We sought to understand the frequency of contraception documentation for women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in a large U.S. electronic health record (EHR)-based registry, and to identify disparities by teratogen prescription and patient race and ethnicity.
Contraception documentation from structured data fields within the RISE (Rheumatology Informatics System for Effectiveness) Registry was collected for women of childbearing age (18-45 years) in 2018 who had at least 2 visits with ICD-9/10 diagnosis codes for SLE or RA (at any time). Univariate and multivariate analyses compared the frequency of contraception documentation based on patient characteristics including diagnosis, age, race, and teratogenicity of prescribed anti-rheumatic medications.
In 2018 there were 9,826 women of childbearing age with SLE and 19,009 with RA, of whom 9.1% had any contraception documented. Rates of contraceptive documentation were significantly lower for women with SLE (adjusted OR 0.84 (0.76, 0.92)). Women of Hispanic ethnicity, Black and Asian race were all less likely than white women to have contraception documentation. Teratogen prescription was associated with higher rates of contraception documentation for women with RA but not SLE (RA adjusted OR 1.31 (1.16, 1.47); SLE adjusted OR 1.08 (0.91, 1.28)).
There are large gaps in contraception documentation within the RISE registry that are particularly stark among women of color. While these data likely underestimate contraception use, they highlight that most rheumatologists do not have a systematic approach to collecting and recording this information in the EHR.