Date Presented 04/04/19
A cross-sectional analysis of billing records for privately insured individuals with and without IDD from across the US was conducted to determine the prevalence of STI and STI testing among individuals with IDD. Our results speak to the need for increased STI testing in this population. OT practitioners have a unique role in promoting sexual and reproductive health and safety for this population.
Primary Author and Speaker: Elizabeth Schmidt
Additional Authors and Speakers: Brittany Hand
Contributing Authors: Amy Darragh, Kit Simpson
PURPOSE: Individuals with intellectual and developmental disabilities (I/DD) are just as interested as individuals without I/DD in experiencing intimate relationships, despite caregiver and professionals’ beliefs regarding their sexuality (Chou et al., 2018). Individuals with I/DD, however, may be at higher risk for contracting a sexually transmitted infection (STI) due to limited sexual knowledge (Miller et al., 2017), high rates of sexual abuse (Jones et al., 2012), and disparities in access to primary and preventative care (Havercamp & Scott, 2015) when compared to adolescents and adults without I/DD. STIs can have devastating, lifelong consequences, yet little is known about the prevalence of these conditions in adults with I/DD. Understanding the prevalence of STIs in this population is essential to determine whether individuals with I/DD require targeted STI prevention programs.
DESIGN: A cross-sectional retrospective analysis of 2014-2015 healthcare billing records of privately insured individuals from across the US was conducted. Individuals aged 14-64 years with I/DD (n=25,193) were identified using International Classification of Diseases (ICD-9) codes for nine different I/DDs. A control cohort was identified using group frequency matching for age, sex, and US region of residence (n=25,193).
METHODS: Prevalence of STIs and STI testing was extracted from outpatient and inpatient medical records using ICD-9 and Current Procedural Terminology (CPT) codes, respectively. Multivariable logistic regression was used to examine the relationship between I/DD status and study outcomes while controlling for the known risk factors of: age, sex, US region of residence, insurance plan type, presence of a mental health comorbidity, and presence of comorbid ADHD. The final multivariable models were identified using backwards stepwise regression.
RESULTS: Individuals without I/DD had 2.2 times the odds (95% confidence interval = 2.0 - 2.5) of having an STI than those with I/DD, after controlling for demographic characteristics. Individuals with I/DD aged 20-24 years were significantly less likely than same-aged controls to be tested for STIs. Additionally, among individuals without co-occurring mental health conditions, individuals with I/DD were less likely than controls to receive STI testing.
CONCLUSION: While individuals with I/DD were less likely to be diagnosed with STIs, they were also often less likely to be tested, which may lead to underestimated prevalence. Our results speak to the need for increased testing in this population, particularly for younger individuals and those without co-occurring mental health conditions. Future research is warranted to better understand the prevalence of STIs and STI testing in individuals with I/DD who may be uninsured, or who have public health insurance. Future work is needed to understand the perceptions of healthcare providers, caregivers, and individuals with I/DD to recognize and overcome barriers to STI testing for this population. As the occupational therapy practice framework recognizes sexual activity as an activity of daily living, sexual health and wellbeing should be addressed in clinical practice. Occupational therapists are uniquely poised to promote sexual and reproductive health through addressing sexuality in activities of daily living, in formal education settings, and when facilitating social participation for individuals with I/DD.
References
Chou, Y. C., Lu, Z. Y. J., & Lin, C. J. (2018). Comparison of attitudes to the sexual health of men and women with intellectual disability among parents, professionals, and university students. Journal of Intellectual & Developmental Disability, 43(2), 164-173.
Miller, HL, Pavlik, KM, Kim, MA & Rogers, KC, (2017). An exploratory study of the knowledge of personal safety skills among children with developmental disabilities and their parents. Journal of Applied Research in Intellectual Disabilities, 30, 290-300.
Jones, L, Bellis, MA, Wood, S, HIghes, K, McCoy, E, Eckley, L & Officer, A, (2012). Prevalence and risk of young people with intellectual disabilities and their non-disabled peers. Lancet, 380, 899-907.
Havercamp, S. M., & Scott, H. M. (2015). National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities. Disability and health journal, 8(2), 165-172.
