Joshua D Brown1, Amie J Goodin1, Jeffery C Talbert2. 1. Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida. 2. Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky.
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.
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.
Authors: Andrew W Dick; Rosalie L Pacula; Adam J Gordon; Mark Sorbero; Rachel M Burns; Douglas Leslie; Bradley D Stein Journal: Health Aff (Millwood) Date: 2015-06 Impact factor: 6.301
Authors: Stephen W Patrick; Robert E Schumacher; Brian D Benneyworth; Elizabeth E Krans; Jennifer M McAllister; Matthew M Davis Journal: JAMA Date: 2012-04-30 Impact factor: 56.272
Authors: Hendree E Jones; Peter R Martin; Sarah H Heil; Karol Kaltenbach; Peter Selby; Mara G Coyle; Susan M Stine; Kevin E O'Grady; Amelia M Arria; Gabriele Fischer Journal: J Subst Abuse Treat Date: 2008-01-14
Authors: Jean Y Ko; Stephen W Patrick; Van T Tong; Roshni Patel; Jennifer N Lind; Wanda D Barfield Journal: MMWR Morb Mortal Wkly Rep Date: 2016-08-12 Impact factor: 17.586
Authors: Andrew Rosenblum; Charles M Cleland; Chunki Fong; Deborah J Kayman; Barbara Tempalski; Mark Parrino Journal: J Environ Public Health Date: 2011-07-06
Authors: Lindsay K Admon; Gavin Bart; Katy B Kozhimannil; Caroline R Richardson; Vanessa K Dalton; Tyler N A Winkelman Journal: Am J Public Health Date: 2018-11-29 Impact factor: 9.308
Authors: Christine A Schalkoff; Kathryn E Lancaster; Bradley N Gaynes; Vivian Wang; Brian W Pence; William C Miller; Vivian F Go Journal: Subst Abus Date: 2019-08-12 Impact factor: 3.716
Authors: Amna Umer; Sean Loudin; Stefan Maxwell; Christa Lilly; Meagan E Stabler; Lesley Cottrell; Candice Hamilton; Janine Breyel; Christina Mullins; Collin John Journal: Pediatr Res Date: 2018-10-04 Impact factor: 3.756
Authors: Hannah Lf Cooper; David H Cloud; Patricia R Freeman; Monica Fadanelli; Travis Green; Connor Van Meter; Stephanie Beane; Umedjon Ibragimov; April M Young Journal: Int J Drug Policy Date: 2020-03-26