Erickson Anne K, Nelson D Alan, Shaw Jonathan G, Loftus Pooja D, Kurina Lianne M, Shaw Kate A
Departments of Medicine and Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
Obstet Gynecol. 2017 May;129(5):800-809. doi: 10.1097/AOG.0000000000001971.
To quantify uptake of long-acting reversible contraceptives (LARC)-intrauterine devices (IUDs) and hormonal implants-among U.S. Army active-duty female soldiers and identify characteristics associated with uptake.
This retrospective cohort study used the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty U.S. Army soldiers from 2011 to 2014. We analyzed data from women aged 18-44 years to assess rates of LARC initiation using medical billing codes. We then evaluated predictors of LARC initiation using multivariable regression.
Among 114,661 servicewomen, 14.5% received a LARC method; among those, 60% received an IUD. Intrauterine device insertions decreased over the study period (38.7-35.9 insertions per 1,000 women per year, β=0.14, 95% confidence interval [CI] -0.23 to -0.05, P<.05), whereas LARC uptake increased, driven by an increase in implant insertions (20.3-35.4/1,000 women per year, β=0.41, CI 0.33-0.48, P<.001). Younger age was a positive predictor of LARC uptake: 32.4% of IUD users and 62.6% of implant users were in the youngest age category (18-22 years) compared with 9.6% and 2.0% in the oldest (36-44 years). The likelihood of uptake among the youngest women (compared with oldest) was most marked for implants (adjusted relative risk 7.12, CI 5.92-8.55; P<.001). A total of 26.2% of IUD users had one child compared with 13.2% among non-LARC users (adjusted relative risk 1.94, CI 1.85-2.04, P<.001). The majority (52.2%) of those initiating IUDs were married, which was predictive of uptake over never-married women (adjusted relative risk 1.52, CI 1.44-1.59, P<.001).
Among servicewomen, we observed low but rising rates of LARC insertion, driven by increasing implant use. Unmarried and childless soldiers were less likely to initiate LARC. These findings are consistent with potential underutilization and a need for education about LARC safety and reversibility in a population facing unique consequences for unintended pregnancies.
量化美国陆军现役女兵长效可逆避孕法（LARC）——宫内节育器（IUD）和激素植入剂的使用情况，并确定与使用相关的特征。
这项回顾性队列研究使用了斯坦福军事数据存储库，其中包括2011年至2014年美国陆军现役士兵所有数字化记录的医疗就诊情况。我们分析了18 - 44岁女性的数据，使用医疗计费代码评估LARC开始使用的比率。然后我们使用多变量回归评估LARC开始使用的预测因素。
在114,661名女兵中，14.5%采用了LARC方法；其中，60%使用了宫内节育器。在研究期间，宫内节育器的插入数量有所下降（每年每1000名女性中38.7 - 35.9次插入，β = 0.14，95%置信区间[CI] - 0.23至 - 0.05，P <.05），而LARC的使用增加，这是由植入剂插入数量的增加推动的（每年每1000名女性中20.3 - 35.4次/年，β = 0.41，CI 0.33 - 0.48，P <.001）。年龄较小是LARC使用的一个积极预测因素：32.4%的宫内节育器使用者和62.6%的植入剂使用者属于最年轻年龄组（18 - 22岁），而最年长组（36 - 44岁）分别为9.6%和2.0%。最年轻女性（与最年长女性相比）使用植入剂的可能性最为显著（调整后的相对风险为7.12，CI 5.92 - 8.55；P <.001）。共有26.2%的宫内节育器使用者育有一个孩子，而非LARC使用者中这一比例为13.2%（调整后的相对风险为1.94，CI 1.85 - 2.04，P <.001）。大多数（52.2%）开始使用宫内节育器的人已婚，这预示着其使用比例高于未婚女性（调整后的相对风险为1.52，CI 1.44 - 1.59，P <.001）。
在女兵中，我们观察到LARC插入率较低但呈上升趋势，这是由植入剂使用增加所推动的。未婚和未育士兵开始使用LARC的可能性较小。这些发现与潜在的利用不足情况一致，并且表明在面临意外怀孕会产生独特后果的人群中，需要开展关于LARC安全性和可逆性的教育。
