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Research ArticleORIGINAL RESEARCH

Variations in Receipt of Contraceptives by Insurance Status and Race/Ethnicity

Tsai-Ling Liu, Yhenneko J. Taylor, Johanna Claire Schuch, Lisa Tucker, Kathryn M. Zager and Michael F. Dulin
North Carolina Medical Journal January 2022, 83 (1) 58-66; DOI: https://doi.org/10.18043/ncm.83.1.58
Tsai-Ling Liu
Assistant professor, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.
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  • For correspondence: Tsai-Ling.Liu@AtriumHealth.org
Yhenneko J. Taylor
Director of health services research and associate professor, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.
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Johanna Claire Schuch
Postdoctoral fellow, Academy for Population Health Innovation, University of North Carolina at Charlotte, Charlotte, North Carolina.
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Lisa Tucker
Pregnancy medical home coordinator, Community Care Partners of Greater Mecklenburg, Charlotte, North Carolina.
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Kathryn M. Zager
Social research specialist, UNC Charlotte Urban Institute, Charlotte, North Carolina.
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Michael F. Dulin
Professor, Academy for Population Health Innovation, University of North Carolina at Charlotte, Charlotte, North Carolina.
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  • FIGURE 1.
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    FIGURE 1.

    Patient Inclusion and Exclusion Criteria

  • FIGURE 2.
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    FIGURE 2.

    Multinomial Logistic Regression Estimating the Odds of Contraception Use

    Note. No contraception, ORs show the odds of using LARC/Non-LARC for difference insurances and race/ethnicity groups compared to the non-Hispanic White women with commercial insurance. Models were adjusted for age and area-level socioeconomic proxy including median household income, percentage of patients with poverty, percentage of patients with bachelor’s degree, and unemployment rate.

Tables

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    TABLE 1.

    ICD-9-CM, ICD-10-CM, CPT, and HCPCS Codes Used to Identify Contraceptive Methods

    CodeDescription
    LARCICD-9-CMV25.11Encounter for insertion of intrauterine contraceptive device
    V25.12Encounter for removal of intrauterine contraceptive device
    V25.13Encounter for removal and reinsertion of intrauterine contraceptive device
    V25.42Surveillance of intrauterine contraceptive device
    V25.43Surveillance of implantable subdermal contraceptive
    V25.5xInsertion of implantable subdermal contraceptive
    ICD-10-CMZ30.014Encounter for initial prescription of intrauterine contraceptive device
    Z30.430Encounter for insertion of intrauterine contraceptive device
    Z30.431Encounter for routine checking of intrauterine contraceptive device
    Z30.432Encounter for removal of intrauterine contraceptive device
    Z30.433Encounter for removal and reinsertion of intrauterine contraceptive device
    Z97.5xxPresence of (intrauterine) contraceptive device
    CPT11981Insertion, non-biodegradable drug delivery implant
    11982Removal, non-biodegradable drug delivery implant
    11983Removal with reinsertion, non-biodegradable drug delivery implant
    58300Insertion of IUD
    58301Removal of IUD
    HCPCSJ7297Levonorgestrel-releasing intrauterine contraceptive system (Liletta®), 52 mg (4 year duration)
    J7298Levonorgestrel-releasing intrauterine contraceptive system (Mirena®), 52 mg (5 year duration)
    J7300Intrauterine copper contraceptive (Paragard®) (10 year duration)
    J7301Levonorgestrel-releasing intrauterine contraceptive system (Skyla®), 13.5 mg (3 year duration)
    J7302Levonorgestrel-releasing intrauterine contraceptive system, 52 mg
    J7307Etonogestrel (contraceptive) implant system, including implant and supplies
    Non-LARCICD-9-CMV25.01General counseling on prescription of oral contraceptives
    V25.02General counseling on initiation of other contraceptive measures
    V25.03Encounter for emergency contraceptive counseling and prescription
    V25.04Counseling and instruction in natural family planning to avoid pregnancy
    V25.09Other general counseling and advice on contraceptive management
    V25.3xMenstrual extraction
    V25.40Contraceptive surveillance, unspecified
    V25.41Surveillance of contraceptive pill
    V25.49Surveillance of other contraceptive method
    ICD-10-CMZ30.011Encounter for initial prescription of contraceptive pills
    Z30.012Encounter for prescription of emergency contraception
    Z30.013Encounter for initial prescription of injectable contraceptive
    Z30.015Encounter for initial prescription of vaginal ring hormonal contraceptive
    Z30.016Encounter for initial prescription of transdermal patch hormonal contraceptive device
    Z30.017Encounter for initial prescription of implantable subdermal contraceptive
    Z30.018Encounter for initial prescription of other contraceptives
    Z30.019Encounter for initial prescription of other contraceptives, unspecified
    Z30.02xCounseling and instruction in natural family planning to avoid pregnancy
    Z30.09xEncounter for other general counseling and advice on contraception
    Z30.40xEncounter for surveillance of contraceptives, unspecified
    Z30.41xEncounter for surveillance of contraceptive pills
    Z30.42xEncounter for surveillance of injectable contraceptive
    Z30.44xEncounter for surveillance of vaginal ring hormonal contraceptive device
    Z30.45xEncounter for surveillance of transdermal patch hormonal contraceptive device
    Z30.46xEncounter for surveillance of implantable subdermal contraceptive
    Z30.49xEncounter for surveillance of other contraceptives
    Z30.8xxEncounter for other contraceptive management
    Z30.9xxEncounter for contraceptive management, unspecified
    • Note. LARC, Long-acting reversible contraceptives; ICD-CM, International Statistical Classification Diseases, Clinical Modification; CPT, Current Procedural Terminology; HCPCS, Healthcare Common Procedure Coding System; IUD, Intrauterine Device.

