Prenatal syphilis screening rate among Medicaid recipients varies greatly in Southern US
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Data show that prenatal syphilis screening, although required by law in some states and recommended by the U.S. Preventive Services Task Force and CDC, has not reached 100% among Medicaid recipients in six Southern states.
The rates of syphilis among women of childbearing age and congenital syphilis have been simultaneously increasing annually since 2012, according to researchers. The most recent nationwide data indicate 1,870 infants were born with the disease in 2019. Healio has previously reported that the United States, unlike other countries, has not been WHO-certified as having eliminated congenital syphilis.
The new study is “the first study of syphilis screening among Medicaid beneficiaries in multiple Southern states,” Paul Lanier, MSW, PhD, an associate professor in the School of Social Work at the University of North Carolina at Chapel Hill, and colleagues wrote in the American Journal of Preventive Medicine.
Lanier and colleagues analyzed prenatal syphilis screening rates from 504,943 Medicaid claims filed from Georgia, Kentucky, Louisiana, North Carolina, South Carolina and Tennessee during fiscal years 2017-2018 and 2018-2019. They also compared the screening rates among women who were enrolled in Medicaid during their first trimester of pregnancy with those who enrolled later in their pregnancy.
“It is possible that syphilis screening occurred outside periods of Medicaid enrollment. To address this limitation in Medicaid claims data, two subsamples were developed from the larger study sample,” Lanier and colleagues wrote.
The first subgroup consisted of all the women who met the study criteria — which excluded women who were simultaneously enrolled in Medicare and Medicaid and those aged younger than 12 years or older than 64 years — and had 1 or more days of Medicaid enrollment before their child was born. The second subgroup was limited to those who were registered for Medicaid during their entire first trimester.
The researchers wrote that across the six states and the entire study period, the percentage of women who had a prenatal syphilis test at any point during their pregnancy ranged from 56% to 91% (mean = 70%) in the first subgroup and from 78% to 90% (mean = 83%) in the second subgroup.
In addition, syphilis screening during a woman’s first trimester ranged from 15% to 62% (mean = 39%) among all enrollees and 32% to 72% (mean = 53%) when considering only those with continuous enrollment in the first trimester. Screening rates during the third trimester varied from 9% to 55% (mean = 30%) among all enrollees and 8% to 72% (mean = 35%) among first-trimester enrollees. States that did not mandate third-trimester screening had a lower percentage of beneficiaries who underwent screening in the third trimester compared with states that did.
“The findings suggest inconsistencies in policy and practice between states and the need for concerted public health strategies to improve prenatal syphilis screening,” Lanier and colleagues wrote.