Racial and Ethnic Disparities in Prenatal Syphilis Screening among Women with Medicaid-covered Deliveries in Florida
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Black and Hispanic infants are 19.9 and 10.3 times more likely, respectively, than white infants to develop congenital syphilis (CS), a disease that is preventable with timely prenatal screening and treatment. We examined racial/ethnic group differences in prenatal syphilis screening among pregnant women with equal financial access to prenatal care through Medicaid.
We used Florida claims data to examine any, early, and repeat screening among non-Hispanic white, non-Hispanic black, and Hispanic women with Medicaid-covered deliveries in FY1995 (n = 56,088) and FY2000 (n = 54,073). We estimated screening rates for each group, and used logistic regression to assess whether screening disparities remained after controlling for other factors, including Medicaid enrollment characteristics and prenatal care source, and associations between access-related factors and screening odds for each group.
Between FY1995 and FY2000, rates of any and early syphilis screening increased, while repeat screening rates decreased. In FY1995, any, early, and repeat rates were highest for blacks and lowest for Hispanics. In FY2000, any and early screening rates were highest for whites and lowest for blacks, while repeat screening rates were similar across groups. Racial/ethnic differences in any and early screening remained for non-Hispanic blacks after adjustment. In general, Medicaid enrollment early in pregnancy, primary care case management participation, and use of a safety net clinic were associated with higher screening odds, though results varied by test type and across groups.
Unexplained racial/ethnic disparities in prenatal syphilis screening remain for blacks, but not Hispanics. Individual, provider, and program factors contribute to differences across and within groups.
KeywordsPrenatal syphilis screening Congenital syphilis Maternal syphilis Medicaid Claims data
This publication was made possible through the Centers for Disease Control and Prevention (CDC) and the Association for Prevention Teaching and Research (APTR) Cooperative Agreement No. U50/CCU300860. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the CDC or APTR. The authors thank the editor and four anonymous reviewers for their helpful suggestions. We also thank RTI Programmer Bob Baker for his assistance in creating the variables needed to conduct the analysis, and Florida state officials for information about the Medicaid program, syphilis prevention efforts, and CS surveillance data.
- 2.Centers for Disease Control and Prevention (2004). Congenital syphilis—United States, 2002. MMWR Morbidity and Mortality Weekly Report, 53(31), 716–719.Google Scholar
- 3.Centers for Disease Control and Prevention (2001). Congenital syphilis—United States, 2000. MMWR Morbidity and Mortality Weekly Report, 50(27), 573–577.Google Scholar
- 6.Centers for Disease Control and Prevention (2002). Sexually transmitted diseases treatment guidelines 2002. MMWR Recommendations and Reports, 51(RR-6), 1–80.Google Scholar
- 7.American Academy of Pediatrics (2002). The American College of Obstetricians and Gynecologists. Guidelines for perinatal care—5th edition. Elk Grove Village, IL: American Academy of Pediatrics.Google Scholar
- 9.Centers for Disease Control and Prevention, Division of Sexually Transmitted Diseases. Syphilis Elimination Effort (SEE). Home Page. Accessed at: http://www.cdc.gov/stopsyphilis/default.htm.
