Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
Family and Community Medicine, University of California, San Francisco, San Francisco, CA.
Am J Obstet Gynecol. 2020 Dec;223(6):892.e1-892.e12. doi: 10.1016/j.ajog.2020.07.002. Epub 2020 Jul 5.
Adverse reproductive health outcomes are well documented among people experiencing homelessness or housing instability. Little is known about abortion outcomes among this population.
This study aimed to investigate the relationship between housing status and abortion outcomes and whether gestational age mediates this relationship.
Our sample comprised 1903 individuals who had abortions at an urban clinic in San Francisco, CA, from 2015 to 2017. We defined homelessness or housing instability as a binary exposure, which included staying outside, with friends and/or family, or in a tent, vehicle, shelter, transitional program, or hotel. We evaluated gestational duration of ≥20 weeks as a mediator variable. Our primary outcome was any abortion complication. Logistic regression models were adjusted for age, race, substance use, mental health diagnoses, and previous vaginal and cesarean deliveries.
Approximately 19% (n=356) of abortions were among people experiencing homelessness or housing instability. Compared with those with stable housing, people experiencing homelessness or housing instability presented later in pregnancy (mean gestational duration, 13.3 vs 9.5 weeks; P<.001) and had more frequent complications (6.5% vs 2.8%; P<.001; odds ratio, 2.2; 95% confidence interval, 1.2-3.9). Adjusting for race, substance use, mental health diagnoses, and previous cesarean deliveries, individuals experiencing homelessness or housing instability were more likely to have abortion complications (odds ratio, 2.3; 95% confidence interval, 1.3-4.0). However, the relationship was attenuated after adjusting for gestational duration (odds ratio, 1.4; 95% confidence interval, 0.7-2.6), suggesting that gestational duration mediates the relationship between housing status and abortion complications.
Patients experiencing homelessness or housing instability presented later in gestation, which seems to contribute to the increased frequency of abortion complications.
在无家可归或住房不稳定的人群中，不良生殖健康结局已有充分记录。关于这一人群的堕胎结局知之甚少。
本研究旨在调查住房状况与堕胎结局之间的关系，以及妊娠龄是否在其中起中介作用。
我们的样本包括 2015 年至 2017 年在加利福尼亚州旧金山一家城市诊所进行堕胎的 1903 名个体。我们将无家可归或住房不稳定定义为一个二元暴露因素，包括住在外面、与朋友和/或家人一起或住在帐篷、车辆、避难所、过渡性项目或酒店。我们将妊娠 20 周以上的持续时间评估为中介变量。我们的主要结局是任何堕胎并发症。逻辑回归模型调整了年龄、种族、物质使用、心理健康诊断和既往阴道分娩和剖宫产。
约 19%（n=356）的堕胎发生在无家可归或住房不稳定的人群中。与住房稳定的人相比，无家可归或住房不稳定的人妊娠晚期就诊（平均妊娠持续时间，13.3 周 vs 9.5 周；P<.001），并发症更常见（6.5% vs 2.8%；P<.001；优势比，2.2；95%置信区间，1.2-3.9）。调整种族、物质使用、心理健康诊断和既往剖宫产分娩后，无家可归或住房不稳定的个体更有可能发生堕胎并发症（优势比，2.3；95%置信区间，1.3-4.0）。然而，在调整妊娠持续时间后，这种关系减弱（优势比，1.4；95%置信区间，0.7-2.6），表明妊娠持续时间中介了住房状况与堕胎并发症之间的关系。
无家可归或住房不稳定的患者妊娠晚期就诊，这似乎导致堕胎并发症的频率增加。
