Trends in Chlamydia trachomatis Treatment Prescribing Practices in King County, Washington, 2010-2018.

BACKGROUND: In 2021, national Chlamydia trachomatis (CT) treatment guidelines changed from recommending either azithromycin (1 g; single dose) or doxycycline (100 mg twice daily for 7 days) to recommending only doxycycline as first-line treatment. The distribution and trends in CT prescribing practices before the guidelines change is largely unknown. METHODS: We conducted a trends analysis using Washington STD surveillance data. We included all female cases of urogenital CT 15 years or older who resided in King County and were diagnosed between 2010 and 2018. Surveillance data included information on demographics, sexual history, clinical features, diagnosing facility (eg, emergency department, family planning), and treatment regimen. We conducted descriptive analyses to examine trends in prescribing practices over time and by facility type. We used Poisson regression to examine the association between CT case characteristics and receipt of receipt of azithromycin. RESULTS: There were 36,830 cases of female urogenital CT during the study period. The percent of cases receiving azithromycin increased significantly from 86% in 2010 to 94% in 2018; the percent receiving doxycycline decreased from 13% to 5%. Five of the 8 facility types prescribed azithromycin to >95% of CT cases by 2018. Cases who were younger or cases of color were more likely to receive azithromycin (versus doxycycline) compared with older and White cases, respectively. CONCLUSIONS: A substantial shift in CT prescribing practices will be needed to adhere to new CT treatment guidelines. Our findings highlight the need for targeted provider education and training to encourage the transition to doxycycline use.

Racial inequity in preterm delivery among college-educated women: The role of racism.

BACKGROUND: Non-Hispanic Black (NHB) women face a 50% increased risk of delivering preterm compared to non-Hispanic White (NHW) women in the United States. Sociodemographic and pregnancy risk factors do not fully explain this inequity. This inequity exists even among women with a college education, although recent empirical analysis on racial inequities in preterm delivery (PTD) among college-educated women is lacking. Furthermore, the contribution of preconception risk factors to the racial inequity in PTD has not been examined. OBJECTIVES: To determine whether: (i) there is a NHB-NHW inequity in PTD among college-educated women; (ii) the prevalence of known, measured sociodemographic, pregnancy, and preconception PTD risk factors differs between NHB and NHW college-educated women; (iii) equalising the distribution of risk factors between college-educated NHB and NHW women reduces or eliminates the racial inequity in PTD. METHODS: We analysed US natality data from 2015 to 2016 among women with a college degree or higher (n = 2 326 512). We calculated frequencies of sociodemographic, pregnancy, and preconception risk factors among all women and separately by race/ethnicity. We used modified Poisson regression models to estimate the association between race/ethnicity and PTD controlling for known, measured sociodemographic, pregnancy, and preconception factors. RESULTS: The largest percentage point differences in risk factors between NHW and NHB women were observed for marital status, trimester of care initiation, body mass index, and birth interval. Among college-educated women, the unadjusted risk of PTD for NHB women was 1.77 (95% CI 1.74, 1.79) times the risk for NHW women. After controlling for sociodemographic, pregnancy, and preconception factors, this attenuated to RR 1.47 (95% CI 1.45, 1.49). CONCLUSIONS: A racial inequity in PTD persists among college-educated women. Racism contributes to the NHB-NHW inequity in PTD, in part, through its influence on known sociodemographic, pregnancy, and preconception risk factors for PTD and, in part, through unmeasured pathways.