Neonatal Outcomes in a Medicaid Population With Opioid Dependence
Abstract Confounding may account for the apparently improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid-dependent mother-infant pairs (2006–2011), supplemented with confounder da...
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| Veröffentlicht in: | American journal of epidemiology 2018-06, Vol.187 (6), p.1153-1161 |
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| container_title | American journal of epidemiology |
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| creator | Brogly, Susan B Hernández-Diaz, Sonia Regan, Emily Fadli, Ela Hahn, Kristen A Werler, Martha M |
| description | Abstract
Confounding may account for the apparently improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid-dependent mother-infant pairs (2006–2011), supplemented with confounder data from an external Boston, Massachusetts, cohort (2015–2016). Associations between prenatal buprenorphine exposure versus methadone exposure and infant outcomes in the MAX cohort were adjusted for measured MAX confounders and were additionally adjusted for unmeasured confounders with bias analysis using external cohort data. A total of 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users than methadone users were white and used psychotropic medications. After adjustment for MAX confounders, risk ratios among infants exposed to buprenorphine versus those exposed to methadone were 0.45 (95% confidence interval (CI): 0.34, 0.61) for preterm birth (birth at |
| doi_str_mv | 10.1093/aje/kwx341 |
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Confounding may account for the apparently improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid-dependent mother-infant pairs (2006–2011), supplemented with confounder data from an external Boston, Massachusetts, cohort (2015–2016). Associations between prenatal buprenorphine exposure versus methadone exposure and infant outcomes in the MAX cohort were adjusted for measured MAX confounders and were additionally adjusted for unmeasured confounders with bias analysis using external cohort data. A total of 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users than methadone users were white and used psychotropic medications. After adjustment for MAX confounders, risk ratios among infants exposed to buprenorphine versus those exposed to methadone were 0.45 (95% confidence interval (CI): 0.34, 0.61) for preterm birth (birth at <37 weeks) and 0.75 (95% CI: 0.51, 1.11) for low birth weight for gestational age. The mean difference in infant hospitalization was −7.35 days (95% CI: −9.16, −5.55). After further adjustment with bias analysis, the risk ratios were 0.53 (95% CI: 0.39, 0.71) for preterm birth and 1.14 (95% CI: 0.77, 1.69) for low birth weight for gestational age, and the mean difference in infant hospitalization was −3.66 days (95% CI: −5.46, −1.87). External confounder data can be used to adjust for unmeasured confounding in studies of prenatal outcomes among women on opioid agonist therapy based on administrative databases.</description><identifier>ISSN: 0002-9262</identifier><identifier>EISSN: 1476-6256</identifier><identifier>DOI: 10.1093/aje/kwx341</identifier><identifier>PMID: 29155919</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Bias ; Birth weight ; Buprenorphine ; Confidence intervals ; Confounding (Statistics) ; Dependence ; Drug dependence ; Drug withdrawal ; Editor's Choice ; Exposure ; Gestational age ; Government programs ; Health risk assessment ; Infants ; Low birth weight ; Medicaid ; Methadone ; Narcotics ; Neonates ; Newborn babies ; Opioids ; Original Contributions ; Pregnancy ; Premature birth ; Prenatal experience ; Prenatal exposure ; Risk analysis ; Weight</subject><ispartof>American journal of epidemiology, 2018-06, Vol.187 (6), p.1153-1161</ispartof><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-d8038c7a9bf58d277fb89fb99d6cf8e6f0f2f84a6fe2c2b4db9d07da9d1ff9ca3</citedby><cites>FETCH-LOGICAL-c462t-d8038c7a9bf58d277fb89fb99d6cf8e6f0f2f84a6fe2c2b4db9d07da9d1ff9ca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29155919$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brogly, Susan B</creatorcontrib><creatorcontrib>Hernández-Diaz, Sonia</creatorcontrib><creatorcontrib>Regan, Emily</creatorcontrib><creatorcontrib>Fadli, Ela</creatorcontrib><creatorcontrib>Hahn, Kristen A</creatorcontrib><creatorcontrib>Werler, Martha M</creatorcontrib><title>Neonatal Outcomes in a Medicaid Population With Opioid Dependence</title><title>American journal of epidemiology</title><addtitle>Am J Epidemiol</addtitle><description>Abstract
Confounding may account for the apparently improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid-dependent mother-infant pairs (2006–2011), supplemented with confounder data from an external Boston, Massachusetts, cohort (2015–2016). Associations between prenatal buprenorphine exposure versus methadone exposure and infant outcomes in the MAX cohort were adjusted for measured MAX confounders and were additionally adjusted for unmeasured confounders with bias analysis using external cohort data. A total of 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users than methadone users were white and used psychotropic medications. After adjustment for MAX confounders, risk ratios among infants exposed to buprenorphine versus those exposed to methadone were 0.45 (95% confidence interval (CI): 0.34, 0.61) for preterm birth (birth at <37 weeks) and 0.75 (95% CI: 0.51, 1.11) for low birth weight for gestational age. The mean difference in infant hospitalization was −7.35 days (95% CI: −9.16, −5.55). After further adjustment with bias analysis, the risk ratios were 0.53 (95% CI: 0.39, 0.71) for preterm birth and 1.14 (95% CI: 0.77, 1.69) for low birth weight for gestational age, and the mean difference in infant hospitalization was −3.66 days (95% CI: −5.46, −1.87). External confounder data can be used to adjust for unmeasured confounding in studies of prenatal outcomes among women on opioid agonist therapy based on administrative databases.</description><subject>Bias</subject><subject>Birth weight</subject><subject>Buprenorphine</subject><subject>Confidence intervals</subject><subject>Confounding (Statistics)</subject><subject>Dependence</subject><subject>Drug dependence</subject><subject>Drug withdrawal</subject><subject>Editor's Choice</subject><subject>Exposure</subject><subject>Gestational age</subject><subject>Government programs</subject><subject>Health risk assessment</subject><subject>Infants</subject><subject>Low birth weight</subject><subject>Medicaid</subject><subject>Methadone</subject><subject>Narcotics</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Opioids</subject><subject>Original Contributions</subject><subject>Pregnancy</subject><subject>Premature birth</subject><subject>Prenatal experience</subject><subject>Prenatal exposure</subject><subject>Risk analysis</subject><subject>Weight</subject><issn>0002-9262</issn><issn>1476-6256</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kctKxTAQhoMoerxsfAApiCBCNUnbNNkI4h3U40JxGdJkojn2JLVpvby9laOiLlwNzHz8_MOH0DrBuwSLbE9NYO_x5TXLyRwakbxkKaMFm0cjjDFNBWV0CS3HOMGYEFHgRbREBSkKQcQIHVxB8KpTdTLuOx2mEBPnE5VcgnFaOZNch6avVeeCT-5c95CMGxeG9RE04A14Datowao6wtrnXEG3J8c3h2fpxfj0_PDgItU5o11qOM64LpWobMENLUtbcWErIQzTlgOz2FLLc8UsUE2r3FTC4NIoYYi1QqtsBe3Pcpu-moLR4LtW1bJp3VS1bzIoJ39fvHuQ9-FZFoLTkmdDwPZnQBueeoidnLqooa6Vh9BHSQRjguc5ywd08w86CX3rh_ckzTCjGS8ZG6idGaXbEGML9rsMwfLDjBzMyJmZAd74Wf8b_VIxAFszIPTNf0Hvon-YYA</recordid><startdate>20180601</startdate><enddate>20180601</enddate><creator>Brogly, Susan B</creator><creator>Hernández-Diaz, Sonia</creator><creator>Regan, Emily</creator><creator>Fadli, Ela</creator><creator>Hahn, Kristen A</creator><creator>Werler, Martha M</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180601</creationdate><title>Neonatal Outcomes in a Medicaid Population With Opioid Dependence</title><author>Brogly, Susan B ; Hernández-Diaz, Sonia ; Regan, Emily ; Fadli, Ela ; Hahn, Kristen A ; Werler, Martha M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-d8038c7a9bf58d277fb89fb99d6cf8e6f0f2f84a6fe2c2b4db9d07da9d1ff9ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Bias</topic><topic>Birth weight</topic><topic>Buprenorphine</topic><topic>Confidence intervals</topic><topic>Confounding (Statistics)</topic><topic>Dependence</topic><topic>Drug dependence</topic><topic>Drug withdrawal</topic><topic>Editor's Choice</topic><topic>Exposure</topic><topic>Gestational age</topic><topic>Government programs</topic><topic>Health risk assessment</topic><topic>Infants</topic><topic>Low birth weight</topic><topic>Medicaid</topic><topic>Methadone</topic><topic>Narcotics</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Opioids</topic><topic>Original Contributions</topic><topic>Pregnancy</topic><topic>Premature birth</topic><topic>Prenatal experience</topic><topic>Prenatal exposure</topic><topic>Risk analysis</topic><topic>Weight</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brogly, Susan B</creatorcontrib><creatorcontrib>Hernández-Diaz, Sonia</creatorcontrib><creatorcontrib>Regan, Emily</creatorcontrib><creatorcontrib>Fadli, Ela</creatorcontrib><creatorcontrib>Hahn, Kristen A</creatorcontrib><creatorcontrib>Werler, Martha M</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brogly, Susan B</au><au>Hernández-Diaz, Sonia</au><au>Regan, Emily</au><au>Fadli, Ela</au><au>Hahn, Kristen A</au><au>Werler, Martha M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neonatal Outcomes in a Medicaid Population With Opioid Dependence</atitle><jtitle>American journal of epidemiology</jtitle><addtitle>Am J Epidemiol</addtitle><date>2018-06-01</date><risdate>2018</risdate><volume>187</volume><issue>6</issue><spage>1153</spage><epage>1161</epage><pages>1153-1161</pages><issn>0002-9262</issn><eissn>1476-6256</eissn><abstract>Abstract
Confounding may account for the apparently improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid-dependent mother-infant pairs (2006–2011), supplemented with confounder data from an external Boston, Massachusetts, cohort (2015–2016). Associations between prenatal buprenorphine exposure versus methadone exposure and infant outcomes in the MAX cohort were adjusted for measured MAX confounders and were additionally adjusted for unmeasured confounders with bias analysis using external cohort data. A total of 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users than methadone users were white and used psychotropic medications. After adjustment for MAX confounders, risk ratios among infants exposed to buprenorphine versus those exposed to methadone were 0.45 (95% confidence interval (CI): 0.34, 0.61) for preterm birth (birth at <37 weeks) and 0.75 (95% CI: 0.51, 1.11) for low birth weight for gestational age. The mean difference in infant hospitalization was −7.35 days (95% CI: −9.16, −5.55). After further adjustment with bias analysis, the risk ratios were 0.53 (95% CI: 0.39, 0.71) for preterm birth and 1.14 (95% CI: 0.77, 1.69) for low birth weight for gestational age, and the mean difference in infant hospitalization was −3.66 days (95% CI: −5.46, −1.87). External confounder data can be used to adjust for unmeasured confounding in studies of prenatal outcomes among women on opioid agonist therapy based on administrative databases.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>29155919</pmid><doi>10.1093/aje/kwx341</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Bias Birth weight Buprenorphine Confidence intervals Confounding (Statistics) Dependence Drug dependence Drug withdrawal Editor's Choice Exposure Gestational age Government programs Health risk assessment Infants Low birth weight Medicaid Methadone Narcotics Neonates Newborn babies Opioids Original Contributions Pregnancy Premature birth Prenatal experience Prenatal exposure Risk analysis Weight |
| title | Neonatal Outcomes in a Medicaid Population With Opioid Dependence |
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