TY - JOUR
KW - Adult
KW - African Americans/statistics & numerical data
KW - Buprenorphine/therapeutic use
KW - Continental Population Groups/statistics & numerical data
KW - European Continental Ancestry Group/statistics & numerical data
KW - Female
KW - Healthcare Disparities/statistics & numerical data
KW - Hispanic Americans/statistics & numerical data
KW - Humans
KW - Massachusetts
KW - Methadone/therapeutic use
KW - Opiate Substitution Treatment/statistics & numerical data
KW - Opioid-Related Disorders/complications/drug therapy
KW - Pregnancy
KW - Pregnancy Complications/drug therapy
AU - D. M. Schiff
AU - T. Nielsen
AU - B. B. Hoeppner
AU - M. Terplan
AU - H. Hansen
AU - D. Bernson
AU - H. Diop
AU - M. Bharel
AU - E. E. Krans
AU - S. Selk
AU - J. F. Kelly
AU - T. E. Wilens
AU - E. M. Taveras
A1 - 
AB - IMPORTANCE: Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown. OBJECTIVE: To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates. MAIN OUTCOMES AND MEASURES: Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. RESULTS: The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment. CONCLUSIONS AND RELEVANCE: This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women. Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.
AD - Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts.; Child Population and Translational Health Research, University of Sydney, Randwick, New South Wales, Australia.; Department of Psychiatry, Massachusetts General Hospital, Boston.; Friends Research Institute, Baltimore, Maryland.; Department of Psychiatry, New York University, New York, New York.; Massachusetts Department of Public Health, Boston.; Massachusetts Department of Public Health, Boston.; Massachusetts Department of Public Health, Boston.; Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.; Massachusetts Department of Public Health, Boston.; Department of Psychiatry, New York University, New York, New York.; Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston.; Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts.
BT - JAMA network open
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 5
DO - 10.1001/jamanetworkopen.2020.5734
IS - 5
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown. OBJECTIVE: To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates. MAIN OUTCOMES AND MEASURES: Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. RESULTS: The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment. CONCLUSIONS AND RELEVANCE: This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women. Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.
PY - 2020
SN - 2574-3805; 2574-3805
T1 - Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts
T2 - JAMA network open
TI - Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 32453384
U3 - 10.1001/jamanetworkopen.2020.5734
VL - 3
VO - 2574-3805; 2574-3805
Y1 - 2020
Y2 - May 1
ER -