Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012
Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012
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DOI：
10.1038/jp.2015.36
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发表时间：
2015-08-01
影响因子：
2.9
通讯作者：
Cooper, W. O.
中科院分区：
文献类型：
--
作者：
Patrick, S. W.;Davis, M. M.;Cooper, W. O.
目的：新生儿戒断综合征 (NAS)，一种产后阿片类药物戒断综合征，从 2000 年到 2009 年增加了三倍。自 2009 年以来，美国各地的阿片类止痛药处方和并发症显着增加。了解 NAS 的最新变化及其地理变异性将为州和地方政府制定公共卫生应对措施提供信息。 研究设计：我们利用了儿童住院患者数据库和全国住院患者样本中 200 年（至 2012 年）出院的诊断和人口统计数据。利用国际疾病分类第九版修订版临床修改代码识别了 NAS 相关诊断。所有分析均采用 全国加权数据。支出数据调整为2012年美元。利用最小二乘回归确定年间差异。 结果：从 2009 年到 2012 年，全国范围内的 NAS 发病率从每 1000 名医院出生的 3.4 例（95% 置信区间 (CI)：3.2 至 3.6）增加到 5.8 例（95% CI 5.5 至 6.1），总共有 21 732 名婴儿被诊断。医院综合收费 NAS 从 7.32 亿美元增加到 15 亿美元（P < 0.001），其中 81% 归因于 2012 年的州医疗补助计划。NAS 发生率因地理人口普查分区而异，中东南分区（肯塔基州、田纳西州、密西西比州）发病率最高（每 1000 名医院新生儿），为 16.2（95% CI 12.4 至 18.9）和阿拉巴马州），中西南部分区最低 俄克拉荷马州、德克萨斯州、阿肯色州和路易斯安那州 2.6（95% CI 2.3 至 2.9）。结论：在我们的研究期间，NAS 发病率和住院费用大幅增长。这一代价高昂的公共卫生问题需要采取公共卫生措施来减轻对妇女和儿童的伤害。各国，特别是受该综合征影响最严重的地区，必须继续采取初级预防策略，以限制阿片类止痛药滥用的影响。
OBJECTIVE: Neonatal abstinence syndrome (NAS), a postnatal opioid withdrawal syndrome, increased threefold from 2000 to 2009. Since 2009, opioid pain reliever prescriptions and complications increased markedly throughout the United States. Understanding recent changes in NAS and its geographic variability would inform state and local governments in targeting public health responses.STUDY DESIGN: We utilized diagnostic and demographic data for hospital discharges from 200 (to 2012 from the Kids' Inpatient Database and the Nationwide Inpatient Sample. NAS-associated diagnoses were identified utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes. All analyses were conducted with nationally weighted data. Expenditure data were adjusted to 2012 US dollars. Between-year differences were determined utilizing least squares regression.RESULTS: From 2009 to 2012, NAS incidence increased nationally from 3.4 (95% confidence interval (CI): 3.2 to 3.6) to 5.8 (95% CI 5.5 to 6.1) per 1000 hospital births, reaching a total of 21 732 infants with the diagnosis. Aggregate hospital charges for NAS increased from $732 million to $1.5 billion (P < 0.001), with 81% attributed to state Medicaid programs in 2012. NAS incidence varied by geographic census division, with the highest incidence rate (per 1000 hospital births) of 16.2 (95% CI 12.4 to 18.9) in the East South Central Division (Kentucky, Tennessee, Mississippi and Alabama) and the lowest in West South Central Division Oklahoma, Texas, Arkansas and Louisiana 2.6 (95% CI 2.3 to 2.9).CONCLUSION: NAS incidence and hospital charges grew substantially during our study period. This costly public health problem merits a public health approach to alleviate harm to women and children. States, particularly, in areas of the country most affected by the syndrome must continue to pursue primary prevention strategies to limit the effects of opioid pain reliever misuse.