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Patient Characteristics of Repeat Induced Terminations of Pregnancy — New York City, 2010

Patient Characteristics of Repeat Induced Terminations of Pregnancy — New York City, 2010. Amita Toprani, MD, MPH. New York City Department of Health & Mental Hygiene EIS Field Assignments Branch Centers for Disease Control and Prevention CSTE Conference June 4, 2012.

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Patient Characteristics of Repeat Induced Terminations of Pregnancy — New York City, 2010

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  1. Patient Characteristics of Repeat Induced Terminations of Pregnancy — New York City, 2010 Amita Toprani, MD, MPH New York City Department of Health & Mental Hygiene EIS Field Assignments Branch Centers for Disease Control and Prevention CSTE Conference June 4, 2012 Office of Surveillance, Epidemiology, and Laboratory Services Scientific Education and Professional Development Program Office

  2. Why Study Repeat Abortions? • Majority of abortions result from unintended pregnancy • Repeat abortion = repeat unintended pregnancy • Women undergoing abortion are high risk group for future unintended pregnancy • Little known about women who undergo repeat abortions • Opportunity to provide long-acting reversible contraceptives

  3. Abortions are Reportable to the NYC Bureau of Vital Statistics • NYC Health Code requires abortion reporting • Within 5 days of event • Definition of abortion • Purposeful interruption of intrauterine pregnancy • Intention other than to produce live-born infant • Does not result in live birth • 80,000 abortions reported yearly • Estimated to capture 88% of procedures

  4. Abortions are Reportable to the NYC Bureau of Vital Statistics • Healthcare provider or designee completes report form • Self report of past pregnancy outcomes • Abortions, miscarriages, and births • Demographic and socioeconomic data

  5. Questions • How common are repeat abortions in New York City? • What characteristics are associated with repeat abortions?

  6. Methods • Inclusion criteria • Procedures among NYC residents • Performed during 2010 • Outcome of interest: repeat abortion • Procedure where the patient reported a history of one or more prior abortions • Rates of first and repeat abortion • Age • Race/ethnicity • Neighborhood level poverty

  7. Descriptive Analysis Methods • Proportion of all abortions that are repeat procedures by: • Stratified analysis • Race/ethnicity and neighborhood-level poverty

  8. 2010 Abortion Procedures by Total Abortions Obtained Including Current

  9. 2010 Abortion Procedures by Total Abortions Obtained Including Current 57% repeat abortions

  10. Abortion Rates by Age GroupNew York City, 2010 First Repeat

  11. Abortion Rates by Race/Ethnicity New York City, 2010 First Repeat

  12. Abortion Rates by Race/Ethnicity New York City, 2010 First Repeat 4x Ref

  13. Abortion Rates by Race/Ethnicity New York City, 2010 9x First Repeat 4x Ref Ref

  14. Abortion Rates by Neighborhood Poverty New York City, 2010 First Repeat

  15. Patient Age and Repeat Abortions

  16. Patient Age and Repeat Abortions

  17. Patient Age and Repeat Abortions

  18. Patient Age and Repeat Abortions

  19. Race/Ethnicity and Repeat Abortions

  20. Poverty and Repeat Abortions

  21. Number of Living Children and Repeat Abortions

  22. Education and Repeat Abortions Among Women Aged ≥25 Years

  23. Payment Method and Repeat Abortions

  24. Marital Status and Repeat Abortions

  25. Percent Repeat Abortionsby Race Within Neighborhood Level Poverty Strata

  26. Percent Repeat Abortionsby Neighborhood Level Poverty Within Race Strata

  27. Bivariate Analysis Methods • Predictor variables • Outcome: Mean number of prior abortions • Negative binomial regression with single predictor

  28. Bivariate Analyses

  29. Multivariate Analysis Methods • Negative binomial regression • Outcome = mean number of prior abortions • Predictor variables significant in bivariate analyses • Education variable removed due to 21% missing

  30. Multivariate Analysis • All predictors significant after adjustment

  31. Ratio of Mean Number of Prior Abortionsby Patient Age

  32. Ratio of Mean Number of Prior Abortionsby Patient Age

  33. Ratio of Mean Number of Prior Abortionsby Patient Age

  34. Ratio of Mean Number of Prior Abortionsby Race/Ethnicity

  35. Ratio of Mean Number of Prior Abortionsby Race/Ethnicity

  36. Ratio of Mean Number of Prior Abortionsby Race/Ethnicity

  37. Ratio of Mean Number of Prior Abortionsby Neighborhood-level Poverty

  38. Ratio of Mean Number of Prior Abortionsby Neighborhood-level Poverty

  39. Ratio of Mean Number of Prior Abortionsby Neighborhood-level Poverty

  40. Ratio of Mean Number of Prior Abortionsby Number of Living Children

  41. Ratio of Mean Number of Prior Abortionsby Number of Living Children

  42. Ratio of Mean Number of Prior Abortionsby Number of Living Children

  43. Ratio of Mean Number of Prior Abortionsby Payment Method

  44. Ratio of Mean Number of Prior Abortionsby Payment Method

  45. Ratio of Mean Number of Prior Abortionsby Payment Method

  46. Discussion • Patient age • Number of living children • Race/ethnic disparities • Economic disparities

  47. Limitations • Self report of abortion history • Unit of analysis is abortion event, not woman • Missing values • Cannot exclude medically indicated abortions

  48. Conclusions • Repeat abortions comprised over half of all abortions • Repeat abortion common across all sociodemographic characteristics • Race/ethnicity strongly correlated with repeat abortion

  49. Next Steps • Identify interventions to integrate with abortion visits • Include post-abortion contraception in surveillance • Reduce barriers to provision of long-term contraception • Further research needed on race/ethnic disparities

  50. Acknowledgments The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Office of Surveillance, Epidemiology, and Laboratory Services Scientific Education and Professional Development Program Office

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