622 Racial disparities in U.S. neonatal opioid withdrawal hospital length of stay, 2009-2016

Abstract

Neonatal opioid withdrawal syndrome (NOWS) incidence is on the rise amid the US opioid epidemic. Substance use surveillance data shows differences in type of opioids accessed by different racial groups. A recent study showed a difference in rates of pharmacotherapy administered to Black vs White newborns with NOWS. Differing treatment modalities and the type and amount of in-utero opioid exposure impacts hospital length of stay (LOS), a driver of healthcare expenditures and a contributor to postpartum maternal stress. We analyzed NOWS LOS trends by race, and patient and systems-level factors that may be associated with variations in LOS. We conducted a retrospective, serial, cross sectional analysis of a large sample of newborns with NOWS using the Kids’ Inpatient Database (KID) to identify newborns with NOWS from 2009 to 2016 by ICD-9 and ICD-10 codes. We performed Multivariable linear regressions to identify associations between LOS and the main independent variables (race/ethnicity), as well as other key co-variates previously associated with NOWS LOS (severity, comorbidities, sex, insurance, region). We analyzed 94,327 newborns, of which most were Non-Hispanic White (76,515, 81.12%), while 6284 (6.66%) were Non-Hispanic Black, and 5545 (5.88%) were Hispanic. Black neonates’ NOWS LOS increased from 2009 to 2016 (16.29 to 22.18 days), compared to near-steady LOS for the overall cohort, and among White neonates (16.29 to 16 16.2 days). When adjusting for NAS severity, geography, comorbidities, sex and insurance, the disparities remain: NOWS LOS is over a day longer for Black neonates (1.15, 95% CI 0.88,2.86, P <0.001) and over 2 days longer for Hispanic neonates (2.3, 95% CI, 0.81,3.79, P <0.001). County fixed-effects account for Black-White, but not White-Hispanic disparity. White newborns with NOWS have shorter LOS than Black or Hispanic newborns with NOWS. This difference may be due to variations in-utero exposure, hospital and county-level factors. These findings may have implications for pediatric and postpartum maternal mental health disparities.