The number of Medicaid-financed births that are impacted by NAS has risen substantially and totaled $462 million in hospital costs in 2014. Improving affordable health insurance coverage for low-income women before pregnancy would expand access to substance use disorder treatment and could reduce NAS-related morbidity and costs.

OBJECTIVE: To describe racial and ethnic disparities in the incidence of severe maternal morbidity during delivery hospitalizations in the United States. METHODS: We conducted a pooled, cross-sectional analysis of 2012–2015 data from the National Inpatient Sample to define the prevalence of chronic conditions and incidence of severe maternal morbidity among deliveries to non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, and Native American or Alaska Native women. We used weighted multivariable logistic regression and predictive margins to generate prevalence and incidence estimates. Adjusted rate ratios and differences were calculated to quantify disparities across racial and ethnic categories. Subgroup analyses were performed to examine the incidence of severe maternal morbidity among deliveries to women with comorbid physical health conditions, behavioral health conditions, and multiple chronic conditions within each racial and ethnic category. RESULTS: The incidence of severe maternal morbidity was significantly higher among deliveries to women in every racial and ethnic minority category compared with deliveries among non-Hispanic white women. Severe maternal morbidity occurred in 231.1 (95% CI 223.6–238.5) and 139.2 (95% CI 136.4–142.0) per 10,000 delivery hospitalizations among non-Hispanic black and non-Hispanic white women, respectively (P<.001). When excluding cases in which blood transfusion was the only indicator of severe maternal morbidity, only deliveries to non-Hispanic black women had a higher incidence of severe maternal morbidity compared with deliveries among non-Hispanic white women: 50.2 (95% CI 47.6–52.9) and 40.9 (95% CI 39.6–42.3) per 10,000 delivery hospitalizations, respectively (risk ratio 1.2 [95% CI 1.2–1.3], risk difference 9.3 [95% CI 6.5–12.2] per 10,000 delivery hospitalizations; P<.001 for each comparison). Among deliveries to women with comorbid physical and behavioral health conditions, significant differences in severe maternal morbidity were identified among racial and ethnic minority compared with non-Hispanic white women and the largest disparities were identified among women with multiple chronic conditions. CONCLUSION: Programs for reducing racial and ethnic disparities in severe maternal morbidity may have the greatest effect focusing on women at highest risk for blood transfusion and maternity care management for women with comorbid chronic conditions, particularly multiple chronic conditions.

Incidence rates for neonatal abstinence syndrome (NAS) and maternal opioid use increased nearly 5-fold in the United States between 2000 and 2012. 1 Previous studies suggest the incidence of NAS may be increasing rapidly in some rural states, 2 in parallel with rising rural rates of other opioid use-related conditions including hepatitis C and overdose deaths. 3,4 To our knowledge, no study has examined national trends in NAS and maternal opioid use among rural patients compared with their urban counterparts. Methods | We used 2004 to 2013 data from the National Inpatient Sample, a nationally representative, all-payer sample of hospital discharges in the United States compiled by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.The study population consisted of all neonatal births and obstetric deliveries between 2004 and 2013. 5 Infants with NAS were identified using the International Classifica-tion of Diseases, Ninth Revision, Clinical Modification code of 779.5 in any diagnosis field. Cases of potentially iatrogenic NAS were excluded using previously described methods. 6 Maternal opioid use was defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes 304.0x, 304.7x, or 305.5x. The University of Michigan institutional review board determined the study was exempt because the National Inpatient Sample Data contain deidentified data. Patient consent was therefore neither required or obtainable.Location of residence was defined as rural or urban using the National Center for Health Statistics Classification Scheme for Counties. We tabulated demographic characteristics for infants with NAS and mothers with opioid use by rural/urban status and calculated the proportion of NAS cases accounted for by rural infants in each 2-year period. Incidence rates of NAS and maternal opioid use by rural/urban status were calculated using predictive margins with 2 separate logistic regression models that interacted variables for each 2-year period with rural/urban status.To allow for comparisons over time, we used trend weights provided by the Healthcare Cost and Utilization Project that account for National Inpatient Sample sampling changes in Table. Characteristics of Infants and Mothers With Opioid-Related Diagnoses in the United States, 2004-2013 Characteristic No. (weighted %)

