chlamydia trends: what we do and don’t know
DESCRIPTION
Presented by Lizzi Torrone, MSPH, PhD, Epidemiologist, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting.TRANSCRIPT
Chlamydia Trends: What We Do and Don’t Know
Lizzi TorroneEpidemiologist
Division of STD Prevention
National Chlamydia CoalitionJanuary 26, 2012
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of STD Prevention
Chlamydia—Rates by Sex, United States, 1990–2010
NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.
Rate (per 100,000 population)
Year
0
125
250
375
500
625
750
20102008200620042002200019981996199419921990
Women
Total
Men
Chlamydia—Rates by Age and Sex, United States, 2010
15–19
20–24
25–29
30–34
35–39
40–44
45–54
55–64
65+
Total
Men WomenRate (per 100,000 population)
Age3,700 2,960 2,220 1,480 740 0 0 740 1,480 2,220 2,960 3,700
774.3
1,187.0
598.0
309.0
153.2
91.3
39.3
233.7
2.8
10.9
3,378.2
3,407.9
1,236.1
530.9
220.1
94.7
32.8
610.6
2.1
9.3
Chlamydia—Percentage of Reported Cases by Sex and Selected Reporting Sources,
United States, 2010
*HMO = health maintenance organization; HD = health department.NOTE: These categories represent 72.5% of cases with a known reporting source. Of all cases, 11.6% had a missing or unknown reporting source.
STD Clinic
Private Physician/HMO*
Other HD* Clinic
Family Planning Clinic
Emergency Room
Percentage
Men Women0
5
10
15
20
25
30
35
40
What do chlamydia case report data tell us?
Chlamydia is the most commonly reported nationally notifiable disease.
Chlamydia is most commonly diagnosed among young females.
Many females are diagnosed in private healthcare settings.
What do chlamydia case report data NOT tell us?
The incidence and prevalence of chlamydia. Duration of infection is unknown Doesn’t account for changes in
• Screening coverage• Test technology used• Empiric treatment• Reporting practices
Chlamydia Screening Coverage* Trends (Women Aged 16-20 and 21-24 years, HEDIS)
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
Medicaid (21-24 yos)Medicaid (16-20 yos)
*Among women enrolled in commercial or Medicaid plans who had a visit where they were determined to be sexually active
The State of Healthcare Quality, 2011: http://www.ncqa.org/LinkClick.aspx?fileticket=FpMqqpADPo8%3d&tabid=836
Percentage
What do chlamydia case report data NOT tell us?
The incidence and prevalence of chlamydia. Duration of infection is unknown Doesn’t account for changes in
• Screening coverage• Test technology used• Empiric treatment• Reporting practices
Percentage of Nucleic Acid Amplification Tests (NAATs) Used Among Women, Infertility
Prevention Project, 2000–2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
Percentage
What do chlamydia case report data NOT tell us?
The incidence and prevalence of chlamydia. Duration of infection is unknown Doesn’t account for changes in
• Screening coverage• Test technology used• Empiric treatment• Reporting practices
What do we know about trends in Chlamydia?
Case reports are increasing, but… Likely reflects increased screening and use of NAATs
After analyzing data at the clinic level to account for unmeasured factors between
clinics (e.g., screening practices), positivity remained stable from 2004–2008.
Limitation: Can’t account for changes within clinics over time (e,g., demographic shifts in who
goes to the clinic)
Among both women (19%) and men (8%) aged 16-24 years entering the national job
training program, chlamydia prevalence declined significantly from 2003–2007.
Limitation: May not be generalizable and population entering program may change
over time
epub, Dec 2012
In nationally representative surveys from 1999–2008,
prevalence decreased 40% among men and women aged 14–39 years and prevalence
remained stable among women aged 14–25 years.
Limitation: Small sample sizes and low prevalence limit ability to monitor trends in
subgroups
What do we know about trends in chlamydia?
Case reports are increasing, but… Likely reflects increasing screening and use of NAATs
Positivity and prevalence estimates suggest stable or decreasing morbidity, but… Current national data sources have limitations
What don’t we know about trends in chlamydia?
What opportunities do we have?
Increase screening coverage Particularly among adolescents Within the context of a changing healthcare
environment Improve chlamydia surveillance
Limitations of current national data sources Consider different metrics and data sources
Acknowledgements
Jim Braxton LaZetta Grier Rob Nelson Catherine
Satterwhite Hillard Weinstock
Thank [email protected]
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD , and TB Prevention
Division of STD Prevention