Contraception Among Women with Selected Autoimmune Diseases in the United States, 2019: A Claims Analysis

We aimed to estimate contraceptive claims prevalence among reproductive-aged women with selected autoimmune diseases compared with those without these conditions in 2019.

Using IBM MarketScan Commercial Claims and Encounters and Multistate Medicaid databases, we analyzed permanent and prescription contraception claims prevalence among women aged 15-49 years with inflammatory bowel disease (IBD), multiple sclerosis (MS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and among women with these autoimmune diseases using selected fetotoxic medications. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) using Poisson regression.

In 2019, most (60-75%) insured women with selected autoimmune diseases did not have contraception claims. Among commercially insured women, those with SLE were less likely to have claims for any method assessed (aPR = 0.90, 95% CI: 0.86-0.95), less likely to have combined hormonal contraceptives (CHC) claims (aPR = 0.65, 95% CI: 0.60-0.70), and more likely to have long-acting reversible contraceptives (LARC) claims (aPR = 1.14, 95% CI: 1.05-1.23) than women without selected autoimmune diseases. Among Medicaid-insured women, those with IBD, MS, RA, and SLE were more likely to have claims for any method assessed (aPR = 1.23-1.31) and LARC (aPR = 1.23-1.47) than women without selected autoimmune diseases. Women with SLE with lupus nephritis were less likely to have CHC claims (aPR = 0.56, 95% CI: 0.35-0.89) than females without selected autoimmune diseases. Among those using selected fetotoxic medications, 70.4% of commercially insured women and 72.2% of Medicaid-insured women did not have contraceptive claims in 2019.

Less than half of the insured women with selected autoimmune diseases had permanent or prescription contraception claims in 2019.