Association Among County-level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome

Abstract

(JAMA. 2019;321(4):385–393) Opioid use in the United States increased between 1999 and 2014, including opioid analgesics, heroin, and fentanyl. Opioid overdose deaths also increased during this time. From 2000 to 2014, the rate of neonatal abstinence syndrome (NAS) in the United States increased from 1.2 per 1000 hospital births to 80 per 1000 hospital births. The increases in both opioid overdose deaths and the rate of NAS disproportionately affected impoverished rural communities. Opioid-related complications for adults have been associated with poor access to health care, lack of economic opportunity, and diminished social capital, but links between these economic factors and opioid-related outcomes for infants have not yet been evaluated. This study aimed to examine the associations between long-term unemployment, clinician supply, and rates of NAS, while evaluating how these affect rural versus urban communities.