Temporal trend in the use of hysteroscopic vs laparoscopic sterilization and the characteristics of commercially insured and Medicaid-insured females in the US who have had the procedures

Figures & data

Figure 1 A patient flow diagram of the selection of women in the commercially insured and Medicaid-insured study populations.

Table 1 Demographics of study cohorts within commercially insured study population

	HS		LS
Total, n	32,012		64,725
Age (years), mean (SD)a	37.2 (5.7)		36.4 (6.0)
	n	%	n	%
Age group (years)
15–19	9	0.03	64	0.1
20–24	370	1.2	1,643	2.5
25–29	2,848	8.9	7,331	11.3
30–34	7,098	22.2	15,010	23.2
35–39	10,029	31.3	19,516	30.2
40–44	8,392	26.2	15,560	24.0
45–49	3,266	10.2	5,601	8.7
US region of residence
Northeast	2,801	8.8	6,577	10.2
North Central	8,792	27.5	15,541	24.0
South	15,063	47.1	31,630	48.9
West	5,139	16.1	10,432	16.1
Unknown	217	0.7	545	0.8
Health plan type
Missing/unknown	968	3.0	1,826	2.8
Comprehensive	291	0.9	1,442	2.2
EPO	570	1.8	739	1.1
HMO	6,432	20.1	14,003	21.6
POS	3,003	9.4	7,432	11.5
PPO	18,757	58.6	36,251	56.0
POS with capitation	165	0.5	800	1.2
CDHP	1,279	4.0	1,588	2.5
HDHP	547	1.7	644	1.0
Women with sterilization procedure in study years
2003	0	0.0	3,757	100.0
2004	0	0.0	5,521	100.0
2005	462	6.6	6,491	93.4
2006	887	14.4	5,264	85.6
2007	1,413	23.0	4,727	77.0
2008	2,837	31.9	6,070	68.1
2009	5,311	40.7	7,732	59.3
2010	6,306	45.2	7,630	54.8
2011	7,367	46.9	8,329	53.1
2012	7,429	44.7	9,204	55.3
Index year group
2003–2007	2,762	8.6	25,760	39.8
2008–2012	29,250	91.4	38,965	60.2

Note:

a P<0.001.

Abbreviations: HS, hysteroscopic sterilization; LS, laparoscopic sterilization; EPO, exclusive provider organization; HMO, health maintenance organization; POS, point of service; PPO, preferred provider organization; CDHP, consumer-driven health plan; HDHP, high deductible health plan.

Table 2 Demographics of study cohorts within Medicaid-insured study population

	HS		LS
Total, n	2,001		12,523
Age (years), mean (SD)a	30.1 (5.8)		28.8 (5.7)
	n	%	n	%
Age group (years)
15–19	0	0	2	0.02
20–24	371	18.5	3,188	25.5
25–29	681	34.0	4,570	36.5
30–34	483	24.1	2,638	21.1
35–39	316	15.8	1,419	11.3
40–44	118	5.9	572	4.6
45–49	32	1.6	134	1.1
Race
White	1,004	50.2	7,911	63.2
Black	736	36.8	3,758	30.0
Hispanic	79	4.0	290	2.3
Other	182	9.1	564	4.5
Women with sterilization procedure in study years
2006	207	5.1	3,870	94.9
2007	130	7.9	1,526	92.1
2008	179	11.3	1,402	88.7
2009	371	18.5	1,638	81.5
2010	546	20.7	2,087	79.3
2011	568	22.1	2,000	77.9
Index year group
2006–2008	516	25.8	6,798	54.3
2009–2011	1,485	74.2	5,725	45.7

Note:

a P<0.001.

Abbreviations: HS, hysteroscopic sterilization; LS, laparoscopic sterilization.

Table 3 Clinical characteristics of study cohorts within commercially insured and Medicaid-insured study populations

	Commercially insured				Medicaid-insured
	HS		LS		HS		LS
Total, n	32,012		64,725		2,001		12,523
CCI score, mean (SD)	0.18 (0.6)		0.18 (0.5)		0.32 (0.8)a		0.25 (0.7)a
	n	%	n	%	n	%	n	%
Most recent contraceptive type
None	12,448	38.9	35,890	55.5	679	33.9	6,817	54.4
IUS	1,084	3.4	2,304	3.6	51	2.6	416	3.3
Implant	47	0.2	95	0.2	14	0.7	87	0.7
Injectable	4,994	15.6	2,787	4.3	746	37.3	1,660	13.3
Patch	289	0.9	1,376	2.1	20	1.0	393	3.1
Oral contraceptive	12,363	38.6	21,062	32.5	458	22.9	2,780	22.2
Ring	787	2.5	1,211	1.9	33	1.7	370	3.0
Prior OC use	13,658	42.7	21,901	33.8	588	29.4	3,097	24.7
Chronic conditions
IBD	190	0.6	354	0.6	5	0.3	29	0.2
Asthma	1,499	4.7	3,008	4.7	195	9.8	1,033	8.3
Hypothyroidism	2,442	7.6	4,515	7.0	84	4.2	426	3.4
Obesity	1,660	5.2	2,643	4.1	312	15.6	932	7.4
Rheumatoid arthritis	256	0.8	491	0.8	9	0.5	69	0.6
Diabetes	1,187	3.7	2,154	3.3	105	5.3	545	4.4
Hypertension	3,468	10.8	7,451	11.5	293	14.6	1,217	9.7
Systemic lupus erythematosus	125	0.4	296	0.5	14	0.7	43	0.3
Any of the chronic conditions	8,497	26.5	16,850	26.0	710	35.5	3,261	26.0

Note:

a P<0.001.

Abbreviations: HS, hysteroscopic sterilization; LS, laparoscopic sterilization; CCI, Charlson Comorbidity Index; IUS, intrauterine system; OC, oral contraceptive; IBD, inflammatory bowel disease.

Table 4 Differences in characteristics of commercially insured women having HS vs LS

Variables	OR	95% wald confidence limits		P-value
		Lower	Upper
Age	1.03	1.03	1.03	<0.001
Regions vs Northeast
North Central	1.46	1.38	1.55	<0.001
South	1.24	1.17	1.31	<0.001
West	1.33	1.25	1.42	<0.001
Unknown	0.80	0.67	0.95	<0.01
Health plan vs comprehensive
Exclusive provider organization	1.73	1.45	2.06	<0.001
Health maintenance organization	1.63	1.41	1.87	<0.001
Point of service	1.50	1.30	1.73	<0.001
Preferred provider organization	1.42	1.23	1.62	<0.001
Consumer-driven health plan	1.66	1.42	1.93	<0.001
High deductible health plan	1.62	1.36	1.94	<0.001
Index year group 2008–2012 vs 2003–2007	7.10	6.80	7.42	<0.001
Chronic conditions: yes vs no
Asthma	0.89	0.83	0.95	<0.001
Obesity	1.08	1.01	1.15	0.03
Hypertension	0.82	0.78	0.86	<0.001
Prior oral contraceptive use	1.53	1.49	1.58	<0.001

Abbreviations: HS, hysteroscopic sterilization; LS, laparoscopic sterilization; OR, odds ratio.

Table 5 Differences in characteristics of Medicaid-insured women having HS vs LS

Variables	OR	95% wald confidence limits		P-value
		Lower	Upper
Age	1.03	1.02	1.04	<0.001
Race vs white
Black	1.48	1.33	1.65	<0.001
Hispanic	1.58	1.21	2.06	<0.001
Other	2.50	2.07	3.03	<0.001
Index year group 2009–2011 vs 2006–2008	3.3	2.95	3.66	<0.001
Chronic conditions: yes vs no
Obesity	1.73	1.49	2.00	<0.001
Hypertension	1.18	1.01	1.37	0.03
Prior oral contraceptive use	1.42	1.28	1.59	<0.001

Abbreviations: HS, hysteroscopic sterilization; LS, laparoscopic sterilization; OR, odds ratio.