Department of Obstetrics and Gynecology, School of Medicine & Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, United States of America.
Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, United States of America.
J Subst Use Addict Treat. 2023 Feb;145:208935. doi: 10.1016/j.josat.2022.208935. Epub 2023 Jan 7.
The overdose crisis is increasingly revealing disparities in opioid use disorder (OUD) outcomes by race and ethnicity. Virginia, like other states, has witnessed drastic increases in overdose deaths. However, research has not described how the overdose crisis has impacted pregnant and postpartum Virginians. We report the prevalence of OUD-related hospital use during the first year postpartum among Virginia Medicaid members in the years preceding the COVID-19 pandemic. We secondarily assess how prenatal OUD treatment is associated with postpartum OUD-related hospital use.
This population-level retrospective cohort study used Virginia Medicaid claims data for live infant deliveries between July 2016 and June 2019. The primary outcome of OUD-related hospital use included overdose events, emergency department visits, and acute inpatient stays. Independent variables of interest were prenatal receipt of medication for OUD (MOUD) and receipt of non-MOUD treatment components in line with a comprehensive care approach (e.g., case management, behavioral health). Both descriptive and multivariate analyses were performed for all deliveries and stratified by White and Black non-Hispanic individuals to bring attention to the devastating impacts of the overdose crisis within communities of color.
The study sample included 96,649 deliveries. Over a third were by Black birthing individuals (n = 34,283). Prenatally, 2.5 % had evidence of OUD, which occurred more often among White (4 %) than Black (0.8 %) non-Hispanic birthing individuals. Postpartum OUD-related hospital use occurred in 10.7 % of deliveries with OUD, more commonly after deliveries by Black, non-Hispanic birthing individuals with OUD (16.5 %) than their White, non-Hispanic counterparts (9.7 %), and this disparity persisted in the multivariable analysis (Black AOR 1.64, 95 % CI 1.14-2.36). Postpartum OUD-related hospital events were less frequent for individuals receiving versus not receiving postpartum MOUD within 30 days prior to the event. Prenatal OUD treatment, including MOUD, was not associated with decreased odds of postpartum OUD-related hospital use in the race-stratified models.
Postpartum individuals with OUD are at high risk for mortality and morbidity, especially Black individuals not receiving MOUD after delivery. An urgent need remains to effectively address the systemic and structural drivers of racial disparities in transitions of OUD care through the one-year postpartum period.
阿片类药物使用障碍（OUD）的过量危机日益揭示出种族和民族之间的差异。弗吉尼亚州和其他州一样，目睹了过量死亡人数的急剧增加。然而，研究尚未描述过量危机如何影响弗吉尼亚州怀孕和产后的居民。我们报告了 COVID-19 大流行前几年弗吉尼亚州医疗补助计划成员产后第一年与 OUD 相关的住院治疗的流行率。我们还评估了产前 OUD 治疗与产后 OUD 相关住院治疗的相关性。
本人口水平回顾性队列研究使用了弗吉尼亚州医疗补助计划从 2016 年 7 月至 2019 年 6 月期间的活婴分娩数据。与 OUD 相关的住院治疗的主要结局包括过量事件、急诊就诊和急性住院治疗。感兴趣的独立变量包括产前接受阿片类药物使用障碍（MOUD）治疗和接受符合综合护理方法的非 MOUD 治疗成分（例如，病例管理、行为健康）。对所有分娩进行了描述性和多变量分析，并按白人和非裔美国人进行分层，以引起人们对有色人种社区内过量危机的破坏性影响的关注。
研究样本包括 96649 次分娩。其中三分之一以上是由黑人产妇（n=34283）分娩的。产前有 2.5%的人有 OUD 证据，非西班牙裔白人（4%）比黑人（0.8%）更常见。有 OUD 的分娩中，产后与 OUD 相关的住院治疗发生率为 10.7%，黑人、非西班牙裔产妇 OUD （16.5%）比白人、非西班牙裔产妇 OUD （9.7%）更常见，这种差异在多变量分析中仍然存在（黑人 AOR 1.64，95%CI 1.14-2.36）。与事件发生前 30 天内未接受产后 MOUD 治疗的个体相比，接受产后 MOUD 治疗的个体发生产后 OUD 相关住院治疗的可能性较小。在按种族分层的模型中，产前 OUD 治疗，包括 MOUD，与产后 OUD 相关住院治疗的可能性降低无关。
患有 OUD 的产后个体有很高的死亡和发病风险，尤其是未在产后接受 MOUD 治疗的黑人个体。迫切需要通过产后一年的时间，有效解决 OUD 护理过渡过程中系统性和结构性种族差异的驱动因素。
