Table 1.
Distribution of Demographic and Clinical Characteristics by Syphilis Surveillance Stage and Treatment Status, SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network), Six States, 2018–2021
| Not Treated or Inadequately Treated(n=621, 42.1%) |
||||
|---|---|---|---|---|
| Characteristic | Total (N=1,476) | P/S/E (n=244)* | LL/U (n=377)† | Total (n=621) |
|
| ||||
| Urbanicity# | ||||
| Medium–large metropolitan (250,000 or more) | 1,297 (88.0) | 222 (91.7) | 339 (89.9) | 561 (90.6) |
| Rural–small metropolitan (249,999 or fewer) | 177 (12.0) | 20 (8.3) | 38 (10.1) | 58 (9.4) |
| Missing | 2 (0.1) | 2 (0.8) | 0 (0.0) | 2 (0.3) |
| Age at first diagnosis (y) | 27 (23–31) | 27 (22–31) | 28 (24–33) | 28 (23–32) |
| 24 or younger | 574 (39.4) | 90 (37.8) | 114 (30.7) | 204 (33.5) |
| 25–29 | 434 (29.8) | 74 (31.1) | 111 (29.9) | 185 (30.4) |
| 30–34 | 289 (19.8) | 45 (18.9) | 85 (22.9) | 130 (21.3) |
| 35 or older | 160 (11.0) | 29 (12.2) | 61 (16.4) | 90 (14.8) |
| Missing | 19 (1.3) | 6 (2.5) | 6 (1.6) | 12 (1.9) |
| Race and ethnicity** | ||||
| American Indian, American Native, Native Hawaiian, Pacific Islander | 78 (5.4) | 14 (5.8) | 22 (5.9) | 36 (5.9) |
| Asian | 30 (2.1) | 5 (2.1) | 4 (1.1) | 9 (1.5) |
| Black, non-Hispanic | 486 (33.8) | 81 (33.8) | 102 (27.3) | 183 (29.8) |
| Hispanic or Latinx | 530 (36.9) | 83 (34.6) | 144 (38.5) | 227 (37.0) |
| Multiple or other unspecified | 14 (1.0) | 3 (1.3) | 6 (1.6) | 9 (1.5) |
| White, non-Hispanic | 298 (20.8) | 54 (22.5) | 96 (25.7) | 150 (24.4) |
| Missing | 40 (2.7) | 4 (1.6) | 3 (0.8) | 7 (1.1) |
| Health insurance at delivery | ||||
| Private | 174 (15.0) | 25 (14.3) | 25 (8.6) | 50 (10.8) |
| Public | 897 (77.2) | 133 (76.0) | 230 (79.3) | 363 (78.1) |
| Other, none, self-pay | 91 (7.8) | 17 (9.7) | 35 (12.1) | 52 (11.2) |
| Missing | 314 (21.3) | 69 (28.3) | 87 (23.1) | 156 (25.1) |
| History of incarceration†† | ||||
| Yes | 91 (8.5) | 15 (8.6) | 33 (13.0) | 48 (11.2) |
| No | 984 (91.5) | 159 (91.4) | 220 (87.0) | 379 (88.8) |
| Missing | 401 (27.2) | 70 (28.7) | 124 (32.9) | 194 (31.2) |
| History of homelessness†† | ||||
| Yes | 126 (11.7) | 31 (18.7) | 53 (20.2) | 84 (19.6) |
| No | 946 (88.2) | 135 (81.3) | 209 (79.8) | 344 (80.4) |
| Missing | 404 (27.4) | 78 (32.0) | 115 (30.5) | 193 (31.1) |
| No. of prenatal care visits | 8 (3–12) | 6 (2–10) | 2 (0–8) | 4 (0–9) |
| Receipt of prenatal care | ||||
| Timely (at least 30 d before pregnancy outcome) | 1,143 (82.2) | 169 (74.1) | 198 (56.4) | 367 (63.4) |
| Nontimely (less than 30 d before pregnancy outcome) | 71 (5.1) | 21 (9.2) | 36 (10.3) | 57 (9.8) |
| No prenatal care | 177 (12.7) | 38 (16.7) | 117 (33.3) | 155 (26.8) |
| Missing | 86 (5.8) | 16 (6.6) | 26 (6.9) | 42 (6.8) |
| MOUD receipt‡‡ | ||||
| Yes | 79 (5.5) | 17 (7.6) | 33 (9.3) | 50 (8.6) |
| No | 1,345 (94.5) | 208 (92.4) | 321 (90.7) | 529 (91.4) |
| Missing | 52 (3.5) | 19 (7.8) | 23 (6.1) | 42 (6.8) |
| Any substance use§§ | ||||
| Yes | 279 (19.6) | 55 (24.4) | 137 (38.7) | 192 (33.2) |
| No | 1,145 (80.4) | 170 (75.6) | 217 (61.3) | 387 (66.8) |
| Missing | 52 (3.5) | 19 (7.8) | 23 (6.1) | 42 (6.8) |
