Abstract
Objective Individual patient-level measures of adverse social determinants of health are associated
with neonatal opioid withdrawal syndrome (NOWS), but the relative impact of community-level
adverse social determinants of health remains to be defined. We examined the association
between community-level social vulnerability and NOWS among pregnant individuals receiving
buprenorphine for opioid use disorder.
Study Design We conducted a secondary analysis of an established cohort of pregnant individuals
and their infants participating in a multidisciplinary prenatal/addiction care program
from 2013 to 2021. Addresses were geocoded using ArcGIS and linked at the census tract
to the Centers for Disease Control and Prevention 2018 Social Vulnerability Index
(SVI), incorporating 15 census variables. The primary exposure was the SVI as a composite
measure of community-level social vulnerability, and secondarily, individual scores
for four thematic domains (socioeconomic status, household composition and disability,
minority status and language, and housing type and transportation). The primary outcome
was a clinical diagnosis of NOWS defined as withdrawal requiring pharmacological treatment
following buprenorphine exposure.
Results Among 703 pregnant individuals receiving buprenorphine, 39.8% (280/703) of infants
were diagnosed with NOWS. Among our patinets, those who were nulliparous, had post-traumatic
stress disorder, a term birth (≥ 37 weeks) and had a male infant were more likely
to have an infant diagnosed with NOWS. Individuals with and without an infant diagnosed
with NOWS had similarly high community-level social vulnerability per composite SVI
scores (mean [standard deviation]: 0.6 [0.4–0.7] vs. 0.6 [0.4–0.7], p = 0.2]. In adjusted analyses, SVI, as a composite measure as well as the four domains,
was not associated with NOWS diagnosis.
Conclusion Among pregnant persons receiving buprenorphine enrolled in a multidisciplinary prenatal
and addition care program, while individual risk factors that measure adverse social
determinants of health were associated with an NOWS diagnosis in the infant, community-level
social vulnerability as measured by the SVI was not associated with the outcome.
Key Points
Community-level SVI was not associated with neonatal opioid use disorder.
Certain individual risk factors were identified as being associated with NOWS.
Homogeneity of composite SVI scores may have led to lack of significant findings.
Keywords co-located prenatal care - health care disparities - pregnancy - substance abuse
