Postpartum Opioid Related Mortality in Medicaid Patients

医疗补助患者产后阿片类药物相关死亡率

• 批准号: 10197601
• 负责人: Brian Thomas Bateman
• 金额: $ 26.84万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197601
• 关键词: Affect; Alcohols; Authorization documentation; Birth; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Complement; Data; Databases; Death Certificates; Diagnosis; Discipline of obstetrics; Enrollment; Ensure; Epidemiology; Frequencies; Homicide; Inpatients; Insurance; Intervention; Link; Liver diseases; Maternal Mortality; Medicaid; Mental Health; Opioid; Opioid Analgesics; Outpatients; Overdose; Patients; Pattern; Pharmaceutical Preparations; Policies; Population; Postnatal Care; Postpartum Period; Pregnancy; Procedures; Relapse; Risk; Risk Factors; Safety; Source; Stress; Substance Use Disorder; Suicide; System; Time; United States Centers for Medicare and Medicaid Services; Washington; Woman; beneficiary; cohort; comorbidity; data resource; demographics; design; experience; health care service utilization; improved; indexing; insight; medication safety; member; modifiable risk; mortality; motherhood; novel; obstetrical complication; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose death; pregnancy associated death; prenatal; prescription opioid; safety study; tool

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.

摘要 随着妊娠期阿片类药物使用障碍（OUD）发生率的上升，OUD的过量和其他并发症 已成为孕产妇死亡的一个日益重要的原因。产后时期是一个时间， 特别容易发生过量用药和其他OUD相关死亡原因，但原因和风险因素 因为这还没有完全阐明。产后期间阿片类药物使用复发可能是由于 新母亲的压力，失去保险，停止OUD治疗和阿片类镇痛药 在交付时的接触导致持续使用和滥用类阿片，但数据很少。此外，妇女 OUD患者在产后期间也可能特别容易受到其他死亡原因的影响， 产科并发症自杀和他杀有必要系统地确定可改变的风险 可作为政策和质量改进举措重点的因素 我们的团队率先使用了全国医疗补助分析中的怀孕队列 eXtract（MAX）数据库，用于研究妊娠期药物的安全性。MAX源于医疗保健 从所有州和华盛顿提交给医疗保险和医疗补助服务中心的使用索赔， DC. MAX包含有关患者人口统计学、住院和门诊诊断的信息， 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），包含来自死亡证明的信息，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 过量死亡和非过量死亡的女性OUD。我们召集了一位经验丰富的 团队在流行病学、因果推理、药物使用障碍和产科方面拥有广泛的专业知识 创建此数据资源并实现拟议的目标。这不仅将提供新的见解， 用药过量和OUD相关产后死亡的流行病学，也创造了一个强有力的新数据 研究产妇死亡率的资源。