Objective The Centers for Disease Control and Prevention last estimated a national ectopic pregnancy rate in 1992, when it was 1.97 percent of all reported pregnancies. Since then rates have been reported among privately insured women and regional healthcare provider populations, ranging from 1.6 to 2.45 percent. This study assessed the rate of ectopic pregnancy among Medicaid beneficiaries (New York, California, and Illinois, 2000–03), a previously unstudied population. Study Design We identified Medicaid administrative claims records for inpatient and outpatient encounters with a principal ICD9 diagnosis code for ectopic pregnancy. We calculated the ectopic pregnancy rate among female beneficiaries ages 15–44 as the number of ectopic pregnancies divided by the number of total pregnancies, which included spontaneous abortions, induced abortions, ectopic pregnancies, and all births. We used Poisson regression to assess the risk of ectopic pregnancy by age and race. Results Four-year Medicaid ectopic pregnancy rates were 2.38 percent of pregnancies in New York, 2.07 percent in California, and 2.43 percent in Illinois. Risk was higher among Black women compared to whites in all states (RR= 1.26, 95% CI 1.25 – 1.28, p< 0.0001), and among older women compared to younger (trend for age, p <0.001). Conclusion Medicaid beneficiaries in these three states experienced higher rates of ectopic pregnancy than reported for privately insured women nationwide in the same years. Relying on private insurance databases may underestimate ectopic pregnancy’s burden in the United States population. Furthermore, within this low-income population racial disparities exist.
Objective To assess 2004–08 ectopic pregnancy rates among Medicaid recipients in 14 states and 2000–08 time trends in 3 states, and to identify differences in rate by race/ethnicity. Design Secondary analysis of Medicaid administrative claims data. Setting United States. Subjects Women ages 15–44 enrolled in Medicaid in Arizona, California, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, or Texas in 2004–08 (n=19,135,106), and in California, Illinois and New York in 2000–03. Interventions None. Main Outcome Measure Number of ectopic pregnancies divided by the number of total pregnancies (spontaneous abortions, induced abortions, ectopic pregnancies, and all births). Results The 2004–08 Medicaid ectopic pregnancy rate for all 14 states combined was 1.40% of all reported pregnancies. Adjusted for age, the rate was 1.47%. Ectopic pregnancy incidence was 2.3 per 1,000 woman-years. In states for which longer-term data were available (California, Illinois and New York), the rate declined significantly 2000–08. In all 14 states, Black women were more likely to experience an ectopic pregnancy compared to whites (Relative Risk 1.46, 95% Confidence Interval 1.45–1.47). Conclusions Ectopic pregnancy remains an important health risk for women enrolled in Medicaid. Black women are at consistently higher risk than whites.
Objective To estimate prevalence and correlates of abortion provision among practicing obstetrician–gynecologists in the United States. Methods We conducted a national probability sample mail survey of 1,800 practicing obstetrician–gynecologists. Key variables included whether respondents ever encountered patients seeking abortion in their practice, and whether they provided abortion services. Correlates of providing abortion included physician demographic characteristics, religious affiliation, religiosity, and the religious affiliation of the facility in which a physician primarily practices. Results Among practicing obstetrician–gynecologists, 97% encountered patients seeking abortions, while 14% performed them. Young female physicians were the most likely to provide abortions (18.6% vs. 10.6%, adjusted OR = 2.54, 95% CI = 1.57–4.08), as were those in the Northeast or West, those in highly urban zip codes, and those who identify as Jewish. Catholics, Evangelical Protestants, non–Evangelical Protestants, and physicians with high religious motivation were less likely to provide abortions. Conclusion The proportion of U.S. obstetrician–gynecologists who provide abortion may be lower than estimated in previous research. Access to abortion remains limited by the willingness of physicians to provide abortion services, particularly in rural communities and in the South and Midwest.
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