Factors associated with the contraindicated use of oral contraceptives in Brazil

Corrêa, Daniele Aparecida Silva; Felisbino-Mendes, Mariana Santos; Mendes, Mayara Santos; Malta, Deborah Carvalho; Velasquez-Melendez, Gustavo

doi:10.1590/S1518-8787.2017051006113

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Sumário

Original Articles • Rev. Saúde Pública 51 (0) • 2017 • https://doi.org/10.1590/S1518-8787.2017051006113 copy

Factors associated with the contraindicated use of oral contraceptives in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To estimate the prevalence of the contraindicated use of oral contraceptives and the associated factors in Brazilian women.

METHODS

20,454 women who answered the VIGITEL survey in 2008 also participated in this study, of which 3,985 reported using oral contraceptives. We defined the following conditions for the contraindicated use of contraceptives: hypertension; cardiovascular diseases such as heart attack, stroke/cerebrovascular accident; diabetes mellitus; being smoker and 35 years old or older. We estimated the prevalence and 95% confidence intervals of contraindicated use in users of oral contraceptives and the factors associated with contraindication by prevalence ratio and 95% confidence intervals.

RESULTS

In the total population, 21% (95%CI 19.7–21.9) of women showed some contraindication to the use of oral contraceptives, of which 11.7% (95%CI 10.6–13.7) belonged to the group of users of oral contraceptives. The most frequent contraindication in users of oral contraceptives was hypertension (9.1%). The largest proportion of women with at least one contraindication was aged between 45 and 49 years (45.8%) and with education level between zero and eight years (23.8%). The prevalence of contraindication to oral contraceptives was higher in women less educated (zero to eight years of study) (PR = 2.46; 95%CI 1.57–3.86; p < 0.05) and with age between 35-44 years (PR = 4.00; 95%CI 2.34–6.83) and 45-49 years (PR = 5.59; 95%CI 2.90–10.75).

CONCLUSIONS

Age greater than or equal to 35 and low education level were demographic and iniquity factors, respectively, in the contraindicated use of oral contraceptives.

Contraceptives, Oral, contraindications; Prescription Drug Misuse; Risk Factors; Women’s Health; Sexual and Reproductive Health

Contraindications	Total women (n = 20.454)			Use of OCP

				Yes (n = 3.985)			No (n = 16.469)

	n	%	95%CI	n	%	95%CI	n	%	95%CI
At least one contraindication	4,040	20.8	19.7–21.9	480	11.7	10.6–13.7	3,560	23.5	22.3–24.8
Number of contraindications
1	3,454	17.4	16.4–18.4	426	10.5	8.9–12.4	3,028	19.5	18.4–20.7
2	531	3.1	2.6–3.7	50	1.2	0.8–1.9	481	3.6	3.0–4.3
3 or +	55	0.3	0.1–0.5	4	0.03	0.01–0.1	51	0.4	0.2–0.6
Types of contraindications
SH	2,874	15.1	14.1–16.1	354	9.1	7.6–10.8	2,520	16.9	15.7–18.1
Smokers and ≥ 35 years	1,156	6.1	5.5–6.7	112	2.6	1.8–3.7	1,044	7.1	6.4–8.0
DM	451	2.2	1.8–2.6	51	0.9	0.6–1.4	400	2.6	2.2–3.1
CVD	201	1.1	0.8–1.5	21	0.5	0.3–0.9	180	1.3	0.9–1.8

Sociodemographic characteristics	Women using OCP

	n	%	95%CI	p^a	PR	95%CI	p^b
Education level (years)				< 0.0001
12 and more	1,840	6.3	4.4–9.0		1.0	-	-
9 to 11	1,670	10.4	8.2–13.0		1.6	1.1–2.5	0.022
0 to 8	475	23.8	18.5–30.0		3.8	2.4–5.8	< 0.000
Age (years)				< 0.0001
18 to 24	1,172	6.2	3.4–9.6		1.0	-	-
25 to 34	1,858	7.5	5.7–9.7		1.2	0.7–2.0	0.493
35 to 44	823	30.7	25.0–37.0		4.9	3.0–8.0	< 0.000
45 to 49	132	45.8	31.3–61.1		7.3	4.2–12.8	< 0.000
Marital status				0.0001
Single	2,021	8.8	6.8–11.3		1.0	-	-
Married	1,802	14.8	12.1–18.1		1.7	1.2–2.3	0.001
Widow	26	15.0	5.3–35.8		1.7	0.6–4.7	0.303
Separated/Divorced	136	27.3	15.7–43.1		3.1	1.8–5.5	< 0.000
Has health plan or insurance				0.003
Yes	2,308	14.8	12.2–17.7		1.0	-	-
No	1,677	9.2	7.1–11.9		0.6	0.4–0.8	0.004
Skin color				0.176
White	1,832	9.9	7.7–12.5		1.0	-	-
Black	190	11.2	6.6–18.5		1.1	0.6–2.0	0.660
Brown	1,942	13.6	11.0–16.8		1.4	1.0–1.9	0.530
Other	21	21.0	5.0–57.2		2.1	0.6–7.8	0.255
Region				0.844
North	928	14.0	10.3–18.9		1.0	-	-
Northeast	979	11.5	8.8–15.0		0.8	0.5–1.3	0.334
Midwest	722	10.7	8.3–13.7		0.8	0.5–1.1	0.179
Southeast	734	11.8	9.0–15.3		0.8	0.6–1.2	0.394
South	632	11.9	9.2–15.2		0.8	0.6–1.2	0.409

Sociodemographic characteristics	Contraindication

	Adjusted PR	95%CI	p*
Education level (years)
12 and more	1.0	-	-
9 to 11	1.7	1.1-2.5	0.014
0 to 8	2.5	1.6-3.9	< 0.000
Age (years)
18 to 24	1.0	-	-
25 to 34	1.1	0.6–1.9	0.727
35 to 44	4.0	2.3–6.8	< 0.000
45 to 49	5.6	2.9–10.7	< 0.000
Marital status
Single	1.0	-	-
Married	1.0	0.7-1.4	0.939
Widow	0.6	0.2-1.8	0.354
Separated/Divorced	1.5	0.8-2.8	0.160
Has health plan or insurance
Yes	1.0	-	-
No	0.9	0.7–1.2	0.522
Skin color
White	1.0	–	-
Black	0.9	0.5–1.7	0.754
Brown	1.1	0.8–1.6	0.450
Other	2.4	0.7–8.6	0.162
Region
North	1.0	-	-
Northeast	0.8	0.5–1.2	0.522
Midwest	0.8	0.6–1.2	0.316
Southeast	0.8	0.6–1.3	0.444
South	0.8	0.6–1.2	0.353

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[1] Correspondence: Gustavo Velasquez-Melendez Escola de Enfermagem – UFMG Av. Professor Alfredo Balena, 190 Santa Efigênia 30130-100 Belo Horizonte, MG, Brasil E-mail: guveme@ufmg.br