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Busse CE, Latour CD, Dejene SZ, Knittel AK, Wood ME, Kinlaw AC, Dissanayake MV. Incidence of new outpatient long-acting reversible contraceptive insertions among a commercially insured, US population from 2010 to 2020. Contracept X 2023; 5:100101. [PMID: 37823033 PMCID: PMC10562738 DOI: 10.1016/j.conx.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives Characterize new use of long-acting reversible contraceptives (LARCs), highly effective contraceptive methods, in a broad population over time. Study Design We constructed a retrospective cohort of commercially insured individuals aged 15 to 54 years from 2010 to 2020 and estimated monthly incidence of new LARC insertions. Results The monthly standardized incidence increased from 6.0 insertions per 10,000 individuals in January 2010 to 14.1 in December 2020, with a dip in insertions after March 2020. Hormonal intrauterine devices were consistently the most inserted LARC; implants were increasingly favored over time. Conclusions LARCs are increasingly popular forms of contraception among commercially insured individuals. Implications Given the increasing popularity, ensuring access to LARCs is critical.
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Affiliation(s)
- Clara E. Busse
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Chase D. Latour
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sara Z. Dejene
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mollie E. Wood
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alan C. Kinlaw
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, United States
| | - Mekhala V. Dissanayake
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Shaw JG, Goldthwaite LM, Marić I, Shaw KA, Stevenson DK, Shaw GM. Postpartum long-acting reversible contraception among privately insured: U.S. National analysis 2007-2016, by term and preterm birth. Contraception 2023; 125:110065. [PMID: 37210023 DOI: 10.1016/j.contraception.2023.110065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To investigate postpartum long-acting reversible contraception (LARC) use among privately insured women, with specific consideration of use after preterm delivery. STUDY DESIGN We used the national IBM MarketScan Commercial Database to identify singleton deliveries from 2007 to 2016, spontaneous preterm birth, and follow-up ≤12 weeks postpartum. We assessed ≤12-week postpartum LARC placement overall and after spontaneous preterm deliveries, across study years. We examined timing of placement, rates of postpartum follow-up, and state-level variation in postpartum LARC. RESULTS Among 3,132,107 singleton deliveries, 6.6% were spontaneous preterm. Over the time period, total postpartum LARC use increased 4.8% to 11.7% for intrauterine devices (IUDs), 0.2% to 2.4% for implants. In 2016, those who experienced a spontaneous preterm birth were less likely to initiate postpartum IUDs compared to their peers (10.2% vs 11.8%, p < 0.001), minimally more likely to initiate implants (2.7% vs 2.4%, p = 0.04) and more likely to present for postpartum care (61.7% vs 55.9%, p < 0.001). LARC placement prior to hospital discharge was rare (preterm: 8 per 10,000 deliveries vs all others: 6.3 per 10,000 deliveries, p = 0.002). State-level analysis showed wide variation in postpartum LARC (range 6%-32%). CONCLUSIONS While postpartum LARC use increased among the privately insured 2007-2016, few received LARC prior to hospital discharge. Those experiencing preterm birth were no more likely to receive inpatient LARC. Postpartum follow-up remained low and regional variation of LARC was high, highlighting the need for efforts to remove barriers to inpatient postpartum LARC for all who desire it-public and privately insured alike. IMPLICATIONS Among the half of U.S. births that are privately insured, postpartum LARC is increasing after both term and preterm births, yet exceedingly few (<0.1%) received LARC prior to hospital discharge.
