Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-24 (of 24 Records) |
Query Trace: Kent CK [original query] |
---|
Community-based interventions to decrease obesity and tobacco exposure and reduce health care costs: Outcome estimates from Communities Putting Prevention to Work for 2010-2020
Soler R , Orenstein D , Honeycutt A , Bradley C , Trogdon J , Kent CK , Wile K , Haddix A , O'Neil D , Bunnell R . Prev Chronic Dis 2016 13 E47 INTRODUCTION: In 2010, the Centers for Disease Control and Prevention (CDC) launched Communities Putting Prevention to Work (CPPW), a $485 million program to reduce obesity, tobacco use, and exposure to secondhand smoke. CPPW awardees implemented evidence-based policy, systems, and environmental changes to sustain reductions in chronic disease risk factors. This article describes short-term and potential long-term benefits of the CPPW investment. METHODS: We used a mixed-methods approach to estimate population reach and to simulate the effects of completed CPPW interventions through 2020. Each awardee developed a community action plan. We linked plan objectives to a common set of interventions across awardees and estimated population reach as an early indicator of impact. We used the Prevention Impacts Simulation Model (PRISM), a systems dynamics model of cardiovascular disease prevention, to simulate premature deaths, health care costs, and productivity losses averted from 2010 through 2020 attributable to CPPW. RESULTS: Awardees completed 73% of their planned objectives. Sustained CPPW improvements may avert 14,000 premature deaths, $2.4 billion (in 2010 dollars) in discounted direct medical costs, and $9.5 billion (in 2010 dollars) in discounted lifetime and annual productivity losses through 2020. CONCLUSION: PRISM results suggest that large investments in community preventive interventions, if sustained, could yield cost savings many times greater than the original investment over 10 to 20 years and avert 14,000 premature deaths. |
The program cost of a brief video intervention shown in sexually transmitted disease clinic waiting rooms
Gift TL , O'Donnell LN , Rietmeijer CA , Malotte KC , Klausner JD , Margolis AD , Borkowf CB , Kent CK , Warner L . Sex Transm Dis 2016 43 (1) 61-64 BACKGROUND: Patients in sexually transmitted disease (STD) clinic waiting rooms represent a potential audience for delivering health messages via video-based interventions. A controlled trial at 3 sites found that patients exposed to one intervention, Safe in the City, had a significantly lower incidence of STDs compared with patients in the control condition. An evaluation of the intervention's cost could help determine whether such interventions are programmatically viable. MATERIALS AND METHODS: The cost of producing the Safe in the City intervention was estimated using study records, including logs, calendars, and contract invoices. Production costs were divided by the 1650 digital video kits initially fabricated to get an estimated cost per digital video. Clinic costs for showing the video in waiting rooms included staff time costs for equipment operation and hardware depreciation and were estimated for the 21-month study observation period retrospectively. RESULTS: The intervention cost an estimated $416,966 to develop, equaling $253 per digital video disk produced. Per-site costs to show the video intervention were estimated to be $2699 during the randomized trial. CONCLUSIONS: The cost of producing and implementing Safe in the City intervention suggests that similar interventions could potentially be produced and made available to end users at a price that would both cover production costs and be low enough that the end users could afford them. |
The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV infection
Chesson HW , Bernstein KT , Gift TL , Marcus JL , Pipkin S , Kent CK . Sex Transm Dis 2013 40 (5) 366-71 BACKGROUND: Men who have sex with men (MSM) who have a current or recent history of rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection are at greater risk for HIV than MSM with no history of rectal infection. Screening and treating MSM for rectal CT/GC infection may help reduce any increased biological susceptibility to HIV infection. METHODS: We used 2 versions of a Markov state-transition model to examine the impact and cost-effectiveness of screening MSM for rectal CT/GC infection in San Francisco: a static version that included only the benefits to those screened and a dynamic version that accounted for population-level impacts of screening. HIV prevention through reduced susceptibility to HIV was the only potential benefit of rectal CT/GC screening that we included in our analysis. Parameter values were based on San Francisco program data and the literature. RESULTS: In the base case, the cost per quality-adjusted life year gained through screening MSM for rectal CT/GC infection was $16,300 in the static version of the model. In the dynamic model, the cost per quality-adjusted life year gained was less than $0, meaning that rectal screening was cost-saving. The impact of rectal CT/GC infection on the risk of HIV acquisition was the most influential model parameter. CONCLUSIONS: Although more information is needed regarding the impact of rectal CT/GC screening on HIV incidence, rectal CT/GC screening of MSM can potentially be a cost-effective, scalable intervention targeted to at-risk MSM in certain urban settings such as San Francisco. |
