Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents, 2007–2014

Katy B Kozhimannil, Tongtan Chantarat, Alexandra M. Ecklund, Carrie E Henning-Smith, Cresta W Jones

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Purpose: Opioid use disorder (OUD) during pregnancy is associated with poor maternal and infant outcomes, including neonatal abstinence syndrome (NAS), and both maternal OUD and NAS are increasing disproportionately among rural residents. This study describes the trajectory and characteristics associated with diagnosis of maternal OUD or NAS among rural residents who gave birth at different types of hospitals based on rural/urban location and teaching status. Methods: Hospital discharge data from the all-payer National Inpatient Sample were used to describe maternal OUD and infant NAS among rural residents from 2007–2014. Hospitals were categorized as rural, urban teaching, and urban nonteaching. We estimated incidence trends by hospital categories, followed by multivariable logistic regression analyses to identify correlates of OUD and NAS among rural residents, stratified by hospital category. Findings: Incidence of maternal OUD increased in all hospital categories, with higher rates (8.9/1,000 deliveries) among rural residents who gave birth at urban teaching hospitals compared with those who gave birth at rural hospitals (4.3/1,000 deliveries) or urban nonteaching hospitals (3.6/1,000 deliveries; P <.001). A similar pattern was observed for infant NAS. In multivariable models, the association between maternal OUD and infant NAS diagnoses and hospital category differed by rurality (micropolitan vs. noncore.). Conclusions: There has been a sustained increase in both maternal OUD and NAS diagnoses among rural residents. Measured sociodemographic and clinical correlates of maternal OUD and NAS differ by hospital category, indicating variability across hospital locations in patient populations and clinical needs for rural residents with these conditions.

Original languageEnglish (US)
Pages (from-to)122-132
Number of pages11
JournalJournal of Rural Health
Volume35
Issue number1
DOIs
StatePublished - Jan 2019

Bibliographical note

Funding Information:
Funding: This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), US Department of Health and Human Services (HHS) Cooperative Agreement U1CRH03717. The information, conclusions and opinions expressed are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Information:
The authors gratefully acknowledge Alex Evenson's contributions to the design of the figures included in this manuscript. This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), US Department of Health and Human Services (HHS) Cooperative Agreement U1CRH03717. The information, conclusions and opinions expressed are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Publisher Copyright:
© 2018 National Rural Health Association

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • hospitals
  • maternal opioid use
  • neonatal abstinence syndrome
  • substance use disorder

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