OBJECTIVE To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate. DESIGN Retrospective cohort. SETTING Academic-affiliated fertility center. SUBJECTS Women presenting for initial infertility evaluation from January 2010-December 2021. EXPOSURE Initial infertility evaluation and treatment utilization. MAIN OUTCOME MEASURE(S) The prevalence of reproductive-aged women who reside in Massachusetts presenting for initial consult versus census-based estimates was calculated for each racial and ethnic group. Age at initial consult, insurance coverage, drive time to nearest affiliated center, and neighborhood deprivation as measured by Area Deprivation Index, were considered determinants of treatment utilization in regression analysis. RESULT(S) A total of 16,160 women presenting for an infertility consult from 2010-2021 met inclusion criteria. Compared to census estimates, Non-Hispanic (NH) Asian and NH White individuals were overrepresented in initial consults, whereas the NH Black and Hispanic populations were underrepresented throughout the study period. Mean age at presentation was higher in NH Black women compared to the NH Asian reference group (35.7 ± 5.1 vs 34.6 ± 4.4 years old). A lower proportion of Hispanic and NH Black women had private insurance (78% and 79%, respectively) compared to 86% of NH Asian women. Over a fifth of Hispanic and NH Black women lived in the most disadvantaged ADI quintile (23 and 21%, respectively) compared to 6% of the reference population. Overall, the absence of private insurance, greater neighborhood disadvantage, and increased driving distance were associated with lower treatment utilization (OR 0.79, [95% confidence interval 0.71-0.87], for other vs. private insurance; OR 0.62, [0.53-0.72], for ADI quintile 5 vs. 1, OR 0.84 [0.72-0.97] for drive time 15-30 vs. <15 minutes), whereas age was not (OR 0.96 [0.93-1.00] for each 5-year increase). CONCLUSION(S) Relative to their numbers in the broader population of reproductive-aged women in Massachusetts, the NH Black and Hispanic populations were the most underrepresented racial and ethnic groups seen for infertility evaluation at our center. These individuals were less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization.

中文翻译：

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在具有全面不孕症任务的州按种族和民族使用不孕症服务的决定因素。


目的 在具有全面不孕症任务的州，检查社会人口学因素与种族和民族对不孕症服务利用之间的关联。设计 回顾性队列。SETTING 学术附属生育中心。对象 2010 年 1 月至 2021 年 12 月进行初步不孕症评估的女性。暴露 初步不孕症评估和治疗利用。主要结局指标 计算了每个种族和族裔群体居住在马萨诸塞州进行初步咨询的育龄妇女患病率与基于人口普查的估计值。在回归分析中，初次咨询年龄、保险覆盖率、到最近的附属中心的车程以及通过区域剥夺指数衡量的社区剥夺被认为是治疗利用的决定因素。结果： 16,160 年至 2010 年共有 2021 名接受不孕症咨询的女性符合纳入标准。与人口普查估计相比，非西班牙裔 （NH） 亚裔和 NH 白人在初次咨询中的代表性过高，而 NH 黑人和西班牙裔人口在整个研究期间的代表性不足。与 NH 亚裔参考组相比，NH 黑人女性的平均就诊年龄更高 （35.7 ± 5.1 vs 34.6 ± 4.4 岁）。与 86% 的新罕布什尔州亚裔女性相比，西班牙裔和 NH 黑人女性拥有私人保险的比例较低（分别为 78% 和 79%）。超过五分之一的西班牙裔和新罕布什尔州黑人女性生活在最弱势的 ADI 五分之一（分别为 23% 和 21%），而参考人群的这一比例为 6%。总体而言，没有私人保险、更大的邻里劣势和增加的驾驶距离与较低的治疗利用率 （OR 0.79， [95% 置信区间 0.71-0.87]，其他保险与私人保险;ADI 五分位数 5 对 1 的 OR 0.62，[0.53-0.72]，或驾驶时间 15-30 对 <15 分钟的 0.84 [0.72-0.97]），而年龄则不是（每增加 5 年，年龄为 0.96 [0.93-1.00]）。结论 相对于她们在马萨诸塞州更广泛的育龄妇女群体中的人数，NH 黑人和西班牙裔人口是我们中心不孕症评估中代表性最不足的种族和族裔群体。这些人不太可能拥有私人保险，更有可能生活在弱势社区，这些是对不孕症治疗利用产生负面影响的变量。