Investigating the potential public health benefit of jail-based screening and treatment programs for chlamydia
Owusu-Edusei K Jr , Gift TL , Chesson HW , Kent CK . Am J Epidemiol 2013 177 (5) 463-73 Observational studies have found mixed results on the impact of jail-based chlamydia screen-and-treat programs on community prevalence. In the absence of controlled trials or prospectively designed studies, dynamic mathematical models that incorporate movements in and out of jail and sexual contacts (including disease transmission) can provide useful information. We explored the impact of jail-based chlamydia screening on a hypothetical community's prevalence with a deterministic compartmental model focusing on heterosexual transmission. Parameter values were obtained from the published literature. Two analyses were conducted. One used national values (large community); the other used values reported among African Americans-the population with the highest incarceration rates and chlamydia burden (small community). A comprehensive sensitivity analysis was carried out. For the large-community analysis, chlamydia prevalence decreased by 13% (from 2.3% to 2.0%), and based on the ranges of parameter values (including screening coverage of 10%-100% and a postscreening treatment rate of 50%-100%) used in the sensitivity analysis, this decrease ranged from 0.1% to 58%. For the small-community analysis, chlamydia prevalence decreased by 54% (from 4.6% to 2.1%). Jail-based chlamydia screen-and-treat programs have the potential to reduce chlamydia prevalence in communities with high incarceration rates. However, the magnitude of this potential decrease is subject to considerable uncertainty. |
The association between racial disparity in income and reported sexually transmitted infections
Owusu-Edusei K Jr , Chesson HW , Leichliter JS , Kent CK , Aral SO . Am J Public Health 2013 103 (5) 910-6 OBJECTIVES: We examined the association between racial disparity in income and reported race-specific county-level bacterial sexually transmitted infections (STIs) in the United States focusing on disparities between Blacks and Whites. METHODS: Data are from the US 2000 decennial census. We defined 2 race-income county groups (high and low race-income disparity) on the basis of the difference between Black and White median household incomes. We used 2 approaches to examine disparities in STI rates across the groups. In the first approach, we computed and compared race-specific STI rates for the groups. In the second approach, we used spatial regression analyses to control for potential confounders. RESULTS: Consistent with the STI literature, chlamydia, gonorrhea, and syphilis rates for Blacks were substantially higher than were those for Whites. We also found that racial disparities in income were associated with racial disparities in chlamydia and gonorrhea rates and, to a lesser degree, syphilis rates. CONCLUSIONS: Racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income. |
Insights into the timing of repeated testing after treatment for Chlamydia trachomatis: data and modelling study
Heijne JC , Herzog SA , Althaus CL , Tao G , Kent CK , Low N . Sex Transm Infect 2013 89 (1) 57-62 OBJECTIVES: The objective of this study was to determine the optimal time interval for a repeated Chlamydia trachomatis (chlamydia) test. METHODS: The authors used claims data for US women aged 15-25 years who were enrolled in commercial health insurance plans in the MarketScan database between 2002 and 2006. The authors determined the numbers of initial positive and negative tests that were followed by a repeated test and the positivity of repeated tests. The authors used a dynamic transmission pair model that reflects the partnership formation and separation processes in 15-25 year olds to determine the time course of repeated infections in women under different levels of notifying the current partner. The authors then explored the additional impact of repeated testing uptake on reducing chlamydia prevalence. RESULTS: 40% (4949/12,413) of positive tests were followed by a repeated test compared with 22% (89,119/402,659) of negative tests at any time. Positivity of repeated tests followed by an initial positive test was high: 15% (736) after a positive test versus 3% (2886) after a negative test. The transmission model showed a peak in repeated infections between 2 and 5 months after treatment. For a chlamydia testing uptake of 10% per year, the additional impact of repeated testing on reducing chlamydia population prevalence was modest. CONCLUSIONS: The mathematical model predictions support the recommended interval for repeat chlamydia testing. This study provides information that can be used to design randomised controlled trials to determine more effective interventions to prevent chlamydial reinfection. |
