Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA.
College of Nursing, University of Utah, Salt Lake City, UT, USA.
J Gen Intern Med. 2020 Mar;35(3):637-642. doi: 10.1007/s11606-019-05425-5. Epub 2019 Nov 7.
Women with chronic health conditions benefit from reproductive planning and access to highly effective contraception.
To determine the prevalence of and relationship between chronic health conditions and use of highly effective contraception among reproductive-age women.
Retrospective cohort study using electronic health records.
We identified all women 16-49 years who accessed care in the two largest health systems in the US Intermountain West between January 2010 and December 2014.
We employed administrative codes to identify highly effective contraception and flag chronic health conditions listed in the US Medical Eligibility Criteria for Contraceptive Use (US MEC) and known to increase risk of adverse pregnancy outcomes. We described use of highly effective contraception by demographics and chronic conditions. We used multinomial logistic regression to relate demographic and disease status to contraceptive use.
Of 741,612 women assessed, 32.4% had at least one chronic health condition and 7.3% had two or more chronic conditions. Overall, 7.6% of women with a chronic health condition used highly effective contraception vs. 5.1% of women without a chronic condition. Women with chronic conditions were more likely to rely on public health insurance. The proportion of women using long-acting reversible contraception did not increase with chronic condition number (5.8% with 1 condition vs. 3.2% with 5 or more). In regression models adjusted for age, race, ethnicity, and payer, women with chronic conditions were more likely than those without chronic conditions to use highly effective contraception (aRR 1.4; 95% CI 1.4-1.5). Public insurance coverage was associated with both use of long-acting reversible contraception (aRR 2.2; 95% CI 2.1-2.3) and permanent contraception (aRR 2.9; 95% CI 2.7-3.1).
Nearly a third of reproductive-age women in a regional health system have one or more chronic health condition. Public insurance increases the likelihood that women with a chronic health condition use highly effective contraception.
患有慢性疾病的女性受益于生殖规划和获得高效避孕措施。
确定育龄妇女慢性疾病的流行情况及其与使用高效避孕措施之间的关系。
使用电子健康记录的回顾性队列研究。
我们确定了 2010 年 1 月至 2014 年 12 月期间在美国 Intermountain West 两个最大的医疗保健系统就诊的所有 16-49 岁的女性。
我们采用行政代码识别高效避孕措施，并标记美国生育控制使用医学资格标准（US MEC）中列出的、已知会增加不良妊娠结局风险的慢性疾病。我们按人口统计学和慢性疾病描述高效避孕措施的使用情况。我们使用多项逻辑回归将人口统计学和疾病状况与避孕措施的使用联系起来。
在评估的 741612 名女性中，32.4%患有至少一种慢性疾病，7.3%患有两种或更多种慢性疾病。总体而言，7.6%患有慢性疾病的女性使用高效避孕措施，而 5.1%没有慢性疾病的女性使用高效避孕措施。患有慢性疾病的女性更有可能依赖公共医疗保险。使用长效可逆避孕措施的女性比例并未随着慢性疾病数量的增加而增加（有 1 种疾病的比例为 5.8%，有 5 种或更多疾病的比例为 3.2%）。在调整年龄、种族、民族和支付者的回归模型中，患有慢性疾病的女性比没有慢性疾病的女性更有可能使用高效避孕措施（ARR 1.4；95%CI 1.4-1.5）。公共保险覆盖与长效可逆避孕措施的使用（ARR 2.2；95%CI 2.1-2.3）和永久性避孕措施的使用（ARR 2.9；95%CI 2.7-3.1）均相关。
区域性医疗系统中近三分之一的育龄妇女患有一种或多种慢性疾病。公共保险增加了患有慢性疾病的女性使用高效避孕措施的可能性。
