Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;34(1):6-13.
doi: 10.1111/jrh.12251. Epub 2017 Jul 7.

Rural and Appalachian Disparities in Neonatal Abstinence Syndrome Incidence and Access to Opioid Abuse Treatment

Joshua D Brown  1 , Amie J Goodin  1 , Jeffery C Talbert  2
Affiliations

Rural and Appalachian Disparities in Neonatal Abstinence Syndrome Incidence and Access to Opioid Abuse Treatment

Joshua D Brown et al. J Rural Health. 2018 Dec.

Abstract

Objective: Incidence of neonatal abstinence syndrome (NAS) is increasing due to the rise in opioid use. Rural states like Kentucky have been disproportionally impacted by opioid abuse, and this study determines NAS burden nationally and in Kentucky while quantifying differences in access to care between Appalachian and non-Appalachian counties.

Methods: NAS rates were calculated using National (2013) and Kentucky (2008-2014) National Inpatient Sample discharge data. Births were identified using International Classification of Diseases v9 code 779.5 and live birth codes V30.x-V38.x. Counties were classified as rural, micropolitan, or metropolitan using census data. Proximity analysis was conducted via mapping from ZIP code centroid to nearest opioid treatment facility. Distance to treatment facilities was calculated and then compared using nonparametric testing for counties by rural and Appalachian status.

Results: NAS cases tripled from 2008 to 2014 in Kentucky counties, with a 2013 NAS rate more than double the national NAS rate. Rural and Appalachian counties experienced an NAS increase per 1,000 births that was 2-2.5 times higher than urban/non-Appalachian counties, with a greater number of NAS births overall in Appalachian counties. All opioid treatment facility types were further from rural patients than micropolitan/metropolitan patients (P < .001), as well as further for Appalachians versus non-Appalachians (P < .001, all facility types).

Conclusions: NAS burden disparately affects rural and Appalachian Kentucky counties, while treatment options are disproportionately further away for these residents. Policy efforts to increase NAS prevention and encourage opioid abuse treatment uptake in pregnant women should address rural and Appalachian disparities.

Keywords: Appalachia; neonatal abstinence syndrome; opioid abuse; substance abuse; treatment disparities.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Neonatal abstinence syndrome (NAS) in the United States by patient residence status, 2013
Error bars indicate 95% confidence intervals. Data from 2013 National Inpatient Sample, classifications of metro/suburbs/rural residence status from Agency for Healthcare Research and Quality HCUPnet online tool.
Figure 2
Figure 2. Number and rate of NAS births by residence status in Kentucky, 2008–2014
Metropolitan classifications based on Core-Based Statistical Area codes mapped to 5-digit patient zip codes in discharge data. Appalachian region defined by Appalachian Regional Commission county list linked to ZIP codes.
Figure 3
Figure 3. Map of NAS birth rate per 1,000 live births by Kentucky county, 2014
Appalachian region defined by Appalachian Regional Commission county list linked to ZIP codes. Rates are color coded, absolute numbers are within each county in text.
See this image and copyright information in PMC

References

    1. Patrick S, Schumacher R, Benneyworth B, Krans E, McAllister J, Davis M. Neonatal abstinence syndrome and associated health care expenditures. JAMA: The Journal of the American Medical Association. 2012:307. doi: 10.1001/jama.2012.3951. http://dx.doi.org/10.1001/jama.2012.3951. - DOI - DOI - PubMed
    1. Hudak ML, Tan RC COMMITTEE ON DRUGS, COMMITTEE ON FETUS AND NEWBORN, American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012;129(2):e540–e560. doi: 10.1542/peds.2011-3212. - DOI - PubMed
    1. Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the united states. N Engl J Med. 2015;372(3):241–248. doi: 10.1056/NEJMsa1406143. - DOI - PubMed

    1. McConnell M. Protecting our infants act of 2015. S 799. 2015(114th Congress).

    1. Bonamici S. 21st century cures act. 12/13/2016;HR.34(114th Congress (2015–2016)).

Publication types

MeSH terms

LinkOut - more resources