The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008
Owusu-Edusei K Jr , Chesson HW , Gift TL , Tao G , Mahajan R , Ocfemia MC , Kent CK . Sex Transm Dis 2013 40 (3) 197-201 BACKGROUND: Millions of cases of sexually transmitted infections (STIs) occur in the United States each year, resulting in substantial medical costs to the nation. Previous estimates of the total direct cost of STIs are quite dated. We present updated direct medical cost estimates of STIs in the United States. METHODS: We assembled recent (i.e., 2002-2011) cost estimates to determine the lifetime cost per case of 8 major STIs (chlamydia, gonorrhea, hepatitis B virus, human immunodeficiency virus (HIV), human papillomavirus, genital herpes simplex virus type 2, trichomoniasis and syphilis). The total direct cost for each STI was computed as the product of the number of new or newly diagnosed cases in 2008 and the estimated discounted lifetime cost per case. All costs were adjusted to 2010 US dollars. RESULTS: Results indicated that the total lifetime direct medical cost of the 19.7 million cases of STIs that occurred among persons of all ages in 2008 in the United States was $15.6 (range, $11.0-$20.6) billion. Total costs were as follows: chlamydia ($516.7 [$258.3-$775.0] million), gonorrhea ($162.1 [$81.1-$243.2] million), hepatitis B virus ($50.7 [$41.3-$55.6] million), HIV ($12.6 [$9.5-$15.7] billion), human papillomavirus ($1.7 [$0.8-$2.9] billion), herpes simplex virus type 2 ($540.7 [$270.3-$811.0] million), syphilis ($39.3 [$19.6-$58.9] million), and trichomoniasis ($24.0 [$12.0-$36.0] million). Costs associated with HIV infection accounted for more than 81% of the total cost. Among the nonviral STIs, chlamydia was the most costly infection. CONCLUSIONS: Sexually transmitted infections continue to impose a substantial cost burden on the payers of medical care in the United States. The burden of STIs would be even greater in the absence of STI prevention and control efforts. |
Self-reported chlamydia testing rates of sexually active women aged 15-25 years in the United States, 2006-2008
Tao G , Hoover KW , Leichliter JS , Peterman TA , Kent CK . Sex Transm Dis 2012 39 (8) 605-7 Using the 2006-2008 National Survey of Family Growth, we estimated a 37.9% annual chlamydia testing rate for sexually active US women aged 15 to 25 years, defined as having ≥1 sex partner in the past year. Our results highlight the need for increased testing among sexually active young women. |
Higher yet suboptimal chlamydia testing rates at community health centers and outpatient clinics compared with physician offices
Eugene JM , Hoover KW , Tao G , Kent CK . Am J Public Health 2012 102 (8) e26-9 To assess chlamydia testing in women in community health centers, we analyzed data from national surveys of ambulatory health care. Women with chlamydial symptoms were tested at 16% of visits, and 65% of symptomatic women were tested if another reproductive health care service (pelvic examination, Papanicolaou test, or urinalysis) was performed. Community health centers serve populations with high sexually transmitted disease rates and fill gaps in the provision of sexual and reproductive health care services as health departments face budget cuts that threaten support of sexually transmitted disease clinics. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e4. doi:10.2105/AJPH.2012.300744). |
Disparities in sexually transmitted disease rates across the "eight Americas"
