(466) Racialized Disparities in Adverse Health Outcomes During Second Trimester Medication Abortion

To evaluate potential disparities in health outcomes for non-Hispanic Black (NHB) people undergoing 2nd trimester (2T) medication abortion (MAB) compared to non-Hispanic White (NHW) people.

Study Design:

This was a retrospective cohort study of people undergoing 2T MAB at 4 tertiary care centers in Cook County, IL from 2009 to 2019. The primary exposure was self-reported race. The primary outcome was composite morbidity (i.e., uterine rupture, blood transfusion, chorioamnionitis, intensive care unit admission, and hospital readmission within 6 weeks). The secondary outcomes were the composite morbidity without and all components of the composite. We performed multivariable regression analyses via backwards stepwise selection of covariates, with eligibility based on p< 0.10 on bivariate analyses. A priori, we controlled for mifepristone use, the only covariate ultimately selected for inclusion. Subgroup analyses were performed based on uterine scarring and parity. Pairwise comparisons were done based on gestational duration. A post-hoc sensitivity analysis was conducted excluding preterm prelabor rupture of membranes, preterm labor, and cervical insufficiency.

Results:

669 people were included, 51.3% identifying as NHB. NHB people had a higher BMI, lower frequency of prior uterine scarring, and presented 1 week earlier in gestation (Table 1). NHB people had a higher frequency of the primary outcome, which persisted when controlling for mifepristone (aRR 1.50, 95% CI 1.10-2.05). The secondary outcome was not significantly different between groups. The only significant difference in the components of the primary outcome was a higher frequency of chorioamnionitis among NHB people (Table 2). No significant difference was found on subgroup analyses based on uterine scarring or parity. No significant difference was found in NHW people based on gestational duration at presentation. Sensitivity analyses were consistent with the primary findings.  

Conclusion:

NHB people have a higher risk of morbidity during 2T MAB compared to NHW, with the difference driven by clinical chorioamnionitis.