Continuity of Health Insurance Coverage and Sexually Transmitted Infection Screening Among US Women

In the United States, gaps in health care insurance coverage correlate with lower use of preventive care. We aimed to determine whether part-year or year-round uninsurance was associated with lower use of testing for sexually transmitted infections (STIs).

We identified women aged 19 to 49 years in the 2017-2019 National Survey of Family Growth. Completion of any STI testing in the past year and location of STI testing were regressed on pattern of insurance coverage, classified as continuous private, continuous public, part-year uninsured, or year-round uninsured.

Based on the analytic sample (N = 4119), 12% of women aged 19 to 49 years experienced part-year uninsurance, and 8% experienced year-round uninsurance, whereas 31% received an STI test in the past year. On multivariable analysis, respondents with part-year uninsurance were the group most likely to have received STI testing (odds ratio compared with continuous private coverage, 1.56; 95% confidence interval, 1.09-2.23; P = 0.015), whereas respondents with year-round uninsurance were the group least likely to receive STI testing (odds ratio vs. continuous private coverage, 0.37; 95% confidence interval, 0.25-0.55; P < 0.001). Year-round uninsurance was associated with higher likelihood of receiving a test at locations other than public or private clinics, such as at a hospital or at an in-store clinic.

Low use of STI testing among women with year-round uninsurance indicates a need for expanded insurance coverage and greater access to STI testing. However, high rates of STI testing among women with part-year uninsurance challenge the presumed association of insurance continuity with higher uptake of preventive care.