Disparities in receipt of medications for opioid use disorder among pregnant women

Abstract

Background: Medications for opioid use disorder (MOUD) improve outcomes for pregnant women and infants. Our primary aim was to examine disparities in maternal MOUD receipt by family sociodemographic characteristics. Methods: This retrospective cohort study included mother-infant dyads with Medicaid-covered deliveries in Tennessee from 2009 to 2016. First, we examined family sociodemographic characteristics – including race/ethnicity, rurality, mother’s primary language and education level, and whether paternity was recorded in birth records – and newborn outcomes by type of maternal opioid use. Second, among pregnant women with OUD, we used logistic regression to measure disparities in receipt of MOUD by family sociodemographic characteristics including interactions between characteristics. Results: Our cohort from Medicaid-covered deliveries consisted of 314,965 mother-infant dyads, and 4.2 percent were exposed to opioids through maternal use. Among dyads with maternal OUD, MOUD receipt was associated with lower rates of preterm and very preterm birth. Logistic regression adjusted for family sociodemographic characteristics showed that pregnant women with OUD in rural versus urban areas (aOR: 0.66; 95% CI: 0.60–0.72) and who were aged ≥35 years versus ≤25 years (aOR: 0.75; 95% CI: 0.64–0.89) were less likely to have received MOUD. Families in which the mother’s primary language was English (aOR: 2.47; 95% CI: 1.24–4.91) and paternity was recorded on the birth certificate (aOR: 1.30; 95% CI: 1.19–1.42) were more likely to have received MOUD. Regardless of high school degree attainment, non-Hispanic Black versus non-Hispanic White race was associated with lower likelihood of MOUD receipt. Hispanic race was associated with lower likelihood of MOUD receipt among women without a high school degree. Conclusions: Among a large cohort of pregnant women, we found disparities in receipt of MOUD among non-Hispanic Black, Hispanic, and rural pregnant women. As policymakers consider strategies to improve access to MOUD, they should consider targeted approaches to address these disparities.

Keywords:

• Opioid-related disorders
• social determinants of health
• obstetrics
• neonatology

Acknowledgments

The authors thank Matt Harris, PhD for critical comments on the manuscript and Jim Daugherty, MS for technical advising on database construction. We are indebted to the Division of TennCare of the Tennessee Department of Finance and Administration that provided the data. We are also indebted to the Tennessee Department of Health, Office of Health Statistics for providing vital records data.

Disclosure statement

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation or the National Institutes of Health. The funders had no role in the study design, analysis, interpretation of the data, or preparation or review of the manuscript. Use of the data does not imply that TennCare agrees or disagrees with any presentations, analyses, interpretations, or conclusions herein. The findings and conclusions in this manuscript are those of the authors.

Author contributions

L.E.H. and S.W.P. contributed to the study concept and design as well as the drafting of the manuscript. M.B.B. and S.C.H. contributed to the acquisition of data. L.E.H and P.L. contributed to the statistical analysis. L.E.H., M.B.B., and S.W.P contributed to interpretation of data. L.E.H., M.B.B., S.C.H., P.L., and S.W.P contributed to revisions and approved the final manuscript.

Additional information

Funding

This study was funded by a Robert Wood Johnson Foundation Policies for Action Grant (#75821) and by the National Institute on Drug Abuse of the National Institutes of Health under award number R01DA045729 (S.W.P., M.B.B.).