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Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009–2014: ecological analysis of hospital data
  1. Jane L Goller1,
  2. Alysha M De Livera1,
  3. Rebecca, J Guy2,
  4. Nicola Low3,
  5. Basil Donovan2,
  6. Matthew Law2,
  7. John M Kaldor2,
  8. Christopher K Fairley4,
  9. Jane S Hocking1
  1. 1Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
  2. 2The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
  4. 4Central Clinical School, Monash University and Melbourne Sexual Health Centre, Carlton, Victoria, Australia
  1. Correspondence to Jane L Goller, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria 3010, Australia; jane.goller{at}unimelb.edu.au

Abstract

Objective To analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014.

Methods We calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15–44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related (Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models.

Results For PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher.

Conclusions PID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.

  • women
  • pelvic inflammatory disease
  • chlamydia infection
  • gonorrhoea

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Footnotes

  • Handling editor Gwenda Hughes

  • Contributors JLG collected, cleaned and analysed the data, contributed to the analysis plan, and drafted and revised the manuscript. AMDL provided statistical advice, supervised the analysis, and contributed to the manuscript draft and revisions. JSH, RG, NL, CKF, BD, ML and JMK designed the Australian Chlamydia Control Effectiveness Pilot study, contributed to the analysis plan, interpretation of results, and contributed to the manuscript draft and revisions. All authors approved the final submitted version of the manuscript.

  • Funding These data are being analysed as part of the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) study funded by the Australian Government Department of Health and the National Health and Medical Research Council. JLG is supported by an Australian Government Research Training Program Scholarship at the University of Melbourne.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Royal Australian College of General Practitioners National Research and Evaluation Ethics Committee (NREEC09.019).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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