Chesson HW , Kent CK , Owusu-Edusei K Jr , Leichliter JS , Aral SO . Sex Transm Dis 2012 39 (6) 458-64 BACKGROUND: The purpose of this study was to examine rates of 3 bacterial sexually transmitted diseases (STDs; syphilis, gonorrhea, and chlamydia) in 8 subpopulations (known as the "eight Americas") defined by race and a small number of county-level sociodemographic and geographical characteristics. The eight Americas are (1) Asians and Pacific Islanders in specific counties; (2) Northland low-income rural white; (3) Middle America; (4) Low-income whites in Appalachia and Mississippi Valley; (5) Western Native American; (6) Black middle America; (7) Southern low-income rural black; and (8) High-risk urban black. METHODS: A list of the counties comprising each of the eight Americas was obtained from the corresponding author of the original eight Americas project, which examined disparities in mortality rates across the eight Americas. Using county-level STD surveillance data, we calculated syphilis, gonorrhea, and chlamydia rates (new cases per 100,000) for each of the eight Americas. RESULTS: Reported STD rates varied substantially across the eight Americas. STD rates were generally lowest in Americas 1 and 2 and highest in Americas 6, 7, and 8. CONCLUSIONS: Although disparities in STDs across the eight Americas are generally similar to the well-established disparities in STDs across race/ethnicity, the grouping of counties into the eight Americas does offer additional insight into disparities in STDs in the United States. The high STD rates we found for black Middle America are consistent with the assertion that sexual networks and social factors are important drivers of racial disparities in STDs. |
Low rates of hepatitis screening and vaccination of HIV-infected MSM in HIV clinics
Hoover KW , Butler M , Workowski KA , Follansbee S , Gratzer B , Hare CB , Johnston B , Theodore JL , Tao G , Smith BD , Chorba T , Kent CK . Sex Transm Dis 2012 39 (5) 349-353 BACKGROUND: HIV-infected men who have sex with men (MSM) are at increased risk of viral hepatitis because of similar behavioral risk factors for acquisition of these infections. Our objective was to estimate adherence to HIV management guidelines that recommend screening HIV-infected persons for hepatitis A, B, and C infection, and vaccinating for hepatitis A and B if susceptible. METHODS: We evaluated hepatitis prevention services received by a random sample of HIV-infected MSM in 8 HIV clinics in 6 US cities. We abstracted medical records of all visits made by the patients to the clinic during the period from 2004 to 2007, to estimate hepatitis screening and vaccination rates overall and by clinic site. RESULTS: Medical records of 1329 patients who had 14,831 visits from 2004 to 2006 were abstracted. Screening rates for hepatitis A, B, and C were 47%, 52%, and 54%, respectively. Among patients who were screened and found to be susceptible, 29% were vaccinated for hepatitis A and 25% for hepatitis B. The percentage of patients screened and vaccinated varied significantly by clinic. CONCLUSIONS: Awareness of hepatitis susceptibility and hepatitis coinfection status in HIV-infected patients is essential for optimal clinical management. Despite recommendations for hepatitis screening and vaccination of HIV-infected MSM, rates were suboptimal at all clinic sites. These low rates highlight the importance of routine review of adherence to recommended clinical services. Such reviews can prompt the development and implementation of simple and sustainable interventions to improve the quality of care. |
Chlamydia testing patterns for commercially insured women, 2008
Tao G , Hoover KW , Kent CK . Am J Prev Med 2012 42 (4) 337-41 BACKGROUND: Annual chlamydia screening for sexually active women aged ≤25 years is recommended, and chlamydia testing rates have continuously increased. However, several studies have shown that many providers screen all women of reproductive age in public settings. PURPOSE: To examine chlamydia testing patterns in private settings for women and young women aged 15-44 years (hereafter referred to as women). METHODS: A large commercial claims database was used to estimate the chlamydia testing rate for women aged 15-44 years who had reproductive health services in 2008. Such services and tests were identified using diagnostic and procedural codes in 2008. RESULTS: Of 3.2 million women aged 15-44 years who had reproductive health services in 2008, 19.2% had at least a claim for a sexually transmitted disease (STD), 29.3% for pregnancy, and 81.2% for a gynecologic exam. Of those 3.2 million, 22.3% had chlamydia testing: 34.2% aged 15-25 years vs 18.3% aged 26-44 years. Of the 0.7 million who were tested, 65% were aged 26-44 years, and the reason for the healthcare visit in which their first chlamydia test was performed was an STD for 22.7% and pregnancy for 33.5%. CONCLUSIONS: In this population of insured women, young women are undertested and older women are overtested for chlamydia. Efforts to improve screening practices should be evaluated. |
A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies
Chesson HW , Gift TL , Owusu-Edusei K Jr , Tao G , Johnson AP , Kent CK . Sex Transm Dis 2011 38 (10) 889-91 We conducted a literature review of studies of the economic burden of sexually transmitted diseases in the United States. The annual direct medical cost of sexually transmitted diseases (including human immunodeficiency virus) has been estimated to be $16.9 billion (range: $13.9-$23.0 billion) in 2010 US dollars. |
