patient characteristics of repeat induced terminations of pregnancy — new york city, 2010
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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. - PowerPoint PPT PresentationTRANSCRIPT
Amita Toprani, MD, MPHNew York City Department of Health & Mental
HygieneEIS Field Assignments Branch
Centers for Disease Control and PreventionCSTE Conference
June 4, 2012
Patient Characteristics of Repeat Induced Terminations of Pregnancy — New York
City, 2010
Office of Surveillance, Epidemiology, and Laboratory ServicesScientific Education and Professional Development Program Office
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
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
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 Patient age Level of education Race/
ethnicity Method of payment
Zip code Marital status
Questions How common are repeat abortions in New York
City?
What characteristics are associated with repeat abortions?
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
Descriptive Analysis Methods Proportion of all abortions that are repeat
procedures by:
Stratified analysis Race/ethnicity and neighborhood-level poverty
Patient age Level of education Race/ethnicity Method of payment Neighborhood-level
poverty Marital status
Number of living children
2010 Abortion Procedures by Total Abortions Obtained Including Current
Total Abortions Number Percent
1 32,944 432 19,154 253 11,492 154 6,129 8
≥5 6,895 9Total 76,614 100
2010 Abortion Procedures by Total Abortions Obtained Including Current
Total Abortions Number Percent
1 32,944 432 19,154 253 11,492 154 6,129 8
≥5 6,895 9Total 76,614 100
57%repeat abortions
Abortion Rates by Age GroupNew York City, 2010
Repeat
First
<15 15–17 18–19 20–24 25–29 30–34 35–39 ≥400
5
10
15
20
25
30
35
40
45
Age Group
Abor
tion
Rat
e pe
r 10
00
Wom
en
Abortion Rates by Race/Ethnicity New York City, 2010
0102030405060
Race/Ethnicity
Abor
tion
Rat
e pe
r 10
00
Wom
en
Repeat
First
Abortion Rates by Race/Ethnicity New York City, 2010
0102030405060
Race/Ethnicity
Abor
tion
Rat
e pe
r 10
00
Wom
en
Repeat
First
4x
Ref
Abortion Rates by Race/Ethnicity New York City, 2010
0102030405060
Race/Ethnicity
Abor
tion
Rat
e pe
r 10
00
Wom
en
Repeat
First9x
Ref
4x
Ref
Abortion Rates by Neighborhood Poverty
New York City, 2010
<10% 10 to 19.9% 20 to 29.9% ≥30%0
10
20
30
40
50
60
Neighborhood Level Poverty
Abor
tion
Rat
e pe
r 10
00
Wom
en
Repeat
First
Patient Age and Repeat Abortions
<15 15–17 18–19 20–24 25–29 30–34 35–39 ≥400
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Age Group
Repe
at A
bort
ions
(N
umbe
r)
Patient Age and Repeat Abortions
<15 15–17
18–19
20–24
25–29
30–34
35–39
≥400
2,000
4,000
6,000
8,000
10,000
12,000
14,000
0%10%20%30%40%50%60%70%80%90%100%
Age Group
Repe
at A
bort
ions
(N
umbe
r)
Repe
at A
bort
ions
(Per
cent
)
Patient Age and Repeat Abortions
<15 15–17
18–19
20–24
25–29
30–34
35–39
≥400
2,000
4,000
6,000
8,000
10,000
12,000
14,000
0%10%20%30%40%50%60%70%80%90%100%
Age Group
Repe
at A
bort
ions
(N
umbe
r)
Repe
at A
bort
ions
(Per
cent
)
Patient Age and Repeat Abortions
<15 15–17
18–19
20–24
25–29
30–34
35–39
≥400
2,000
4,000
6,000
8,000
10,000
12,000
14,000
0%10%20%30%40%50%60%70%80%90%100%
Age Group
Repe
at A
bort
ions
(N
umbe
r)
Repe
at A
bort
ions
(Per
cent
)
Race/Ethnicity and Repeat Abortions
05,000
10,00015,00020,00025,000
0%20%40%60%80%100%
Race/Ethnicity
Repe
at A
bort
ions
(Num
ber)
Repe
at A
bort
ions
(Per
cent
)
Poverty and Repeat Abortions
<10% 10 to 19.9%
20 to 29.9%
≥30%02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
0%10%20%30%40%50%60%70%80%90%100%
Neighborhood Level Poverty
Repe
at A
bort
ions
(Num
ber)
Repe
at A
bort
ions
(Per
cent
)
Number of Living Children and Repeat Abortions
0 1 2 3 4 ≥50
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