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    TABLE 2.

    Patient Demographics by Contraception Type

    Total (N = 51,900)LARC (n = 4,364)Non-LARC (n = 8,333)No contraception (n = 39,203)P-value
    Insurance, n (%)< .001
       Managed Care/Commercial33,716 (65.0)2,557 (58.6)4,665 (56.0)26,494 (67.6)
       Medicaid/pending8,040 (15.5)958 (22.0)1,871 (22.5)5,211 (13.3)
       Self-pay and othera10,144 (19.6)849 (19.4)1,797 (21.6)7,498 (19.1)
    Age, mean (SD)23.6 (3.5)23.4 (3.3)22.8 (3.5)23.8 (3.5)< .001
    Race/Ethnicity, n (%)< .001
       Non-Hispanic White23,752 (45.8)1,797 (41.2)3,183 (38.2)18,772 (47.9)
       Non-Hispanic Black16,693 (32.2)1,536 (35.2)3,290 (39.5)11,867 (30.3)
       Hispanic5,773 (11.1)715 (16.4)1,252 (15.0)3,806 (9.7)
       Other5,682 (10.9)316 (7.2)608 (7.3)4,758 (12.1)
    Marital status, n (%)< .001
       Married7,309 (14.1)718 (16.5)891 (10.7)5,700 (14.5)
       Single41,730 (80.4)3,464 (79.4)7,146 (85.8)31,120 (79.4)
    Area-level socioeconomic status
       Median household income in thousands, mean (SD)60.6 (29.2)55.7 (27.2)55.6 (28.2)62.2 (29.5)< .001
       Percentage of patients with poverty, mean (SD)17.3 (13.1)19.3 (13.6)19.7 (13.8)16.5 (12.8)< .001
       Percentage of patients with bachelor’s degree, mean (SD)41.7 (21.7)37.9 (21.4)37.4 (21.9)43.1 (21.5)< .001
       Unemployment rate, mean (SD)6.7 (3.7)7.3 (3.9)7.3 (3.9)6.5 (3.6)< .001
    • ↵aSelf-pay and other insurance include self-pay, charity, indigent, and missing insurance status. Among the total population, about 16.7% had self-pay and 2.7% had other insurance.

    • View popup
    SUPPLEMENTARY TABLE 1.

