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How has the Affordable Care Act changed what contraceptives women use? Plus: Does exercise protect against coronary heart disease?
A first-of-its-kind analysis of claims data before and after implementation of the Affordable Care Act (ACA) shows that the legislation had a significant impact on women’s choice of contraception, with a trend toward increased use of long-term methods, particularly in those aged 18 to 30. The data, from a regional health plan in the upper Midwest, were published in Health Affairs.
Nearly 30,000 women aged 18 to 46 who had enrolled in insurance plans through 499 employer groups with at least 50 employees were included in the cohort. The treatment group had at least one year-end observation of contraceptive choice before and one after implementation of the ACA, which eliminated cost sharing for prescription contraceptives. The controls were covered by one of 13 employers that had not complied with the ACA mandate as of September 2014.
The researchers looked at trends in usage of both short-term (hormonal pills, hormone patch, vaginal ring, diaphragm, cervical cap, injectable hormones) and long-term (implants, intrauterine devices, sterilization) contraceptive methods. Prior to ACA, the latter methods were associated with significantly higher up-front costs and the control group was slightly less likely to have chosen prescription contraceptives than the treatment group (26.4% versus 30.2%).
Before ACA was enacted, usage of short-term and long-methods was 24.6% and 5.6% among women in the treatment group, versus 21.8% and 4.6%, respectively, in the women in the control group. After the removal of cost-sharing for contraception, the percentage of women in the treatment group using long-term methods rose to 9.8% versus 21.2% for short-term methods. A similar trend was seen among women in the control group, with 8.0% and 21.1% using long- and short-term methods, respectively, after ACA.
When the sample was restricted to women aged 18 to 30, the researchers found that change in cost sharing predicted a 2.81% increase in choice of prescription contraceptives, of which 1.16% was attributable to long-term methods. Those data, the authors said, suggest that “younger women were more sensitive to the elimination of cost sharing, especially when it comes to long-term contraceptive methods.”
Describing the study’s limitations, the authors cautioned that it reflected the prices of and cultural attitudes about contraception among the population in the upper Midwest and that could not account for use of over-the-counter birth control or of low-cost generics paid for completely out of pocket. They also postulated that some of the trends “could be a secondary effect of increased physician encounters for other preventive services, instead of simply the effect of changes in contraceptive cost sharing.”
Does moderate activity help heart health in younger women?
Moderate activity in women aged 27 to 44 may lower the risk of coronary heart disease (CHD), according to results of a new prospective analysis published in Circulation.
Researchers looked at 97,230 women who were aged 27 to 44 at the study’s baseline in 1991. A biennial questionnaire was used to assess leisure-time physical activity. The associations between CHD risk and physical activity frequency, type, and volume were examined with Cox proportional hazard models.
Over the course of 20 years of follow up, the authors found 544 incident cases of CHD. In models that were adjusted for multiple variables, the hazard ratio of CHD comparing ≥30 with <1 metabolic equivalent of task-hours/wk of physical activity was 0.75 (0.57–0.99) (P, trend=0.01). Brisk walking on its own was linked with significantly lower CHD risk. When models included overall activity volume, the frequency of physical activity was not linked with CHD risk. The association was not modified by body mass index (P, interaction=0.70).
The data indicate that the total volume of leisure-time physical activity was linked to a lower risk of CHD among younger women. The researchers stressed that it was important to tell women that this was not by weight.