Association of race and ethnicity with postpartum contraceptive method choice, receipt, and subsequent pregnancy.
Association of race and ethnicity with postpartum contraceptive method choice, receipt, and subsequent pregnancy.
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DOI：
10.1186/s12905-020-01162-8
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发表时间：
2021-01-07
期刊：
影响因子：
--
通讯作者：
Arora KS
中科院分区：
文献类型：
--
作者：
Ngendahimana D;Amalraj J;Wilkinson B;Verbus E;Montague M;Morris J;Arora KS
在考虑了避孕方法使用的临床和人口统计学相关因素后，我们试图评估种族/民族在选择产后避孕方法方面的差异。这是一项针对2012年至2014年产后妇女的单中心回顾性队列研究的二次分析。我们确定了自我认同的种族/民族与产后避孕、收货、收货时间、产后就诊率和分娩365天内的后续妊娠之间的关系。在本研究的8649例分娩中，黑人妇女占46%，白人妇女占36%，西班牙裔妇女占12%，其他种族妇女占6%。与白人妇女相比，黑人和西班牙裔妇女更有可能对所有方法进行产后避孕计划。多变量分析后，西班牙裔女性（相对于白人女性）更不可能接受他们选择的方法（优势比[OR] 0.74, 95%可信区间[CI] 0.64-0.87）。与白人女性相比，非黑人或西班牙裔女性在接受所需的高效方法时延迟的可能性较小（风险比[HR] = 0.70, 95% CI 0.52-0.94）。在产后随访依从性方面，种族/民族之间没有差异。与白人女性相比，黑人女性更有可能被诊断出妊娠（OR 1.17, 95% CI 1.04-1.32）。考虑到临床和人口统计学差异后，产后避孕结果的种族/民族差异仍然存在。虽然应该更好地理解和尊重患者在避孕偏好方面的内在差异，但临床医生应该采取措施确保所观察到的产后避孕计划方法在种族/民族之间的差异不是由于有偏见的咨询。
We sought to assess racial/ethnic differences in choice of postpartum contraceptive method after accounting for clinical and demographic correlates of contraceptive use. This is a secondary analysis of a single-center retrospective cohort study examining postpartum women from 2012 to 2014. We determined the association between self-identified race/ethnicity and desired postpartum contraception, receipt, time to receipt, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery. Of the 8649 deliveries in this study, 46% were by Black women, 36% White women, 12% Hispanic, and 6% by women of other races. Compared with White women, Black and Hispanic women were more likely to have a postpartum contraception plan for all methods. After multivariable analysis, Hispanic women (relative to White women) were less likely to receive their chosen method (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.64–0.87). Women of races other than Black or Hispanic were less likely to experience a delay in receipt of their desired highly-effective method compared to White women (hazard ratio [HR] = 0.70, 95% CI 0.52–0.94). There were no differences between racial/ethnic groups in terms of postpartum visit adherence. Black women were more likely to be diagnosed with a subsequent pregnancy compared to White women (OR 1.17, 95% CI 1.04–1.32). Racial/ethnic variation in postpartum contraceptive outcomes persists after accounting for clinical and demographic differences. While intrinsic patient-level differences in contraceptive preferences should be better understood and respected, clinicians should take steps to ensure that the observed differences in postpartum contraceptive plan methods between racial/ethnic groups are not due to biased counseling.
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