Epidemiologic research using administrative databases: garbage in, garbage out
Hoover KW , Tao G , Kent CK , Aral SO . Obstet Gynecol 2011 117 (3) 729 We agree with Dr. Grimes that epidemiologic research using administrative data can be problematic and is associated with possible pitfalls,1 and support his cautionary message about the careful use of these data in epidemiologic studies. However, we would like to point out that administrative claims data are ideal data for health services research and economic analyses. As is true of all data sources, administrative data are not a panacea for all research. The optimal data for a study should depend on the question being posed, and for some questions administrative data are the most appropriate choice. Many of the pitfalls that Dr. Grimes described can be avoided with careful analysis designs, transparency in the reporting of methods and results, and discussion of a study's limitations. | Administrative data are derived from insurers' billing systems and contain information about health plan enrollees' demographic characteristics, clinician profiles, healthcare services provided by providers who submit claims, and the cost of those services. These data are processed to create valid variables, are supported by a data clearinghouse, and made available for research. They are an invaluable resource for health services research studies monitoring access, utilization, quality of health services, and healthcare expenditures. Although Dr. Grimes discussed the use of Medicaid, Medicare, and HMO databases, he did not discuss the very large claims databases for services provided to other commercially-insured populations. These service provision data tend to be more complete, because services for most commercially-insured persons are typically provided on a fee-for-service basis which results in careful, complete filing of claims. This type of administrative data has steadily improved in completeness and accuracy in recent years by including more patient demographic information and laboratory testing data.2,3 Although medical records are thought to be the gold standard of healthcare service provision, analysis of administrative data along with medical record review can identify more sexual health services for adolescents than medical record review alone.4 In addition, administrative data have an important role in disease surveillance and outbreak detection in the United States.5 | The use of administrative data in health services and economic analyses can result in quality output that is essential for assessing the healthcare landscape, and the importance of these databases will grow in the upcoming years with the requirement to monitor both quality of services and spending for those services. |
2009 cervical cytology guidelines and Chlamydia testing among sexually active young women
Tao G , Hoover KW , Kent CK . Obstet Gynecol 2010 116 (6) 1319-23 OBJECTIVE: An American College of Obstetricians and Gynecologists Practice Bulletin published in 2009 recommended that cervical cancer screening should begin at age 21 years and women younger than 30 years should be rescreened every 2 years rather than annually. The purpose of this study is to estimate the effect that decreased frequency of cervical cancer screening would have on chlamydia screening, which is recommended annually for sexually active women aged 25 years or younger. METHODS: Using an administrative database of medical claims from commercially insured girls and women, we compared annual chlamydia screening rates of sexually active adolescent girls and young women aged 15 to 25 years in 2007 among those who underwent cervical cancer screening and those who were not screened for cervical cancer. RESULTS: We identified 701,193 sexually active adolescent girls and young women aged 15 to 25 years. Chlamydia screening rates were significantly higher among adolescent girls and young women who underwent cervical cancer screening compared with those who did not: 43.6% compared with 9.5% for adolescent girls and young women aged 15 to 20 years and 36.1% compared with 12.2% for women aged 21 to 25 years. Among adolescent girls and young women identified as sexually active in 2007, 90.5% had visits for reproductive health services other than cervical cancer screening that could provide opportunities for chlamydia screening. CONCLUSION: Although the revised American College of Obstetricians and Gynecologists Practice Bulletin recommending less frequent cervical cancer screening will likely reduce chlamydia screening rates in adolescent girls and young women, health care providers should be aware of other opportunities for chlamydial testing. Options include patient self-collected vaginal swabs and urine specimens collected during visits at which adolescent girls and young women seek other reproductive health or preventive services. LEVEL OF EVIDENCE: II. |
