Department of Health Policy and Management, University of Pittsburgh, the University of Pittsburgh, and the Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2020 Sep;136(3):556-564. doi: 10.1097/AOG.0000000000003907.
To assess trends in polysubstance use among pregnant women with opioid use disorder in the United States.
We conducted a time trend analysis of pooled, cross-sectional data from the National Inpatient Sample, an annual nationally representative sample of U.S. hospital discharge data. Among 38.0 million females aged 15-44 years with a hospitalization for delivery from 2007 to 2016, we identified 172,335 pregnant women with an International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of opioid use disorder. Polysubstance use among pregnant women with opioid use disorder was defined as at least one co-occurring diagnosis of other substance use, including alcohol, amphetamine, cannabis, cocaine, sedative, or tobacco. We fit weighted multivariable logistic regression models to produce nationally representative estimates, including an interaction between year and rural compared with urban county of residence; controlled for age, race, and insurance type. Average predicted probabilities and 95% CIs were derived from regression results.
Polysubstance use among women with opioid use disorder increased from 60.5% (95% CI 58.3-62.8%) to 64.1% (95% CI 62.8%-65.3%). Differential time trends in polysubstance use among women with opioid use disorder were found in rural compared with urban counties. Large increases in amphetamine use occurred among those in both rural and urban counties (255.4%; 95% CI 90.5-562.9% and 150.7%; 95% CI 78.2-52.7%, respectively), similarly to tobacco use (30.4%; 95% CI 16.9-45.4% and 23.2%; 95% CI 15.3-31.6%, respectively). Cocaine use diagnoses declined among women with opioid use disorder at delivery in rural (-70.5%; 95% CI -80.4% to -55.5%) and urban (-61.9%; 95% CI -67.6% to -55.1%) counties. Alcohol use diagnoses among those with opioid use disorder declined -57% (95% CI -70.8% to -37.7%) in urban counties but did not change among those in rural counties.
Over the past decade, polysubstance use among pregnant women with opioid use disorder has increased more rapidly in rural compared with urban counties in the United States, with amphetamines and tobacco use increasing most rapidly.
评估美国患有阿片类药物使用障碍的孕妇中多物质使用的趋势。
我们对 2007 年至 2016 年全国住院患者样本（美国医院出院数据的年度全国代表性样本）中合并的、横断面数据进行了时间趋势分析。在年龄在 15-44 岁之间、因分娩住院的 3800 万女性中，我们确定了 172335 名患有阿片类药物使用障碍的孕妇，其国际疾病分类，第九修订版，临床修正或国际疾病分类，第十修订版，临床修正诊断。患有阿片类药物使用障碍的孕妇的多物质使用定义为至少同时存在其他物质使用的一种共同诊断，包括酒精、苯丙胺、大麻、可卡因、镇静剂或烟草。我们拟合了加权多变量逻辑回归模型，以产生具有全国代表性的估计值，包括年与农村与城市县居住之间的交互作用；控制年龄、种族和保险类型。从回归结果中得出平均预测概率和 95%CI。
患有阿片类药物使用障碍的女性中多物质使用的比例从 60.5%（95%CI 58.3-62.8%）增加到 64.1%（95%CI 62.8%-65.3%）。在农村县与城市县之间，患有阿片类药物使用障碍的女性中多物质使用的时间趋势存在差异。阿片类药物使用障碍患者的苯丙胺使用大幅增加，无论是在农村县还是城市县（分别为 255.4%（95%CI 90.5-562.9%）和 150.7%（95%CI 78.2-52.7%）），同样的还有烟草使用（30.4%（95%CI 16.9-45.4%）和 23.2%（95%CI 15.3-31.6%））。农村（-70.5%（95%CI-80.4%至-55.5%）和城市（-61.9%（95%CI-67.6%至-55.1%））县的阿片类药物使用障碍患者可卡因使用诊断下降。在城市县，患有阿片类药物使用障碍的患者的酒精使用诊断下降了 57%（95%CI-70.8%至-37.7%），但在农村县没有变化。
在过去十年中，美国患有阿片类药物使用障碍的孕妇中多物质使用的比例在农村县比城市县增长更快，其中苯丙胺和烟草使用的增长最快。