- 11.Centers for Disease Control and Prevention, Division of STD Prevention (1999). Sexually transmitted disease surveillance 1998. Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
- 12.Centers for Disease Control and Prevention, Division of STD Prevention (2006). Sexually transmitted disease surveillance, 2005. Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
- 13.Schrag, S. J., Arnold, K. E., Mohle-Boetani, J. C., Lynfield, R., Zell, E. R., Stefonek, K., Noga, H., Craig, A. S., Thomson Sanza, L., Smith, G., & Schuchat, A. (2003). Prenatal screening for infectious diseases and opportunities for prevention. Obstetrics and Gynecology, 102(4), 753–760.PubMedCrossRefGoogle Scholar
- 16.Southwick, K. L., Guidry, H. M., Weldon, M. M., Mert, K. J., Berman, S. M., & Levine, W. C. (1999). An epidemic of congenital syphilis in Jefferson County, Texas, 1994–1995: Inadequate prenatal syphilis testing after an outbreak in adults. American Journal of Public Health, 89(4), 557–560.PubMedGoogle Scholar
- 20.Lewis, C. T., Matthews, T. J., & Heuser, R. L. (1996). Prenatal care in the United States, 1980–94. Vital and Health Statistics, 21(54), 1–17.Google Scholar
- 21.Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., & Munson, M. L. (2005). Births: Final data for 2003. National Vital Statistics Reports, 54(2), 1–116.Google Scholar
- 23.Centers for Disease Control and Prevention (1998). Epidemic of congenital syphilis—Baltimore, 1996–1997. MMWR Morbidity and Mortality Weekly Report, 47(42), 904–947.Google Scholar
- 25.National Governors’ Association (NGA), Center for Best Practices (2003). MCH Update 2002: State health coverage for low-income pregnant women, children, and parents. Washington, DC: NGA.Google Scholar
- 26.National Governors’ Association (NGA), Center for Best Practices (1994). MCH Update October 1994: State Medicaid coverage of pregnant women and children. Washington, DC: NGA.Google Scholar
- 27.Harigopal, P., & Brewer, T. H. (2005). Treatment and special care consideration for syphilis. The Journal of the Florida Medical Association, Inc, 89(1), 12–15.Google Scholar
- 28.Florida Department of Health, Division of Disease Control, Bureau of STD Prevention and Control Data Files. Congenital syphilis cases by age, race/ethnicity, and sex: 1995 and 2000. Accessed at: http://www.doh.state.fl.us.disease_ctrl/std/trends/florida.html.
- 29.Florida Department of Health, State Office of Vital Statistics, Community Health Assessment Resource Tool Set (CHARTS), Florida Birth Query System. Resident births by mother’s race and ethnicity: All counties, 1995 and 2000. Accessed at: http://www.floridacharts.com/charts/BirthQuery.aspx.
- 30.SAS (2005). Release 9.1. SAS Institute. Cary, NC: SAS Institute, Inc.Google Scholar
- 31.Centers for Medicare & Medicaid Services (CMS). Medicaid Eligibility. Accessed at: http://www.cms.hhs.gov/medicaid/eligibility/criteria.asp.
- 32.National Governors’ Association (NGA), Center for Best Practices (1996). MCH Update September 1996: Medicaid coverage of pregnant women and children. Washington, DC: NGA.Google Scholar
- 33.Schneider, A., Elias, R., Garfield, R., Rousseau, D., & Wachino, V. (2002). The Medicaid resource book. Washington, DC: The Henry J. Kaiser Family Foundation.Google Scholar
- 34.State of Florida Agency for Health Care Administration. Overview of MediPASS. Accessed at: http://www.fdhc.state.fl.us/Medicaid/MediPass/index.shtml.
- 37.US Department of Agriculture Economic Research Service (USDA/ERS). Measuring rurality: Rural–urban continuum codes (prior to 2003). Accessed at: http://www.ers.usda.gov/Briefing/Rurality/RuralUrbCon/priordescription.htm.
- 38.Perloff, J. D., Kletke, P., & Fossett, J. W. (2005). Which physicians limit their Medicaid participation, and why. Health Services Research, 30(1), 7–26.Google Scholar
- 42.Florida Department of Health, Division of Family Health Services (2006) Uncompensated prenatal care among non-U.S. citizens: Florida, 1996 to 2005. Tallahassee, FL: Florida Department of Health.Google Scholar
- 43.Florida Department of Health, Office of Maternal and Child Health (2000). Healthy Start annual report. Tallahassee, FL: Florida Department of Health.Google Scholar
- 46.Schwalberg, R., Mathis, S. A., Giffen, M., Mohamadi, L., Zimmerman, B., & Sines, E. (2001). Medicaid coverage of perinatal services: Results of a national survey. Menlo Park, CA: The Henry J. Kaiser Family Foundation.Google Scholar
- 52.Rosenbaum, S., Shin, P., & Darnell, J. (2004). Economic stress and the safety net: A health center update. Washington, DC: Kaiser Commission on Medicaid and the Uninsured, The Henry J. Kaiser Family Foundation.Google Scholar