Studies relying on passive retrospective cohorts developed from health services data provide biased estimates of incidence of sexually transmitted infections

Sex Transm Dis. 2004 Oct;31(10):596-600. doi: 10.1097/01.olq.0000140011.93104.32.


Objective: Passive retrospective cohorts composed of persons who have tested 2 or more times for a sexually transmitted infection (STI) of interest during clinical visits have been used to estimate STI incidence. We hypothesized that the analytic period of a passive cohort might affect the estimate of STI incidence, with shorter periods yielding higher estimates of incidences of infection.

Study: We analyzed data collected from women, 12 to 24 years of age, tested for chlamydia 2 or more times at 6 sites in San Francisco between January 1997 and December 2000. Incidence was calculated for 10 different analytic periods.

Results: The calculated incidence of chlamydial infection during 1997 was 16.8 (95% confidence interval [CI], 10.9-24.0) per 1000 person-months of follow up. The calculated incidence dropped markedly as the analytic period lengthened, with the incidence estimated to be 9.7 (95% CI, 8.6-10.9) using a study period of 4 years (1997-2000). Estimates of incidence were similar when using the same analytic period, regardless of calendar year, and there was a similar decline in estimated incidence using longer analytic periods.

Conclusions: Estimates of STI incidence based on passive cohort data may have limited epidemiologic value because incidence measures may be highly dependent on the analytic period.

MeSH terms

  • Adolescent
  • Adult
  • Bias*
  • Child
  • Chlamydia Infections / epidemiology
  • Chlamydia Infections / etiology
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Retrospective Studies
  • San Francisco / epidemiology
  • Sexually Transmitted Diseases / epidemiology*
  • Sexually Transmitted Diseases / etiology*