性传播感染(STIs)在美国(US)继续构成重大的公共卫生挑战。监视,疾病控制和预防的基石,可以加强,以便更及时地推广,高效,通过将健康信息交换(HIE)和其他大规模健康数据源纳入报告,以及公平的做法。从Healthix获得2018年1月1日至2023年6月30日之间的纽约市患者级电子健康记录数据,美国最大的公众HIE。Healthix数据与来自美国社区调查的邻里级信息相关联。在这项病例对照研究中,衣原体,淋病,使用具有logit函数和稳健标准误差的广义估计方程,将HIV阳性病例与对照组进行比较,以估计接受特定实验室检测或阳性结果的几率.在衣原体的1,519,121项测试中,1,574,772用于淋病,和1,200,560艾滋病毒,2%,0.6%和0.3%为衣原体阳性,淋病,艾滋病毒,分别。衣原体和淋病共发生1,854例(衣原体占7%,淋病总病例占21%)。测试行为通常与阳性病例的地理和社会人口统计学模式不一致。例如,生活在贫困程度最高地区的人们进行淋病检测的可能性较小,但检测呈阳性的可能性几乎是低贫困地区的两倍。区域HIE能够使用现有报告实践通常无法获得的细粒度和补充数据对测试和案例进行审查。增强的监测突出了某些人群中检测模式和性传播感染风险之间的潜在不一致,信号潜在的测试不足和过度。从HIE数据中得出的这些和未来的见解可用于持续告知公共卫生实践,并推动进一步改进服务和计划的提供和评估。
Sexually transmitted infections (STIs) continue to pose a substantial public health challenge in the United States (US). Surveillance, a cornerstone of disease control and prevention, can be strengthened to promote more timely, efficient, and equitable practices by incorporating health information exchange (HIE) and other large-scale health data sources into reporting. New York City patient-level electronic health record data between January 1, 2018 and June 30, 2023 were obtained from Healthix, the largest US public HIE. Healthix data were linked to neighborhood-level information from the American Community Survey. In this casecontrol study, chlamydia, gonorrhea, and HIV-positive cases were compared to controls to estimate the odds of receiving a specific laboratory test or positive result using generalized estimating equations with logit function and robust standard errors. Among 1,519,121 tests performed for chlamydia, 1,574,772 for gonorrhea, and 1,200,560 for HIV, 2%, 0.6% and 0.3% were positive for chlamydia, gonorrhea, and HIV, respectively. Chlamydia and gonorrhea co-occurred in 1,854 cases (7% of chlamydia and 21% of gonorrhea total cases). Testing behavior was often incongruent with geographic and sociodemographic patterns of positive cases. For example, people living in areas with the highest levels of poverty were less likely to test for gonorrhea but almost twice as likely to test positive compared to those in low poverty areas. Regional HIE enabled review of testing and cases using granular and complementary data not typically available given existing reporting practices. Enhanced surveillance spotlights potential incongruencies between testing patterns and STI risk in certain populations, signaling potential under- and over-testing. These and future insights derived from HIE data may be used to continuously inform public health practice and drive further improvements in provision and evaluation of services and programs.