Long-term Unemployment Linked to Neonatal Abstinence Syndrome

Highlights:

Long-term unemployment and poor mental health services encourage opioid use
This can lead to the birth of babies suffering from neonatal abstinence syndrome (NAS) due to opioid exposure before birth
Improvement of economic conditions could reduce opioid use thereby reducing the incidence of NAS

Long-term unemployment and poor mental healthcare services are linked to neonatal abstinence syndrome (NAS), which is a withdrawal syndrome experienced by babies due to opioid exposure before birth. This new study was carried out by a research team at Vanderbilt University Medical Center and RAND Corporation, USA.

The study analyzed data from 6.3 million births from eight states having diverse demographic characteristics. It was found that babies born in counties having high rates of long-term unemployment and low mental healthcare services were born with NAS. This association was mainly observed in metropolitan counties.

The study is significant because it is the first to examine the association between poor economy, healthcare personnel shortages and the incidence of NAS, which occurs in babies who are chronically exposed to opioids before birth.

The study was led by Dr. Stephen W. Patrick, MD, MPH, MS, FAAP, who is an Assistant Professor of Pediatrics and Health Policy at the Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

The study has been published in the Journal of the American Medical Association (JAMA).

Neonatal Abstinence Syndrome – Causes Symptoms Diagnosis Treatment
Neonatal abstinence syndrome is a condition where newborn babies experience withdrawal symptoms due to use of addictive illicit or prescription drugs such as narcotics.

‘Neonatal abstinence syndrome (NAS) occurs in counties in the US having long-term unemployment rates and poor mental healthcare services. Improvement of economic conditions could reduce opioid use, thereby reducing the incidence of NAS.’
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Neonatal Abstinence Syndrome (NAS): Facts & Figures

Between 2000-2014, the rates of NAS increased from 1.2 cases per 1,000 hospital births to 8 cases per 1,000 hospital births
In 2014, on an average, one baby born every 15 minutes in the US suffered from NAS
Between 2009-2015, the rates of NAS increased from 3.2 cases to 14.5 cases per 1,000 hospital births
Between 2009-2015, the 10-year unemployment rate increased from 6.5 percent to 8.2 percent
County macroeconomic conditions affect rates of NAS, especially in rural counties
Economic development should be considered as a health intervention for reducing the incidence of NAS cases

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Key Aspects of the Study

The key aspects of the study are indicated below:

The study is based on county-level data from eight states: (1) Florida, (2) Kentucky, (3) Massachusetts, (4) Michigan, (5) North Carolina, (6) New York, (7) Tennessee, and (8) Washington
The research team analyzed data from 6.3 million births between 2009-2015 in 580 counties of the above eight states

Opioid Affected Births Rising Among Rural Residents
Opioid addicted pregnant women are giving more births in rural hospitals, where both maternity care and substance use treatment are limited.

Key Findings of the Study

The major findings of the study are indicated below:

Counties with persistently higher unemployment rates were associated with increased prevalence of NAS, especially in rural remote counties
Prevalence of NAS in counties with the highest unemployment rates was 20.1 cases per 1,000 hospital births
Prevalence of NAS in counties with the lowest unemployment rates was 7.8 cases per 1,000 hospital births
In rural remote counties, a higher proportion of manufacturing jobs was associated with increased rates of NAS
The degree of shortage of mental healthcare providers in various counties is presented below:

Metropolitan counties: 78 percent shortage
Metro-adjacent rural counties: 86 percent shortage
Rural remote counties: 91 percent shortage

Counties with a shortage of mental healthcare providers were associated with higher rates of NAS, especially in metropolitan counties
Counties with mental healthcare provider shortages had 14 NAS cases per 1,000 hospital births, compared to 1.6 NAS cases per 1,000 hospital births in other counties
Prevalence of NAS cases had no correlation with physical healthcare providers

In this regard, Patrick says: “The finding should open our eyes to the social complexities that lead to newborns being treated for drug withdrawal in our nation’s hospitals.”

Non-pharmacologic Approaches May Improve Neonatal Abstinence Syndrome
Non-pharmacologic treatment approaches such as parental presence at the infant's bedside, skin to skin contact, and breastfeeding as first-line treatment can improve neonatal abstinence syndrome (NAS) symptoms.

Expert Comments

“We know that individuals with mental health problems are more likely to use or be dependent on opioids,” says co-senior author, Dr. Bradley D. Stein, MD, MPH, PhD, who is a Senior Physician Policy Researcher at the Pittsburgh Office of RAND Corporation and an Adjunct Associate Professor of Psychiatry, University of Pittsburgh, Pennsylvania, USA. “Our findings suggest that until we can provide better access to effective mental health care, we face an uphill battle effectively addressing the opioid crisis.”

In this regard, Patrick says: “The opioid crisis is not just a health care problem, it is also a social problem, and solutions will need to address the social needs of communities as well as the healthcare needs.” He adds: “As Congress considers legislation, particularly those related to building infrastructure in rural communities, it should consider that these investments may also benefit the health of communities.”

Reference:

Association among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome - (https://jamanetwork.com/journals/jama/article-abstract/2722771)

Source-Medindia