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Receipt of Prescription Contraception by Commercially Insured Women With Chronic Medical Conditions

DeNoble, Anna E. MSc; Hall, Kelli S. PhD, MS; Xu, Xiao PhD; Zochowski, Melissa K. BS, MBA; Piehl, Kenneth BS; Dalton, Vanessa K. MD, MPH

doi: 10.1097/AOG.0000000000000279
Contents: Original Research

OBJECTIVE: To assess differences in receipt of prescription contraception among women with and without chronic medical conditions.

METHODS: This observational study used 3 years of administrative claims records for insured women aged 21–45 years who were enrolled in a commercial insurance company in Michigan between 2004 and 2009. Women were considered to have a chronic medical condition if they had at least two claims for one of the following conditions, in order of prevalence in our study population: hypertension, asthma, hypothyroidism, diabetes, obesity, rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus. Our primary outcome was receipt of prescription contraception, defined by a pharmacy claim or diagnostic or procedural code. We used multivariable logistic regression to estimate the association of chronic condition status with the odds of receiving prescription contraception within 3 years adjusting for age, community-level socioeconomic status, total outpatient visits, and cervical cancer screening.

RESULTS: Of 11,649 women studied, 16.0% (n=1,862) had at least one of the chronic conditions we considered. Of those with a chronic condition, 33.5% (n=623) received prescription contraception during the 3-year study period compared with 41.1% (n=4,018) of those without a chronic condition (P<.001). After adjusting for covariates, women with a chronic condition remained less likely than women without a chronic condition to have received prescription contraception (adjusted odds ratio 0.85, 95% confidence interval 0.76–0.96, P=.010).

CONCLUSION: Despite a greater risk for adverse outcomes with an unplanned pregnancy, women with these chronic conditions were less likely to receive prescription contraception.

LEVEL OF EVIDENCE: III

Women with chronic medical conditions are less likely to receive prescription contraception than are women without these conditions.

Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, the University of Michigan Medical School, Ann Arbor, Michigan; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.

Corresponding author: Anna E. DeNoble, MSc, 1500 E Medical Center Drive, L4000 Women's Hospital 0276, University of Michigan Medical Center, Ann Arbor, MI 48109; e-mail: aeheinr@umich.edu.

Supported by the Blue Cross Blue Shield of Michigan Foundation (Dalton; Award #1814II). The research training program for Anna E. DeNoble was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (Grant #2TL1TR000435) through the Michigan Institute for Clinical and Health Research. Kelli S. Hall's work was supported by National Institute of Child Health and Human Development Building Interdisciplinary Research Careers in Women's Health “BIRCWH” K-12 Career Development Award #K12HD001438 (Principal Investigator Johnson).

The authors thank Tom Fraser, Kathleen Pruchnik, and the Blue Care Network of Michigan for providing the study data and logistical support.

Financial Disclosure Dr. Dalton has received funding from McNeil to participate on an advisory committee. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.