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White adolescent females may be less likely than black counterparts to be tested for STIs
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DENVER — When presenting to a pediatric emergency department, white adolescent females are less likely than black adolescents to be screened for sexually transmitted infections, according to findings presented here at the Pediatric Academic Societies’ 2011 Annual Meeting.
According to Carolyn Holland, MD, MEd, an emergency medicine physician at Cincinnati Children's Hospital Medical Center and assistant professor of clinical pediatrics and emergency medicine at the University of Cincinnati, and colleagues, sexually active white adolescent females who present to the ED with chief complaints indicative of an STI have testing performed less frequently than black adolescent females.
“As STIs are only able to be definitively diagnosed with testing, this disparity indicates that white adolescent females are being under evaluated for STIs in this PED setting,” Holland said during her presentation. “Fifty-eight percent of white females with a sexual history had STI testing, while 87% of blacks with sexual history had STI testing.”
According to the data, white patients were less likely to receive STI testing (adjusted odds ratio [AOR] 0.30; 95% CI 0.10-0.92), and patients with a gynecologic chief complaint (AOR 2.88; 95% CI 1.15-7.20) and reporting sexual activity (AOR 28.3; 95% CI, 8.23-98.0) were more likely to receive STI testing.
The retrospective study included 460 visits from 432 unique visits over 3 months. After exclusions, 293 visits from 281 unique patients were included. The mean age for white patient visits (n=129) was 16 years (standard deviation [SD]=2.0) and for black patient visits (n=164) was 17 years (SD=2.0). Race and sexual activity were independent predictors of STI testing. Race, sexual activity, and gynecological chief complaint were significant predictors (P<.05) of STI testing in a multivariate model that controlled for age, presence of a chronic medical condition, and provider demographics, according to Holland.
“Fifty-five percent of the study population was black, and 44% were white, which was similar to our local ED demographics,” Holland said.
This study included 13- to 21-year-old females who presented to a pediatric ED with chief complaints of abdominal, urinary or gynecologic complaints. Patients excluded from the study included those who were known or were suspected to be pregnant, had a recent trauma, were victims of abuse, were not seen primarily by an ED physician or were medically unstable.
“The primary reason for exclusion was known or suspected pregnancy,” Holland said during her presentation.
Holland added that trained reviewers blinded to study objectives abstracted sexual history and STI testing from redacted medical records. Additional abstraction collected information on patient chief complaints, medical history and provider characteristics. Predictors of the primary outcome of obtaining STI testing were determined using univariable and multivariable logistic regression.
“Our plans for the future include trying to better serve our white patients and do STI testing more often,” Holland said.
Disclosure: Dr. Holland reports no relevant financial disclosures.
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