Department of Family Medicine, the MDisability Program, and the Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and the Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
Obstet Gynecol. 2021 Sep 1;138(3):398-408. doi: 10.1097/AOG.0000000000004505.
To evaluate contraceptive provision and contraceptive care quality measures for individuals who are deaf or hard of hearing and compare these outcomes to those individuals who are not.
We conducted a claims analysis with data from the 2014 Massachusetts All-Payer Claims Database. Among premenopausal enrollees aged 15-44, we determined provision of any contraception (yes or no) and provision by contraception type: prescription contraception (pills, patch, ring, injectables, or diaphragm), long-acting reversible contraceptive (LARC) devices, and permanent contraception (tubal sterilization). We compared these outcomes by deaf or hard-of-hearing status (yes or no). The odds of contraceptive provision were calculated with regression models adjusted for age, Medicaid insurance, a preventive health visit, and deaf or hard-of-hearing status. We calculated contraceptive care quality measures, per the U.S. Office of Population Health, as the percentage of enrollees who used: 1) LARC methods or 2) most effective or moderately effective methods (tubal sterilization, pills, patch, ring, injectables, or diaphragm).
We identified 1,171,838 enrollees at risk for pregnancy; 13,400 (1.1%) were deaf or hard of hearing. Among individuals who were deaf or hard of hearing, 31.4% were provided contraception (23.5% prescription contraception, 5.4% LARC, 0.7% tubal sterilization). Individuals who were deaf or hard of hearing were less likely to receive prescription contraception (adjusted odds ratio 0.92, 95% CI 0.88-0.96) than individuals who were not deaf or hard of hearing. The percentage of individuals who were deaf or hard of hearing who received most effective or moderately effective methods was less than that for individuals who were not (24.2% vs 26.3%, P<.001). There were no differences in provision of LARC or permanent contraception by deaf and hard-of-hearing status.
Individuals who were deaf or hard of hearing were less likely to receive prescription contraception than individuals who were not; factors underlying this pattern need to be examined. Provision of LARC or permanent contraception did not differ by deaf or hard-of-hearing status. These findings should be monitored and compared with data from states with different requirements for contraceptive coverage.
评估失聪或听力受损个体的避孕措施提供情况和避孕护理质量，并将这些结果与非失聪或听力受损个体进行比较。
我们利用 2014 年马萨诸塞州全支付者索赔数据库的数据进行了索赔分析。在 15-44 岁的绝经前参保人中，我们确定了任何避孕措施（是或否）的提供情况以及通过避孕类型提供的避孕措施情况：处方避孕药（药丸、贴片、环、注射剂或隔膜）、长效可逆避孕（LARC）装置和永久性避孕（输卵管绝育）。我们通过失聪或听力受损状况（是或否）来比较这些结果。使用回归模型，根据年龄、医疗补助保险、预防性健康访问和失聪或听力受损状况，对避孕措施提供情况进行了调整，计算了优势比。我们根据美国人口健康办公室计算了避孕护理质量指标，即使用以下方法的参保人数百分比：1）LARC 方法或 2）最有效或中度有效的方法（输卵管绝育、药丸、贴片、环、注射剂或隔膜）。
我们确定了 1171838 名有妊娠风险的参保人；13400 人（1.1%）失聪或听力受损。在失聪或听力受损的个体中，有 31.4%的人接受了避孕措施（23.5%的处方避孕药、5.4%的 LARC、0.7%的输卵管绝育）。与非失聪或听力受损的个体相比，失聪或听力受损的个体接受处方避孕药的可能性较低（调整后的优势比为 0.92，95%置信区间为 0.88-0.96）。失聪或听力受损个体使用最有效或中度有效的方法的比例低于非失聪或听力受损个体（24.2%比 26.3%，P<.001）。失聪或听力受损状况对 LARC 或永久性避孕措施的提供没有影响。
与非失聪或听力受损的个体相比，失聪或听力受损的个体接受处方避孕药的可能性较低；需要对造成这种模式的因素进行检查。LARC 或永久性避孕措施的提供情况不因失聪或听力受损状况而异。应监测这些发现，并与具有不同避孕覆盖要求的州的数据进行比较。
