Assistant professor, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.
Director of health services research and associate professor, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.
N C Med J. 2022 Jan-Feb;83(1):58-66. doi: 10.18043/ncm.83.1.58.
Although use of contraceptives has increased among young women in the United States, more than half of pregnancies remain unplanned. The goal of this study was to examine the association between insurance status and receipt of contraceptives among young women receiving care within a large integrated health care system in the Southeastern United States to better inform strategies for increasing access to contraception. This retrospective study used electronic medical record data from an integrated health care system based in Charlotte, North Carolina. Data were analyzed for 51,900 women aged 18-29 who lived in Mecklenburg County and had at least 1 primary care visit between 2014 and 2016. Contraceptive orders were identified by service and procedure codes and grouped into long-acting reversible contraceptives (LARC) and non-LARC categories. Adjusted multinomial logistic regression models were used to assess the association between receipt of contraceptives and insurance status. Compared to non-Hispanic White women with commercial insurance, non-Hispanic Black (OR = 1.25; 95% CI, 1.13-1.38) and Hispanic (OR = 2.25; 95% CI, 1.93-2.61) women with Medicaid had higher odds of receiving LARC. Similar variations by insurance and race/ethnicity were observed for the non-LARC group. Data were limited to a single health care system and did not capture contraceptive orders by unaffiliated providers. Analyses used the most frequent payor and did not account for changes in insurance status. Findings indicate an important role of race/ethnicity and insurance coverage in contraceptive care. Higher receipt of LARC among Black and Hispanic women also suggests that implicit biases may influence contraception counseling and promotion practices. Future study is warranted to further delineate these relationships.
尽管美国年轻女性使用避孕药具的比例有所增加，但仍有超过一半的怀孕是意外怀孕。本研究旨在调查在东南地区大型综合性医疗保健系统中接受护理的年轻女性中，保险状况与避孕药具使用之间的关系，以便更好地制定增加避孕药具可及性的策略。本回顾性研究使用了北卡罗来纳州夏洛特市一家综合性医疗保健系统的电子病历数据。对居住在梅克伦堡县且在 2014 年至 2016 年间至少有 1 次初级保健就诊的 51900 名 18-29 岁女性进行了数据分析。通过服务和程序代码来确定避孕药具的处方，并将其分为长效可逆避孕方法（LARC）和非 LARC 类别。使用调整后的多项逻辑回归模型来评估避孕药具使用与保险状况之间的关联。与具有商业保险的非西班牙裔白人女性相比，具有医疗补助的非西班牙裔黑人（OR = 1.25；95%CI，1.13-1.38）和西班牙裔（OR = 2.25；95%CI，1.93-2.61）女性使用 LARC 的可能性更高。在非 LARC 组中也观察到了类似的保险和种族/族裔差异。数据仅限于单一医疗保健系统，并未捕获非附属提供者的避孕药具处方。分析使用了最常见的付款人，并未考虑保险状况的变化。研究结果表明种族/族裔和保险覆盖范围在避孕护理中起着重要作用。黑人和西班牙裔女性中 LARC 的使用率更高，这表明隐性偏见可能会影响避孕咨询和推广实践。需要进一步研究以进一步阐明这些关系。