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Affiliation(s)
- Jonathan G Shaw
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | | | - Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kate A Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Krebs E, Hongdilokkul N, Dale LM, Min JE, Schnepel KT, Shigeoka H, Nosyk B. The effect of a methadone reformulation on opioid agonist treatment outcomes: A population-based study in British Columbia, Canada, 2013-14. J Subst Abuse Treat 2022; 138:108714. [PMID: 35101357 PMCID: PMC9833651 DOI: 10.1016/j.jsat.2021.108714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The province of British Columbia, Canada, changed the existing oral anhydrous methadone solution to a 10-times more concentrated pre-mixed solution, Methadose®, on February 1, 2014. We aimed to assess the immediate effects of the methadone reformulation on missed doses, days off methadone, changes in medication dosing and dispensations of opioids for pain, and hospitalizations and mortality among all people receiving treatment at or near the time of the change. METHODS We conducted a population-based retrospective cohort study including all individuals receiving at least one methadone dispensation in the 12 months prior to the study period. We executed a difference-in-differences analysis by estimating a multivariate regression model to compare outcomes in the three months before and after the reformulation (November 1, 2013 to April 30, 2014) versus a time-lagged control cohort with similar characteristics observed during an equivalent nonoverlapping interval. We used daily individual-level linked health administrative data capturing missed doses, days off methadone, changes in methadone dosing, concurrent dispensations of opioids for pain, hospitalizations, and mortality. We stratified the cohorts into three subgroups: (i) those receiving OAT for ≥12 months; (ii) those receiving OAT for <12 months; and (iii) those not receiving OAT at the start of the study period. We conducted sensitivity analyses and placebo tests to assess the robustness of our results. RESULTS Among the 16,339 individuals receiving methadone during the study period, the reformulation was associated with more instances of methadone dose increases (34.5% [95% Confidence Interval (CI): 27.4%, 41.5%]). For those retained in treatment ≥12 months prior to the study period (n = 7449), the reformulation was associated with more instances of methadone dose increases (50.2% [39.5%, 60.8%]) and dispensations of opioids for pain (62.2% [40.8%, 83.5%]), as well as an increase in missed doses (41.9% [29.1%, 54.7%]) and days off methadone (62.6% [39.7%, 85.4%]). We found no statistically significant change in risk of hospitalization or mortality. Sensitivity analyses supported our results. CONCLUSION Our results reinforce the need expressed by people receiving methadone for greater client involvement in the planning and implementation of regulatory changes that may impact client care, especially those patients with a relatively long treatment history.
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Affiliation(s)
- Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6,Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
| | - Natt Hongdilokkul
- BC Office of the Human Rights Commissioner, 999 Canada Place, Vancouver, British Columbia, Canada, V6C 3L5
| | - Laura M Dale
- Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
| | - Jeong E Min
- Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
| | - Kevin T Schnepel
- Department of Economics, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6
| | - Hitoshi Shigeoka
- Department of Economics, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6,Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
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Prata N, Weidert K, Zepecki A, Yon E, Pleasants E, Sams-Abiodun P, Guendelman S. Using Application Programming Interfaces (APIs) to Access Google Data and Gain Insights Into Searches on Birth Control in Louisiana and Mississippi, 2014-2018: Infoveillance Study. J Med Internet Res 2021; 23:e25923. [PMID: 34255662 PMCID: PMC8314156 DOI: 10.2196/25923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/25/2021] [Accepted: 05/04/2021] [Indexed: 02/02/2023] Open
Abstract
Background It is now common to search for health information online. A 2013 Pew Research Center survey found that 77% of online health seekers began their query at a search engine. The widespread use of online health information seeking also applies to women’s reproductive health. Despite online interest in birth control, not much is known about related interests and concerns reflected in the search terms in the United States. Objective In this study, we identify the top search terms on Google related to birth control in Louisiana and Mississippi and compare those results to the broader United States, examining how Google searches on birth control have evolved over time and identifying regional variation within states. Methods We accessed search data on birth control from 2014-2018 from 2 Google application programming interfaces (APIs), Google Trends and Google Health Trends. We selected Google as it is the most commonly used search engine. We focused our analysis on data from 2017 and compared with 2018 data as appropriate. To assess trends, we analyzed data from 2014 through 2018. To compare the relative search frequencies of the top queries across Louisiana, Mississippi, and the United States, we used the Google Health Trends API. Relative search volume by designated marketing area (DMA) gave us the rankings of search volume for each birth control method in each DMA as compared to one another. Results Results showed that when people searched for “birth control” in Louisiana and the broader United States, they were searching for information on a diverse spectrum of methods. This differs from Mississippi, where the data indicated people were mainly searching for information related to birth control pills. Across all locations, searches for birth control pills were significantly higher than any other queries related to birth control in the United States, Louisiana, and Mississippi, and this trend remained constant from 2014 to 2018. Regional level analysis showed variations in search traffic for birth control across each state. Conclusions The internet is a growing source of health information for many users, including information on birth control. Understanding popular Google search queries on birth control can inform in-person discussions initiated by family planning practitioners and broader birth control messaging campaigns. International Registered Report Identifier (IRRID) RR2-10.2196/16543
