Receipt of prescription contraception by commercially insured women with chronic medical conditions

Abstract

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.

Conflict of interest statement

The other authors did not report any potential conflicts of interest.

Figures

Figure 1. Study Design

Inclusion criteria: subjects were required to have 1) at least 54 months of continuous enrollment, 2) benefit coverage of contraceptive services and prescriptions throughout the 54-month continuous enrollment period, and 3) at least two outpatient visits between 2004 and 2009.