PDF(Pubmed)
Abstract：
BACKGROUND: Prescribed contraception is used worldwide by over 400 million women of reproductive age. Monitoring contraceptive use is a major public health issue that usually relies on population-based surveys. However, these surveys are conducted on average every 6 years and do not allow close follow-up of contraceptive use. Moreover, their sample size is often too limited for the study of specific population subgroups such as people with low income. Health administrative data could be an innovative and less costly source to study contraceptive use.
OBJECTIVE: We aimed to explore the potential of health administrative data to study prescribed contraceptive use and compare these data with observations based on survey data.
METHODS: We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database, which covers 98% of the resident population (n=14,788,124), and in the last French population-based representative survey, the Health Barometer Survey, conducted in 2016 (n=4285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey, it was self-declared by the women. In both sources, the prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, intrauterine devices (IUDs), and implants. Prevalences were analyzed by age.
RESULTS: There were more low-income women in health administrative data than in the population-based survey (1,576,066/14,770,256, 11% vs 188/4285, 7%, respectively; P<.001). In health administrative data, 47.6% (7034,710/14,770,256; 95% CI 47.6%-47.7%) of women aged 15-49 years used a prescribed contraceptive versus 50.5% (2297/4285; 95% CI 49.1%-52.0%) in the population-based survey. Considering prevalences by the type of contraceptive in health administrative data versus survey data, they were 26.9% (95% CI 26.9%-26.9%) versus 27.7% (95% CI 26.4%-29.0%) for oral contraceptives, 17.7% (95% CI 17.7%-17.8%) versus 19.6% (95% CI 18.5%-20.8%) for IUDs, and 3% (95% CI 3.0%-3.0%) versus 3.2% (95% CI 2.7%-3.7%) for implants. In both sources, the same overall tendency in prevalence was observed for these 3 contraceptives. Implants remained little used at all ages, oral contraceptives were highly used among young women, whereas IUD use was low among young women.
CONCLUSIONS: Compared with survey data, health administrative data exhibited the same overall tendencies for oral contraceptives, IUDs, and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health.
OBJECTIVE: We aimed to explore the potential of health administrative data to study prescribed contraceptive use and compare these data with observations based on survey data.
METHODS: We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database, which covers 98% of the resident population (n=14,788,124), and in the last French population-based representative survey, the Health Barometer Survey, conducted in 2016 (n=4285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey, it was self-declared by the women. In both sources, the prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, intrauterine devices (IUDs), and implants. Prevalences were analyzed by age.
RESULTS: There were more low-income women in health administrative data than in the population-based survey (1,576,066/14,770,256, 11% vs 188/4285, 7%, respectively; P<.001). In health administrative data, 47.6% (7034,710/14,770,256; 95% CI 47.6%-47.7%) of women aged 15-49 years used a prescribed contraceptive versus 50.5% (2297/4285; 95% CI 49.1%-52.0%) in the population-based survey. Considering prevalences by the type of contraceptive in health administrative data versus survey data, they were 26.9% (95% CI 26.9%-26.9%) versus 27.7% (95% CI 26.4%-29.0%) for oral contraceptives, 17.7% (95% CI 17.7%-17.8%) versus 19.6% (95% CI 18.5%-20.8%) for IUDs, and 3% (95% CI 3.0%-3.0%) versus 3.2% (95% CI 2.7%-3.7%) for implants. In both sources, the same overall tendency in prevalence was observed for these 3 contraceptives. Implants remained little used at all ages, oral contraceptives were highly used among young women, whereas IUD use was low among young women.
CONCLUSIONS: Compared with survey data, health administrative data exhibited the same overall tendencies for oral contraceptives, IUDs, and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health.