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Affiliation(s)
- Ndola Prata
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Karen Weidert
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Anne Zepecki
- The Wallace Center for Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Elina Yon
- College of Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Elizabeth Pleasants
- The Wallace Center for Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | | | - Sylvia Guendelman
- The Wallace Center for Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
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Provision of Immediate Postpartum Long-Acting Reversible Contraceptives Before and After Wisconsin Medicaid's Payment Change. Womens Health Issues 2021; 31:317-323. [PMID: 33849768 DOI: 10.1016/j.whi.2021.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to estimate the association between Medicaid unbundling of payment for long-acting reversible contraceptives (LARC) from the global delivery fee and immediate postpartum (IPP) LARC provision, in a state outside a select group of early-adopters. We also examine the potential moderating roles of hospital academic affiliation and Catholic status on the association between unbundling and IPP LARC provision. METHODS We used a pre-post design to examine the association between unbundling and IPP LARC provision. We observed Medicaid-covered childbirth deliveries in Wisconsin hospitals between January 2016 and December 2017 (n = 45,200) in the State Inpatient Database from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. We conducted multivariate regressions using generalized linear mixed models. RESULTS From 2016 to 2017, IPP LARC provision increased from 0.28% to 0.44% of deliveries (p = .003). In our adjusted model, IPP LARC provision was 1.55 times more likely in the post-period versus the pre-period (95% confidence interval, 1.12-2.13). Both before and after unbundling, IPP LARC provision was significantly more common in academic versus nonacademic settings and was exceedingly rare in Catholic institutions. CONCLUSIONS In contrast with many early adopting states, in this later adopting state, Wisconsin Medicaid's unbundling of LARC from the global fee did not meaningfully change the rates of IPP LARC provision. These results indicate that delivery hospital characteristics are strong correlates of access to IPP LARC and suggest the need for interventions-perhaps outside of the inpatient setting-to ensure that patients can access desired contraceptive methods promptly postpartum.
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Olofinbiyi BA, Awoleke JO, Atiba BP, Olaogun OD, Olofinbiyi RO, Awoleke AO. Predictors of Maternal Preference for Sex-Selective Pregnancy Termination in a Developing Nation with Restrictive Abortion Laws. Matern Child Health J 2020; 25:813-820. [PMID: 33244681 DOI: 10.1007/s10995-020-03062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The rapid and unexpected increase in the sex ratio at birth in Nigeria between 1996 and 2014 is yet to be fully explained. The contribution of sex-selective abortion has not been explored. METHODS A cross-sectional survey of pregnant women was employed to address this need. RESULTS Preference for sex-selective abortion was noted in 8.6% of the respondents. The association between parity ≥ 4 and preference for sex-selective abortion was statistically significant. Women who were child gender-biased were significantly more likely to prefer sex-selective abortion. Experiencing intimate partner violence, and having problems with in-laws for inability to give birth to their desired gender, were predictors of maternal preference for sex-selective abortion. Women who preferred sex-selective abortion, however, felt it was necessary to campaign against gender preference. CONCLUSION Preference for sex-selective abortion exists in Nigeria, despite our restrictive abortion laws. However, the women's underlying reasons may include gender balancing in the family and an escape from discrimination. Improving contraceptive uptake, restriction of disclosure of fetal sex for non-medical indications, and sanctions against violent partners/oppressive in-laws are advocated. Rapid progress towards achieving a world free of the offensive gender inequalities that force women to opt for sex-selective abortion ab initio is desirable.
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Affiliation(s)
- Babatunde Ajayi Olofinbiyi
- Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, P.M.B. 5355, Ado Ekiti, Nigeria
| | - Jacob Olumuyiwa Awoleke
- Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, P.M.B. 5355, Ado Ekiti, Nigeria.
| | | | - Oluwole Dominic Olaogun
- Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, P.M.B. 5355, Ado Ekiti, Nigeria
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What Women Want: Factors Impacting Contraceptive Satisfaction in Privately Insured Women. Womens Health Issues 2020; 30:93-97. [DOI: 10.1016/j.whi.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/10/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022]
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