Abstract：
OBJECTIVE: This study aimed to assess the association between insurance type and permanent contraception fulfillment among those with cesarean deliveries. Additionally, we sought to examine modification by the scheduled status of the cesarean.
METHODS: We used data from a multi-site cohort study of patients who delivered in 2018-2019 at Northwestern Memorial Hospital in Illinois, MetroHealth Medical System in Ohio, or University of Alabama at Birmingham in Alabama. All patients had permanent contraception as their contraceptive plan in their medical chart during delivery hospitalization. We used logistic regression to model the association between insurance type, scheduled status of cesarean and permanent contraception fulfillment by hospital discharge. The scheduled status of cesarean delivery was examined as an effect modifier.
RESULTS: Compared to patients with private insurance, those with Medicaid were less likely to have their desired permanent contraception procedure fulfilled by hospital discharge (89.3% vs. 96.8%, p < 0.001). After adjusting for covariates, patients with Medicaid had a lower odds of permanent contraception fulfillment by hospital discharge (OR: 0.41; 95% CI: 0.21, 0.77). This association was stronger among those who had unscheduled cesarean deliveries (OR: 0.29; 95% CI: 0.12, 0.74) than those with scheduled cesarean deliveries (OR: 0.77; 95% CI: 0.32, 1.88).
CONCLUSIONS: Compared to patients with private insurance undergoing a cesarean delivery, those with Medicaid insurance were less likely to have their desired permanent contraception fulfilled. Physicians and hospitals must examine their practices surrounding Medicaid forms to ensure that patients have valid consent forms available at the time of delivery.
METHODS: We used data from a multi-site cohort study of patients who delivered in 2018-2019 at Northwestern Memorial Hospital in Illinois, MetroHealth Medical System in Ohio, or University of Alabama at Birmingham in Alabama. All patients had permanent contraception as their contraceptive plan in their medical chart during delivery hospitalization. We used logistic regression to model the association between insurance type, scheduled status of cesarean and permanent contraception fulfillment by hospital discharge. The scheduled status of cesarean delivery was examined as an effect modifier.
RESULTS: Compared to patients with private insurance, those with Medicaid were less likely to have their desired permanent contraception procedure fulfilled by hospital discharge (89.3% vs. 96.8%, p < 0.001). After adjusting for covariates, patients with Medicaid had a lower odds of permanent contraception fulfillment by hospital discharge (OR: 0.41; 95% CI: 0.21, 0.77). This association was stronger among those who had unscheduled cesarean deliveries (OR: 0.29; 95% CI: 0.12, 0.74) than those with scheduled cesarean deliveries (OR: 0.77; 95% CI: 0.32, 1.88).
CONCLUSIONS: Compared to patients with private insurance undergoing a cesarean delivery, those with Medicaid insurance were less likely to have their desired permanent contraception fulfilled. Physicians and hospitals must examine their practices surrounding Medicaid forms to ensure that patients have valid consent forms available at the time of delivery.
摘要：
目的：本研究旨在评估剖宫产者的保险类型与永久避孕效果之间的关系。此外,我们试图通过剖宫产的预定状态来检查修改。
方法：我们使用了2018-2019年在伊利诺伊州西北纪念医院分娩的患者的多地点队列研究数据，俄亥俄州的MetroHealth医疗系统，或阿拉巴马大学伯明翰分校。在分娩住院期间，所有患者都将永久避孕作为其医疗图表中的避孕计划。我们使用逻辑回归对保险类型之间的关联进行建模，出院时剖宫产和永久性避孕的预定状态。将剖宫产的预定状态作为效果调节剂进行检查。
结果：与有私人保险的患者相比，那些接受医疗补助的人不太可能在出院前完成他们想要的永久避孕程序(89.3%vs.96.8%,p<0.001)。在调整协变量后，Medicaid组患者出院时实现永久性避孕的几率较低(OR:0.41;95%CI:0.21,0.77).非计划剖宫产者（OR：0.29；95％CI：0.12，0.74）的这种关联比计划剖宫产者（OR：0.77；95％CI：0.32，1.88）更强。
结论：与接受剖腹产的私人保险患者相比，那些有医疗补助保险的人不太可能实现他们想要的永久避孕。医生和医院必须检查他们围绕医疗补助表格的做法，以确保患者在分娩时拥有有效的同意书。
方法：我们使用了2018-2019年在伊利诺伊州西北纪念医院分娩的患者的多地点队列研究数据，俄亥俄州的MetroHealth医疗系统，或阿拉巴马大学伯明翰分校。在分娩住院期间，所有患者都将永久避孕作为其医疗图表中的避孕计划。我们使用逻辑回归对保险类型之间的关联进行建模，出院时剖宫产和永久性避孕的预定状态。将剖宫产的预定状态作为效果调节剂进行检查。
结果：与有私人保险的患者相比，那些接受医疗补助的人不太可能在出院前完成他们想要的永久避孕程序(89.3%vs.96.8%,p<0.001)。在调整协变量后，Medicaid组患者出院时实现永久性避孕的几率较低(OR:0.41;95%CI:0.21,0.77).非计划剖宫产者（OR：0.29；95％CI：0.12，0.74）的这种关联比计划剖宫产者（OR：0.77；95％CI：0.32，1.88）更强。
结论：与接受剖腹产的私人保险患者相比，那些有医疗补助保险的人不太可能实现他们想要的永久避孕。医生和医院必须检查他们围绕医疗补助表格的做法，以确保患者在分娩时拥有有效的同意书。
