Evaluation of the Association Between Comorbidities and the Initiation of Long-acting Reversible Contraception

Long-acting reversible contraceptives (LARC) are safe, highly effective methods for women who need to avoid an unintended pregnancy (UIP).  Women with comorbidities are at higher risk for poor pregnancy outcomes, especially with UIP.  Kaiser Permanente, Northern California (KPNC) promotes LARC use, primarily intrauterine contraceptive devices, among women with comorbidities as a means to protect preconception health and prevent UIP.

A retrospective cohort study of 66,552 women, with and without comorbidities (diabetes, hypertension, cardiovascular disease, obesity), ages 15-44, was conducted to identify type of contraception initiated in 2010.  Demographic and clinical characteristics (age, race/ethnicity, income, coded evidence of select comorbidities, type of contraception initiated) were obtained from electronic database extraction and compared between LARC and non-LARC initiators using Chi-square tests for categorical variables and t-tests for continuous variables.  Logistic regression models were used to examine potential predictors (comorbidities, age, race/ethnicity and income) of LARC use.

LARC initiation among KPNC members in 2010 was high (14.3%) compared with national use estimates (8.9%).  Women with comorbidities had significantly higher LARC initiation compared with women without comorbidities (20.4% vs. 13.5%, p<0.0001) regardless of age, race/ethnicity or income.  The mean age of women with comorbidities was significantly older compared with those without comorbidities (31.5 vs. 27.7, p<0.001).  Having one or more comorbidities was significantly related to LARC use (OR: 1.33, p<0.0001), controlling for age, race/ethnicity and income.

Promotion of LARC use within KPNC, especially among women with comorbidities, resulted in higher LARC initiation among women with comorbidities, thereby reducing their risks for an unintended pregnancy.