Background: Chlamydia is the most frequently reported infectious disease in the US. American Indians and Alaska Natives (AI/ANs) are disproportionally affected. To evaluate utility of electronic health records for surveillance, we examined chlamydia rates among AI/ANs using the Indian Health Service discharge datasets.
Methods: We analyzed ICD-9-CM codes for chlamydia infection for AI/ANs ages 10–49 years during 2001–2013. We calculated overall rates and rates by age group, gender and year. Rates were calculated per 1,000 persons. Poisson regression was used to identify any trends. For 2013, we calculated repeat visits defined as any visits with a chlamydia diagnosis occurring after the original chlamydia diagnosis.
Results: Annual rates of chlamydia-associated visits increased for all age groups for males and females from 2001–2013. Rates increased from 19.4 (N=8,432) in 2001 to 28.4 (N=13,930) in 2013 for females (p<0.0001), and from 4.2 (N=1,683) to 7.0 (N=3,173) (p<0.0001) for males. In 2013, 20–24 year old females had the highest rate of infection (64.8; N=5,077); among males, the highest rate was in 20–24 year olds (15.4; N=1,076). Thirty-eight percent (N=3,595) of patients had a repeat visit in 2013; median time between visits was 7 days. The average number of visits per patient was 1.8 (range: 1–13). For females, 41.3%. (N=3,040) had a repeat visit with the majority (78.6%) occurring less than 30 days from the initial visit. For males, 27.3% (N=555) had a repeat visit, and 80.3% of those visits were in less than 30 days.
Conclusions: Increasing trends of chlamydia infection were observed among AI/ANs during 2001–2013, with young females predominantly affected. In 2013, the high frequency of repeat visits indicate some might be attributable to persistent chlamydia infection or reinfection. Our analysis demonstrates that discharge datasets could be used to enhance surveillance and examine trends of chlamydia infection among AI/ANs.