Impact of access to care and race/ethnicity on IVF care discontinuation

Research question: Is race/ethnicity or access to care, as defined by insurance coverage, distance to the clinic and zip code (postal code), associated with care discontinuation following IVF?Design: A retrospective cohort study of 878 diverse women who underwent 1571 IVF cycles from 2014 to 2018 at a Southeastern academic medical centre was performed. Women were divided into low (LAC) and high (HAC) access to care groups. HAC was defined as possessing IVF insurance coverage, living <_25 miles from the clinic, and living in a zip code with a median income >=$75,000. Access groups and racial/ethnic groups were compared for differences in relative risk of care discontinuation following an unsuccessful IVF cycle.Results: Women with HAC had a poorer IVF prognosis than the LAC group, which possibly impacted the association with care discontinuation. Distance to the clinic, but not insurance coverage or zip code, was associated with increased risk of care discontinuation. Among women <_34 years, HAC showed some evidence of an association with an increased risk of care discontinuation (adjusted relative risk 2.5, 95% confidence interval 0.8-8.1). Despite having higher rates of insurance coverage (51.2% versus 36.5%), non-Hispanic Black women were more likely to discontinue care (58.3% versus 40.2%) and less likely to achieve a live birth (53.0% versus 68.0%) than non-Hispanic White women.Conclusions: Identification as non-Hispanic Black, and distance to the clinic, but not insurance coverage or zip code, were associated with increased risk of care discontinuation following an unsuccessful IVF cycle. In women <_34 years old, HAC may be associated with a higher rate of care discontinuation.

Automated summary

This study investigated the association between race/ethnicity, access to care (including insurance coverage, distance to the clinic, and zip code), and care discontinuation following IVF. The results showed that women with high access to care had poorer IVF prognosis compared to the low access group, which may have influenced the association with care discontinuation. Distance to the clinic, rather than insurance coverage or zip code, was associated with an increased risk of care discontinuation. Non-Hispanic Black women, despite having higher rates of insurance coverage, were more likely to discontinue care and less likely to achieve a live birth compared to non-Hispanic White women.