Hellsten Lovisa, Ahlqvist Viktor H, Nielsen Anna M, Brandén Gunnar, Ekström Anna Mia, Kosidou Kyriaki
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Mayo Clin Proc Digit Health. 2025 Jul 8;3(3):100251. doi: 10.1016/j.mcpdig.2025.100251. eCollection 2025 Sep.
To examine uptake of in-person and digital sexual and reproductive health (SRH) services among adolescents and young adults, quantify uptake across time, and explore whether the introduction of digital services affected the sociodemographic composition of users.
This Swedish total population study included all Stockholm residents aged 12-22 years between January 1st 2018 and December 31st 2022. The primary outcome was in-person or digital visits (chat and video) of SRH services within a year, identified using regional health care registries. Sociodemographic predictors included sex, age, migrant background, parental education, and household income, analyzed with repeated-measures multivariable regressions.
Among the 454,405 individuals, 23.96% had at some point used SRH services (80.01% women) between 2018 and 2022. In-person visits remained the predominant mode of contact. Women had higher annual utilization rate of both in-person (women: 15.27%; 95% CI, 15.13-15.40; men: 1.75%; 95% CI, 1.72-1.78) and digital visits (women: 2.23%; 95% CI, 2.16-2.30; men: 0.12%; 95% CI, 0.11-0.13). Significantly lower uptake was also observed in the lowest income quintile (digital: adjusted odds ratio [aOR], 0.34; 95% CI, 0.31-0.36; in-person: aOR, 0.43; 95% CI, 0.42-0.45) compared with the highest quintile (reference group). Among digital visits, chat was more equitably used than video consultations across sociodemographic groups, including smaller differences between the highest and lowest income quintiles (chat: aOR, 0.59; 95% CI, 0.54-0.65; video: aOR, 0.25; 95% CI, 0.23-0.27). Only modest reductions in socioeconomic disparities were observed after the introduction of digital services.
Sociodemographic disparities in utilization were not alleviated by the introduction of digital visits; in-person users were also the primary digital users. Chat could be more equitable than video, but further research is needed.
研究青少年和青年成年人对面对面及数字化性与生殖健康（SRH）服务的接受情况，量化不同时间的接受率，并探讨数字化服务的引入是否影响了用户的社会人口构成。
这项瑞典全国人口研究纳入了2018年1月1日至2022年12月31日期间所有年龄在12至22岁的斯德哥尔摩居民。主要结局是一年内面对面或数字化（聊天和视频）的SRH服务就诊情况，通过地区医疗保健登记系统确定。社会人口学预测因素包括性别、年龄、移民背景、父母教育程度和家庭收入，采用重复测量多变量回归进行分析。
在454,405名个体中，23.96%在2018年至2022年期间曾在某个时间使用过SRH服务（80.01%为女性）。面对面就诊仍然是主要的接触方式。女性面对面就诊（女性：15.27%；95%置信区间，15.13 - 15.40；男性：1.75%；95%置信区间，1.72 - 1.78）和数字化就诊（女性：2.23%；95%置信区间，2.16 - 2.30；男性：0.12%；95%置信区间，0.11 - 0.13）的年使用率均更高。与最高收入五分位数组（参照组）相比，最低收入五分位数组的接受率也显著更低（数字化：调整优势比[aOR]，0.34；95%置信区间，0.31 - 0.36；面对面：aOR，0.43；95%置信区间，0.42 - 0.45）。在数字化就诊中，聊天在各社会人口学组中的使用比视频咨询更为均衡，包括最高和最低收入五分位数组之间的差异更小（聊天：aOR，0.59；95%置信区间，0.54 - 0.65；视频：aOR，0.25；95%置信区间，0.23 - 0.27）。引入数字化服务后，社会经济差距仅略有缩小。
数字化就诊的引入并未缓解使用方面的社会人口学差异；面对面就诊的用户也是主要的数字化用户。聊天可能比视频更具公平性，但仍需进一步研究。
