Trends in the use of hormonal contraception in Estonia 2005–2019 and the risk of arterial and venous thromboembolism: a population-based study

Abstract

Purpose

To describe trends in hormonal contraceptive use, incidence of thromboembolism and presence of risk factors for thromboembolism among the users in Estonia.

Material and methods

Data of 223 312 female patients aged 15–49 years in 2005–2019 from national health insurance databases was derived. Annual prevalence rates of hormonal contraceptive users, incidence rates of thromboembolism and prevalence rates of risk factors were calculated.

Results

Between 2005–2019 usage of progestogen-only contraceptives (POCs) increased steadily (from 24 to 135 users per 1000 population), whereas combined hormonal contraceptive (CHC) use declined (from 209 in 2012 to 161 users per 1000 population in 2019). During the study period, 390 cases of venous thromboembolism and 108 arterial thromboembolism coincided with hormonal contraceptive use. Incidence rate for venous thromboembolism was 5.0 (95% CI 4.5–5.5) and for arterial thromboembolism 1.4 per 10 000 person-years (95% CI 1.1–1.7) among hormonal contraceptive users. Age adjusted incidence of venous thromboembolism among CHC users was 5.8 (95% CI 4.1–8.2) times higher than in POC users. Among CHC users, 10.3% had more than one risk factor for thrombosis.

Conclusions

In regards to the risk of thromboembolism, wider use of POCs and declining prevalence of CHCs in Estonia is positive trend. Still, women with history of thrombosis receiving CHC is a serious concern.

2005-2019年间爱沙尼亚激素类避孕药的应用趋势以及动静脉血栓栓塞风险：一项基于人群的研究 摘要

目的：阐述爱沙尼亚激素避孕药的应用趋势、血栓栓塞的发生率和危险因素。

材料和方法：从国家健康保障数据库中获取2005-2019年间223312名15-49岁女性患者的数据。计算激素避孕药的年应用率、血栓栓塞的发生率和危险因素患病率。

结果：2005-2019年间, 仅应用孕激素避孕药（POCs）的人数稳步增加（每千人中有24人至135人）, 而应用复方激素避孕药（CHC）的人数则下降（从2012年的209人降至2019年的161人）。在研究期间, 390例静脉血栓栓塞和108例动脉血栓栓塞与激素避孕药的应用相关。应用激素避孕药人群中静脉血栓栓塞的发生率为5.0/10 000人/年（95%CI 4.5-5.5）, 动脉血栓栓塞的发生率为1.4/10 000人/年（95%CI 1.1-1.7）。应用CHC人群经年龄校正后静脉血栓栓塞发生率是应用POC人群的5.8（95%CI 4.1-8.2）倍。在应用CHC人群中, 10.3%有一个以上的血栓形成危险因素。

结论：关于血栓栓塞风险, 爱沙尼亚更广泛地应用POC和CHC应用率下降是积极趋势。尽管如此, 有血栓形成史的女性是否应用CHC是一个重要的问题。

Keywords:

• Hormonal contraception
• combined hormonal contraceptives
• thromboembolism
• risk minimisation

Disclosure statement

The authors report no conflict of interest.

Data availability statement

The data underlying the presented results in this paper can be shared by sending a request via the regular mechanism for obtaining access to data from the Estonian Health Insurance Fund (https://www.haigekassa.ee/andmeparingud).

Additional information

Funding

No funding was received for the preparation of this article.