| Gestational age at pregnancy outcome (wk) | ||||
| Less than 35 | 222 (15.0) | 53 (21.7) | 114 (30.2) | 167 (26.9) |
| 35 or more | 1,254 (85.0) | 191 (78.3) | 263 (69.8) | 454 (73.1) |
| Missing | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Adequately Treated (n=855, 57.9%) |
|||||
|---|---|---|---|---|---|
| Characteristic | P/S/E (n=358)‡ | LL/U (n=497)§ | Total (n=855) | RR (95% CI)║ | P ¶ |
|
| |||||
| Urbanicity# | .008 | ||||
| Medium–large metropolitan (250,000 or more) | 323 (90.2) | 413 (83.1) | 736 (86.1) | 1.00 (ref) | |
| Rural–small metropolitan (249,999 or fewer) | 35 (9.8) | 84 (16.9) | 119 (13.9) | 0.76 (0.61–0.94) | |
| Missing | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| Age at first diagnosis (y) | 26 (22–30) | 26 (23–31) | 26 (23–31) | <.001 | |
| 24 or younger | 156 (43.8) | 214 (43.5) | 370 (43.6) | 1.00 (ref) | |
| 25–29 | 107 (30.1) | 142 (28.9) | 249 (29.4) | 1.20 (1.03–1.40) | |
| 30–34 | 65 (18.3) | 94 (19.1) | 159 (18.8) | 1.27 (1.07–1.50) | |
| 35 or older | 28 (7.9) | 42 (8.5) | 70 (8.3) | 1.58 (1.33–1.89) | |
| Missing | 2 (0.6) | 5 (1.0) | 7 (0.8) | ||
| Race and ethnicity** | .004 | ||||
| American Indian, American Native, Native Hawaiian, Pacific Islander | 18 (5.2) | 24 (5.0) | 42 (5.1) | 0.92 (0.70–1.20) | |
| Asian | 5 (1.4) | 16 (3.4) | 21 (2.6) | 0.60 (0.34–1.04) | |
| Black, non-Hispanic | 135 (39.1) | 168 (35.2) | 303 (36.9) | 0.75 (0.64–0.88) | |
| Hispanic or Latinx | 125 (36.2) | 178 (37.3) | 303 (36.9) | 0.85 (0.73–0.99) | |
| Multiple or other unspecified | 2 (0.6) | 3 (0.6) | 5 (0.6) | 1.28 (0.85–1.92) | |
| White, non-Hispanic | 60 (17.4) | 88 (18.4) | 148 (18.0) | 1.00 (ref) | |
| Missing | 13 (3.6) | 20 (4.0) | 33 (3.9) | ||
| Health insurance at delivery | <.001 | ||||
| Private | 45 (15.7) | 79 (19.3) | 124 (17.8) | 1.00 (ref) | |
| Public | 227 (79.1) | 307 (74.9) | 534 (76.6) | 1.41 (1.10–1.80) | |
| Other, none, self-pay | 15 (5.2) | 24 (5.9) | 39 (5.6) | 1.99 (1.48–2.67) | |
| Missing | 71 (19.8) | 87 (17.5) | 158 (18.5) | ||
| History of incarceration†† | .008 | ||||
| Yes | 13 (4.9) | 30 (7.8) | 43 (6.6) | 1.37 (1.11–1.69) | |
| No | 250 (95.1) | 355 (92.2) | 605 (93.4) | 1.00 (ref) | |
| Missing | 95 (26.5) | 112 (22.5) | 207 (24.2) | ||
| History of homelessness†† | <.001 | ||||
| Yes | 23 (8.7) | 19 (5.0) | 42 (6.5) | 1.83 (1.58–2.13) | |
| No | 241 (91.3) | 361 (95.0) | 602 (93.5) | 1.00 (ref) | |
| Missing | 94 (26.3) | 117 (23.5) | 211 (24.7) | ||
| No. of prenatal care visits | 9 (6–12) | 10 (7–12) | 10 (6–12) | ||
| Receipt of prenatal care | <.001 | ||||
| Timely (at least 30 d before pregnancy outcome) | 328 (95.3) | 448 (95.7) | 776 (95.6) | 1.00 (ref) | |
| Nontimely (less than 30 d before pregnancy outcome) | 5 (1.5) | 9 (1.9) | 14 (1.7) | 2.50 (2.17–2.88) | |
| No prenatal care | 11 (3.2) | 11 (2.4) | 22 (2.7) | 2.73 (2.47–3.02) | |
| Missing | 14 (3.9) | 29 (5.8) | 43 (5.0) | ||
| MOUD receipt‡‡ | <.001 | ||||
| Yes | 16 (4.5) | 13 (2.6) | 29 (3.4) | 1.61 (1.34–1.93) | |
| No | 338 (95.5) | 478 (97.4) | 816 (96.6) | 1.00 (ref) | |
| Missing | 4 (1.1) | 6 (1.2) | 10 (1.2) | ||