摘要：
背景：全球超过4亿育龄妇女使用处方避孕。监测避孕药具的使用是一个主要的公共卫生问题，通常依赖于基于人群的调查。然而,这些调查平均每6年进行一次，不允许对避孕药具的使用进行密切随访。此外，他们的样本量通常太有限，无法研究特定的人群亚组，如低收入人群。卫生行政数据可能是研究避孕药具使用的创新且成本较低的来源。
目的：我们旨在探索卫生管理数据在研究处方避孕药具使用方面的潜力，并将这些数据与基于调查数据的观察结果进行比较。
方法：我们选择了所有15-49岁的女性，由法国健康保险覆盖并居住在法国，在卫生行政数据库中，占常住人口的98%(n=14,788,124)，在上一次法国人口代表性调查中，健康晴雨表调查，2016年进行（n=4285）。在卫生行政数据中，记录了避孕药具的使用情况，并提供了有关产品的详细信息，而在调查中，这是由妇女自己宣布的。在这两个来源中，对所有处方避孕药具和避孕药具类型的全球避孕药具使用率进行了估计：口服避孕药，宫内节育器（IUD），和植入物。按年龄分析了患病率。
结果：卫生行政数据中的低收入妇女多于基于人口的调查（1,576,066/14,770,256，11％vs188/4285，7％，分别；P<.001）。在卫生行政数据中，在基于人群的调查中，有47.6％（7034,710/14,770,256；95％CI47.6％-47.7％）的15-49岁女性使用了处方避孕药，而50.5％（2297/4285；95％CI49.1％-52.0％）。考虑到卫生行政数据与调查数据中避孕药具类型的患病率，口服避孕药分别为26.9%(95%CI26.9%-26.9%)和27.7%(95%CI26.4%-29.0%),宫内节育器的17.7%（95%CI17.7%-17.8%）与19.6%（95%CI18.5%-20.8%），和3%（95%CI3.0%-3.0%）与3.2%（95%CI2.7%-3.7%）的植入物。在这两个来源中，这3种避孕药具的总体流行趋势相同.植入物在各个年龄段都很少使用，口服避孕药在年轻女性中使用率很高，而年轻女性的宫内节育器使用率较低。
结论：与调查数据相比，卫生行政数据显示口服避孕药的总体趋势相同，宫内节育器,和植入物。卫生行政数据的主要优势之一是关于避孕药具使用的高质量信息和大量的观察,允许研究人口的亚组。因此，卫生行政数据似乎是以人口为基础的方法监测避孕的有希望的新来源。它们可以为研究开辟新的视角，并成为指导生殖健康和性健康公共政策的宝贵新资产。
目的：我们旨在探索卫生管理数据在研究处方避孕药具使用方面的潜力，并将这些数据与基于调查数据的观察结果进行比较。
方法：我们选择了所有15-49岁的女性，由法国健康保险覆盖并居住在法国，在卫生行政数据库中，占常住人口的98%(n=14,788,124)，在上一次法国人口代表性调查中，健康晴雨表调查，2016年进行（n=4285）。在卫生行政数据中，记录了避孕药具的使用情况，并提供了有关产品的详细信息，而在调查中，这是由妇女自己宣布的。在这两个来源中，对所有处方避孕药具和避孕药具类型的全球避孕药具使用率进行了估计：口服避孕药，宫内节育器（IUD），和植入物。按年龄分析了患病率。
结果：卫生行政数据中的低收入妇女多于基于人口的调查（1,576,066/14,770,256，11％vs188/4285，7％，分别；P<.001）。在卫生行政数据中，在基于人群的调查中，有47.6％（7034,710/14,770,256；95％CI47.6％-47.7％）的15-49岁女性使用了处方避孕药，而50.5％（2297/4285；95％CI49.1％-52.0％）。考虑到卫生行政数据与调查数据中避孕药具类型的患病率，口服避孕药分别为26.9%(95%CI26.9%-26.9%)和27.7%(95%CI26.4%-29.0%),宫内节育器的17.7%（95%CI17.7%-17.8%）与19.6%（95%CI18.5%-20.8%），和3%（95%CI3.0%-3.0%）与3.2%（95%CI2.7%-3.7%）的植入物。在这两个来源中，这3种避孕药具的总体流行趋势相同.植入物在各个年龄段都很少使用，口服避孕药在年轻女性中使用率很高，而年轻女性的宫内节育器使用率较低。
结论：与调查数据相比，卫生行政数据显示口服避孕药的总体趋势相同，宫内节育器,和植入物。卫生行政数据的主要优势之一是关于避孕药具使用的高质量信息和大量的观察,允许研究人口的亚组。因此，卫生行政数据似乎是以人口为基础的方法监测避孕的有希望的新来源。它们可以为研究开辟新的视角，并成为指导生殖健康和性健康公共政策的宝贵新资产。
