O-162 Ethnic disparity in the use of treatment with assisted reproductive technologies in Denmark
Authors: Aaen A , Østergaard S , Vassard D , Schmidt L , Kyhl F 
Published: July 2024

Abstract

Study question
Is ethnic background among 18-45-year-old women associated with initiating ART-treatment in Denmark?

Summary answer
Results indicate ethnic disparity in the use of ART-treatment, with immigrants and descendants having lower odds of initiating ART-treatment compared to women with Danish origin.

What is known already
The use of fertility treatment has increased over the past decades. Ethnic disparity exists in the use of health care, but there is limited knowledge about the association between ethnicity and use of fertility treatment. Previous studies have shown that women with lower socioeconomic position (SEP) have lower odds of initiating ART-treatment compared to women with higher SEP. Immigrants and descendants often have lower SEP compared to the general population, but specific mechanisms might be at play when residing and navigating in a new country and healthcare system.

Study design, size, duration
This is a national, register-based study based on the DANAC II cohort. Women initiating ART-treatment (IVF or ICSI) aged 18–45 were identified in the Danish IVF Register from 1994-2017. According to the time of ART-treatment women were included in the study and randomly age-matched with 10 untreated women in the background population. The study population consisted of 676.355 women.

Participants/materials, setting, methods
The probability of initiating ART-treatment was compared across ethnic groups and examined in logistic regression analysis. Migration status and country of origin were used as proxies for ethnic group in separate analysis. Age was accounted for by matching, and additional factors of interest such as SEP measures were classified as potential mediators and thus not included in the main analyses. The effect of duration of residence in Denmark was analysed separately among immigrants.

Main results and the role of chance
The study population consisted of 526.507 (78 %) women of Danish origin, 142.656 (21 %) were immigrants and 7.192 (1 %) descendants of immigrants. Among women of Danish origin 11 % had initiated ART-treatment compared to 5 % of immigrants and 9 % of descendants. Immigrants had 56 % lower odds of receiving first ART-treatment compared to women of Danish origin (OR 0,44, CI 95 % 0,43-0,45), while descendants had 22 % lower odds compared to women of Danish origin (OR 0,78, CI 95 % 0,72-0,84).
Regarding the analysis looking at country of origin results showed that 3-4 % of women originating from western countries had received first ART-treatment, compared to 6-8 % of women originating from non-western countries. Women originating from western countries had between 65-78% lower odds for receiving first ART-treatment compared to women of Danish origin. Odds of receiving ART-treatment among women of non-western origin was between 34-47 % lower compared to women of Danish origin. This indicates that disparity in first ART-treatment is particularly distinctive among women of western origin, possibly explained by differences in reasons for migrating.

Limitations, reasons for caution
Information on the reason for infertility and desire to have children could have provided more insight into the disparity. Data about basis for residence could have provided information on reasons for immigration and duration of residence.

Wider implications of the findings
Infertility and childlessness can have severe consequences for individuals and society, and equal access to fertility treatment is important, not least in a universal welfare society. The results of this study indicate ethnic disparity in ART-treatment, and we encourage further research regarding the possible causes and barriers to initiate treatment.

Trial registration number
not applicable