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.
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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.
Article info
Publication history
Published online: June 03, 2022
Accepted:
April 27,
2022
Received in revised form:
April 22,
2022
Received:
August 16,
2021
Footnotes
Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declarations of Conflicts of Interest: Dr. Marsh is a consultant for Myovant Sciences and Pfizer. The other authors have no disclosures to report.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
