title: Receipt of prescription contraception by commercially insured women with chronic medical conditions.
abstract: OBJECTIVE
  To assess differences in receipt of prescription contraception among women with and without chronic medical conditions.
  
  
  METHODS
  This observational study used 3 years of administrative claims records for insured women aged 21-45 years who were enrolled in a commercial insurance company in Michigan between 2004 and 2009. Women were considered to have a chronic medical condition if they had at least two claims for one of the following conditions, in order of prevalence in our study population: hypertension, asthma, hypothyroidism, diabetes, obesity, rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus. Our primary outcome was receipt of prescription contraception, defined by a pharmacy claim or diagnostic or procedural code. We used multivariable logistic regression to estimate the association of chronic condition status with the odds of receiving prescription contraception within 3 years adjusting for age, community-level socioeconomic status, total outpatient visits, and cervical cancer screening.
  
  
  RESULTS
  Of 11,649 women studied, 16.0% (n=1,862) had at least one of the chronic conditions we considered. Of those with a chronic condition, 33.5% (n=623) received prescription contraception during the 3-year study period compared with 41.1% (n=4,018) of those without a chronic condition (P<.001). After adjusting for covariates, women with a chronic condition remained less likely than women without a chronic condition to have received prescription contraception (adjusted odds ratio 0.85, 95% confidence interval 0.76-0.96, P=.010).
  
  
  CONCLUSIONS
  Despite a greater risk for adverse outcomes with an unplanned pregnancy, women with these chronic conditions were less likely to receive prescription contraception.
  
  
  METHODS
  III.
authors.affiliation: Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, the University of Michigan Medical School, Ann Arbor, Michigan; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Anna E
authors.initials: AE
authors.lastname: DeNoble
authors.forename: Kelli S
authors.initials: KS
authors.lastname: Hall
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Zochowski
authors.forename: Kenneth
authors.initials: K
authors.lastname: Piehl
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003267:Contraception / Q000706:statistics & numerical data*; D003276:Contraceptives, Oral; D005193:Family Planning Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral