Racial disparities in fertility success persist despite insurance mandates

November 15, 2022

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Despite state insurance mandates, racial and ethnic disparities in the use of in vitro fertilization and its clinical outcomes still persist, researchers report.

“A recent retrospective cohort study using national IVF data in 2018 demonstrated comprehensive State-mandated insurance coverage for IVF services Among other positive clinical outcomes, it was associated with a higher live birth rate per cycle, albeit with a smaller effect size. ” Dr. Catherine Correia, An assistant professor of statistics and a colleague at Amherst College in Massachusetts wrote, “However, because they did not have patient-level data, the association between blanket obligations and clinical outcomes was the same for all races and ethnicities.” We have not been able to assess whether there is

Data obtained from Correia KFB et al.  J Obstet Gynecol.  2022; doi:10.1016/j.ajog.2022.10.043

Data obtained from Correia KFB et al. Am J Obstett Guinecole2022;doi:10.1016/j.ajog.2022.10.043.

Correia and colleagues identified 1,096,539 autologous IVF cycles from 487,191 women recorded in the Society for Assisted Reproductive Technology (SART) clinical outcome reporting system from 2014 to 2019. Researchers evaluated IVF utilization. Age — by year, state, race, ethnicity. They also assessed birth rates, clinical pregnancy rates, spontaneous abortion rates, and cycle cancellation rates.

Only eight states mandated insurance for the entire study period, and only one state still mandated insurance in 2019, so most cycles (72.9%) were in states with no insurance coverage mandate. has occurred.

use of in vitro fertilization

States with mandates had higher rates of IVF use across racial and ethnic groups than states without mandates. However, the relative increase in utilization between states with and without mandates was significant only for non-Hispanic white and non-Hispanic Asian women. For example, non-Hispanic white women in mandated states experienced the least increase in IVF use in 2018 (RR = 2.42; 95% CI, 1.65-3.55) and the greatest increase in 2017 (RR = 2.53; 95% CI). , 1.72-3.74).

There was no significant difference in the relative increase in IVF use between states with and without mandates for non-Hispanic black and Hispanic women, but the absolute difference was greater when compared to non-Hispanic white women. became. For example, in mandatory states, IVF use increased by 23.5 cycles per 10,000 women in non-Hispanic white women and 56.2 cycles per 10,000 women in non-Hispanic black women in 2019.

clinical outcome

The analysis determined the status of state insurance powers of attorney and Race and Ethnicity, and Clinical Outcomes.

“This lack of significance indicates that the associations between patient race, ethnicity, and clinical outcome were the same between states with and without This means that the associations between outcomes did not differ among racial and ethnic groups of patients,” Correia and colleagues wrote.

After adjusting for patient characteristics, non-Hispanic black women had lower live birth rates compared with non-Hispanic white women regardless of state mandated status (non-mandated adjusted OR = 0.84; 95% CI obligation aOR = 0.81; 95% CI, 0.77-0.84).

Non-Hispanic Asians (unforced aOR = 0.86; 95% CI, 0.8-0.88; forced aOR = 0.86; 95% CI, 0.83-0.9) and Hispanics (unforced aOR = 0.93; 95 % CI, 0.9– 0.96; required aOR = 0.91; 95% CI, 0.89–0.94) comparing females with non-Hispanic white females.

Compared with non-Hispanic white women, women of other races and ethnicities had higher rates of spontaneous abortion. The odds of clinical pregnancy were comparatively low. Hispanic women were similarly likely.

Researchers theorized that the disparity persisted because state orders only applied to certain types of insurance plans and excluded Medicaid coverage for fertility treatments.

“Future multidisciplinary research efforts are needed to better understand the underlying causes of these disparities and to inform policy and public health interventions,” Correia and colleagues wrote. Ongoing research efforts in the obstetrics and gynecology subfields could serve as examples for the field of in vitro fertilization.”

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