Characterization of neonatal opioid withdrawal syndrome in Arizona from 2010-2017

Abstract

In this paper, we describe a population of mothers who are opioid dependent at the time of giving birth and neonates exposed to opioids in utero who experience withdrawal following birth. While there have been studies of national trends in this population, there remains a gap in studies of regional trends. Using data from the Arizona Department of Health Services Hospital Discharge Database, this study aimed to characterize the population of neonates with neonatal opioid withdrawal syndrome (NOWS) and mothers who were opioid dependent at the time of giving birth, in Arizona. We analyzed approximately 1.2 million electronic medical records from the Arizona Department of Health Services Hospital Discharge Database to identify patterns and disparities across socioeconomic, ethnic, racial, and/or geographic groupings. In addition, we identified comorbid conditions that are differentially associated with NOWS in neonates or opioid dependence in mothers. Our analysis was designed to assess whether indicators such as race/ethnicity, insurance payer, marital status, and comorbidities are related to the use of opioids while pregnant. Our findings suggest that women and neonates who are non-Hispanic White and economically disadvantaged, tend be part of our populations of interest more frequently than expected. Additionally, women who are opioid dependent at the time of giving birth are unmarried more often than expected, and we suggest that marital status could be a proxy for support. Finally, we identified comorbidities associated with neonates who have NOWS and mothers who are opioid dependent not previously reported.

Fig 1. NOWS hospitalization rates, per 10,000 births, in Arizona from 2010 to 2017.

Mothers who are dependent on opioids at the time of giving birth (dark grey) and newborn infants with NOWS (light grey).

Fig 2. Comparison of the observed versus expected proportions of NOWS in each racial/ethnic group of infants.

Boxes labelled higher or lower indicate that observed proportions are significantly higher or lower than expected proportions based on a chi-square analysis after post-hoc comparisons that incorporate a Bonferroni correction with six groups (p<0.001/6). A: Asian, H/L: Hispanic or Latino, AI/AN: American Indian or Alaskan Native, B: Black, NH/PI: Native Hawaiian or Pacific Islander, NHW: Non-Hispanic White.

Fig 3. Comparison of the observed versus expected proportions of opioid dependence at the time of giving birth in each racial/ethnic group of mothers.

Boxes labelled higher or lower mean that the observed proportions are significantly higher or lower than the expected proportion after post-hoc comparisons that incorporate a Bonferroni correction with six groups (p<0.001/6). A: Asian, H/L: Hispanic or Latino, AI/AN: American Indian or Alaskan Native, B: Black, NH/PI: Native Hawaiian or Pacific Islander, NHW: Non-Hispanic White.

Fig 4. Comparison of the observed versus expected proportions of NOWS at the time birth in each payor group utilized for infants.

Boxes labelled higher or lower mean that the observed proportions are significantly higher or lower than the expected proportion after post-hoc comparisons that incorporate a Bonferroni correction with six groups (p<0.001/6). PHI: Private Health Insurance, Self: Self Pay, IHS: Indian Health Services.

Fig 5. Comparison of the observed versus expected proportions of opioid dependence at the time of giving birth in each payor group utilized for mothers.

Boxes labelled higher or lower mean that the observed proportions are significantly higher or lower than the expected proportion after post-hoc comparisons that incorporate a Bonferroni correction with six groups (p<0.001/6). PHI: Private Health Insurance, Self: Self Pay, IHS: Indian Health Services.

Fig 6. Comparison of the observed versus expected proportions of opioid dependence at the time of giving birth in by maternal marital status.

Boxes labelled higher or lower mean that the observed proportions are significantly higher or lower than the expected proportion after post-hoc comparisons that incorporate a Bonferroni correction with six groups (p<0.001/5). M: Married, K: Unknown, D: Divorced, I: Single, S: Separated.

Fig 7. Comparison of the observed versus expected proportions of opioid dependence at the time of giving birth by maternal residential PCA.

Red or blue indicates that there is a significantly higher or lower number of mothers using opioids than expected. A map with all PCAs labelled can be found on the ADHS website: https://www.azdhs.gov/documents/prevention/health-systems-development/data-reports-maps/maps/azpca.pdf.