Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, the University of Michigan Medical School, Ann Arbor, Michigan; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
Obstet Gynecol. 2014 Jun;123(6):1213-1220. doi: 10.1097/AOG.0000000000000279.
To assess differences in receipt of prescription contraception among women with and without chronic medical conditions.
This observational study used 3 years of administrative claims records for insured women aged 21-45 years who were enrolled in a commercial insurance company in Michigan between 2004 and 2009. Women were considered to have a chronic medical condition if they had at least two claims for one of the following conditions, in order of prevalence in our study population: hypertension, asthma, hypothyroidism, diabetes, obesity, rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus. Our primary outcome was receipt of prescription contraception, defined by a pharmacy claim or diagnostic or procedural code. We used multivariable logistic regression to estimate the association of chronic condition status with the odds of receiving prescription contraception within 3 years adjusting for age, community-level socioeconomic status, total outpatient visits, and cervical cancer screening.
Of 11,649 women studied, 16.0% (n=1,862) had at least one of the chronic conditions we considered. Of those with a chronic condition, 33.5% (n=623) received prescription contraception during the 3-year study period compared with 41.1% (n=4,018) of those without a chronic condition (P<.001). After adjusting for covariates, women with a chronic condition remained less likely than women without a chronic condition to have received prescription contraception (adjusted odds ratio 0.85, 95% confidence interval 0.76-0.96, P=.010).
Despite a greater risk for adverse outcomes with an unplanned pregnancy, women with these chronic conditions were less likely to receive prescription contraception.
III.
评估有和无慢性疾病的女性在获得处方避孕药方面的差异。
本观察性研究使用了密歇根州一家商业保险公司 2004 年至 2009 年间 21-45 岁参保女性 3 年的行政索赔记录。如果女性至少有两次以下疾病中的一种的索赔记录，则认为其患有慢性疾病，按我们研究人群中的患病率排列为：高血压、哮喘、甲状腺功能减退、糖尿病、肥胖症、类风湿性关节炎、炎症性肠病或系统性红斑狼疮。我们的主要结局是通过药房索赔或诊断或程序代码来确定的处方避孕药的使用情况。我们使用多变量逻辑回归来估计慢性疾病状态与 3 年内接受处方避孕药的可能性之间的关联，调整了年龄、社区级社会经济地位、总门诊就诊次数和宫颈癌筛查等因素。
在研究的 11649 名女性中，16.0%（n=1862）至少有一种我们考虑的慢性疾病。在患有慢性疾病的女性中，33.5%（n=623）在 3 年研究期间接受了处方避孕药，而无慢性疾病的女性中这一比例为 41.1%（n=4018）（P<.001）。在调整了协变量后，患有慢性疾病的女性接受处方避孕药的可能性仍然低于没有慢性疾病的女性（调整后的优势比 0.85，95%置信区间 0.76-0.96，P=.010）。
尽管意外怀孕对不良后果的风险更高，但患有这些慢性疾病的女性接受处方避孕药的可能性较低。
III。
