Table 5.
Claims Related to Pain and Menstrual Bleeding in the Year Following Long-Acting Contraceptive Procedures Provided by Medicaid to California Patients, 2008–2014
| Day of procedure | 2–89 days | 90–179 days | 180–364 days | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| %*rate† |
Adj IRR‡ (95% CI) |
%* | Rate† |
Adj IRR‡ (95% CI) |
%* | Rate† |
Adj IRR‡ (95% CI) |
%* | Rate† |
Adj IRR‡ (95% CI) |
|
| Pelvic pain | |||||||||||
| Tubal ligation | 19.41 | Ref | 11.52 | 0.21 | Ref | 6.63 | 0.13 | ref | 9.61 | 0.12 | Ref |
| Levonorgestrel IUC | 0.55 |
0.06 (0.05–0.07) |
4.52 | 0.07 |
0.55 (0.52–0.59) |
3.41 | 0.06 |
0.64 (0.59–0.68) |
6.16 | 0.05 |
0.69 (0.65–0.73) |
| Copper IUC | 0.32 |
0.04 (0.03–0.05) |
3.92 | 0.06 |
0.51 (0.48–0.55) |
3.13 | 0.04 |
0.56 (0.51–0.61) |
5.68 | 0.05 |
0.70 (0.66–0.75) |
| Menstrual bleeding concerns | |||||||||||
| Tubal ligation | 6.71 | Ref | 4.87 | 0.08 | Ref | 3.91 | 0.07 | Ref | 5.67 | 0.06 | Ref |
| Levonorgestrel IUC | 3.64 |
1.35 (1.23–1.48) |
5.22 | 0.07 |
1.45 (1.35–1.56) |
3.04 | 0.04 |
0.84 (0.77–0.92) |
4.98 | 0.03 |
0.72 (0.67–0.77) |
| Copper IUC | 2.64 |
1.09 (0.98–1.22) |
4.21 | 0.06 |
1.18 (1.09–1.29) |
3.37 | 0.04 |
0.93 (0.84–1.02) |
6.10 | 0.04 |
0.96 (0.88–1.03) |
| Abdominal pain and gastrointestinal symptoms | |||||||||||
| Tubal ligation | 3.93 | Ref | 12.51 | 0.27 | Ref | 8.59 | 0.18 | Ref | 13.62 | 0.18 | Ref |
| Levonorgestrel IUC | 0.14 |
0.05 (0.04–0.07) |
5.78 | 0.10 |
0.57 (0.54–0.60) |
5.53 | 0.10 |
0.80 (0.76–0.85) |
9.84 | 0.10 |
0.77 (0.73–0.80) |
| Copper IUC | 0.19 |
0.08 (0.06–0.11) |
5.95 | 0.10 |
0.61 (0.58–0.65) |
4.95 | 0.09 |
0.76 (0.71–0.81) |
9.19 | 0.09 |
0.80 (0.76–0.84) |
| Non-abdominal pain | |||||||||||
| Tubal ligation | 0.35 | Ref | 12.69 | 0.29 | Ref | 14.04 | 0.34 | Ref | 20.81 | 0.34 | Ref |
| Levonorgestrel IUC | 0.26 |
1.31 (0.94–1.82) |
9.11 | 0.19 |
1.07 (1.02–1.11) |
9.06 | 0.19 |
0.89 (0.86–0.93) |
14.69 | 0.19 |
0.90 (0.87–0.92) |
| Copper IUC | 0.28 |
1.58 (1.11–2.26) |
8.29 | 0.16 |
1.03 (0.99–1.08) |
8.18 | 0.17 |
0.91 (0.86–0.95) |
13.28 | 0.16 |
0.83 (0.80–0.86) |
| Pelvic inflammatory disease | |||||||||||
| Tubal ligation | 6.28 | Ref | 1.70 | 0.04 | Ref | 0.50 | 0.007 | Ref | 0.74 | 0.006 | Ref |
| Levonorgestrel IUC | 00.02 |
0.01 (0.00–0.01) |
0.47 | 0.01 |
0.34 (0.28–0.41) |
0.32 | 0.005 |
0.99 (0.75–1.30) |
0.55 | 0.004 |
0.83 (0.66–1.04) |
| Copper IUC | 0.01 |
0.004 (0.00–0.01) |
0.41 | 0.01 |
0.35 (0.28–0.43) |
0.34 | 0.005 |
1.12 (0.83–1.52) |
0.55 | 0.004 |
0.95 (0.74–1.21) |
| Genitourinary pain | |||||||||||
| Tubal ligation | 0.13 | Ref | 1.36 | 0.02 | Ref | 1.21 | 0.02 | Ref | 2.05 | 0.023 | Ref |
| Levonorgestrel IUC | 0.06 |
0.62 (0.32–1.21) |
0.82 | 0.01 |
0.92 (0.79–1.07) |
1.76 | 0.01 |
0.86 (0.73–1.01) |
1.41 | 0.012 |
0.80 (0.70–0.90) |
| Copper IUC | 0.03 |
0.47 (0.20–1.11) |
0.72 | 0.01 |
0.84 (0.71–1.00) |
1.69 | 0.01 |
0.85 (0.71–1.02) |
1.16 | 0.011 |
0.75 (0.65–0.87) |
Ref referent
*Proportion of patients with one or more claims for condition during interval of interest; data censored on 8/31/2014
†Number of days with one or more claims for condition during interval per 100 patients days, rates were censored at time of claims indicating IUC removal or switch to another type of IUC, contraceptive implant or tubal ligation, pregnancy, hysterectomy, oopherectomy, enrollment gaps > 3 months, or end of data availability on December 31, 2014
‡Incident rate ratios from multivariable Poisson models adjusted for year of procedure, Medi-Cal program, age category, race/ethnicity, region, baseline months eligibility, endometrial ablation, health care utilization in the 2 years pre-procedure (i.e., claims related to abdominal pain or other gastrointestinal symptoms, genitourinary pain, menorrhagia, non-abdominal pain, pelvic inflammatory disease, pelvic pain, fibroids, mood disorder, obesity, pregnancy history, use of any contraceptive method, Charlson Comorbidity Index), censored at time of claims indicating IUC removal, switch to another type of IUD, placement of contraceptive implant or tubal ligation, pregnancy, hysterectomy, oophorectomy, gaps in enrollment >3 months, or end of available data on December 31, 2014
Values shown in bold are statistically significant, at the level of p < 0.05