Dieke Ada C, Zhang Yujia, Kissin Dmitry M, Barfield Wanda D, Boulet Sheree L
1 Epidemic Intelligence Service , Centers for Disease Control and Prevention, Atlanta, Georgia .
2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
J Womens Health (Larchmt). 2017 Jun;26(6):605-608. doi: 10.1089/jwh.2017.6467. Epub 2017 Jun 6.
Disparities in infertility and access to infertility treatments, such as assisted reproductive technology (ART), by race/ethnicity, have been reported. However, identifying disparities in ART usage may have been hampered by missing race/ethnicity information in ART surveillance. We review infertility prevalence and treatment disparities, use recent data to examine ART use in the United States by race/ethnicity and residency in states with mandated insurance coverage for in vitro fertilization (IVF), and discuss approaches for reducing disparities. We used 2014 National ART Surveillance System (NASS) data to calculate rates of ART procedures per million women 15-44 years of age, a proxy measure of ART utilization, for Census-defined racial/ethnic groups in the United States; rates were further stratified by the presence of insurance mandates for IVF treatment. Missing race/ethnicity data (35.6% of cycles) were imputed. Asian/Pacific Islander (A/PI) women had the highest rates of ART utilization at 5883 ART procedures per million women 15-44 years of age in 2014, whereas American Indian/Alaska Native non-Hispanic women had the lowest rates at 807 per million, compared with other racial/ethnic groups. In each racial/ethnic category, ART utilization rates were higher for women in states with an insurance mandate for IVF treatment versus those without. In 2014, A/PI women had the highest rates of ART utilization. ART utilization for all racial/ethnic groups was higher in states with insurance mandates for IVF than those without, although disparities were still evident. Although mandates may increase access to infertility treatments, they are not sufficient to eliminate these disparities.
据报道，在不孕症以及获得不孕症治疗（如辅助生殖技术，ART）方面，存在种族/族裔差异。然而，ART监测中种族/族裔信息的缺失可能阻碍了对ART使用差异的识别。我们回顾了不孕症患病率和治疗差异，利用最新数据研究了美国不同种族/族裔以及居住在强制要求体外受精（IVF）保险覆盖州的人群的ART使用情况，并讨论了减少差异的方法。我们使用2014年国家ART监测系统（NASS）的数据，计算了美国人口普查定义的种族/族裔群体中每百万15 - 44岁女性的ART程序率，这是ART利用率的一个替代指标；该率进一步按是否存在IVF治疗的保险强制要求进行分层。对缺失的种族/族裔数据（占周期的35.6%）进行了估算。2014年，亚太岛民（A/PI）女性的ART利用率最高，每百万15 - 44岁女性中有5883例ART程序，而美国印第安/阿拉斯加原住民非西班牙裔女性的利用率最低，每百万中有807例，与其他种族/族裔群体相比。在每个种族/族裔类别中，有IVF治疗保险强制要求州的女性的ART利用率高于没有该要求州的女性。2014年，A/PI女性的ART利用率最高。有IVF保险强制要求州的所有种族/族裔群体的ART利用率都高于没有该要求的州，尽管差异仍然明显。虽然强制要求可能会增加获得不孕症治疗的机会，但它们不足以消除这些差异。