| Any substance use§§ | <.001 | ||||
| Yes | 42 (11.9) | 45 (9.2) | 87 (10.3) | 2.04 (1.82–2.28) | |
| No | 312 (88.1) | 446 (90.8) | 758 (89.7) | 1.00 (ref) | |
| Missing | 4 (1.1) | 6 (1.2) | 10 (1.2) | ||
| Gestational age at pregnancy outcome (wk) | <.001 | ||||
| Less than 35 | 32 (8.9) | 23 (4.6) | 55 (6.4) | 2.08 (1.87–2.31) | |
| 35 or more | 326 (91.1) | 474 (95.4) | 800 (93.6) | 1.00 (ref) | |
| Missing | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
P/S/E/, primary, secondary, or early latent; LL/U, late latent or unknown; RR, risk ratio; ref, reference; MOUD, medications for opioid use disorder.
Data are n (%) or median (interquartile range) unless otherwise specified.
Not treated or inadequately treated, inclusive of treatment other than penicillin or initial dose given less than 30 days before pregnancy outcome.
Not treated or inadequately treated, inclusive of treatment other than penicillin, initial dose given less than 30 days before pregnancy outcome, fewer than three doses given, or doses given outside of the recommended window (more than 9 days apart or less than 5 days apart).
Adequately treated with at least one dose of penicillin during pregnancy, with the dose administered at least 30 days before pregnancy outcome.
Adequately treated with at least three doses of penicillin, spaced 5–9 days apart, with the first dose administered at least 30 days before pregnancy outcome and the final dose occurring during pregnancy.
Combined across syphilis stages, excluding missing cases. Risk ratio describes the risk of inadequate or no syphilis treatment in each category vs the risk of inadequate syphilis treatment in the referent category.
P values from overall x2 tests of association or Fisher exact test of the null hypotheses that the distribution of the demographic or clinical characteristic are similar across the treatment categories (inadequate or no syphilis treatment vs adequate treatment).
The National Center for Health Statistics Urban-Rural Classification Scheme for Counties was used to categorize urbanicity as follows: medium–large metropolitan (population of 250,000 or greater) and rural–small metropolitan (population 249,000 or fewer).24
Race and ethnicity is top-coded in the following hierarchy: 1) Native Hawaiian/Pacific Islander, 2) American Indian/Alaska Native, 3) Asian, 4) Hispanic ethnicity, 5) multiple non-Hispanic races. “Other” race category was a response option in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) for people whose race was not Native Hawaiian, Pacific Islander, American Indian, Alaska Native, Asian, Black or African American, or White.
Within the 12 months preceding case report or positive test results or during this pregnancy.
The pregnant person received MOUD during this pregnancy.
Defined as illicit use of opioids (eg, prescription opioids not taken as prescribed, fentanyl, or heroin) and other illicit, nonprescription substances (eg, cocaine, methamphetamines, inhalants, ecstasy, or hallucinogens, such as LSD or PCP) during this pregnancy.
Missing data were excluded from the denominators for calculating percentages.