Background/Purpose: Highly effective contraception (HEC), which includes intrauterine devices, implants and sterilization, is safe for women with SLE and has a < 1% failure rate for preventing pregnancy. Prior studies have revealed low rates of contraceptive use among reproductive age women with SLE despite periods of high disease activity and frequent teratogenic medication use. Black and Hispanic women with SLE have higher rates of adverse outcomes, including pregnancy complications, compared to white women with SLE. Using U.S. nationwide data, we aimed to examine whether there are racial/ethnic differences in contraception use, and specifically HEC, among women with SLE.

Methods: Using Medicaid claims data from 2000-2010, we identified reproductive age women (18-50 years) with prevalent SLE (3 ICD-9 codes 710.0 separated by ≥30 days). We required 6 months of continuous enrollment prior to the 3^rd SLE code (baseline) and 24 months of continuous enrollment after (follow-up). We excluded women ineligible for new contraceptive use (baseline codes for HEC, hysterectomy, or menopause). We examined uptake of contraception by race during follow-up. We used multivariable logistic regression adjusted for age, calendar year, region, and the SLE risk adjustment index (proxy for SLE severity), to estimate the odds (OR, 95% CI) by race/ethnicity of: A) any encounter for contraceptive management (vs. none), B) any contraception (vs. none), C) HEC (vs. no HEC), and D) HEC (vs. no HEC) in a subset with ≥1 teratogenic medication prescription during the baseline period. We also conducted sensitivity analyses excluding women with pregnancy codes.

Results: We identified 28,662 female Medicaid beneficiaries with SLE. The mean (SD) age was 36; 44% were black, 34% white, 15% Hispanic, 4% Asian, and 1% American Indian/Alaska Native. 15% had an encounter for contraceptive management, 16% received any form of contraception, and 5% received HEC (Figure). Among 4,387 women using a teratogenic medication, 4% received HEC. In multivariable models, compared to white women, despite 1.23 (95% CI 1.13-1.34) times higher odds of a contraceptive visit, black women had 0.72 (95% CI 0.63-0.82) times lower odds of HEC use. Asian women had significantly lower odds of both contraceptive visits and HEC use (Table). Younger age and living in the Midwest and South were associated with higher odds of HEC receipt; more severe SLE was associated with lower odds. Trends demonstrated significantly increased HEC uptake over time for white women, but not for other racial/ethnic groups. Findings were similar when women with pregnancy codes were excluded.

Conclusion: In this nationwide study of reproductive age women with SLE, HEC uptake was very low, even among women receiving teratogenic medications. Despite more encounters for contraception, black women had lower odds of HEC uptake; Asian women had fewer encounters and lower odds of HEC. With known disparities in pregnancy outcomes by race/ethnicity, further study is needed to understand whether racial/ethnic differences in HEC use among women with SLE are due to provider bias, patient preference, cultural factors, or variable access to reproductive counseling and care.

Figure

Table

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-differences-in-highly-effective-contraceptive-use-among-medicaid-beneficiaries-with-sle/