Racial and Ethnic Disparities in Prenatal Syphilis Screening among Women with Medicaid-covered Deliveries in Florida

Abstract

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.