Amphetamine- and Opioid-Affected Births: Incidence, Outcomes, and Costs, United States, 2004-2015
Amphetamine- and Opioid-Affected Births: Incidence, Outcomes, and Costs, United States, 2004-2015
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DOI：
10.2105/ajph.2018.304771
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发表时间：
2019-01-01
影响因子：
12.7
通讯作者：
Winkelman, Tyler N. A.
中科院分区：
文献类型：
--
作者：
Admon, Lindsay K.;Bart, Gavin;Winkelman, Tyler N. A.
目标。估计与安非他明和阿片类药物相关的医院分娩的发病率、结局和成本趋势。我们分析了2004- 2015年全国住院病人样本的数据，这是美国医疗成本和利用项目编制的具有全国代表性的医院出院样本，采用重复横断面设计。我们用加权逻辑回归估计了与母亲使用安非他明或阿片类药物相关的医院分娩发生率。我们用加权多变量logistic回归和广义线性模型来衡量临床结果和成本。2008年至2009年和2014年至2015年期间，4个人口普查区中有3个县的农村地区与城市县相比，安非他明和阿片类药物相关的交付量不成比例地增加。到2014年至2015年，在西部农村约1%的分娩中发现使用安非他明，这高于大多数地区的阿片类药物使用发生率。与阿片类药物相关分娩和其他医院分娩相比，安非他明相关分娩与更高的先兆子痫、早产、严重的孕产妇发病率和死亡率相关。分娩妇女使用安非他明和阿片类药物的发生率不断上升以及相关的不良妊娠结局表明，影响分娩的安非他明和阿片类药物的使用是日益恶化的公共卫生危机。
Objectives. To estimate trends in incidence, outcomes, and costs among hospital deliveries related to amphetamines and opioids.Methods. We analyzed 2004-to-2015 data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States compiled by the Healthcare Cost and Utilization Project, by using a repeated cross-sectional design. We estimated the incidence of hospital deliveries related to maternal amphetamine or opioid use with weighted logistic regression. We measured clinical outcomes and costs with weighted multivariable logistic regression and generalized linear models.Results. Amphetamine-and opioid-related deliveries increased disproportionately across rural compared with urban counties in 3 of 4 census regions between 2008 to 2009 and 2014 to 2015. By 2014 to 2015, amphetamine usewas identified among approximately 1% of deliveries in the rural West, which was higher than the opioid-use incidence in most regions. Compared with opioid-related and other hospital deliveries, amphetamine-related deliveries were associated with higher incidence of preeclampsia, preterm delivery, and severe maternal morbidity and mortality.Conclusions. Increasing incidence of amphetamine and opioid use among delivering women and associated adverse gestational outcomes indicate that amphetamine and opioid use affecting birth represent worsening public health crises.