Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare.
Am J Public Health. 2019 Jan;109(1):148-154. doi: 10.2105/AJPH.2018.304771. Epub 2018 Nov 29.
To estimate trends in incidence, outcomes, and costs among hospital deliveries related to amphetamines and opioids. We analyzed 2004-to-2015 data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States compiled by the Healthcare Cost and Utilization Project, by using a repeated cross-sectional design. We estimated the incidence of hospital deliveries related to maternal amphetamine or opioid use with weighted logistic regression. We measured clinical outcomes and costs with weighted multivariable logistic regression and generalized linear models. Amphetamine- and opioid-related deliveries increased disproportionately across rural compared with urban counties in 3 of 4 census regions between 2008 to 2009 and 2014 to 2015. By 2014 to 2015, amphetamine use was identified among approximately 1% of deliveries in the rural West, which was higher than the opioid-use incidence in most regions. Compared with opioid-related and other hospital deliveries, amphetamine-related deliveries were associated with higher incidence of preeclampsia, preterm delivery, and severe maternal morbidity and mortality. Increasing incidence of amphetamine and opioid use among delivering women and associated adverse gestational outcomes indicate that amphetamine and opioid use affecting birth represent worsening public health crises.
评估与安非他命和阿片类药物相关的医院分娩的发病率、结局和成本趋势。我们分析了美国医疗保健成本与利用项目（HCUP）编制的全国住院患者样本（全美代表性的医院出院患者样本）2004 年至 2015 年的数据，采用重复横断面设计。我们使用加权逻辑回归估计与产妇安非他命或阿片类药物使用相关的医院分娩的发病率。我们使用加权多变量逻辑回归和广义线性模型衡量临床结局和成本。与城市县相比，2008 年至 2009 年和 2014 年至 2015 年，4 个普查区中的 3 个地区农村的安非他命和阿片类药物相关分娩比例不成比例地增加。到 2014 年至 2015 年，农村西部约有 1%的分娩被确定为安非他命使用，这高于大多数地区的阿片类药物使用率。与阿片类药物相关的分娩和其他医院分娩相比，与安非他命相关的分娩与子痫前期、早产和严重产妇发病率和死亡率的发生率较高相关。产妇中安非他命和阿片类药物使用的发生率增加以及相关的不良妊娠结局表明，影响分娩的安非他命和阿片类药物使用代表着日益严重的公共卫生危机。
