Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts
Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts
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DOI：
10.1001/jamanetworkopen.2020.5734
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发表时间：
2020-05-26
影响因子：
13.8
通讯作者：
Taveras, Elsie M.
中科院分区：
文献类型：
--
作者：
Schiff, Davida M.;Nielsen, Timothy;Taveras, Elsie M.
重要性种族和民族差异持续存在于母亲和婴儿的关键健康和药物使用治疗结果中。使用美沙酮或丁丙诺啡等药物治疗阿片类药物使用障碍（OUD）与母亲和婴儿结局的改善有关;然而，只有一半的OUD孕妇接受这些药物治疗。母体种族或民族与使用药物治疗OUD的相关程度、使用药物治疗OUD的持续时间以及妊娠期间用于治疗OUD的药物类型尚不清楚。目的探讨OUD孕妇在分娩前一年使用药物治疗OUD与母亲种族和民族的相关程度。设计、设置和参与者这项回顾性队列研究使用了2011年10月1日至2015年12月31日期间在马萨诸塞州分娩活婴的OUD孕妇的相关人群水平全州数据集。在确定的274 234例分娩中，有5 247例分娩的妇女具有OUD指标，被纳入分析。根据出生证明上自我报告的数据，将母亲的人种和种族定义为非西班牙裔的白色白人、非西班牙裔的黑人或西班牙裔。主要结局和测量主要结局是接受任何治疗OUD的药物，治疗OUD的药物使用的一致性（至少连续6个月使用，不一致使用或不使用），以及用于治疗OUD的药物类型（美沙酮或丁丙诺啡）。多变量模型根据母亲的社会人口学特征、合并症以及协变量与人种和种族之间的任何显著相互作用进行调整。结果样本包括5247名OUD孕妇，在研究期间在马萨诸塞州分娩了一名活婴。母亲分娩时的平均（SD）年龄为28.7（5.0）岁; 4551名女性（86.7%）为非西班牙裔白色人，462名女性（8.8%）为西班牙裔人，234名女性（4.5%）为非西班牙裔黑人。共有3181名白色非西班牙裔妇女（69.9%）在分娩前一年接受了任何类型的药物治疗OUD，而228名西班牙裔妇女（49.4%）和108名黑人非西班牙裔妇女（46.2%）。与非西班牙裔白色白人女性相比，非西班牙裔黑人女性和西班牙裔女性接受任何药物治疗OUD的可能性显著较低（调整后的比值比[aOR]，0.37; 95% CI，0.28-0.49和aOR，0.42; 95% CI，0.35-0.52）。按产妇年龄分层发现，年轻妇女之间的差距更大。与非西班牙裔白色女性相比，非西班牙裔黑人和西班牙裔女性持续使用药物治疗OUD的可能性也较低（aOR，0.24; 95% CI，0.17-0.35和aOR，0.34; 95% CI，0.27-0.44）。关于用于治疗OUD的药物类型，与美沙酮治疗相比，黑人非西班牙裔和西班牙裔女性接受丁丙诺啡治疗的可能性（aOR，0.60; 95% CI，0.40-0.90和aOR，0.77; 95% CI，0.58-1.01）低于白色非西班牙裔女性。结论和相关性本研究发现种族和民族的差异在使用药物治疗OUD在怀孕期间，与黑人非西班牙裔和西班牙裔妇女显着不太可能使用药物一致或在所有相比，白色非西班牙裔women.Further调查患者，临床医生，治疗方案，和系统水平的因素与这些发现是必要的。
Importance Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown. Objective To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. Design, Setting, and Participants This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates. Main Outcomes and Measures Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. Results The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment. Conclusions and Relevance This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women.Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.