Available online 13 December 2025

Pelvic inflammatory disease (PID) is a common reason for hospitalization among female adolescents and young adults (AYA). This study’s objective was to compare inpatient characteristics, outcomes, and trends between AYAs and adults hospitalized with PID in the United States.

This retrospective cohort study used National Inpatient Sample data from 2016 to 2021 to identify patients with a PID diagnosis, stratified into AYA (ages 12-21) and adult (ages 22-50) cohorts. Demographics, comorbidities, complications, length of stay, costs, and discharge disposition were analyzed using t-tests for continuous variables and Chi square tests for categorical variables.

Among 287,365 PID hospitalizations, 9.5% (n = 27,280) occurred in AYAs, rising from 8.3% to 10.3% over the study period. AYAs were more likely than adults to be Black (31.3% vs 26.9%), Hispanic (19.8% vs 17.3%), insured by Medicaid (54.3% vs 31.8%), and live in the Northeast (17.1% vs 15.8%) and Midwest (22.3% vs 19.6%) (all P < .001). Despite having fewer comorbidities, AYAs had significantly higher rates of serious complications like sepsis (11.8% vs 10.4%, P = .001). AYAs also had shorter hospitalizations (3.7 vs 3.9 days, P = .016), lower costs ($42,994 vs $55,238, P < .001), and more routine discharges (93.5% vs 90.5%, P < 001).

AYAs hospitalized with PID experienced more severe disease, suggesting delayed diagnosis and treatment. Stable AYA admissions, despite a declining rate in adults, may reflect barriers to care and disruptions in reproductive healthcare services—particularly during the COVID-19 pandemic. Improved screening, early intervention, and adolescent-centered sexual health services are needed to reduce disease severity and unnecessary hospitalizations.

Pelvic inflammatory disease

Adolescents

Hospital admission

Sexually transmitted infections

Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.