Postpartum Opioid Related Mortality in Medicaid Patients

摘要 随着怀孕期间阿片类药物使用障碍 (OUD) 发生率的上升，过量服用 OUD 和其他并发症 已成为孕产妇死亡的一个日益重要的来源。产后时期是一个时期 特别容易因服药过量和其他原因导致 OUD 相关死亡，但原因和风险因素 对此尚未完全阐明。阿片类药物在产后使用复发可能是由于 初为人母的压力、失去保险、停止 OUD 治疗和阿片类镇痛药 分娩时接触导致阿片类药物持续使用和滥用，但数据很少。此外，女性 OUD 患者在产后期间也可能特别容易因其他原因死亡，包括 产科并发症、自杀和他杀。需要系统地识别可改变的风险 可以成为政策和质量改进举措重点的因素 我们的团队率先使用全国医疗补助分析中的妊娠队列 eXtract (MAX) 数据库用于研究妊娠期药物的安全性。 MAX源自医疗保健 从所有州和华盛顿州向医疗保险和医疗补助服务中心提交的使用索赔， 直流。 MAX 包含有关患者人口统计、住院和门诊诊断的信息以及 程序，并填写门诊处方。在拟议的研究中，我们将把 MAX 与国家 死亡指数 (NDI)，包含从死亡证明中得出的信息，包括死亡原因。 然后，我们将使用链接的 MAX-NDI 数据库来研究频率、时间、原因和风险因素 患有 OUD 的女性的药物过量死亡和非药物过量死亡。我们组建了一支经验丰富的 团队在流行病学、因果推理、物质使用障碍和产科方面拥有丰富的专业知识 创建此数据资源并实现拟议的目标。这不仅将为我们提供新的见解 药物过量和 OUD 相关产后死亡的流行病学，也创造了强有力的新数据 一般研究孕产妇死亡率的资源。

ABSTRACT With rising rates of opioid use disorder (OUD) in pregnancy, overdose and other complications of OUD have become an increasingly important source of maternal mortality. The postpartum period is a time of particular vulnerability for overdose and other causes of OUD related mortality, but the causes and risk factors for this have not been fully elucidated. Opioid use relapse during the postpartum period may be due to the stresses of new motherhood, loss of insurance, discontinuation of OUD treatment, and opioid analgesic exposure at the time of delivery leading to persistent opioid use and misuse, but data are few. Further, women with OUD may also be particularly vulnerable to other causes of death during the postpartum period including obstetrical complications, suicide, and homicide. There is a need to systematically identify modifiable risk factors that can be the focus of policy and quality improvement initiatives Our group has pioneered the use of pregnancy cohorts nested in the nationwide Medicaid Analytic eXtract (MAX) database to study the safety of medications in pregnancy. The MAX is derived from healthcare utilization claims submitted to the Centers for Medicare and Medicaid Services from all states and Washington, DC. The MAX contains information on patient demographics, inpatient and outpatient diagnoses and procedures, and filled outpatient prescriptions. In the proposed study, we will link the MAX with the National Death Index (NDI), which contains information derived from death certificates including the cause of death. We will then use the linked MAX-NDI database to study the frequency, timing, causes, and risk factors for overdose death and non-overdose deaths in women with OUD. We have assembled an experienced team with extensive expertise in epidemiology, causal inference, substance use disorder, and obstetrics to create this data resource and carry out the proposed Aims. This will not only provide new insight into the epidemiology of overdose and OUD related postpartum death, but also create a powerful new data resource to study maternal mortality generally.