0%10%20%30%40%50%60%70%80%90%100%
Number of Living Children
Repe
at A
bort
ions
(Num
ber)
Repe
at A
bort
ions
(Per
cent
)
Education and Repeat Abortions Among Women Aged ≥25 Years
0
2,000
4,000
6,000
8,000
10,000
12,000
0%10%20%30%40%50%60%70%80%90%100%
Level of Education
Repe
at A
bort
ions
(Num
ber)
Repe
at A
bort
ions
(P
erce
nt)
Payment Method and Repeat Abortions
Self Medicaid Other 3rd Party
0
5,000
10,000
15,000
20,000
25,000
0%10%20%30%40%50%60%70%80%90%100%
Payment Method
Repe
at A
bort
ions
(N
umbe
r)
Repe
at A
bort
ions
(P
erce
nt)
Marital Status and Repeat Abortions
Married Not Married0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
0%10%20%30%40%50%60%70%80%90%100%
Marital Status
Repe
at A
bort
ions
(N
umbe
r)
Repe
at A
bort
ions
(P
erce
nt)
Percent Repeat Abortionsby Race Within Neighborhood Level Poverty
Strata
<10% 10 to 19.9% 20 to 29.9% ≥30%0%10%20%30%40%50%60%70%80%90%
100%Black Non-Hispanic
Puerto Rican
Other Hispanic
White non-Hispanic
Asian-Pacific Is-landers
Neighborhood Level Poverty
Perc
ent
Repe
ats
Percent Repeat Abortionsby Neighborhood Level Poverty Within Race
Strata
0%10%20%30%40%50%60%70%80%90%
100% <10%10 to 19.9%20 to 29.9%≥30%
Race/Ethnicity
Perc
ent
Repe
ats
Predictor variables
Outcome: Mean number of prior abortions Negative binomial regression with single
predictor
Bivariate Analysis Methods
Patient age Level of education Race/ethnicity Method of payment Neighborhood-level
poverty Marital status
Number of living children
Bivariate Analyses
Variable p valueAge <0.0001Race/ethnicity <0.0001Neighborhood-level poverty <0.0001Number of living children <0.0001Level of education <0.0001Method of payment <0.0001Marital status 0.7980
Negative binomial regression Outcome = mean number of prior abortions Predictor variables significant in bivariate
analyses Education variable removed due to 21%
missing
Multivariate Analysis Methods
Multivariate Analysis All predictors significant after adjustment
Patient age Number of Living Children
Race/ethnicity Method of payment Neighborhood-level
poverty
Ratio of Mean Number of Prior Abortions
by Patient AgePatient Age (years)
Unadjusted Mean
Adjusted Ratio
<15 0.18 0.1815-17 0.29 0.2718-19 0.56 0.4920-24 1.06 0.7925-29 1.56 130-34 1.77 1.0635-39 1.72 0.99≥40 1.61 0.95
Ratio of Mean Number of Prior Abortions
by Patient AgePatient Age (years)
Unadjusted Mean
Adjusted Ratio
<15 0.18 0.1815-17 0.29 0.2718-19 0.56 0.4920-24 1.06 0.7925-29 1.56 130-34 1.77 1.0635-39 1.72 0.99≥40 1.61 0.95
Ratio of Mean Number of Prior Abortions
by Patient AgePatient Age (years)
Unadjusted Mean
Adjusted Ratio
<15 0.18 0.1815-17 0.29 0.2718-19 0.56 0.4920-24 1.06 0.7925-29 1.56 130-34 1.77 1.0635-39 1.72 0.99≥40 1.61 0.95
Ratio of Mean Number of Prior Abortions
by Race/Ethnicity
Race/Ethnicity
Unadjusted
Mean
Adjusted
RatioAsian/Pacific Islander 0.77 0.79White Non-Hispanic 0.82 1Other Hispanic 1.10 1.09Other race 1.10 1.15Black non-Hispanic 1.52 1.46Puerto Rican 1.56 1.49
Ratio of Mean Number of Prior Abortions
by Race/Ethnicity
Race/Ethnicity
Unadjusted
Mean
Adjusted
RatioAsian/Pacific Islander 0.77 0.79White Non-Hispanic 0.82 1Other Hispanic 1.10 1.09Other race 1.10 1.15Black non-Hispanic 1.52 1.46Puerto Rican 1.56 1.49
Ratio of Mean Number of Prior Abortions
by Race/Ethnicity
Race/Ethnicity
Unadjusted
Mean
Adjusted
RatioAsian/Pacific Islander 0.77 0.79White Non-Hispanic 0.82 1Other Hispanic 1.10 1.09Other race 1.10 1.15Black non-Hispanic 1.52 1.46Puerto Rican 1.56 1.49
Ratio of Mean Number of Prior Abortions
by Neighborhood-level Poverty
Neighborhood-level Poverty
Unadjusted
MeanAdjusted
Ratio<10% 0.99 110-19.9% 1.20 1.1020-29.9% 1.28 1.10≥30% 1.45 1.17
Ratio of Mean Number of Prior Abortions
by Neighborhood-level Poverty
Neighborhood-level Poverty
Unadjusted
MeanAdjusted
