Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome
Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome
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DOI：
10.1001/jamanetworkopen.2019.14078
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发表时间：
2019-11-01
影响因子：
13.8
通讯作者：
Stein, Bradley D.
中科院分区：
文献类型：
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作者：
Faherty, Laura J.;Kranz, Ashley M.;Stein, Bradley D.
重要性尽管关于怀孕期间药物使用的政策环境迅速变化，但关于国家政策与新生儿戒断综合征（NAS）的关系的信息缺乏。目的：确定与孕期药物使用相关的惩罚性或报告性国家政策是否与NAS发生率相关。设计、环境和参与者本重复横断面研究对2003年1月1日至2014年12月31日期间美国8个州住院患者数据库中不同年份的活产婴儿进行了回顾性、差异中差异分析。没有惩罚性或报告政策的州与政策制定前后有政策的州进行了比较，使用逻辑回归模型调整了个人和县级因素以及州和年度固定效应。分析时间为2019年4月10日至2019年7月30日。与怀孕期间药物使用有关的国家政策颁布以来的时间，县级农村和失业，以及县孕妇和产后妇女的专门治疗方案的存在。主要结局和NAS发生率。结果4567963例新生儿中，23377例（0.5%）被诊断为NAS。在患有NAS的新生儿中，3394名（14.5%）生活在没有任何专门针对孕妇和产后妇女的治疗方案的县，20323名（86.9%）生活在大都市县，8135名（34.8%）生活在失业率最高的四分位数县。在对有惩罚性政策的州的新生儿进行的校正分析中，在颁布后的第一个完整日历年内（校正优势比，1.25;95% Cl, 1.06-1.46; P = .007）和颁布后超过1年（校正优势比，1.33;95% Cl, 1.17-1.51; P < .001）， NAS的几率显著增加。经过回归调整后，在没有惩罚性政策的州，年NAS发生率为每10000例活产新生儿中有46例（95% Cl. 43-48）；在实施惩罚性政策的州，每10000例活产新生儿中有57例（95% Cl, 48-65）新生儿患有NAS；在实施惩罚性政策超过一年的州，每10000名活产新生儿中有60名（95% Cl, 56-65）新生儿患有NAS。报告政策与NAS发生率之间没有关联。结论和相关性在对8个州的重复横断面分析中，有惩罚性政策的州在短期和长期内发生NAS的几率更高，但NAS和有报告政策的州之间没有关联。
IMPORTANCE Despite the rapidly changing policy environment regarding substance use during pregnancy, information is lacking on the association of state policies with neonatal abstinence syndrome (NAS).OBJECTIVE To determine if punitive or reporting state policies related to substance use during pregnancy are associated with NAS rates.DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study used retrospective, difference-in-difference analysis of live births in the State Inpatient Databases from 8 US states in varying years between January 1, 2003, and December 31, 2014. States without punitive or reporting policies were compared with states with policies before and after policy enactment using logistic regression models adjusted for individual and county-level factors and state and year fixed effects. Analyses were conducted from April 10, 2019, to July 30, 2019.EXPOSURES Time since enactment of state policies related to substance use in pregnancy, county level rurality and unemployment, and presence of specialized treatment programs for pregnant and postpartum women in a county.MAIN OUTCOME AND MEASURES Rates of NAS.RESULTS Among 4567 963 live births, 23 377 neonates (0.5%) received a diagnosis of NAS. Among neonates with NAS, 3394 (14.5%) lived in counties without any treatment programs specifically for pregnant and postpartum women, 20 323 (86.9%) lived in metropolitan counties, and 8135 (34.8%) lived in counties in the highest unemployment quartile. In adjusted analyses among neonates in states with punitive policies, odds of NAS were significantly greater during the first full calendar year after enactment (adjusted odds ratio, 1.25; 95% Cl, 1.06-1.46; P = .007) and more than 1 full year after enactment (adjusted odds ratio, 1.33; 95% Cl, 1.17-1.51; P < .001). After regression adjustment, the annual NAS rate was 46 (95% Cl. 43-48) neonates with NAS per 10 000 live births in states without punitive policies; 57 (95% Cl, 48-65) neonates with NAS per 10 000 live births in states with punitive policies during the first full year after enactment; and 60 (95% Cl, 56-65) neonates with NAS per 10 000 live births in states with punitive policies in effect for more than 1 full year. There was no association between reporting policies and odds of NAS.CONCLUSIONS AND RELEVANCE In this repeated cross-sectional analysis of 8 states, states with punitive policies were associated with greater odds of NAS immediately and in the longer term, but there was no association between NAS and states with reporting policies.