Uptake of regular chlamydia testing by U.S. women: a longitudinal study
Heijne JC , Tao G , Kent CK , Low N . Am J Prev Med 2010 39 (3) 243-50 BACKGROUND: Routine chlamydia screening is a recommended preventive intervention for sexually active women aged ≤25 years in the U.S. but rates of regular uptake are not known. PURPOSE: This study aimed to examine rates of annual chlamydia testing and factors associated with repeat testing in a population of U.S. women. METHODS: Women aged 15-25 years at any time from January 1, 2002, to December 31, 2006 who were enrolled in 130 commercial health plans were included. Data relating to chlamydia tests were analyzed in 2009. Chlamydia testing rates (per 100 woman-years) by age and rates of repeated annual testing were estimated. Poisson regression was used to examine the effects of age and previous testing on further chlamydia testing within the observation period. RESULTS: In total, 2,632,365 women were included. The chlamydia testing rate over the whole study period was 13.6 per 100 woman years after adjusting for age-specific sexual activity; 8.5 (95% CI=6.0, 12.3) per 100 woman-years in those aged 15 years; and 17.7 (95% CI=17.1, 18.9) in those aged 25 years. Among women enrolled for the entire 5-year study period, 25.9% had at least one test but only 0.1% had a chlamydia test every year. Women tested more than once and older women were more likely to be tested again in the observation period. CONCLUSIONS: The low rates of regular annual chlamydia testing do not comply with national recommendations and would not be expected to have a major impact on the control of chlamydia infection at the population level. |
Household effects of school closure during Pandemic (H1N1) 2009, Pennsylvania, USA
Gift TL , Palekar RS , Sodha SV , Kent CK , Fagan RP , Archer WR , Edelson PJ , Marchbanks T , Bhattarai A , Swerdlow D , Ostroff S , Meltzer MI . Emerg Infect Dis 2010 16 (8) 1315-1317 To determine the effects of school closure, we surveyed 214 households after a 1-week elementary school closure because of pandemic (H1N1) 2009. Students spent 77% of the closure days at home, 69% of students visited at least 1 other location, and 79% of households reported that adults missed no days of work to watch children. |
STD screening of HIV-infected MSM in HIV clinics
Hoover KW , Butler M , Workowski K , Carpio F , Follansbee S , Gratzer B , Hare B , Johnston B , Theodore JL , Wohlfeiler M , Tao G , Brooks JT , Chorba T , Irwin K , Kent CK . Sex Transm Dis 2010 37 (12) 771-6 BACKGROUND: National guidelines for the care of human immunodeficiency virus (HIV)-infected persons recommend asymptomatic routine screening for sexually transmitted diseases (STDs). Our objective was to determine whether providers who care for HIV-infected men who have sex with men (MSM) followed these guidelines. METHODS: We abstracted medical records to evaluate STD screening at 8 large HIV clinics in 6 US cities. We estimated the number of men who had at least one test for syphilis, chlamydia (urethral and/or rectal), or gonorrhea (urethral, rectal, and/or pharyngeal) in 2004, 2005, and 2006. Urethral testing included nucleic acid amplification tests of both urethral swabs and urine. We also calculated the positivity of syphilis, chlamydia, and gonorrhea among screened men. RESULTS: Medical records were abstracted for 1334 HIV-infected MSM who made 14,659 visits from 2004-2006. The annual screening rate for syphilis ranged from 66.0% to 75.8% during 2004-2006. Rectal chlamydia and rectal and pharyngeal gonorrhea annual screening rates ranged from 2.3% to 8.5% despite moderate to high positivity among specimens from asymptomatic patients (3.0%-9.8%) during this period. Annual urethral chlamydia and gonorrhea screening rates were higher than rates for nonurethral sites, but were suboptimal, and ranged from 13.8% to 18.3%. CONCLUSIONS: Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines. The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening. |
Chlamydia screening and pelvic inflammatory disease: Insights from exploratory time-series analyses
