Advertisement

Emergency Department Utilization for Substance Use Disorder During Pregnancy and Postpartum in the United States (2006–2016)

      Abstract

      Objectives

      We aimed to better understand emergency department (ED) use, admission patterns, and demographics for substance use disorder in pregnancy and postpartum (SUDPP).

      Methods

      In this longitudinal study, the United States Nationwide Emergency Department Sample was queried for all ED visits by 15- to 50-year-old women with a primary diagnosis defined by International Classification of Diseases, 9th or 10th edition Clinical Modification, codes of SUDPP between 2006 and 2016. Patterns of ED visit counts, rates, admissions, and ED charges were analyzed.

      Results

      Annual national estimated ED visits for SUDPP increased from 2,919 to 9,497 between 2006 and 2016 (a 12.4% annual average percentage change), whereas admission rates decreased (from 41.9% to 32.0%). ED visits were more frequent among women who were 20–29 years old, using Medicaid insurance, in the lowest income quartile, living in the South, and in metropolitan areas. Compared with the proportion of ED visits, 15- to 19-year-olds had significantly lower admission rates, whereas women with Medicaid and in the lowest income quartile had higher admission rates (p < .001). Opioid use, tobacco use, and mental health disorders were most commonly associated with SUDPP. The ED average inflation-adjusted charges for SUDPP increased from $1,486 to $3,085 between 2006 and 2016 (7.1% annual average percentage change; p < .001), yielding total annual charges of $4.02 million and $28.53 million.

