title: Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth.
abstract: BACKGROUND
  Racial/ethnic disparities in preterm birth remain a major public health challenge in the United States. While 17-alpha hydroxyprogesterone caproate (17OHP-C) is recommended for preterm birth prevention in women with a prior preterm birth, non-Hispanic black women continue to experience higher rates of recurrent preterm birth than white women receiving the same treatment. Further investigation of disparities in 17OHP-C use and adherence is warranted.
  
  
  OBJECTIVE
  We sought to evaluate whether racial and ethnic disparities exist in the use of and adherence to 17OHP-C within a population of eligible women.
  
  
  METHODS
  This was a retrospective cohort study of women with a prior spontaneous, singleton preterm birth who were eligible for 17OHP-C for preterm birth prevention and received care at a single institution from 2010 through 2014. Associations between self-identified race/ethnicity (non-Hispanic black vs women in all other racial/ethnic groups) and documented counseling about 17OHP-C, receipt of any 17OHP-C, and adherence to 17OHP-C administration were each estimated by bivariable analysis and multivariable logistic regression. Adherence to 17OHP-C was defined as not >1 missed dose, initiation <20 weeks' gestational age, and continuation until 37 weeks or delivery.
  
  
  RESULTS
  Of 472 women who were clinically eligible for 17OHP-C, 72% (N = 296) had documented 17OHP-C counseling and 48.9% (N = 229) received 17OHP-C. There were no differences in likelihood of 17OHP-C counseling or receipt of 17OHP-C based on race/ethnicity. While overall 83% (N = 176) of women were adherent to 17OHP-C, only 70% (N = 58) of non-Hispanic black women were adherent, compared to 91% (N = 118) of all other women (P < .001). Non-Hispanic black women had more missed doses (2.4 vs 0.4 doses, P < .001) and later initiation of care (12.0 vs 10.2 weeks, P < .001) than women in other racial/ethnic groups. After adjustment for potential confounders, non-Hispanic black women were significantly less likely to be adherent to 17OHP-C (adjusted odds ratio, 0.16; 95% confidence interval, 0.04-0.65). A significant interaction between non-Hispanic black race/ethnicity and public insurance was identified (adjusted odds ratio, 0.16; 95% confidence interval, 0.05-0.52).
  
  
  CONCLUSIONS
  In a diverse cohort of women eligible for preterm birth prevention, non-Hispanic black women are at an increased risk of nonadherence to 17OHP-C. Non-Hispanic black women with public insurance are at a particularly increased risk of nonadherence.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: lynn.yee@northwestern.edu.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Lilly Y
authors.initials: LY
authors.lastname: Liu
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Allie
authors.initials: A
authors.lastname: Sakowicz
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Janelle R
authors.initials: JR
authors.lastname: Bolden
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
mesh_terms: D000077713:17 alpha-Hydroxyprogesterone Caproate; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data; D037001:Directive Counseling / Q000706:statistics & numerical data; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D007087:Illinois; D007348:Insurance, Health / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D004965:Estrogen Antagonists; D006908:Hydroxyprogesterones; D000077713:17 alpha-Hydroxyprogesterone Caproate
keywords: 17-alpha hydroxyprogesterone caproate; adherence; disparities; health services; preterm birth; preterm birth prevention; racial disparities