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Dr. Jessica Frankeberger, postdoctoral fellow, Department of Pediatrics and Center for Better Beginnings at the University of California San Diego and Dr. Christina Mair, associate professor from the University of Pittsburgh, studied the Social Ecological Contexts of Opioid Overdose and Hospitalizations in Pennsylvania using Pennsylvania Health Care Cost Containment (PHC4) data combined with community data from other sources. Dr. Mair and Dr. Frankeberger conducted this study to identify individual and community risk factors associated with increased susceptibility to postpartum death and hospitalizations among people with an opioid use disorder and aim to prevent further problems during the postpartum period. The team focused their research on the residential community environment in pregnancy and the postpartum period to provide information for service resource allocation and community interventions throughout Pennsylvania.

Dr. Frankeberger expressed that the PHC4 data was the central component for the analysis that allowed her research team to examine spatial patterns of delivery hospitalizations for patients with an opioid use disorder, at the zip code-level, over a period of four years, and to assess the ecological and community factors associated with this geographic variation. She stated, “The PHC4 data provided a cohort of individuals at delivery through 12 months postpartum during 2016 through 2019. The research team examined patient-level factors such as comorbidities and outcomes, including postpartum opioid-related and mental health-related hospitalizations in Pennsylvania, along with community factors such as demographics and health service availability by using patients’ residential county and zip codes.”

Results of the study showed there was an increase in delivery hospitalizations with an opioid use disorder from 1.6% in 2016 to 1.8% in 2019. Dr. Frankeberger shared some of the study results noting, “Hotspots for delivery hospitalizations with an opioid use disorder were found primarily in western and southeastern Pennsylvania. Worse economic conditions and greater population density in a zip code were associated with an increase in delivery hospitalizations with an opioid use disorder, while areas with a greater proportion of non-Hispanic Black and Hispanic residents were associated with fewer delivery hospitalizations with opioid use disorder.”

Dr. Frankeberger stated, “Among a cohort of patients with an opioid use disorder and a delivery hospitalization in 2018, we examined individual- and county-level factors associated with hospitalization throughout the first year postpartum (2018-2019). We identified three co-occurring typologies that involved the presence of either a: substance use disorder (non-opioid use disorder), mental health condition, or infection (e.g., HIV, Hepatitis C). Individuals with a substance use disorder or a mental health condition had an increased risk of hospitalization in both the early (0-42 days) and late (43-365 days) postpartum periods. We then examined county-level factors, such as median income, hospital availability, and opioid use disorder treatment availability, associated with postpartum hospitalizations. After controlling for co-occurring conditions, greater opioid use disorder treatment availability in a county was associated with a decrease in the number of postpartum hospitalizations in the early postpartum period. It was surprising that this protective association of opioid use disorder treatment availability did not continue to be associated with a lower number of hospitalizations in the late postpartum period and may speak to the lack of access and barriers to treatment in this period regardless of geographic availability.”

“We highly recommend anyone interested in studying spatial and temporal hospitalization patterns in Pennsylvania use the PHC4 data.” said Dr. Mair.

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