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Background: Although PID has been reportable in California since 1989, annual case volume has been low (<1,300) and likely under-reported. Hospital patient discharge (HPD) and emergency department (ED) records may provide more accurate estimates of PID.
Methods: We analyzed California statewide ED and HPD records from 1/1/13-12/31/13 to estimate the number of acute PID diagnoses using ICD-9 codes among women aged >15 years. Patient Social Security Number and visit dates were used to identify unique episodes occurring ≥60 days apart. PID episodes were stratified by demographic characteristics. CPT-4 codes were utilized to identify concurrent STD screening among ED PID patients.
Results: We identified 8,649 acute PID records (8,293 unique episodes) in the ED. Nearly two-thirds (62%) of episodes were among women aged <30 years. The highest proportion were among Hispanics (42%), followed by 30% non-Hispanic White, and 20% non-Hispanic Black. The majority of women were covered by public insurance (53%); 23% by private insurance and 24% self-paid. Twenty-one percent of episodes were associated with testing for chlamydia; 20% for gonorrhea, and <1% for HIV/syphilis. We identified 4,074 acute PID records (3,943 unique episodes) in the HPD. Compared with ED patients, a lower proportion (37%) of hospitalized PID patients were aged <30 years. Forty percent of episodes were among Hispanics, 30% non-Hispanic White, and 13% non-Hispanic Black. A higher proportion of HPD patients were covered by private insurance (38%); 50% by public insurance and 10% self-paid. ED and HPD data were combined to estimate an overall 12,045 unique PID episodes (191 duplicate episodes were excluded).
Conclusions: The total number of acute PID diagnoses in HPD and ED is nearly ten-fold the number of case reports in California in 2013 (N=1,234), reflecting the extent of potential under-reporting of PID in California. This estimate is an underestimate of PID burden as it does not include outpatient diagnoses.