Social Ecological Contexts of Hospital Admissions in the First Year Postpartum among Persons with Opioid Use Disorder

Abstract

Opioid overdose is a leading cause of death during pregnancy and within a year of delivery. While the postpartum period is marked by profound life changes for all, individuals with opioid use disorder (OUD) may face additional challenges that heighten their vulnerability to drug and health concerns within the first year postpartum. The goal of this dissertation is to further our understanding of the individual factors and social ecological contexts that contribute to OUD in pregnancy and hospitalization in the first year postpartum among persons with OUD. Utilizing statewide, inpatient hospital discharge data from the Pennsylvania Health Care Cost Containment Council (PHC4), this dissertation aims to: 1) assess the spatial patterns and ZIP code-level factors associated with delivery hospitalizations with OUD across the state; 2) identify subgroups of persons with OUD at delivery by comorbid conditions who are at increased risk of hospitalization in the first year postpartum; and 3) examine the associations of county-level contextual factors with hospitalization within a year of delivery within the same cohort. The first analyses found that ZIP code-level urbanicity, worse economic conditions, overall hospitalization rate, and the presence of an OUD treatment facility were associated with increased OUD delivery hospitalizations in the general population across Pennsylvania. In the second analysis, three distinct subgroups were identified among a cohort of individuals with OUD at delivery by comorbid substance use disorders (SUDs), mental health conditions, and infections. Compared to the Low Comorbidities class (low prevalence of most comorbidities), both the moderate polysubstance use/depression class (all persons had depression and some had co-occurring SUDs) and the high polysubstance use/bipolar disorder class (highest prevalence of SUDs and bipolar disorder across classes) had increased risk of all-cause and mental health-related hospitalizations from 0-42 days postpartum and SUD- and mental health-related hospitalizations from 43-365 days postpartum. The third analysis found that an increased rate of OUD treatment facilities per population in a county was associated with a reduction in OUD-related hospitalizations from 0-42 days postpartum. These findings provide important information needed to develop and implement multilevel interventions to address maternal opioid morbidity and mortality