Moniz Michelle H, Chang Tammy, Heisler Michele, Admon Lindsay, Gebremariam Acham, Dalton Vanessa K, Davis Matthew M
Departments of Obstetrics and Gynecology, Family Medicine, Internal Medicine, Pediatrics, and Communicable Diseases, the Institute for Healthcare Policy and Innovation, and the School of Public Health, University of Michigan, Ann Arbor, Michigan; and the Department of Pediatrics, Northwestern University, Chicago, Illinois.
Obstet Gynecol. 2017 Jun;129(6):1078-1085. doi: 10.1097/AOG.0000000000001970.
To measure rates of long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, and tubal sterilization during delivery hospitalizations and correlates of their use.
This retrospective cohort study used the 2008-2013 National Inpatient Sample, a publicly available all-payer database. We identified delivery hospitalizations with the International Classification of Diseases, 9th Revision, Clinical Modification codes for intrauterine device insertion, contraceptive implant insertion, and tubal sterilization. We used weighted multivariable logistic regression to examine associations between predictors (age, delivery mode, medical comorbidity, payer, hospital type, geographic region, and year) and likelihood of LARC and sterilization and to compare characteristics of LARC and sterilization users.
Our sample included 4,691,683 discharges, representing 22,667,204 delivery hospitalizations. Long-acting reversible contraception insertion increased from 1.86 per 10,000 deliveries (2008-2009) to 13.5 per 10,000 deliveries (2012-2013; P<.001); tubal sterilization remained stable (711-683 per 10,000 deliveries; P=.24). In multivariable analysis adjusting for all predictors, compared with neither LARC nor sterilization, LARC use was highest among women with medical comorbidities (count per 10,000 deliveries: 15.04, standard error 2.11, adjusted odds ratio [OR] 1.92, 95% confidence interval [CI] 1.72-2.13), nonprivate payer (13.50, standard error 2.14, adjusted OR 5.23, 95% CI 3.82-7.16), and at urban teaching hospitals (14.92, standard error 2.25, adjusted OR 20.85, 95% CI 12.73-34.15). Sterilization was least likely among women aged 24 years or younger (251.04, standard error 4.88, adjusted OR 0.12 95% CI 0.12-0.13, compared with 35 years or older) and most likely with cesarean delivery (1,568.74, standard error 20.81, adjusted OR 6.25, 95% CI 5.88-6.63). Comparing only LARC and sterilization users, LARC users tended to have nonprivate insurance (84.95% compared with 57.17%, adjusted OR 1.90, 95% CI 1.38-2.63) and deliver at urban teaching hospitals (94.65% compared with 45.47%, adjusted OR 38.39, 23.52-62.64) in later study years (2012-2013; 55.72% compared with 32.18%, adjusted OR 8.26, 95% CI 4.42-15.44, compared with 2008-2009).
Long-acting reversible contraception insertion increased from 1.86 to 13.5 per 10,000 deliveries but remained less than 2% of the sterilization rate. Inpatient postpartum LARC insertion is more likely among sicker, poorer women delivering at urban teaching hospitals.
测量长效可逆避孕方法（LARC，包括宫内节育器和避孕植入物）的使用率以及分娩住院期间输卵管绝育术的使用率及其使用的相关因素。
这项回顾性队列研究使用了2008 - 2013年全国住院患者样本，这是一个公开可用的全付费者数据库。我们通过国际疾病分类第九版临床修订本编码识别出进行宫内节育器放置、避孕植入物放置和输卵管绝育术的分娩住院病例。我们使用加权多变量逻辑回归来检验预测因素（年龄、分娩方式、合并症、付费者、医院类型、地理区域和年份）与LARC和绝育术使用可能性之间的关联，并比较LARC和绝育术使用者的特征。
我们的样本包括4,691,683例出院病例，代表22,667,204例分娩住院病例。长效可逆避孕方法的放置率从每10,000例分娩1.86例（2008 - 2009年）增加到每万例分娩13.5例（2012 - 2013年；P <.001）；输卵管绝育术保持稳定（每10,000例分娩711 - 683例；P =.24）。在对所有预测因素进行调整的多变量分析中，与既未使用LARC也未进行绝育术的女性相比，合并症女性使用LARC的比例最高（每10,000例分娩计数：15 .04，标准误2.11，调整后的比值比[OR] 1.92，95%置信区间[CI] 1.72 - 2.13），非私人付费者（13.50，标准误2.14，调整后的OR 5.23，95% CI 3.82 - 7.16），以及在城市教学医院（14.92，标准误2.25，调整后的OR 20.85，95% CI 12.73 - 34.15）。24岁及以下女性进行绝育术的可能性最小（251.04，标准误4 .88，调整后的OR 0.12 , 95% CI 0.12 - 0 .13，与35岁及以上女性相比），而剖宫产分娩的女性进行绝育术的可能性最大（1,568.74，标准误 - 20.81，调整后的OR 6.25，95% CI 5.88 - 6.63）。仅比较LARC和绝育术使用者，在后期研究年份（2012年 - - 2013年；分别为55. .72%和32.18%，调整后的OR 8.26，95% CI - 4.42 - 15.44，与2008 - - - - - - 2009 - - - - - -年相比），LARC使用者更倾向于拥有非私人保险（84.95% 相比于57.17%，调整后的OR - 1.90，95% CI 1.38 - 2.63）并且在城市教学医院分娩（94.65% 相比于45.47%，调整后的OR 38.3 - 9，23 .52 - 62.64）。
长效可逆避孕方法的放置率从每10,000例分娩1.86例增加到13.5例，但仍低于绝育率的2%。在城市教学医院分娩的病情较重且贫困的女性更有可能在住院产后使用LARC。
