Geospatial Analysis of Access to Evidence-Based Early Pregnancy Loss Management in New Mexico [ID: 1377363

Abstract

INTRODUCTION: Little is known about availability of evidence-based early pregnancy loss (EPL) treatment in emergency departments (EDs), where patients often first seek care. We evaluated geographic access to mifepristone/misoprostol and uterine aspiration in New Mexican hospitals. METHODS: We used an enhanced two-step floating catchment area method to model accessibility from census block groups’ population-weighted centroids to hospitals. Our primary outcome was access to mifepristone/misoprostol and uterine aspiration in EDs; our secondary outcome was access to in-hospital aspiration, both outcomes defined as less than a 60-minute commute. We surveyed all EDs in New Mexico and used public databases to compute census block groups’ demographic, transportation, rurality, and area deprivation data. We used logistic regression to evaluate the associations between access and race and ethnicity, area deprivation, and rural location. The University of New Mexico IRB approved this study. RESULTS: Thirty-five (83%) of 42 hospitals responded. Two (6%) provided in-ED treatment, and 24 (69%) in-hospital aspiration. Half of reproductive-aged women had access to in-ED treatment, and 90% to in-hospital aspiration. Census block groups with higher quartile proportions of American Indian/Native Alaskan reproductive-aged women had higher adjusted odds ratios of accessing in-ED treatment (2.5–7.3, P<.05). Rural areas and higher area deprivation quartiles had lower in-ED access adjusted odds ratios (0.03–0.07 [P<.05] and 0.3–0.4 [P<.05], respectively) compared with urban and lower area deprivation quartiles. In-hospital aspiration results were similar to in-ED treatment results across all categories. CONCLUSION: By prioritizing rural areas and areas with higher socioeconomic deprivation, EPL treatment implementation efforts can improve equitable care access and equity for patients.