      Conclusions

      Despite the decrease in admissions, the number and charges for ED visits for SUDPP increased substantially between 2006 and 2016. These increasing numbers suggest a continuous need to implement preventive public health measures and provide adequate outpatient care for this condition in this population specifically.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Agency for Healthcare Research and Quality
        HCUP sample design: National databases accessible version.
        (Available:)
        • Ailes E.C.
        • Dawson A.L.
        • Lind J.N.
        • Gilboa S.M.
        • Frey M.T.
        • Broussard C.S.
        • Honein M.A.
        • Centers for Disease Control and Prevention (CDC)
        Opioid prescription claims among women of reproductive age-United States, 2008-2012.
        MMWR Morbidity and Mortal Weekly Report. 2015; 64: 37-41
        • Alati R.
        • Al M.A.
        • Williams G.M.
        • O’Callaghan M.
        • Najman J.M.
        • Bor W.
        In utero alcohol exposure and prediction of alcohol disorders in early adulthood: A birth cohort study.
        Archives of General Psychiatry. 2006; 63: 1009-1016
        • Brown R.A.
        • Dakkak H.
        • Gilliland J.
        • Seabrook J.A.
        Predictors of drug use during pregnancy: The relative effects of socioeconomic, demographic, and mental health risk factors.
        Journal of Neonatology and Perinatal Medicine. 2019; 12: 179-187
        • Clegg L.X.
        • Hankey B.F.
        • Tiwari R.
        • Feuer E.J.
        • Edwards B.K.
        Estimating average annual per cent change in trend analysis.
        Statistics in Medicine. 2009; 28: 3670-3682
        • Compton W.M.
        • Thomas Y.F.
        • Stinson F.S.
        • Grant B.F.
        Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.
        Archives of General Psychiatry. 2007; 64: 566-576
        • D’Onofrio G.
        • O’Connor P.G.
        • Pantalon M.V.
        • Chawarski M.C.
        • Bush S.H.
        • Owens P.H.
        • Fielli D.A.
        Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: A randomized clinical trial.
        JAMA. 2015; 313: 1636-1644
        • El Marroun H.
        • Tiemeier H.
        • Jaddoe V.W.
        • Hofman A.
        • Mackenbach J.P.
        • Steegers E.A.
        • Huizink A.C.
        Demographic, emotional and social determinants of cannabis use in early pregnancy: The Generation R study.
        Drug and Alcohol Dependence. 2008; 98: 218-226
        • Epstein R.A.
        • Bobo W.V.
        • Martin P.R.
        • Morrow J.A.
        • Wang W.
        • Chandrasekhar R.
        • Cooper W.O.
        Increasing pregnancy-related use of prescribed opioid analgesics.
        Annals of Epidemiology. 2013; 23: 498-503
        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: Incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485
        • FRED economic data
        St. Louis Fed.
        (Available:)
        https://fred.stlouisfed.org
        Date accessed: August 20, 2018
        • Froen F.
        • Arnestad M.
        • Frey K.
        • Vege A.
        • Saugstad O.D.
        • Stray-Pedersen B.
        Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995.
        American Journal of Obstetrics and Gynecology. 2001; 184: 694-702
        • Florence C.S.
        • Zhou C.
        • Luo F.
        • Xu L.
        The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013.
        Medical Care. 2016; 54: 901-906
        • HCUP sample design
        national databases accessible version.
        (Available:)
        • Kim H.
        • McConnell J.
        • Sun B.C.
        Comparing emergency department use among Medicaid and commercial patients using all-payer all-claims data.
        Population and Health Management. 2017; 20: 271-277
        • Kotelchuck M.
        • Cheng E.R.
        • Belanoff C.
        • Cabral H.J.
        • Babakhanlou-Chase H.
        • Derrington T.M.
        • Bernstein J.
        The prevalence and impact of substance use disorder and treatment on maternal obstetric experiences and birth outcomes among singleton deliveries in Massachusetts.
        Maternal and Child Health Journal. 2017; 21: 893-902
        • Krans E.E.
        • Patrick S.W.
        Opioid use disorder in pregnancy: Health policy and practice in the midst of an epidemic.
        Obstetrics and Gynecology. 2016; 128: 4-10
        • Kunins H.V.
        • Bellin E.
        • Chazotte C.
        • Du E.
        • Arnsten J.H.
        The effect of race on provider decisions to test for illicit drug use in the peripartum setting.
        Journal of Womens Health (Larchmt). 2017; 16: 245-255
        • MacDorman M.F.
        • Cnattingius S.
        • Hoffman H.J.
        • Kramer M.S.
        • Haglund B.
        Sudden infant death syndrome and smoking in the United States and Sweden.
        American Journal of Epidemiology. 1997; 143: 249-257
        • Malik S.
        • Kothari C.
        • MacCallum C.
        • Liepman M.
        • Tareen S.
        • Rhodes K.V.
        Emergency department use in the perinatal period: An opportunity for early intervention.
        Annals of Emergency Medicine. 2017; 70: 835-839
        • Mitchell E.A.
        • Ford R.P.
        • Stewart A.W.
        • Taylor B.J.
        • Becroft D.M.
        • Thompson J.M.
        • Allen E.M.
        Smoking and the sudden infant death syndrome.
        Pediatrics. 1993; 91: 893-896
        • Morley C.
        • Unwin M.
        • Peterson G.M.
        • Stankovich J.
        • Kinsman L.
        Emergency department crowding: A systematic review of causes, consequences and solutions.
        PLoS One. 2018; 13: e0203316
        • Moyer C.L.
        • Johnson S.
        • Klug M.G.
        • Burd L.
        Substance use in pregnant women using the emergency department: Undertested and overlooked?.
        Western Journal of Emergency Medicine. 2018; 19: 579-584
        • National Institute on Drug Abuse (NIDA)
        Nationwide trends.
        (Available:)
        https://drugabuse.gov/publications/drugfacts/nationwide-trends
        Date: 2015
        Date accessed: December 12, 2019
        • Patrick S.W.
        • Schumacher R.E.
        • Benneyworth B.D.
        • Krans E.E.
        • McAllister J.M.
        • Davis M.M.
        Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009.
        JAMA. 2012; 307: 1934-1940
        • Perlman N.C.
        • Cantonwine D.E.
        • Smith N.A.
        Toxicology testing in pregnancy: Evaluating the role of social profiling.
        Obstetrics and Gynecology. 2020; 136: 607-609
        • Qato D.M.
        • Zhang C.
        • Gandhi A.B.
        • Simoni-Wastila L.
        • Coleman-Cowger V.H.
        Co-use of alcohol, tobacco, and licit and illicit controlled substances among pregnant and non-pregnant women in the United States: Findings from 2006 to 2014 National Survey on Drug Use and Health (NSDUH) data.
        Drug and Alcohol Dependence. 2019; 206: 107729
        • Salameh T.N.
        • Hall L.A.
        • Crawford T.N.
        • Staten R.R.
        • Hall M.T.
        Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014.
        Journal of Psychosomatic Obstetrics and Gynaecology. 2019; 13: 1-10
        • Substance Abuse and Mental Health Services Administration
        Results from the 2018 National Survey on Drug Use and Health: Detailed Accebles.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2019 (Available:)
        www.samhsa.gov/data/
        Date accessed: February 1, 2019
        • Sun R.
        • Karaca Z.
        • Wong H.S.
        Trends in hospital emergency department visits by age and payer, 2006–2015: Statistical Brief #238.
        in: Healthcare Cost and Utilization Project (HCUP) statistical briefs. Agency for Healthcare Research and Quality, Rockville, MD2006 (Available:)
        www.ncbi.nlm.nih.gov/books/NBK513766/
        Date accessed: July 22, 2019
        • U.S. Department of Health and Human Services (U.S. DHHS)
        Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), bridged-race population estimates, United States July 1st resident population by state, county, age, sex, bridged-race, and Hispanic origin. Compiled from 1990-1999 bridged-race intercensal population estimates (released by NCHS on 7/26/2004); revised bridged-race 2000-2009 intercensal population estimates (released by NCHS on 10/26/2012); and bridged-race Vintage 2016 (2010-2016) postcensal population estimates (released by NCHS on 6/26/2017).
        (Available:)
        • Weiss A.J.
        • Barrett M.L.
        • Heslin K.C.
        • Stocks C.
        Trends in emergency department visits involving mental and substance use disorders, 2006–2013. HCUP Stat. Br. #216.
        Agency Healthcare Research and Quality, Rockville, MD2020 (Available:)

      Biography

      Emma Giuliani, MD, is a Reproductive Endocrinology and Infertility specialist. Some of her special interests include fertility preservation as it relates to oncology patients, recurrent pregnancy loss, and endometriosis.

      Biography

      Courtney D. Townsel, MD, MSc, is a board-certified Maternal Fetal Medicine specialist. Her research interests include health disparities, substance use disorders in pregnancy, and translational research. She is currently investigating the placental epigenome in opioid exposed fetuses.

      Biography

      Li Jiang, MS, is a high-level analyst who supports statistical analysis throughout the Obstetrics and Gynecology Department.

      Biography

      Dayna J. Leplatte-Ogini, MD, is board certified in General Psychiatry and Child/Adolescent Psychiatry. She works in the child/adolescent outpatient clinic and provides psychiatric consultation. She is the Assistant Director of Medical Student Education for the Department of Psychiatry.

      Biography

      Martina T. Caldwell, MD, is an Emergency Medicine physician and is the Medical Director of Diversity & Inclusion for Henry Ford Medical Group. Her research focuses on ED interventions to improve reproductive health equity using community-based participatory research, mixed methods, and implementation science.

      Biography

      Erica E. Marsh, MD, MSCI, is a Professor and Chief of the Division of Reproductive Endocrinology and Infertility. She leads several NIH studies investigating reproductive issues in underrepresented populations and is very interested in use of the emergency department for women’s health issues.