Black, Asian women with lupus less likely than white patients to receive contraception
Among Medicaid-insured women with systemic lupus erythematosus, Black and Asian patients are less likely than white patients to receive contraceptives from a health provider, according to data published in Arthritis Care & Research.
“Prior studies have demonstrated that Black and Hispanic women with lupus have the highest rates of potentially avoidable pregnancy complications,” Candace H. Feldman, MD, MPH, ScD, of Brigham and Women’s Hospital and Harvard Medical School, told Healio Rheumatology. “Lupus disease severity is also higher among Black women and this often requires use of teratogenic medications.”
“Comprehensive reproductive health counseling and, when indicated, prescribing of safe and effective contraception is considered a metric of high-quality lupus care and can prevent avoidable adverse outcomes,” she added. “We aimed to examine rates of contraception visits and use among women with lupus, focusing on differences by race or ethnicity, and among individuals receiving teratogenic medications.”
To analyze whether racial disparities exist regarding contraception encounters and dispensing among Medicaid-insured women with SLE, Feldman and colleagues studied claims data from 2000 to 2010. Focusing on women aged 18 to 50 years, the researchers examined contraception encounters and uptake during a period of 24 months. In all, the researchers identified and included 24,693 women with SLE in their study, among whom 43% were Black, 35% were white, 15% were Hispanic, 4% were Asian, 2% were other races and 1% were American Indian or Native Alaskan.
The researchers used multivariable logistic regression to estimate the odds of contraception encounters, any contraception dispensing and highly effective contraception use, by race, adjusted for age, region, year, lupus severity and contraindication to estrogen. Feldman and colleagues also compared contraception encounters and dispensing among women with SLE to the general population without lupus and women with diabetes.
According to the researchers, 9% of included women with SLE had a contraception visit, while 10% received any contraception, and 2% received highly effective contraception. Compared with white women with SLE, Black women with SLE demonstrated a 1.4 (95% CI, 1.25-1.55) times higher chance of having a contraceptive visit, but 0.89 (95% CI, 0.81-0.98) times lower odds of receiving any contraception, and 0.71 (95% CI, 0.56-0.89) times lower odds of using highly effective contraceptives.
Hispanic women with SLE, compared with white patients, had 1.38 (95% CI, 1.20 1.59) times higher odds of having a contraceptive visit. Asian women with SLE, compared with white patients, meanwhile demonstrated significantly lower odds of both a contraceptive visit (OR = 0.66; 95% CI, 0.50-0.88) and receiving any contraception (OR = 0.72; 95% CI, 0.57-0.92).
Overall, women with SLE were more likely to receive highly effective contraception than the general population and women with diabetes.
“Overall, we also found that reproductive age women with SLE had low rates of contraception use, and were less likely than the general population to receive contraception,” Feldman said. “Despite having more visits for contraception, compared to white women, Black women had lower odds of receiving contraception, and specifically, highly effective contraception methods. Asian women had fewer visits and lower odds of receiving contraception.”
“Our findings are in line with other studies that demonstrate that safe, highly effective contraception is likely underused among women with lupus, including among women receiving teratogenic medications,” she added. “Racial or ethnic differences in contraception counseling and use may contribute to the disparities in avoidable adverse pregnancy-related outcomes. Further studies are needed, particularly qualitative, to better understand what is driving the racial differences we observe in contraception use. With this information, interventions can be designed to ensure that the highest-risk patients are receiving high quality reproductive care.”