Advertisement

Trends in pelvic inflammatory disease emergency department visits, United States, 2006–2013

Published:October 15, 2017DOI:https://doi.org/10.1016/j.ajog.2017.10.010

      Background

      Pelvic inflammatory disease is a female genital tract disorder with severe reproductive sequelae. Because of the difficulties in diagnosing pelvic inflammatory disease, it is not a reportable condition in many states. Females seeking care in emergency departments are a sentinel population for pelvic inflammatory disease surveillance.

      Objective

      The objective of the study was to determine trends in diagnoses of acute pelvic inflammatory disease in a nationally representative sample of emergency departments.

      Study Design

      All emergency department visits among females aged 15–44 years with an International Classification of Diseases, ninth revision, Clinical Modification diagnosis code indicating pelvic inflammatory disease during 2006–2013 were assessed from the HealthCare Utilization Project Nationwide Emergency Department Sample. Total and annual percentage changes in the proportion of pelvic inflammatory disease emergency department visits were estimated using trend analyses.

      Results

      While the number of emergency department visits among females aged 15–44 years during 2006–2013 increased (6.5 million to 7.4 million), the percentage of visits due to pelvic inflammatory disease decreased from 0.57% in 2006 to 0.41% in 2013 (total percentage change, –28.4%; annual percent change, –4.3%; 95% confidence interval, –5.7% to –2.9%). The largest decreases were among those aged 15-19 years (total percent change, –40.6%; annual percentage change, –6.6%; 95% confidence interval, –8.6% to –4.4%) and living in the South (total percentage change, –38.0%; annual percentage change, –6.2%; 95% confidence interval, –7.8% to –4.6%). Females aged 15-19 years who lived in the South had a 47.9% decrease in visits due to pelvic inflammatory disease (annual percentage change, –8.4%, 95% confidence interval, –10.4 to –6.5). Patients living in ZIP codes with the lowest median income (<$38,000) had the highest percent of visits with a pelvic inflammatory disease diagnosis; the smallest declines over time were in patients living in ZIP codes with the highest median income (i.e., >$64,000, total percent change, –24.4%; annual percent change, –3.8%; 95% confidence interval, –5.2% to –2.4%). The percentage of emergency department visits due to pelvic inflammatory disease was highest among patients not charged for their visit, self-paying, or those covered by Medicaid, with total percentage changes in these 3 groups of –27.8%, –30.7%, and –35.1%, respectively. Patients with Medicaid coverage had the largest decrease in visits with a diagnosis of pelvic inflammatory disease (total percent change, –35.1%; annual percent change, –5.8%; 95% confidence interval, –7.2% to –4.3%).

      Conclusion

      Nationally representative data indicate the percentage of emergency department visits with a pelvic inflammatory disease diagnosis decreased during 2006–2013 among females aged 15-44 years, primarily driven by decreased diagnoses of pelvic inflammatory disease among females aged 15–19 years and among women living in the southern United States. Despite declines, a large number of females of reproductive age are receiving care for pelvic inflammatory disease in emergency departments. Patients with lower median income and no or public health insurance status, which may decrease access to and use of health care services, consistently had the highest percentage of emergency department visits due to pelvic inflammatory disease. Future research should focus on obtaining a better understanding of factors influencing trends in pelvic inflammatory disease diagnoses and ways to address the challenges surrounding surveillance for this condition.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Westrom L.
        • Eschenbach D.
        Pelvic inflammatory disease.
        in: Sexually transmitted diseases. 4th ed. McGraw-Hill, New York (NY)2008: 783-809
        • Kreisel K.
        • Torrone E.
        • Bernstein K.
        • Hong J.
        • Gorwitz R.
        Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age—United States, 2013–2014.
        MMWR Morb Mort Wkly Rep. 2017; 66: 80-83
        • Haggerty C.L.
        • Gottlieb S.L.
        • Taylore B.D.
        • Low N.
        • Xu F.
        • Ness R.B.
        Risk of sequelae after Chlamydia trachomatis genital infection in women.
        J Infect Dis. 2010; 201: S134-S155
        • Kristensen G.
        • Bollerup A.
        • Lind K.
        • et al.
        Infections with Neisseria gonorrhoeae and Chlamydia trachomatis in women with acute salpingitis.
        Genitourin Med. 1985; 61: 179-184
        • Moller B.R.
        • Mardh P.-A.
        • Ahrons S.
        • Nussler E.
        Infection with Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae in patients with acute pelvic inflammatory disease.
        Sex Transm Dis. 1981; 8: 198-202
        • Eschenbach D.A.
        • Buchanan T.M.
        • Pollock H.M.
        • et al.
        Polymicrobial etiology of acute pelvic inflammatory disease.
        N Engl J Med. 1975; 293: 166-171
        • Sweet R.
        • Draper D.
        • Schachter J.
        • James J.
        • Hadley W.
        • Brooks G.
        Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: what is the appropriate site to sample?.
        Am J Obstet Gynecol. 1980; 138: 985-989
        • Parker C.
        • Topinka M.
        The incidence of positive cultures in women suspected of having PID/salpingitis.
        Acad Emerg Med. 2000; 7: 1170
        • Centers for Disease Control and Prevention
        Sexually transmitted disease surveillance 2016.
        U.S. Department of Health and Human Services, Atlanta2017
        • Oakeshott P.
        • Kerry S.
        • Aghaizu A.
        • et al.
        Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial.
        BMJ. 2010; 340: c1642
        • Scholes D.
        • Stergachis A.
        • Heidrich F.E.
        • Andrilla H.
        • Holmes K.K.
        • Stamm W.E.
        Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection.
        N Engl J Med. 1996; 334: 1362-1366
      1. Centers for Disease Control and Prevention. Pelvic inflammatory disease (PID): Centers for Disease Control and Prevention fact sheet. 2016; Available at: http://www.cdc.gov/std/pid/STDFact-PID.htm. Accessed July 5, 2017.

