Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017

In the United States, the rates of maternal opioid use disorder (MOD) and neonatal abstinence syndrome (NAS) have seen substantial increases between 2000 and 2014. Although these rates vary across states, they were captured before the 2015 transition to International Classification of Diseases, Tenth Revision (ICD-10). The aim of this study was to update the estimated rates of MOD and NAS on the national and state levels, and to examine changes associated with these rates from 2010 to 2017. This study is based on anonymized data from the Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases (SID). Both resources include data on hospital discharges from community hospitals. The SID represents data from 47 states and the District of Columbia. Primary outcomes were MOD and NAS rates. Secondary outcomes were hospital length of stay (LOS) and hospital costs. In the national sample, there were 5375 neonates with NAS out of 751,037 birth hospitalizations and 6065 women with MOD of 748,239 delivery hospitalizations in 2017. From 2010 to 2017, the NAS rate grew from 4.0 to 7.3 per 1000 hospitalizations (95% confidence interval [CI], 3.3-4.7 and 95% CI, 6.8-7.7, respectively)-a relative increase of 82%. Likewise, the MOD rate rose from 3.5 to 8.2 per 1000 hospitalizations (95% CI, 3.0-4.1 and 95% CI, 7.7-8.7, respectively)-a relative increase of 191%. The median LOS for neonates with NAS was 9.2 days longer (95% CI, 8.3-10.0) than other birth hospitalizations (10.8 days [95% CI, 9.9-11.6] vs 1.6 [95% CI, 1.6-1.6]; P < 0.001). The median cost for neonates with NAS was about $14,600 more [95% CI, $13,100-$16,000]) than other birth hospitalizations ($18,800 [95% CI, $17,400-$20,300] vs $4200 [95% CI, $4000-$4500]; P < 0.001). For women with MOD, the median LOS was 0.3 days longer (95% CI, 0.2-0.3) than other delivery hospitalizations (2.1 [95% CI, 2.0-2.1] vs 1.8 [95% CI, 1.8-1.9]; P < 0.001). The median cost was about $900 more (95% CI, $700-$1100) ($6100 [95% CI, $6000-$6300] vs $5100 [95% CI, $5100-$5300]; P < 0.001). Between 2010 and 2017, the median LOS and cost for neonates with NAS or women with MOD were similar. Using data from SID, the number of birth hospitalizations and delivery hospitalizationswere 3,550,105 and 3,561,752, respectively. NAS rates varied from 1.3 per 1000 hospitalizations in Nebraska to >30 per 1000 hospitalizations in West Virginia (53.5) and Maine (31.4). MOD rates ranged from 1.7 per 1000 hospitalizations in Nebraska to >30 per 1000 delivery hospitalizations in Vermont (47.3), West Virginia (40.1), and Maine (37.8). Significant increases in NAS rates were observed between 2010 and 2017 in 42 states, except Nebraska and Vermont. MOD rates also rose significantly during this time in 41 states. Significant increases were observed in both NAS and MOD rates at the national level. Although the rates of NAS and MOD varied by state, the majority of states saw significant increases in both rates.