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Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013.
Obstet Gynecol 2017; 129(6):1078-1085OG

Abstract

OBJECTIVE

To measure rates of long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, and tubal sterilization during delivery hospitalizations and correlates of their use.

METHODS

This retrospective cohort study used the 2008-2013 National Inpatient Sample, a publicly available all-payer database. We identified delivery hospitalizations with the International Classification of Diseases, 9th Revision, Clinical Modification codes for intrauterine device insertion, contraceptive implant insertion, and tubal sterilization. We used weighted multivariable logistic regression to examine associations between predictors (age, delivery mode, medical comorbidity, payer, hospital type, geographic region, and year) and likelihood of LARC and sterilization and to compare characteristics of LARC and sterilization users.

RESULTS

Our sample included 4,691,683 discharges, representing 22,667,204 delivery hospitalizations. Long-acting reversible contraception insertion increased from 1.86 per 10,000 deliveries (2008-2009) to 13.5 per 10,000 deliveries (2012-2013; P<.001); tubal sterilization remained stable (711-683 per 10,000 deliveries; P=.24). In multivariable analysis adjusting for all predictors, compared with neither LARC nor sterilization, LARC use was highest among women with medical comorbidities (count per 10,000 deliveries: 15.04, standard error 2.11, adjusted odds ratio [OR] 1.92, 95% confidence interval [CI] 1.72-2.13), nonprivate payer (13.50, standard error 2.14, adjusted OR 5.23, 95% CI 3.82-7.16), and at urban teaching hospitals (14.92, standard error 2.25, adjusted OR 20.85, 95% CI 12.73-34.15). Sterilization was least likely among women aged 24 years or younger (251.04, standard error 4.88, adjusted OR 0.12 95% CI 0.12-0.13, compared with 35 years or older) and most likely with cesarean delivery (1,568.74, standard error 20.81, adjusted OR 6.25, 95% CI 5.88-6.63). Comparing only LARC and sterilization users, LARC users tended to have nonprivate insurance (84.95% compared with 57.17%, adjusted OR 1.90, 95% CI 1.38-2.63) and deliver at urban teaching hospitals (94.65% compared with 45.47%, adjusted OR 38.39, 23.52-62.64) in later study years (2012-2013; 55.72% compared with 32.18%, adjusted OR 8.26, 95% CI 4.42-15.44, compared with 2008-2009).

CONCLUSION

Long-acting reversible contraception insertion increased from 1.86 to 13.5 per 10,000 deliveries but remained less than 2% of the sterilization rate. Inpatient postpartum LARC insertion is more likely among sicker, poorer women delivering at urban teaching hospitals.

Authors+Show Affiliations

Departments of Obstetrics and Gynecology, Family Medicine, Internal Medicine, Pediatrics, and Communicable Diseases, the Institute for Healthcare Policy and Innovation, and the School of Public Health, University of Michigan, Ann Arbor, Michigan; and the Department of Pediatrics, Northwestern University, Chicago, Illinois.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28486357

Citation

Moniz, Michelle H., et al. "Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013." Obstetrics and Gynecology, vol. 129, no. 6, 2017, pp. 1078-1085.
Moniz MH, Chang T, Heisler M, et al. Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013. Obstet Gynecol. 2017;129(6):1078-1085.
Moniz, M. H., Chang, T., Heisler, M., Admon, L., Gebremariam, A., Dalton, V. K., & Davis, M. M. (2017). Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013. Obstetrics and Gynecology, 129(6), pp. 1078-1085. doi:10.1097/AOG.0000000000001970.
Moniz MH, et al. Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013. Obstet Gynecol. 2017;129(6):1078-1085. PubMed PMID: 28486357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013. AU - Moniz,Michelle H, AU - Chang,Tammy, AU - Heisler,Michele, AU - Admon,Lindsay, AU - Gebremariam,Acham, AU - Dalton,Vanessa K, AU - Davis,Matthew M, PY - 2017/5/10/pubmed PY - 2017/7/15/medline PY - 2017/5/10/entrez SP - 1078 EP - 1085 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 129 IS - 6 N2 - OBJECTIVE: To measure rates of long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, and tubal sterilization during delivery hospitalizations and correlates of their use. METHODS: This retrospective cohort study used the 2008-2013 National Inpatient Sample, a publicly available all-payer database. We identified delivery hospitalizations with the International Classification of Diseases, 9th Revision, Clinical Modification codes for intrauterine device insertion, contraceptive implant insertion, and tubal sterilization. We used weighted multivariable logistic regression to examine associations between predictors (age, delivery mode, medical comorbidity, payer, hospital type, geographic region, and year) and likelihood of LARC and sterilization and to compare characteristics of LARC and sterilization users. RESULTS: Our sample included 4,691,683 discharges, representing 22,667,204 delivery hospitalizations. Long-acting reversible contraception insertion increased from 1.86 per 10,000 deliveries (2008-2009) to 13.5 per 10,000 deliveries (2012-2013; P<.001); tubal sterilization remained stable (711-683 per 10,000 deliveries; P=.24). In multivariable analysis adjusting for all predictors, compared with neither LARC nor sterilization, LARC use was highest among women with medical comorbidities (count per 10,000 deliveries: 15.04, standard error 2.11, adjusted odds ratio [OR] 1.92, 95% confidence interval [CI] 1.72-2.13), nonprivate payer (13.50, standard error 2.14, adjusted OR 5.23, 95% CI 3.82-7.16), and at urban teaching hospitals (14.92, standard error 2.25, adjusted OR 20.85, 95% CI 12.73-34.15). Sterilization was least likely among women aged 24 years or younger (251.04, standard error 4.88, adjusted OR 0.12 95% CI 0.12-0.13, compared with 35 years or older) and most likely with cesarean delivery (1,568.74, standard error 20.81, adjusted OR 6.25, 95% CI 5.88-6.63). Comparing only LARC and sterilization users, LARC users tended to have nonprivate insurance (84.95% compared with 57.17%, adjusted OR 1.90, 95% CI 1.38-2.63) and deliver at urban teaching hospitals (94.65% compared with 45.47%, adjusted OR 38.39, 23.52-62.64) in later study years (2012-2013; 55.72% compared with 32.18%, adjusted OR 8.26, 95% CI 4.42-15.44, compared with 2008-2009). CONCLUSION: Long-acting reversible contraception insertion increased from 1.86 to 13.5 per 10,000 deliveries but remained less than 2% of the sterilization rate. Inpatient postpartum LARC insertion is more likely among sicker, poorer women delivering at urban teaching hospitals. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/28486357/Inpatient_Postpartum_Long_Acting_Reversible_Contraception_and_Sterilization_in_the_United_States_2008_2013_ L2 - http://Insights.ovid.com/pubmed?pmid=28486357 DB - PRIME DP - Unbound Medicine ER -