The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Pediatrics. 2024 Mar 1;153(3). doi: 10.1542/peds.2023-063889.
Coronavirus disease 2019 (COVID-19) posed a significant threat to adolescents' sexual and reproductive health. In this study, we examined population-level pregnancy and sexual health-related care utilization among adolescent females in Ontario, Canada during the pandemic and evaluated relationships between these outcomes and key sociodemographic characteristics.
This was a population-based, repeated cross-sectional study of >630 000 female adolescents (12-19 years) during the prepandemic (January 1, 2018-February 29, 2020) and COVID-19 pandemic (March 1, 2020-December 31, 2022) periods. Primary outcome was pregnancy; secondary outcomes were contraceptive management visits, contraception prescription uptake, and sexually transmitted infection (STI) management visits. Poisson models with generalized estimating equations for clustered count data were used to model pre-COVID-19 trends and forecast expected rates during the COVID-19 period. Absolute rate differences between observed and expected outcome rates for each pandemic month were calculated overall and by urbanicity, neighborhood income, immigration status, and region.
During the pandemic, lower-than-expected population-level rates of adolescent pregnancy (rate ratio 0.87; 95% confidence interval [CI]:0.85-0.88), and encounters for contraceptive (rate ratio 0.82; 95% CI:0.77-0.88) and STI management (rate ratio 0.52; 95% CI:0.51-0.53) were observed. Encounter rates did not return to pre-pandemic rates by study period end, despite health system reopening. Pregnancy rates among adolescent subpopulations with the highest pre-pandemic pregnancy rates changed least during the pandemic.
Population-level rates of adolescent pregnancy and sexual health-related care utilization were lower than expected during the COVID-19 pandemic, and below-expected care utilization rates persist. Pregnancy rates among more structurally vulnerable adolescents demonstrated less decline, suggesting exacerbation of preexisting inequities.
2019 年冠状病毒病（COVID-19）对青少年的性健康和生殖健康构成了重大威胁。本研究旨在评估 COVID-19 大流行期间加拿大安大略省青少年人群的妊娠和与性健康相关的保健利用情况，并分析这些结果与关键社会人口学特征之间的关系。
这是一项基于人群的重复横断面研究，纳入了 COVID-19 大流行前（2018 年 1 月 1 日至 2 月 29 日）和 COVID-19 大流行期间（2020 年 3 月 1 日至 2022 年 12 月 31 日）超过 63 万 12-19 岁的女性青少年的数据。主要结局为妊娠；次要结局为避孕管理就诊、避孕处方使用率和性传播感染（STI）管理就诊。采用广义估计方程泊松模型对整群计数资料进行分析，以模拟 COVID-19 大流行前的趋势，并预测 COVID-19 期间的预期发生率。计算每个大流行月观察到的和预期的结局发生率之间的绝对差异，差异总体上以及根据城市规模、社区收入、移民状况和地区进行分层。
在大流行期间，青少年妊娠率（发生率比 0.87；95%置信区间 [CI]：0.85-0.88）和避孕（发生率比 0.82；95%CI：0.77-0.88）和 STI 管理（发生率比 0.52；95%CI：0.51-0.53）就诊率均低于预期。尽管卫生系统重新开放，但在研究结束时，就诊率仍未恢复到大流行前的水平。在妊娠率最高的青少年亚群中，妊娠率在大流行期间的变化最小。
COVID-19 大流行期间，青少年妊娠率和与性健康相关的保健利用率低于预期，且低于预期的保健利用率持续存在。结构上更为脆弱的青少年妊娠率下降幅度较小，表明先前存在的不平等现象加剧。
