The Influence of Women's Educational Level on Unintended Pregnancy Rates amongst Users of Combined Oral Contraceptives
ESC Congress Library. Bauerfeind A. May 10, 2018; 208169; ESC261
Dr. Anja Bauerfeind
Dr. Anja Bauerfeind
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Background: The contraceptive efficacy of COCs is influenced by a variety of medical and socioeconomic parameters. To a certain amount the educational levels surrogate socioeconomic status, lifestyle or behavioral patterns, but the associated variability of the Pearl Index is unknown. Objective: To determine the variation of the Pearl Index of COCs across different levels of education. Design and methods: Retrospective analysis of pooled data from five prospective, observational cohort studies conducted between 2007-2016 (IOC, TASC, ISCO, IFOC, LASS) assessing the risk of VTE under COC use. Contraceptive efficacy was a secondary outcome for all studies. ISCO and IFOC are ongoing prospective cohorts with study end dates of 2017 and 2019. Studies were conducted across Europe and the United States. We only included women aged between 18 and 35 years, resulting in more than 266,000 women-years of observation. The proportion of contraceptive failure was measured as Pearl index (PI).  Educational level was defined dichotomously as ‘lower' or ‘at least' (‘higher') than university entrance level, respectively. Results: In the United States (US) we obtained a PI=2.26 (CI: 2.16-2.36) for women with a higher educational level compared to 4.04 (3.77-4.33) for women with lower educational level. In Europe (EU) we observed a PI of 0.40 (0.36-0.44) for women with higher versus 0.78 (0.71-0.86) for women with lower educational level. The observed effect was independent of age shown by a subsequent analysis of age groups: 18- < 2 5, 25-< 30, 30-< 35 years. Conclusions: The number of contraceptive failures was observed to be twice as high for women with ‘lower' versus ‘higher' educational level. Despite higher overall Pearl Indices in the United States compared to Europe this effect was observed consistently in both regions, US and EU. It refers to compliance, lifestyle and socioeconomic pattern which may need further clarification.
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