have been screened for Ct in the past year, indicating a population which should be targeted for Ct screening. More investigation is needed to explore the interplay between patient insurance status and other factors—such as clinic policies, number of patient visits, Ct test acceptance, and reason for visit –which may contribute to differential Ct screening coverage by patient insurance status.