    Multinomial Logistic Regression on Contraception Use

    LARC OR95%CIPNon-LARC OR95%CIP
    Insurance
       Commercial1.00------1.00------
       Medicaid1.321.251.40< .0011.181.131.23< .001
       Self-pay and other0.840.790.89< .0011.020.981.06.319
    Race/Ethnicity
       Non-Hispanic White1.00------1.00------
       Non-Hispanic Black1.030.971.09.3321.121.081.17< .001
       Hispanic1.581.471.71< .0011.391.321.48< .001
       Other0.610.560.67< .0010.680.630.72< .001
    Age0.970.960.98< .0010.940.930.94< .001
    Marital status1.431.301.57< .0011.020.941.10.608
    Area-level socioeconomic status
       Median household income in thousands1.000.991.00.0021.001.001.00.129
       Percentage of patients with poverty1.001.001.01.3661.011.001.01< .001
       Percentage of patients with bachelor’s degree1.001.001.00.6181.000.991.00.005
       Unemployment rate1.021.001.03.0121.000.991.01.758
    • Note. No contraception, ORs show the odds of using LRAC/Non-LARC for difference insurances. Other controlled variables: age, race/ethnicity, and area-level proxy including median household income, percentage of patients with poverty, percentage of patients with bachelor’s degree, and unemployment rate.

    • View popup
    SUPPLEMENTARY TABLE 2.

    Multinomial Logistic Regression on Contraception Use

    LARC OR95%CIP-valueNon-LARC OR95%CIP-value
    Insurance/Race
       Commercial/non-Hispanic White------------
       Commercial/non-Hispanic Black0.97(0.93-1.02).5751.00(0.96-1.03).887
       Commercial/Hispanic1.19(1.10-1.29).0300.93(0.87-0.99).279
       Commercial/Other race0.43(0.40-0.46)< .0010.58(0.55-0.61)< .001
       Medicaid/non-Hispanic White1.05(0.95-1.17).6361.02(0.94-1.10)0.835
       Medicaid/non-Hispanic Black1.25(1.19-1.32)< .0011.57(1.52-1.63)< .001
       Medicaid/Hispanic2.23(2.07-2.41)< .0011.26(1.17-1.36).001
       Medicaid/Other race1.78(1.61-1.97)< .0011.13(1.02-1.25).215
       Self-pay and Other insurance/non-Hispanic White0.70(0.65-0.76)< .0010.71(0.66-0.75)< .001
       Self-pay and Other insurance/non-Hispanic Black0.94(0.89-1.00).3461.02(0.98-1.07).646
       Self-pay and Other insurance/Hispanic1.38(1.30-1.47)< .0011.80(1.72-1.88)< .001
       Self-pay and Other insurance/Other race0.45(0.38-0.52)< .0010.70(0.63-0.77)< .001
    Age0.97(0.96-0.97)< 0.0010.93(0.93-0.94)< .001
    Married1.44(1.38-1.51)< 0.0010.99(0.95-1.03).834
    Area-level socioeconomic status
       Median household income in thousands1.00(0.99-1.00)0.0011.00(1.00-1.00).023
       Percentage of patients with poverty1.00(1.00-1.00)0.3921.01(1.00-1.01)< .001
       Percentage of patients with bachelor’s degree1.00(1.00-1.00)0.9061.00(1.00-1.00).053
       Unemployment rate1.02(1.01-1.02)0.0091.00(0.99-1.00).908
    • Note. No contraception, ORs show the odds of using LRAC/Non-LARC for difference insurances and race/ethnicity groups compared to the non-Hispanic White women with commercial insurance. Other controlled variables: age and area-level proxy including median household income, percentage of patients with poverty, percentage of patients with bachelor’s degree, and unemployment rate.

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Variations in Receipt of Contraceptives by Insurance Status and Race/Ethnicity
Tsai-Ling Liu, Yhenneko J. Taylor, Johanna Claire Schuch, Lisa Tucker, Kathryn M. Zager, Michael F. Dulin
North Carolina Medical Journal Jan 2022, 83 (1) 58-66; DOI: 10.18043/ncm.83.1.58

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Variations in Receipt of Contraceptives by Insurance Status and Race/Ethnicity
Tsai-Ling Liu, Yhenneko J. Taylor, Johanna Claire Schuch, Lisa Tucker, Kathryn M. Zager, Michael F. Dulin
North Carolina Medical Journal Jan 2022, 83 (1) 58-66; DOI: 10.18043/ncm.83.1.58
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