Homelessness, housing instability, and abortion outcomes at an urban abortion clinic in the United States.
Abortifacient Agents
/ therapeutic use
Abortion, Induced
Adult
Black or African American
Asian
Cervix Uteri
/ injuries
Cesarean Section
Dilatation and Curettage
Ethnicity
/ statistics & numerical data
Female
Gestational Age
Hispanic or Latino
Ill-Housed Persons
/ statistics & numerical data
Hospitalization
Humans
Intraoperative Complications
/ epidemiology
Lacerations
Logistic Models
Mental Disorders
/ epidemiology
Postoperative Complications
/ epidemiology
Postoperative Hemorrhage
/ epidemiology
Pregnancy
Retrospective Studies
Risk Factors
San Francisco
/ epidemiology
Substance-Related Disorders
/ epidemiology
Surgical Wound Infection
/ drug therapy
Urban Health Services
Uterine Hemorrhage
/ epidemiology
Uterine Inertia
/ epidemiology
Uterine Perforation
/ epidemiology
White People
Young Adult
abortion
homelessness
housing status
Journal
American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
27
03
2020
revised:
14
06
2020
accepted:
02
07
2020
pubmed:
9
7
2020
medline:
5
1
2021
entrez:
9
7
2020
Statut:
ppublish
Résumé
Adverse reproductive health outcomes are well documented among people experiencing homelessness or housing instability. Little is known about abortion outcomes among this population. This study aimed to investigate the relationship between housing status and abortion outcomes and whether gestational age mediates this relationship. Our sample comprised 1903 individuals who had abortions at an urban clinic in San Francisco, CA, from 2015 to 2017. We defined homelessness or housing instability as a binary exposure, which included staying outside, with friends and/or family, or in a tent, vehicle, shelter, transitional program, or hotel. We evaluated gestational duration of ≥20 weeks as a mediator variable. Our primary outcome was any abortion complication. Logistic regression models were adjusted for age, race, substance use, mental health diagnoses, and previous vaginal and cesarean deliveries. Approximately 19% (n=356) of abortions were among people experiencing homelessness or housing instability. Compared with those with stable housing, people experiencing homelessness or housing instability presented later in pregnancy (mean gestational duration, 13.3 vs 9.5 weeks; P<.001) and had more frequent complications (6.5% vs 2.8%; P<.001; odds ratio, 2.2; 95% confidence interval, 1.2-3.9). Adjusting for race, substance use, mental health diagnoses, and previous cesarean deliveries, individuals experiencing homelessness or housing instability were more likely to have abortion complications (odds ratio, 2.3; 95% confidence interval, 1.3-4.0). However, the relationship was attenuated after adjusting for gestational duration (odds ratio, 1.4; 95% confidence interval, 0.7-2.6), suggesting that gestational duration mediates the relationship between housing status and abortion complications. Patients experiencing homelessness or housing instability presented later in gestation, which seems to contribute to the increased frequency of abortion complications.
Sections du résumé
BACKGROUND
Adverse reproductive health outcomes are well documented among people experiencing homelessness or housing instability. Little is known about abortion outcomes among this population.
OBJECTIVE
This study aimed to investigate the relationship between housing status and abortion outcomes and whether gestational age mediates this relationship.
STUDY DESIGN
Our sample comprised 1903 individuals who had abortions at an urban clinic in San Francisco, CA, from 2015 to 2017. We defined homelessness or housing instability as a binary exposure, which included staying outside, with friends and/or family, or in a tent, vehicle, shelter, transitional program, or hotel. We evaluated gestational duration of ≥20 weeks as a mediator variable. Our primary outcome was any abortion complication. Logistic regression models were adjusted for age, race, substance use, mental health diagnoses, and previous vaginal and cesarean deliveries.
RESULTS
Approximately 19% (n=356) of abortions were among people experiencing homelessness or housing instability. Compared with those with stable housing, people experiencing homelessness or housing instability presented later in pregnancy (mean gestational duration, 13.3 vs 9.5 weeks; P<.001) and had more frequent complications (6.5% vs 2.8%; P<.001; odds ratio, 2.2; 95% confidence interval, 1.2-3.9). Adjusting for race, substance use, mental health diagnoses, and previous cesarean deliveries, individuals experiencing homelessness or housing instability were more likely to have abortion complications (odds ratio, 2.3; 95% confidence interval, 1.3-4.0). However, the relationship was attenuated after adjusting for gestational duration (odds ratio, 1.4; 95% confidence interval, 0.7-2.6), suggesting that gestational duration mediates the relationship between housing status and abortion complications.
CONCLUSION
Patients experiencing homelessness or housing instability presented later in gestation, which seems to contribute to the increased frequency of abortion complications.
Identifiants
pubmed: 32640198
pii: S0002-9378(20)30719-5
doi: 10.1016/j.ajog.2020.07.002
pii:
doi:
Substances chimiques
Abortifacient Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
892.e1-892.e12Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.