Owusu-Edusei Jr K , Bohm MK , Chesson HW , Kent CK . Am J Prev Med 2010 38 (6) 652-7 BACKGROUND: Screening for chlamydia has been reported to reduce pelvic inflammatory disease (PID) at the individual level. However, information on population-level association (or causality) is scant. PURPOSE: This study aims to examine the association between chlamydia and gonorrhea screening and PID diagnoses using time-series analyses. METHODS: Monthly chlamydia and gonorrhea screening and PID diagnosis rates were extracted for a cohort of 207,695 continuously enrolled privately insured women from January 2001 to December 2006. An autoregressive integrated moving average model was used to examine whether rates of PID diagnoses in a given month were associated with rates of chlamydia and gonorrhea screening in previous months. RESULTS: Monthly screening rates increased from about 300 to almost 700 per 100,000 for chlamydia and from 250 to almost 650 per 100,000 for gonorrhea, whereas PID diagnosis rates declined during the same period (40-20 per 100,000). Increases in screening rates were associated with decreases in PID diagnosis rates 4 months later. On average, a one-unit (or 10%) increase in the growth of chlamydia and gonorrhea screening rates, separately, in the prior fourth month was significantly associated with a 0.36 (or 3.6%, p<0.05) and 0.32 (or 3.2%, p<0.10) decrease in the growth rate of the PID diagnosis rate, respectively. CONCLUSIONS: Although analyses such as these cannot prove causality, the results are consistent with the hypothesis that increases in chlamydia and gonorrhea screening coverage can lead to reductions in PID at the population level. A population-level focus offers advantages over individual-level analyses of screening and PID, such as the ability to capture indirect benefits of increased screening. |
Utilization of health services in physician offices and outpatient clinics by adolescents and young women in the United States: implications for improving access to reproductive health services
Hoover KW , Tao G , Berman S , Kent CK . J Adolesc Health 2010 46 (4) 324-30 PURPOSE: We examined utilization patterns of adolescents and young women as they seek general and reproductive health services in physician offices and hospital outpatient clinics. METHODS: We analyzed physician office visits in the 2003-2006 National Ambulatory Medical Care Surveys, and hospital outpatient clinic visits in the National Hospital Ambulatory Medical Care Surveys, to examine utilization patterns of females aged 9-26 years by 2-year age intervals and other characteristics such as physician specialty or clinic type. RESULTS: The number of visits to primary care physician offices increased with age, from 4.9 million for ages 9-10 years to 9.0 million for ages 25-26 years. The proportion of visits made to obstetrician-gynecologists and family practitioners increased with age, and by ages 15-16 years fewer than half of all visits to primary care providers were made to pediatricians. The proportion of visits to family practitioners increased from 25% at ages 9-10 years to 30% at ages 25-26 years. By ages 17-18 years, a larger proportion of visits were made to obstetrician-gynecologists (33% of 7.0 million visits) and to family practitioners (34%) than to pediatricians (23%). The proportion of visits for reproductive health services peaked at 53% of 7.5 million physician visits at ages 20-21 years. Similar utilization patterns were observed for the 11.0 million hospital outpatient visits to primary care providers. CONCLUSIONS: Because adolescents and young women most commonly utilize healthcare services provided by obstetrician-gynecologists and family practitioners, these specialties should be priority targets for interventions to improve the quality and availability of reproductive health services. |
Results of a program to test women for rectal chlamydia and gonorrhea
Barry PM , Kent CK , Philip SS , Klausner JD . Obstet Gynecol 2010 115 (4) 753-9 OBJECTIVE: To analyze whether rectal testing among women increased chlamydia and gonorrhea case-finding and whether reported receptive anal intercourse was a risk factor for rectal infection. METHODS: From March 2007 to August 2008, women receiving pelvic examinations at the San Francisco sexually transmitted disease clinic were tested for rectal gonorrhea and chlamydia by using a transcription-mediated amplification assay. Results of testing and clinical and demographic data were analyzed using a cross-sectional study design. RESULTS: Of 1,308 women with both rectal and vaginal tests, test results were positive for 79 patients (6.0%) for rectal chlamydia or gonorrhea and 88 patients (6.7%) for genital chlamydia or gonorrhea. Test results were positive for 13 patients (1.0%) at the rectum only, increasing detection from 88 to 101 patients (14.8%; 95% confidence interval 8.1-23.9). No correlation existed between reported anal sex and rectal chlamydia (P=.74); however, 50% of women with rectal gonorrhea reported anal sex compared with 21% of women without rectal gonorrhea (P=.002). CONCLUSION: Sexually transmitted disease clinics might improve chlamydia and gonorrhea case-finding through rectal testing of women, but more study is needed to determine the effects of finding and treating such infections. Reporting anal intercourse did not predict rectal chlamydial infection among women tested at both the rectum and the vagina. LEVEL OF EVIDENCE: II. |
