Abstract：
Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person\'s reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one\'s entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.
摘要：
背景：一些接受长效可逆避孕（LARC）的人面临停药的障碍。无法在需要时停止避孕方法会对一个人的生殖自主性产生负面影响。受健康社会决定因素（SDH）影响的人可能会受到不成比例的影响。这项研究的目的是评估SDH与患者报告的困难LARC停药的相关性。方法:对2017-2019年全国家庭成长调查周期数据进行回顾性横断面分析。主要结果是在过去10年中，患者报告的终止LARC方法（宫内节育器或植入物）的困难。描述性统计用于识别人口统计学特征和SDH域。使用多变量逻辑回归模型来估计难以去除LARC的SDH域之间的关联。结果：共有754名受访者表示希望移除他们的LARC，105（11％）报告难以终止LARC方法。三分之一的受访者经历了一个或多个SDH，特别是粮食不安全(26%)或运输障碍(30%)。在调整了年龄之后,种族,教育,地理位置,奇偶校验，和体重指数（BMI），与没有任何SDH的受访者相比,有一个或多个SDH的人在难以终止LARC方面的调整比值比(aOR)增加(2.11;95%置信区间[CI]:1.21,3.69).运输障碍显示最大的aOR为2.90（95%CI：1.07，7.87）。结论：SDH与LARC停药的挑战有关。SDH是影响人整个避孕体验的独特危险因素。在避孕咨询时对SDH进行细致入微的讨论可能是解决方法选择和生殖机构交叉性的关键步骤。
