Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America.
Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois, United States of America.
PLoS One. 2023 Apr 5;18(4):e0284040. doi: 10.1371/journal.pone.0284040. eCollection 2023.
Neonatal abstinence syndrome (NAS) is associated with a range of adverse health outcomes, exorbitant health care costs, and race/ethnicity disparity. We examined key sociodemographic factors that may influence the national race/ethnicity disparity in the prevalence of NAS among Whites, Blacks and Hispanics. 2016 and 2019 cycles of cross-sectional data from HCUP-KID national all-payer pediatric inpatient-care database were used to estimate NAS prevalence (ICD-10CM code P96.1) in newborns ≥ 35 weeks gestational-age, excluding iatrogenic-cases (ICD-10CM code P96.2). Multivariable generalized-linear-models with predictive-margins were used to produce race/ethnicity-specific stratified-estimates for select sociodemographic factors, reported as risk-differences (RD) with 95% confidence-intervals (CI). Final models were adjusted for sex, payer-type, ecologic income-level, and hospital size, type, and region. The overall survey weighted-sample prevalence of NAS was 0.98% (i.e., 6282/638100) and did not differ over cycles. Blacks and Hispanics were significantly more likely than Whites to be in the lowest ecologic income quartile and on Medicaid. In fully-specified models, NAS prevalence among Whites was 1.45% (95% CI: 1.33, 1.57) higher than Blacks and 1.52% (95% CI: 1.39, 1.64) higher than Hispanics; and NAS among Blacks was 0.14% higher than Hispanics (95% CI: 0.03, 0.24). NAS prevalence was highest among Whites on Medicaid (RD: 3.79%; 95% CI: 3.55, 4.03) compared to Whites on private-insurance (RD: 0.33%; 95% CI: 0.27, 0.38), and Blacks (RD: 0.73%; 95% CI: 0.63, 0.83; RD: 0.15%; 95% CI: 0.08, 0.21), or Hispanics, with either payer-type (RD: 0.59%; 95% CI: 0.5, 0.67; RD: 0.09%; 95% CI: 0.03, 0.15) respectively. NAS prevalence was higher among Whites in the lowest income-quartile (RD: 2.22%; 95% CI: 1.99, 2.44) compared with Blacks (RD: 0.51%; 95% CI: 0.41, 0.61) and Hispanics (RD: 0.44%; 95% CI: 0.33, 0.54) in the same quartile, and all subgroups in other quartiles. NAS prevalence was higher among Whites in the Northeast (RD: 2.19%; 95% CI: 1.89, 2.5) compared to Blacks (RD: 0.54%; 95% CI: 0.33, 0.74) and Hispanics (RD: 0.31%; 95% CI: 0.17, 0.45). Although Blacks and Hispanics were more likely to be in the lowest income quartile and have Medicaid insurance, Whites on Medicaid, in the lowest income quartile, and in the Northeast, were found to have the highest NAS prevalence.
新生儿戒断综合征 (NAS) 与一系列不良健康后果、高昂的医疗保健费用和种族/民族差异有关。我们研究了可能影响白人、黑人和西班牙裔人群中 NAS 患病率种族/民族差异的关键社会人口因素。使用 HCUP-KID 全国所有支付方儿科住院患者护理数据库 2016 年和 2019 年的横断面数据，估计新生儿 ≥ 35 周胎龄（排除医源性病例，ICD-10CM 代码 P96.2）中 NAS 的患病率（ICD-10CM 代码 P96.1）。使用具有预测边缘的多变量广义线性模型，根据选定的社会人口因素产生种族/民族特异性分层估计值，报告为风险差异（RD）和 95%置信区间（CI）。最终模型调整了性别、支付类型、生态收入水平以及医院规模、类型和地区。NAS 的总体调查加权样本患病率为 0.98%（即 6282/638100），且在两个周期内没有差异。黑人和西班牙裔人比白人更有可能处于生态收入最低的四分位数，并且更有可能获得医疗补助。在完全指定的模型中，白人的 NAS 患病率比黑人高 1.45%（95%CI：1.33，1.57），比西班牙裔高 1.52%（95%CI：1.39，1.64）；黑人的 NAS 患病率比西班牙裔高 0.14%（95%CI：0.03，0.24）。与私人保险相比，医疗保险的白人（RD：3.79%；95%CI：3.55，4.03）的 NAS 患病率最高，与白人（RD：0.33%；95%CI：0.27，0.38）相比，黑人和西班牙裔人（RD：0.73%；95%CI：0.63，0.83；RD：0.15%；95%CI：0.08，0.21）或任何支付类型的西班牙裔人（RD：0.59%；95%CI：0.5，0.67；RD：0.09%；95%CI：0.03，0.15）。与黑人（RD：0.51%；95%CI：0.41，0.61）和西班牙裔（RD：0.44%；95%CI：0.33，0.54）相比，收入最低四分位数的白人（RD：2.22%；95%CI：1.99，2.44）的 NAS 患病率更高，并且在同一四分位数中所有亚组以及其他四分位数中的所有亚组。与黑人（RD：0.54%；95%CI：0.33，0.74）和西班牙裔（RD：0.31%；95%CI：0.17，0.45）相比，东北地区的白人（RD：2.19%；95%CI：1.89，2.5）的 NAS 患病率更高。尽管黑人和西班牙裔人更有可能处于最低收入四分位数并获得医疗补助，但医疗保险的白人、收入最低四分位数的白人以及东北地区的白人的 NAS 患病率最高。