Importance Health profiles and patterns of involvement in the criminal justice system among people with various levels of opioid use are poorly defined. Data are needed to inform a public health approach to the opioid epidemic. Objective To examine the association between various levels of opioid use in the past year and physical and mental health, co-occurring substance use, and involvement in the criminal justice system. Design, Setting, and Participants This retrospective, cross-sectional analysis used the 2015-2016 National Survey on Drug Use and Health to assess the independent association of intensity of opioid use with health, co-occurring substance use, and involvement in the criminal justice system among US adults aged 18 to 64 years using multivariable logistic regression. Exposures No opioid use vs prescription opioid use, misuse, or use disorder or heroin use. Main Outcomes and Measures Self-reported physical and mental health, disability, co-occurring substance use, and past year and lifetime involvement in the criminal justice system. Results The sample consisted of 78 976 respondents (42 495 women and 36 481 men), representative of 196 280 447 US adults. In the weighted sample, 124 026 842 adults reported no opioid use in the past year (63.2%; 95% CI, 62.6%-63.7%), 61 462 897 reported prescription opioid use in the past year (31.3%; 95% CI, 30.8%-31.8%), 8 439 889 reported prescription opioid misuse in the past year (4.3%; 95% CI, 4.1%-4.5%), 1 475 433 reported prescription opioid use disorder in the past year (0.8%; 95% CI, 0.7%-0.8%), and 875 386 reported heroin use in the past year (0.4%; 95% CI, 0.4%-0.5%). Individuals who reported any level of opioid use were significantly more likely than individuals who reported no opioid use to be white, have a low income, and report a chronic condition, disability, severe mental illness, or co-occurring drug use. History of involvement in the criminal justice system increased as intensity of opioid use increased (no use, 15.9% [19 562 158 of 123 319 911]; 95% CI, 15.4%-16.4%; prescription opioid use, 22.4% [13 712 162 of 61 204 541]; 95% CI, 21.7%-23.1%; prescription opioid misuse, 33.2% [2 793 391 of 8 410 638]; 95% CI, 30.9%-35.6%; prescription opioid use disorder, 51.7% [762 189 of 1 473 552]; 95% CI, 45.4%-58.0%; and heroin use, 76.8% [668 453 of 870 250]; 95% CI, 70.6%-82.1%). In adjusted models, any level of opioid use was associated with involvement in the criminal justice system in the past year compared with no opioid use. Conclusions and Relevance Individuals who use opioids have complicated health profiles and high levels of involvement in the criminal justice system. Combating the opioid epidemic will require public health interventions that involve criminal justice systems, as well as policies that reduce involvement in the criminal justice system among indi...

Objective To estimate trends in the prevalence and socio-economic distribution of chronic conditions among women hospitalized for obstetric delivery in the United States. Methods A retrospective, serial cross-sectional analysis was conducted using 2005 to 2014 data from the National Inpatient Sample. We estimated the prevalence of eight common, chronic conditions, each associated with obstetric morbidity and mortality, among all childbearing women and then across socio-economic predictors of obstetric outcomes. Differences over time were measured and compared across rural vs. urban residence, income, and payer subgroups for each condition. Results We identified 8,193,707 delivery hospitalizations, representing 39,273,417 delivery hospitalizations occurring nationally between 2005 and 2014. Identification of at least one chronic condition increased significantly between 2005–2006 and 2013–2014 (66.9 per 1,000 delivery hospitalizations in 2005–2006 vs. 91.8 per 1,000 delivery hospitalizations in 2014–2015). The prevalence of multiple chronic conditions also increased during the study period, from 4.7 (95% CI 4.2–5.2) to 8.1 (95% CI 7.8–8.4) per 1,000 delivery hospitalizations between 2005–2006 and 2013–2014. Chronic respiratory disease, chronic hypertension, substance use disorders, and pre-existing diabetes were the disorders with the greatest increases in prevalence over time Increasing disparities over time were identified across all socio-economic subgroups analyzed including rural vs. urban residence, income, and payer. Key areas of concern include the rate at which substance use disorders rose among rural women and the disproportionate burden of each condition among women from the lowest income communities and among women with Medicaid as their primary payer. Conclusion From 2005–2006 through 2013–2014, the prevalence of chronic conditions increased across all segments of the childbearing population. Widening disparities were identified over time, with key areas of concern including disproportionate, progressive increases in the burden of chronic conditions among women from rural and low income communities and those with deliveries funded by Medicaid.

Key Points Question What are the current trends in frequency and costs of amphetamine-related hospitalizations in the United States? Findings In this cross-sectional study of approximately 1.3 million amphetamine-related US hospitalizations between 2003 and 2015, hospitalizations increased substantially by 2015, with the highest frequency being in the western United States and the predominant payer being Medicaid. Meaning Amphetamine use may be an emerging public health issue; pharmacologic and nonpharmacologic therapies that effectively treat amphetamine use disorder are needed.

Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.

OBJECTIVE: To measure the association between race–ethnicity and insurance status at preconception, delivery, and postpartum and the frequency of insurance gaps and transitions (disruptions) across these time points. METHODS: We conducted a cross-sectional analysis of survey data from 107,921 women in 40 states participating in the Centers for Disease Control and Prevention's Pregnancy Risk Assessment and Monitoring System from 2015 to 2017. We calculated unadjusted estimates of insurance status at preconception, delivery, and postpartum and continuity across these time points for seven racial–ethnic categories (white non-Hispanic, black non-Hispanic, indigenous, Asian or Pacific Islander, Hispanic Spanish-speaking, Hispanic English-speaking, and mixed race or other). We also examined unadjusted estimates of uninsurance at each perinatal time period by state of residence. We calculated adjusted differences in the predicted probability of uninsurance at preconception, delivery, and postpartum using logistic regression models with interaction terms for race–ethnicity and income. RESULTS: For each perinatal time point, all categories of racial–ethnic minority women experienced higher rates of uninsurance than white non-Hispanic women. From preconception to postpartum, 75.3% (95% CI 74.7–75.8) of white non-Hispanic women had continuous insurance compared with 55.4% of black non-Hispanic women (95% CI 54.2–56.6), 49.9% of indigenous women (95% CI 46.8–53.0) and 20.5% of Hispanic Spanish-speaking women (95% CI 18.9–22.2). In adjusted models, lower-income Hispanic women and indigenous women had a significantly higher predicted probability of uninsurance in the preconception and postpartum period compared with white non-Hispanic women. CONCLUSION: Disruptions in perinatal insurance coverage disproportionately affect indigenous, Hispanic, and black non-Hispanic women. Differential insurance coverage may have important implications for racial–ethnic disparities in access to perinatal care and maternal–infant health.