在2010年至2020年期间,美国实施了数百个州级堕胎限制。在同一时期,药物流产被广泛采用。了解卫生政策和政治气候的影响将在快速变化的时期改善生殖保健的提供和获得。为了衡量国家堕胎敌意和米非司酮与程序性堕胎率之间的关系,我们使用MerativeMarketScan2010-2020年雇主赞助的保险索赔数据进行了一项州级重复横断面研究.基于减少或保护堕胎机会的政策的存在,感兴趣的暴露是13分的州级堕胎敌意得分。感兴趣的结果是每年的米非司酮和每100,000名参与者的程序性堕胎索赔。我们使用了线性混合模型来调整城市化程度,年龄组,和年份。我们评估了国家堕胎敌意是否改变了堕胎索赔的时间趋势,方法是通过将一年与两项堕胎敌意的测量值进行交互:2010年的基线评分和基线评分的变化。我们发现,每100,000名参与者中,州级米非司酮的索赔中位数从20增加到37;同时,中位程序性堕胎索赔从每100例69降至20例。对于米非司酮来说,2010年,一个州的基线堕胎敌意评分每增加一个单位,与每100,000名米非司酮索赔减少7.5(CI,-12至-3.6)相关.对于基线敌意和变化分数为零的州,在11年的研究期间,我们没有观察到显著的时间趋势.基线敌意每增加一个单位,时间趋势每年每10万人减少0.5次索赔(CI,-0.8至-0.2)。基线堕胎敌意较高的州总体堕胎较少,米非司酮流产的摄取减少,2010年至2020年间,程序性堕胎的下降速度较慢。在此期间,新限制带来的敌意变化并未显着影响索赔。倡导堕胎的人必须同时关注个人堕胎政策和整体政治气氛。需要对政治气候与不断发展的堕胎护理临床景观之间的关系进行最新研究,以告知这项工作。
Hundreds of state-level abortion restrictions were implemented in the US between 2010 and 2020. Medication abortion was being widely adopted during this same period. Understanding the impact of health policies and political climate will improve the delivery of and access to reproductive healthcare in a period of rapid change. To measure the association between state abortion
hostility and mifepristone and procedural abortion rates, we conducted a state-level repeated cross-sectional study using 2010-2020 employer-sponsored insurance claims data from Merative MarketScan. The exposure of interest was a 13-point state-level abortion
hostility score based on the presence of policies which either reduce or protect access to abortion. Outcomes of interest were annual mifepristone and procedural abortion claims per 100,000 enrollees. We used a linear mixed model adjusting for urbanicity, age group, and year. We assessed whether temporal trends in abortion claims were modified by state abortion hostility by interacting year with two measurements of abortion
hostility: baseline score in 2010 and change from baseline score. We found that median state-level mifepristone claims increased from 20 to 37 per 100,000 included enrollees; meanwhile, median procedural abortions claims decreased from 69 to 20 per 100. For mifepristone, every unit increase in a state\'s baseline abortion
hostility score was associated with 7.5 (CI, -12 to -3.6) fewer mifepristone claims per 100,000 in 2010. For states with baseline hostility and change scores of zero, we did not observe a significant time trend over the 11 year study period. For every unit increase in baseline
hostility, the time trend changed by 0.5 fewer claims (CI, -0.8 to -0.2) per 100,000 per year. States with higher baseline abortion hostility had fewer overall abortions, less uptake of mifepristone abortions, and slower decline in procedural abortions between 2010 and 2020. Changes in hostility from new restrictions during this time period did not significantly impact claims. Advocates for abortion access must simultaneously attend to individual abortion policies and the overall political climate. Updated research on the relationship between political climate and the evolving clinical landscape of abortion care is needed to inform this work.