We sought to examine disparities in realized access to guideline-recommended reproductive health services (e.g., preconception counseling) for young women with type 1 or 2 diabetes mellitus (DM) compared to peers without DM and to determine if/how such disparities varied by geography. We included over 1 million young women (ages 13-39) both with and without DM, using over 2 million person-years of data from Virginia’s All-Payer Claims Data (covering 40% of commercially and 95% of publicly insured people in the state) from 2016-2018. Multivariate regression modeled receipt of reproductive care by DM status and county of residence, adjusting for age, payer, race/ethnicity, and year. We identified 2.4 million visits for reproductive care (mean of 1.17 visits per person per year), including 657K for routine gynecological exams, 824K for contraception management, and 1.05M for STI screening and treatment. Compared to women with DM, those without DM had higher odds of receiving routine gynecological exams (OR:1.20, 95%CI: 1.18-1.22) and visits for contraceptive management (OR:1.05, 95%CI: 1.04-1.07); but among those receiving care, women with DM averaged slightly more visit per year (gynecological exam β=0.06, p<0.01; contraception management β=0.09, p<0.01). County-specific prevalence of DM ranged from 5% to 17% and DM prevalence was higher in smaller counties (pop<20K) compared to medium (20-100K) or large counties (pop>100K). Overall, there were no differences in receipt of reproductive care by DM status in large counties but disparities manifested for those living in medium and smaller counties. Differences by payer and race/ethnicity were also identified. Given the acute health threats for women with DM who do not receive appropriate preventive reproductive services, observed disparities are worrisome. As disparities were exacerbated in counties with the highest prevalence of DM, more work needs to be done to ensure equitable access to care in areas that have a higher disease burden.


L.E. Wisk: None. P.S. Nourbakhsh: None. L.N. Kransdorf: None.


National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01 to L.E.W.); University of California, Los Angeles (to L.E.W.)

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