Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark
Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark
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DOI：
10.1016/s1473-3099(16)30092-5
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发表时间：
2016-09-01
影响因子：
56.3
通讯作者：
Westh, Henrik
中科院分区：
文献类型：
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作者：
Davies, Bethan;Turner, Katy M. E.;Westh, Henrik
背景衣原体感染和重复感染后生殖并发症(盆腔炎、宫外孕和输卵管因素不孕)风险的不确定性阻碍了循证衣原体控制程序的设计。我们估计衣原体感染的诊断与医院保健(住院、门诊和急诊科)的生殖并发症之间的关系。方法我们根据丹麦(1995-2012年)的行政记录，构建并分析了15-44岁女性的回溯性人群队列。我们使用了丹麦国家衣原体研究的一个子集。主数据集包含1992年1月1日至2011年11月2日期间由公共卫生微生物学实验室记录的所有丹麦居民(包括格陵兰)的衣原体检测呈阳性。将个人随机匹配(按年龄和性别)，从人口登记系统(丹麦民事登记系统)中抽取4名在这段时间内衣原体检测未呈阳性的个人。这项研究的结果是诊断为盆腔炎、宫外孕或输卵管因素不孕症的住院患者(住院、门诊和急诊科)。结果发现，516720名女性(103344名阳性，182879名阴性，230497名从未检测)平均随访7.96年。与仅有阴性试验的妇女相比，有一项或多项阳性试验的妇女(盆腔炎，调整后的危险比[AHR]1.50[95%CI 1.43-1.57]；异位妊娠，AHR 1.31[1.25-1.38]；输卵管因素不孕，AHR 1.37[1.24-1.52])和从未进行过试验的妇女(盆腔炎，AHR 0.33[0.31-0.35])，每种并发症的风险高30%。异位妊娠，AHR 0.42[0.39-0.44]；输卵管因素不孕症AHR 0.29[0.25-0.33])。检测阳性对健康的绝对影响较小，因为检测阳性和检测阴性的妇女一生并发症发生率的差异很小(盆腔炎，0.6%；异位妊娠，0.2%；输卵管因素不孕，0.1%)。重复感染使盆腔炎的风险进一步增加20%(AHR 1.20，95%可信区间1.11-1.31)。因此，控制方案必须防止首次和重复感染，以改善妇女的生殖健康。
Background Uncertainty in the risk of reproductive complications (pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital health care (inpatient, outpatient, and emergency department) for a reproductive complication.Methods We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012). We used a subset of the national Danish Chlamydia Study. The master dataset contains all residents of Denmark (induding Greenland) who had a positive chlamydia test recorded by a public health microbiology laboratory from Jan 1, 1992, to Nov 2, 2011. Individuals were randomly matched (by age and sex) to four individuals drawn from the population register (Danish Civil Registration System) who did not have a positive chlamydia test during this interval. The outcomes in the study were hospital episodes of health-care (inpatient, outpatient, and emergency department) with a diagnosis of pelvic inflammatory disease, ectopic pregnancy, or tubal factor infertility.Findings The 516 720 women (103344 positive, 182 879 negative, 230497 never-tested) had a mean follow-up of 7.96 years. Compared with women with only negative tests, the risk of each complication was 30% higher in women with one or more positive tests (pelvic inflammatory disease, adjusted hazard ratio [AHR] 1.50 [95% CI 1.43-1.57]; ectopic pregnancy, AHR 1.31 [1.25-1.38]; tubal factor infertility, AHR 1.37 [1.24-1.52]) and 60% lower in women who were never-tested (pelvic inflammatory disease, AHR 0.33 [0.31-0.35]; ectopic pregnancy, AHR 0.42 [0.39-0.44]; tubal factor infertility AHR 0.29 [0.25-0.33]). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (pelvic inflammatory disease, 0.6%; ectopic pregnancy, 0.2%; tubal factor infertility, 0.1%). Repeat infections increased the risk of pelvic inflammatory disease by a further 20% (AHR 1.20, 95% CI 1.11-1.31).Interpretation A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of pelvic inflammatory disease. Therefore, control programmes must prevent first and repeat infections to improve women's reproductive health.