Racial/Ethnic Differences in the Utilization of Infertility Services: A Focus on American Indian/Alaska Natives
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Objectives Previous studies have identified racial/ethnic disparities in infertility care, but patterns among American Indian/Alaska Natives (AI/AN) have not been reported. Our objective was to evaluate infertility services use in the US by race/ethnicity using data from the National Survey of Family Growth (NSFG). Methods We analyzed female respondent data from the pooled NSFG cycles 2002, 2006–2010 and 2011–2013. Respondents reported use of infertility services and types of services. We calculated weighted crude and adjusted prevalence proportion ratios (PPR) and 95% confidence intervals (95% CI) using modified Poisson regression with robust error variances accounting for the complex survey design to compare infertility services use across race/ethnicities. Results Overall, 8.7% of women reported using medical services to get pregnant. The prevalence of using any medical service to help get pregnant was lower for American Indian/Alaska Native (AI/AN) (PPR: 0.60, 95% CI 0.43–0.83) and black (PPR: 0.53, 95% CI 0.44–0.63) compared to white women and in Hispanic compared to non-Hispanic women (PPR: 0.57, 95% CI 0.48–0.67). The prevalence of accessing treatment, testing, and advice also differed by race and ethnicity. Conclusions for Practice We observed disparities in accessing services to get pregnant among AI/AN and black women and reduced use of advice among Asian/Pacific Islanders compared to whites. We also observed reduced service utilization for Hispanic compared to non-Hispanic women. Differential utilization of specific services suggests barriers to infertility care may contribute to reproductive health disparities among underserved populations.
KeywordsInfertility Services Race Ethnicity Indians, North American
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under 1 R40MC29449-01-00 and the Oklahoma Shared Clinical and Translational Resource Institute NIGMS U54 GM104938. The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Agency for Healthcare Research and Quality, & U.S. Department of Health and Human Services. (2013). 2012 National healthcare disparities report. Retrieved from https://archive.ahrq.gov/research/findings/nhqrdr/nhdr12/index.html.
- Centers for Disease Control & Prevention. (2015). National survey of family growth. Retrieved from https://www.cdc.gov/nchs/nsfg/index.htm.
- Centers for Disease Control and Prevention. (2014). National public health action plan for the detection, prevention, and management of infertility. Retrieved from Atlanta, GA.Google Scholar
- Chandra, A., Copen, C. E., & Stephen, E. H. (2013). Infertility and impaired fecundity in the United States, 1982–2010: Data from the National Survey of Family Growth. National Health Statistics Report, 67, 1–18.Google Scholar
- Chandra, A., Copen, C. E., & Stephen, E. H. (2014). Infertility service use in the United States: Data from the National Survey of Family Growth, 1982–2010. National Health Statistics Report, 73, 1–21.Google Scholar
- Craig, L. B., Weedin, E. A., Walker, W. D., Janitz, A. E., Hansen, K. R., & Peck, J. D. (2018). Racial and Ethnic Differences in Pregnancy Rates Following Intrauterine Insemination with a Focus on American Indians. Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-017-0456-8.Google Scholar
- Dieke, A. C., Zhang, Y., Kissin, D. M., Barfield, W. D., & Boulet, S. L. (2017). Disparities in assisted reproductive technology utilization by race and ethnicity, United States, 2014: A commentary. J Womens Health (Larchmt), 26(6), 605–608. https://doi.org/10.1089/jwh.2017.6467.CrossRefGoogle Scholar
- Feinberg, E. C., Larsen, F. W., Catherino, W. H., Zhang, J., & Armstrong, A. Y. (2006). Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting. Fertility and Sterility, 85(4), 888–894. https://doi.org/10.1016/j.fertnstert.2005.10.028.CrossRefGoogle Scholar
- Hale, J. J., Thompson, D. M., & Darden, P. M. (2013). Calculating subset weighted analysis using PROC SURVEYFREQ and GENMOD (Paper 272–2013). SAS Global Forum.Google Scholar
- Klein, R. J., Proctor, S. E., Boudreault, M. A., & Turczyn, K. M. (2002). Healthy People 2010 Criteria for Data Suppression: Statistical Notes, no 24. Retrieved from Hyattsville, MD: https://www.cdc.gov/nchs/data/statnt/statnt24.pdf.
- Lepkowski, J. M., Mosher, M. J., Davis, K. E., Groves, R. M., van Hoewyk, J., & Willem, J. (2006). National survey of family growth, Cycle 6: Sample design, weighting, imputation, and variance estimation. Vital Health Statistics, 2(142), 1–82.Google Scholar
- Lepkowski, J. M., Mosher, W. D., Davis, K. E., Groves, R. M., & Van Hoewyk, J. (2010). The 2006–2010 national survey of family growth: Sample design and analysis of a continuous survey. Vital Health Statistics, 2(150), 1–36.Google Scholar
- McCarthy-Keith, D. M., Schisterman, E. F., Robinson, R. D., O’Leary, K., Lucidi, R. S., & Armstrong, A. Y. (2010). Will decreasing assisted reproduction technology costs improve utilization and outcomes among minority women? Fertility and Sterility, 94(7), 2587–2589. https://doi.org/10.1016/j.fertnstert.2010.02.021.CrossRefGoogle Scholar
- National Congress of American Indians. (2015). Tribal Nations and the United States: An Introduction. Retrieved from Washington DC: http://www.ncai.org/attachments/PolicyPaper_VmQazPEqbvZDMeaDvbupWTSZLmzyzBKOknQRXnUyoVMoyFkEWGH_Tribal%20Nations%20and%20the%20United%20States_An%20Introduction.pdf.
- Smith, J. F., Eisenberg, M. L., Glidden, D., Millstein, S. G., Cedars, M., Walsh, T. J.,.. . Katz, P. P. (2011). Socioeconomic disparities in the use and success of fertility treatments: Analysis of data from a prospective cohort in the United States. Fertil Steril, 96(1), 95–101. https://doi.org/10.1016/j.fertnstert.2011.04.054.CrossRefGoogle Scholar
- United States Census Bureau. (2017). Race: 2011–2015 American Community Survey 5-Year Estimates. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_5YR_B02001&prodType=table.