Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
CHA Hollywood Presbyterian Medical Center, Los Angeles, California.
JAMA Netw Open. 2023 Jun 1;6(6):e2316696. doi: 10.1001/jamanetworkopen.2023.16696.
While various policies to support couples experiencing infertility have been introduced due to the fertility rate rapidly dropping in developed countries, few large-scale nationwide cohort studies have evaluated the outcomes of assisted reproductive technology (ART) health insurance coverage policies.
To evaluate ART health insurance coverage for multiple pregnancies and births in Korea.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used delivery cohort data from the Korean National Health Insurance Service database between July 1, 2015, and December 31, 2019. A total of 1 474 484 women were included after exclusion of those who gave birth at nonmedical institutions and those with missing data.
Two 27-month periods were examined before and after the Korean National Health Insurance Service had begun covering ART treatment (preintervention period, July 1, 2015, to September 30, 2017; postintervention period, October 1, 2017, to December 31, 2019).
Multiple pregnancies and multiple births were identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. Total births were defined as the total number of babies born to each pregnant woman during the follow-up period. An interrupted time series with segmented regression was conducted to analyze the time trend and its change in outcomes. Data analysis was conducted between December 2, 2022, and February 15, 2023.
Of the 1 474 484 women eligible for the analysis (mean [SD] age, 33.2 [4.6] years), approximately 1.60% had multiple pregnancies and 1.10% had multiple births. After covering ART treatment, the likelihood of multiple pregnancies and multiple births was estimated to increase by 0.7% (estimate, 1.007; 95% CI, 1.004-1.011; P < .001) and 1.2% (estimate, 1.012; 95% CI, 1.007-1.016; P < .001) compared with before coverage. The probability of an increase in the number of total births per pregnant woman after the intervention was estimated to be 0.5% (estimate, 1.005; 95% CI, 1.005-1.005; P < .001). The relatively high-income class above the median income showed a decreasing trend in multiple births and total births before the intervention, but after the intervention, a significant increase was observed.
This population-based cohort study found that the possibility of multiple pregnancies and births in Korea significantly increased after the implementation of an ART health insurance coverage policy. These findings suggest that the development and coverage of policies to support couples experiencing infertility may help address low fertility rates.
由于发达国家的生育率迅速下降，各种支持不孕夫妇的政策已经出台，但很少有大规模的全国性队列研究评估辅助生殖技术（ART）健康保险覆盖政策的结果。
评估韩国的 ART 健康保险对多胎妊娠和分娩的覆盖情况。
设计、地点和参与者：本基于人群的队列研究使用了韩国国家健康保险服务数据库 2015 年 7 月 1 日至 2019 年 12 月 31 日期间的分娩队列数据。排除在非医疗机构分娩和数据缺失的妇女后，共纳入了 1474484 名妇女。
在韩国国家健康保险服务开始覆盖 ART 治疗之前和之后（干预前时期：2015 年 7 月 1 日至 2017 年 9 月 30 日；干预后时期：2017 年 10 月 1 日至 2019 年 12 月 31 日），分别检查了两个 27 个月的时间段。
国际疾病分类和相关健康问题第十次修订诊断代码确定了多胎妊娠和多胎分娩。总分娩数定义为每位孕妇在随访期间所生婴儿的总数。采用中断时间序列和分段回归分析了结果的时间趋势及其变化。数据分析于 2022 年 12 月 2 日至 2023 年 2 月 15 日进行。
在符合分析条件的 1474484 名妇女中（平均[SD]年龄，33.2[4.6]岁），约有 1.60%的妇女多胎妊娠，1.10%的妇女多胎分娩。覆盖 ART 治疗后，多胎妊娠和多胎分娩的可能性估计增加 0.7%（估计值，1.007；95%CI，1.004-1.011；P<.001）和 1.2%（估计值，1.012；95%CI，1.007-1.016；P<.001）。干预后，每位孕妇的总分娩数增加的概率估计为 0.5%（估计值，1.005；95%CI，1.005-1.005；P<.001）。收入中位数以上的较高收入阶层在干预前多胎分娩和总分娩的趋势呈下降趋势，但干预后明显增加。
本基于人群的队列研究发现，韩国多胎妊娠和分娩的可能性在实施 ART 健康保险覆盖政策后显著增加。这些发现表明，制定和覆盖支持不孕夫妇的政策可能有助于解决低生育率问题。