        • Simms I.
        • Warburton F.
        • Westrom L.
        Diagnosis of pelvic inflammatory disease: time for a rethink.
        Sex Transm Infect. 2003; 79: 491-494
        • Leichliter J.S.
        • Chandra A.
        • Aral S.O.
        Correlates of self-reported pelvic inflammatory disease treatment in sexually experienced reproductive-aged women in the United States, 1995 and 2006–2010.
        Sex Transm Dis. 2013; 40: 413-418
        • Bohm M.K.
        • Newman L.
        • Satterwhite C.L.
        • Tao G.
        • Weinstock H.
        Pelvic inflammatory disease among privately insured women, United States, 2001–2005.
        Sex Transm Dis. 2010; 37: 131-136
      2. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed June 17, 2017.

        • Satterwhite C.L.
        • Yu O.
        • Raebel M.A.
        • et al.
        Detection of pelvic inflammatory disease: development of an automated case-finding algorithm using administrative data.
        Infect Dis Obstet Gynecol. 2011; 2011: 428351
        • Owusu-Edusei K.
        • Bohm M.K.
        • Chesson H.W.
        • Kent C.K.
        Chlamydia screening and pelvic inflammatory disease: insights from exploratory time-series analyses.
        Am J Prev Med. 2010; 38: 652-657
        • Goyal M.
        • Hersh A.
        • Luan X.
        • Localio R.
        • Trent M.
        • Zaoutis T.
        National trends in pelvic inflammatory disease among adolescents in the emergency department.
        J Adolesc Health. 2013; 53: 249-252
        • Sutton M.Y.
        • Sternberg M.
        • Zaidi A.
        • St Louis M.E.
        • Markowitz L.E.
        Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States, 1985–2001.
        Sex Transm Dis. 2005; 32: 778-784
        • Centers for Disease Control and Prevention
        Health Disparities and Inequalities Report—United States, 2013.
        MMWR Morb Mort Wkly Rep. 2013; 62: 1-186
        • Tang N.
        • Stein J.
        • Hsia R.Y.
        • Maselli J.H.
        • Gonzales R.
        Trends and characteristics of US emergency department visits, 1997–2007.
        JAMA. 2010; 30: 664-670
        • Kangovi S.
        • Barg F.K.
        • Carter T.
        • Long J.A.
        • Shannon R.
        • Grande D.
        Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care.
        Health Aff (Millwood). 2013; 32: 1196-1203
        • Pearson W.S.
        • Peterman T.A.
        • Gift T.L.
        An increase in sexually transmitted infections seen in US emergency departments.
        Prev Med. 2017; 100: 143-144
        • Finelli L.
        • Schillinger J.A.
        • Wasserheit J.N.
        Are emergency departments the next frontier of sexually transmitted disease screening?.
        Sex Transm Dis. 2001; 28: 40-42
        • Beckmann K.R.
        • Melzer-Lange M.D.
        • Gorelick M.H.
        Emergency department management of sexually transmitted infections in US adolescents: results from the National Hospital Ambulatory Medical Care Survey.
        Ann Emerg Med. 2004; 43: 333-338
        • Mehta S.D.
        Gonorrhea and chlamydia in emergency departments: screening, diagnosis, and treatment.
        Curr Infect Dis Rep. 2007; 92: 134-142
        • Jenkins W.D.
        • Rabins C.
        • Bhattacharya D.
        Importance of physicians in Chlamydia trachomatis control.
        Prev Med. 2011; 53: 335-337
        • Centers for Disease Control and Prevention
        Sexually transmitted disease surveillance, 2010.
        US Department of Health and Human Services, Atlanta, GA2011
        • Centers for Disease Control and Prevention
        Sexually transmitted disease surveillance, 2014.
        US Department of Health and Human Services, Atlanta2015
        • Moore M.S.
        • Golden M.R.
        • Scholes D.
        • Kerani R.P.
        Assessing trends in chlamydia positivity and gonorrhea incidence and their associations with the incidence of pelvic inflammatory disease and ectopic pregnancy in Washington state, 1988–2010.
        Sex Transm Dis. 2016; 43: 2-8
        • Anschuetz G.L.
        • Asbel L.
        • Spain C.V.
        • et al.
        Association between enhanced screening for Chlamydia trachomatis and Neisseria gonorrhoeae and reductions in sequelae among women.
        J Adolesc Health. 2012; 51: 80-85
        • Simms I.
        • Stephenson J.
        Pelvic inflammatory disease epidemiology: what do we know and what do we need to know?.
        Sex Transm Infect. 2000; 76: 80-87