Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012

Abstract

Objectives This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. Methods We used 2007–2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. Results Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44–0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45–0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45–1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64–0.72]; aOR, 0.86 [95% CI, 0.80–0.92]; aOR, 0.71 [95% CI, 0.64–0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80–0.91]; aOR, 0.86 [95% CI, 0.80–0.93]; aOR, 0.83 [95% CI, 0.73–0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05–1.20]; aOR, 1.12 [95% CI, 1.00–1.26]). Conclusions Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.