Trends in the diagnosis and treatment of ectopic pregnancy in the United States
Hoover KW , Tao G , Kent CK . Obstet Gynecol 2010 115 (3) 495-502 OBJECTIVE: To estimate trends in the rates of diagnosis and treatment of ectopic pregnancy in the United States. METHODS: We analyzed data from a large administrative claims database of more than 200 U.S. commercial health plans, and estimated time trends in the rate and incidence of ectopic pregnancy among girls and women aged 15-44 years by 5-year age groups and by region from 2002 to 2007. We also estimated time trends in the proportion of cases that were treated surgically, either by laparoscopy or laparotomy, or medically with methotrexate. RESULTS: We identified 11,989 ectopic pregnancies during the period from 2002 to 2007. The overall rate of ectopic pregnancy among pregnant girls and women aged 15-44 years during the 6-year study period was 0.64%. We did not observe a trend in the rate of ectopic pregnancy by 5-year age group or by geographic region. The ectopic pregnancy rate increased with age; it was 0.3% among girls and women aged 15-19 years and 1.0% among women aged 35-44 years. Methotrexate treatment increased from 11.1% in 2002 to 35.1% in 2007 (P<.001); the methotrexate failure rate was 14.7% over the 6-year study period. Surgical management with laparotomy decreased over the study period from 40.0% to 33.1% (P<.001). CONCLUSION: We did not find an increasing or decreasing trend in the rate of ectopic pregnancy among U.S. commercially insured women from 2002 to 2007. The use of administrative claims data are likely the most feasible method for estimating the rate and monitoring trends of ectopic pregnancy in the United States. LEVEL OF EVIDENCE: II. |
Pandemic influenza: implications for programs controlling for HIV infection, tuberculosis, and chronic viral hepatitis
Heffelfinger JD , Patel P , Brooks JT , Calvet H , Daley CL , Dean HD , Edlin BR , Gensheimer KF , Jereb J , Kent CK , Lennox JL , Louie JK , Lynfield R , Peters PJ , Pinckney L , Spradling P , Voetsch AC , Fiore A . Am J Public Health 2009 99 S333-9 Among vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates of hospitalization, prolonged illness, and increased mortality from influenza compared with the general population. Persons with tuberculosis and chronic viral hepatitis may also be at increased risk of morbidity and mortality from influenza because of altered immunity and chronic illness. These populations also face social and structural barriers that will be exacerbated by a pandemic. Existing infrastructure should be expanded and pandemic planning should include preparations to reduce the risks for these populations. |
Diagnostic methodologies for chlamydia screening in females aged 15 to 25 years from private insurance claims data in the United States, 2001 to 2005
Owusu-Edusei K , Bohm MK , Kent CK . Sex Transm Dis 2009 36 (7) 419-21 Untreated Chlamydial Infection Can Progress into serious sequelae including pelvic inflammatory disease, ectopic pregnancy, and tubal infertility.1–4 In view of the potential sequelae, routine screening for chlamydia is recommended.5–10 Identifying chlamydia is essential for effective control and prevention programs. However, the majority of chlamydial infections are asymptomatic requiring specific and periodic diagnostic tests for detection.11,12 In the United States, an estimated 2.8 million cases occur each year among youth,13 for whom reported incidence rates are highest.14,15 Diagnostic tests for detecting chlamydia have evolved over the last 2 decades with substantial technological improvements in sensitivity. The corollary to the improvement in sensitivity is the increased potential to detect low-organism loads associated with asymptomatic infections.16,17 The increased use of more sensitive tests and expanded screening resulted in increased number of reports of chlamydia and has consequently been used to explain, in part, recent national and local increases in the incidence of chlamydia.18 Previous studies on the trends and volume of diagnostic tests used survey data largely from public laboratories.16–21 However, very little is known about the trends and volume of chlamydia diagnostic tests using claims data. Results from analyzing medical claims data can complement existing knowledge by providing additional information on the use of diagnostic tests from the private sector’s perspective, including some insights into their respective billing patterns. Closer examination of claims data may also provide insight into trends in the chlamydia Health Plan Employer Data and Information Set (HEDIS) measure. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Jun 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure