Association between punitive policies and neonatal abstinence syndrome among Medicaid-insured infants in complex policy environments.
Association between punitive policies and neonatal abstinence syndrome among Medicaid-insured infants in complex policy environments.
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DOI：
10.1111/add.15602
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Stein BD
中科院分区：
文献类型：
--
作者：
Faherty LJ;Heins S;Kranz AM;Patrick SW;Stein BD
估计怀孕期间药物使用妇女的惩罚性政策与医疗保险婴儿中新生儿戒断综合征（NAS）诊断的几率之间的关联，并估计控制其他四项与怀孕期间药物使用相关的政策的存在之间的关联。对2006年至2014年间美国39个州不同年份的医疗补助索赔数据进行了加权广义线性模型分析，该模型具有聚类标准误差和州和年份固定效应。没有惩罚性政策的州的NAS率与政策颁布前后有政策的州的NAS率进行了比较，使用逻辑回归模型调整了个人和县级因素，并包括州和年度固定效应。我们估计了NAS控制潜在治疗阻止政策的可能性，该政策要求报告可疑的产前药物使用情况，以及三项治疗支持政策，为孕妇和产后妇女制定有针对性的计划，优先考虑孕妇获得药物使用障碍治疗计划，并禁止在治疗计划中歧视孕妇。在9714798名加权活产婴儿（1896082名未加权活产婴儿）中，49670名（0.51%）被诊断为NAS。对于惩罚性政策是否在短期或长期内与NAS的几率有关，研究结果尚无定论。在有报告政策的州出生的婴儿发生NAS的几率低于没有报告政策的州出生的婴儿（aOR=0.77, 95% CI 0.61-0.98）。在美国，对怀孕期间使用药物的妇女的惩罚性政策似乎与新生儿戒断综合征（NAS）的低几率无关。报告策略的组件和实现是异构的，在控制其他相关策略时，报告策略似乎与NAS的可能性较低相关。
To estimate the association between punitive policies for women with substance use during pregnancy and odds of neonatal abstinence syndrome (NAS) diagnosis among Medicaid-insured infants, and to estimate this association controlling for the presence of four other policies related to substance use in pregnancy. Analysis of live births in Medicaid claims data from 39 US states in varying years between 2006 and 2014 using weighted generalized linear models with clustered standard errors and state and year fixed effects. NAS rates in states without punitive policies were compared with rates in states with policies before and after policy enactment using logistic regression models adjusted for individual and county-level factors and including state and year fixed effects. We estimated odds of NAS controlling for the presence of a potentially treatment deterring policy requiring reporting of suspected prenatal substance use, and three treatment supportive policies that create targeted programs for pregnant and postpartum women, prioritize pregnant women’s access to substance use disorder treatment programs, and prohibit discrimination towards pregnant women in treatment programs. Among 9,714,798 weighted live births (1,896,082 unweighted), 49,670 (0.51%) had an NAS diagnosis. The findings were inconclusive as to whether or not punitive policies were associated with odds of NAS either in the short or long term. Odds of NAS among infants born in states with reporting policies were lower than those born in states without such policies (aOR=0.77, 95% CI 0.61–0.98). In the United States, punitive policies for women with substance use during pregnancy do not appear to be associated with lower odds of neonatal abstinence syndrome (NAS). Reporting policies, which are heterogenous in their components and implementation, appear to be associated with lower odds of NAS when controlling for other relevant policies.
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