Ratio<10% 0.99 110-19.9% 1.20 1.1020-29.9% 1.28 1.10≥30% 1.45 1.17
Ratio of Mean Number of Prior Abortions
by Neighborhood-level Poverty
Neighborhood-level Poverty
Unadjusted
MeanAdjusted
Ratio<10% 0.99 110-19.9% 1.20 1.1020-29.9% 1.28 1.10≥30% 1.45 1.17
Ratio of Mean Number of Prior Abortions
by Number of Living Children
Number of Living Children
Unadjusted
MeanAdjusted
Ratio0 0.56 11 1.56 2.032 1.93 2.323 2.11 2.474 2.21 2.50≥5 2.50 2.78
Ratio of Mean Number of Prior Abortions
by Number of Living Children
Number of Living Children
Unadjusted
MeanAdjusted
Ratio0 0.56 11 1.56 2.032 1.93 2.323 2.11 2.474 2.21 2.50≥5 2.50 2.78
Ratio of Mean Number of Prior Abortions
by Number of Living Children
Number of Living Children
Unadjusted
MeanAdjusted
Ratio0 0.56 11 1.56 2.032 1.93 2.323 2.11 2.474 2.21 2.50≥5 2.50 2.78
Ratio of Mean Number of Prior Abortions
by Payment Method
Payment Method
Unadjusted
MeanAdjusted
RatioSelf pay 1.00 1Medicaid 1.39 1.16Third-party insurance 1.44 1.19
Ratio of Mean Number of Prior Abortions
by Payment Method
Payment Method
Unadjusted
MeanAdjusted
RatioSelf pay 1.00 1Medicaid 1.39 1.16Third-party insurance 1.44 1.19
Ratio of Mean Number of Prior Abortions
by Payment Method
Payment Method
Unadjusted
MeanAdjusted
RatioSelf pay 1.00 1Medicaid 1.39 1.16Third-party insurance 1.44 1.19
Discussion Patient age
Number of living children
Race/ethnic disparities
Economic disparities
Limitations Self report of abortion history
Unit of analysis is abortion event, not woman
Missing values
Cannot exclude medically indicated abortions
Conclusions Repeat abortions comprised over half of all
abortions
Repeat abortion common across all sociodemographic characteristics
Race/ethnicity strongly correlated with repeat abortion
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
Office of Surveillance, Epidemiology, and Laboratory Services
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.
Scientific Education and Professional Development Program Office
AcknowledgmentsNew York City
Department of Health and Mental Hygiene
Centers for Disease Control and Prevention
Elizabeth BegierWenhui Li
Sung woo LimCarolyn GreeneJudith Sackoff
Cristina Yunzal-ButlerDeborah Kaplan
Julie MagriKaren Pazol
Betsy CadwellDiana Bensyl
Who is Required to Report? If event occurs in a hospital or en route
thereto The person in charge of hospital or his or her designee
If event occurs elsewhere than a hospital The health care practitioner in attendance or the person in charge of the clinic or hospital with
which the practitioner is associated or the designee of such person in charge
If event is investigated by the Office of the Chief Medical Examiner A medical examiner within that office
Abortion Rates by AgeNew York City, 2010
Abortions per 1,000 WomenAge (years) 1st Abortion Repeat Abortion<15 3.9 0.5715–17 21.1 5.918–19 39.2 23.820–24 29.7 37.525–29 16.5 32.030–34 11.0 25.035–39 7.0 16.1≥40 3.0 6.2
Abortion Rates by Race/Ethnicity New York City, 2010
Race/Ethnicity
Abortions per 1,000 Women1st
Abortion Repeat Abortion
White Non-Hispanic 6.8 5.6Asian /Pacific Islander 8.6 6.6
Hispanic 18.1 25.9
Black Non-Hispanic 27.6 52.5
Abortion Rates by Neighborhood Poverty
New York City, 2010
Abortions per 1,000 WomenNeighborhood Level Poverty 1st Abortion Repeat Abortion
<10% 9.22 9.39
10–19.9% 14.24 18.08
20–29.9% 16.15 22.96
≥30% 22.06 37.12
Sensitivity: Number of Terminations Reported
NYC Health Department
GuttmacherInstitute
Sensitivity
2004 91,673 104,536 88%2005 88,891 103,565 86%2007 90,870 100,046 91%2008 89,469 101,756 88%Overall 360,903 409,903 88%
Variable Missing Values
Prior abortions 2,468 (3%)Patient age 292 (0.4%)Race/ethnicity 4,074 (5%)Neighborhood-level poverty 1,460 (2%)Number of living children 2,089 (3%)Level of education 17,725 (21%)Method of payment 3,176 (4%)Marital Status 3,253 (4%)
Missing Data