(477) Comorbidity Burden and Social Vulnerability Among Non-Pregnant Reproductive-Age Patients: Opportunities for Preconception Counseling

Objective: To determine the proportion of non-pregnant reproductive age patients with high comorbidity burden and less effective contraception that may benefit from preconception counseling.

Study Design: Retrospective cohort of patients 15-49 years of age presenting for annual gynecological examinations throughout a large health system in New York between January 2019 and December 2022. Clinical and sociodemographic data was obtained from the electronic medical record. Patients were classified into 3 groups based on risk to conceive: 1) no risk—menopause or prior hysterectomy, 2) low risk—intrauterine device, implant, female sterilization, 3) high risk—pill, patch, ring, shot, or no contraception documented. Obstetrical comorbidity index (OB-CMI) score was calculated (pregnancy-specific components excluded) based on ICD-10 codes and clinical documentation. High comorbidity burden was defined as OBCMI >=4. Social vulnerability index (SVI) score was determined based on the census tract of each patient’s home address, and patients were grouped by SVI quartile.

Results: Of the 30,722 patients, most (79%; n=24,228) had less effective or no contraception documented. The rates of highly reliable contraception did not vary when stratified by SVI quartile or OBCMI score. Non-Hispanic Black patients were more likely to have highly reliable contraception compared to non-Hispanic White patients (20.4% vs. 17.2%; OR 1.23, 95% CI 1.12-1.36). High comorbidity burden was seen in 15% of patients with less effective contraception (n=3,443/24,228). Among patients with less effective contraception, non-Hispanic Black patients were more likely to have a high comorbidity burden compared to non-Hispanic White patients (20.9% vs. 14.3%; OR 1.58, 95% CI 1.42-1.75).

Conclusion: Racial and ethnic differences in contraceptive method and comorbidity burden were seen in this cohort of reproductive age patients. By identifying non-pregnant patients with high comorbidity burden and less effective contraception, we have an opportunity to direct targeted interventions such as referral for high-risk preconception counseling or family planning.