Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012.
OBJECTIVE
Neonatal abstinence syndrome (NAS), a postnatal opioid withdrawal syndrome, increased threefold from 2000 to 2009. Since 2009, opioid pain reliever prescriptions and complications increased markedly throughout the United States. Understanding recent changes in NAS and its geographic variability would inform state and local governments in targeting public health responses.


METHODS
We utilized diagnostic and demographic data for hospital discharges from 2009 to 2012 from the Kids' Inpatient Database and the Nationwide Inpatient Sample. NAS-associated diagnoses were identified utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes. All analyses were conducted with nationally weighted data. Expenditure data were adjusted to 2012 US dollars. Between-year differences were determined utilizing least squares regression.


RESULTS
From 2009 to 2012, NAS incidence increased nationally from 3.4 (95% confidence interval (CI): 3.2 to 3.6) to 5.8 (95% CI 5.5 to 6.1) per 1000 hospital births, reaching a total of 21,732 infants with the diagnosis. Aggregate hospital charges for NAS increased from $732 million to $1.5 billion (P<0.001), with 81% attributed to state Medicaid programs in 2012. NAS incidence varied by geographic census division, with the highest incidence rate (per 1000 hospital births) of 16.2 (95% CI 12.4 to 18.9) in the East South Central Division (Kentucky, Tennessee, Mississippi and Alabama) and the lowest in West South Central Division Oklahoma, Texas, Arkansas and Louisiana 2.6 (95% CI 2.3 to 2.9).


CONCLUSIONS
NAS incidence and hospital charges grew substantially during our study period. This costly public health problem merits a public health approach to alleviate harm to women and children. States, particularly, in areas of the country most affected by the syndrome must continue to pursue primary prevention strategies to limit the effects of opioid pain reliever misuse.
1] Department of Pediatrics, Vanderbilt University, Nashville, TN, USA [2] Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, TN, USA [3] Vanderbilt Center for Health Services Research, Nashville, TN, USA [4] Department of Health Policy, Vanderbilt University, Nashville, TN, USA.
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Patrick
1] Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA [2] Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA [3] Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Davis
1] Department of Pediatrics, Vanderbilt University, Nashville, TN, USA [2] Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, TN, USA [3] Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.
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Lehmann
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Lehman
1] Department of Pediatrics, Vanderbilt University, Nashville, TN, USA [2] Vanderbilt Center for Health Services Research, Nashville, TN, USA [3] Department of Health Policy, Vanderbilt University, Nashville, TN, USA.
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Cooper
D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D017722:Hospital Charges / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008484:Medicaid / Q000191:economics*; D009357:Neonatal Abstinence Syndrome / Q000191:economics* / Q000453:epidemiology*; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology
D000701:Analgesics, Opioid