P076Contraceptive use by females with chronic medical conditions in a large integrated healthcare system

Abstract

<h3>Objectives</h3> Females with chronic medical conditions (CMCs) face greater risk of pregnancy complications yet have higher risk of unplanned pregnancy than healthy females. To identify opportunities to optimize care, we investigated differences in contraceptive use among those with CMCs vs. those without these conditions within Kaiser Permanente Mid-Atlantic States (KPMAS). <h3>Methods</h3> We conducted a retrospective cohort study using electronic medical record data. We included females aged 15–44 enrolled within KPMAS between January 1, 2021 and December 31, 2021 without hysterectomy or bilateral oophorectomy. We defined CMCs using the US Medical Eligibility Criteria for Contraceptive Use and identified contraception through ICD-10 and CPT codes for intrauterine device (IUD), implant, female sterilization, and injectables; and pharmacy dispensing data for pills, patches, and rings. Controlling for sociodemographic differences, we used multinomial logistic regression to determine the odds of using each tier of contraception vs. none of the specified tiers for those with CMCs versus those without. <h3>Results</h3> Of 128,340 patients, 13,672 (10.7%) had CMCs with hypertension, diabetes, and sickle cell disease most common. 44% of those with CMCs used one of the specified methods versus 40% of those without (OR, 1.19; 95% CI, 1.15–1.23). Those with CMCs were more likely to be >35yo, Black, and have Medicaid (p<0.01) and to use female sterilization (aOR 1.79, 95% CI 1.66-1.93) or long-acting reversible contraception (aOR 1.32, 95% CI 1.26-1.39). <h3>Conclusions</h3> In our diverse cohort, females with CMCs were more likely to use effective contraception than their healthy counterparts, although there may be room for improvement given their unique health risks.