Epilepsy, Intellectual and Developmental Disabilities, and Contraception in U.S. Medicaid Claims Data

To evaluate how epilepsy and intellectual and developmental disabilities (IDD) affect contraceptive provision among females with Medicaid insurance.

We obtained Medicaid claims data from 2016-2021 for females aged 12-51 years. We excluded individuals with diagnosis codes for menopause and those who underwent sterilization in 2016-2017. Using a validated definition of epilepsy, we identified females who met the criteria for epilepsy in 2016-2017, and we identified a comparison group of females enrolled in 2016-2017 who never met the criteria for epilepsy. We used International Classification of Diseases, Tenth Revision codes from previous claims studies to determine IDD diagnoses. We ascertained contraceptive prescriptions from 2018-2021. To evaluate the effects of epilepsy and IDD and their interaction on contraceptive prescription, we performed a multivariable logistic regression for prescription of any contraceptive method from 2018-2021. We performed similar logistic regressions for prescription of individual contraceptive methods from 2018-2021 among females prescribed any method of contraception.

Our final sample included 207,699 females with epilepsy and 3,573,052 females without epilepsy. The logistic regression for contraceptive prescription showed that, compared with females who did not have epilepsy or IDD, females with epilepsy were significantly more likely to be prescribed any contraceptive method (adjusted odds ratio [aOR], 1.05, 95% CI, 1.04-1.06, P <.007), females with IDD were significantly less likely to be prescribed any contraceptive method (aOR, 0.57, 0.56-0.58, P <.007), and there was intermediate likelihood of contraceptive provision to females with co-occurring epilepsy and IDD (aOR, 0.83, 95% CI, 0.81-0.85, P <.007). There were statistically significant differences in prescription patterns for specific contraceptives among females with epilepsy alone, IDD alone, co-occurring epilepsy and IDD, and neither epilepsy nor IDD.

Epilepsy has a small and statistically significant effect on contraceptive prescription for females with Medicaid insurance, even when adjusting for confounders. There is a statistically significant interaction between epilepsy and IDD that affects overall contraceptive prescriptions and prescriptions for specific methods.