Incidence of Neonatal Abstinence Syndrome Epidemic and Associated Predictors in Nevada: A Statewide Audit, 2016–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Source
2.2. Sample Selection
2.3. Statistical Analysis
3. Results
3.1. Incidence
3.2. Predictors
4. Discussion
4.1. Limitations
4.2. Strengths
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Geographical Unit | Number of NAS Cases | Rate Per 1000 Hospital Births a | Overall Rate Per 1000 | ||||
---|---|---|---|---|---|---|---|
(95% Confidence Interval e) | |||||||
2016 | 2017 | 2018 | 2016 | 2017 | 2018 | (2016–2018) | |
Statewide (Nevada) | 292 | 247 | 257 | 8.6 (8.0, 10.0) | 7.5 (7.0, 8.0) | 7.7 (7.0, 9.0) | 8.0 (7.0, 9.0) |
Region b name | |||||||
Southern Nevada | 234 | 194 | 192 | 9.1 (8.0, 10.0) | 7.8 (7.0, 9.0) | 7.7 (7.0, 9.0) | 8.2 (8.0, 9.0) |
Northern Nevada | 12 | 12 | 10 | 7.1 (5.0, 17.0) | 7.1 (3.0, 11.0) | 7.2 (4.0, 12.0) | 7.1 (5.0, 9.0) |
Washoe | 34 | 33 | 39 | 6.5 (4.0, 9.0) | 6.6 (4.0, 9.0) | 7.5 (5.0, 10.0) | 6.8 (6.0, 8.0) |
Rural Nevada | NR c | NR | NR | 4.1 (0, 9.0) | 2.4 (0, 6.0) | 5.3 (0.0, 10.0) | 4.0 (1.0, 6.0) |
County name | |||||||
Clark | 230 | 191 | 190 | 9.1 (8.0, 10.0) | 7.8 (7.0, 9.0) | 7.7 (7.0, 9.0) | 8.2 (8.0, 9.0) |
Washoe | 34 | 33 | 39 | 6.5 (4.0, 9.0) | 6.5 (4.0, 9.0) | 7.5 (5.0, 10.0) | 6.8 (6.0, 8.0) |
Others d | 20 | 18 | 23 | 7.0 (4.0, 10.0) | 6.0 (3.0, 9.0) | 7.9 (5.0, 11.0) | 7.0 (5.0, 9.0) |
City name | |||||||
Las Vegas | 164 | 140 | 137 | 8.6 (7.0, 10.0) | 7.6 (6.0, 9.0) | 7.4 (6.0, 9.0) | 8.0 (7.0, 9.0) |
Henderson | 43 | 29 | 27 | 15.0 (11.0, 20.0) | 10.0 (6.0, 14.0) | 9.7 (6.0, 13.0) | 11.6 (9.0, 14.0) |
North Las Vegas | 18 | 18 | 23 | 5.6 (3.0, 8.0) | 6.0 (3.0, 9.0) | 7.5 (4.0, 11.0) | 6.4 (5.0, 8.0) |
Reno | 26 | 21 | 27 | 7.6 (5.0, 11.0) | 6.4 (4.0, 9.0) | 8.0 (5.0, 11.0) | 7.3 (6.0, 9.0) |
Sparks | NR | NR | NR | 5.0 (1.0, 9.0) | 6.9 (2.0, 11.0) | 5.0 (1.0, 9.0) | 5.5 (3.0, 8.0) |
Group Criteria | Number of NAS Cases | Rate Per 1000 Hospital Births | Overall Rate Per 1000 | ||||
---|---|---|---|---|---|---|---|
(95% Confidence Interval g) | |||||||
2016 | 2017 | 2018 | 2016 | 2017 | 2018 | (2016–2018) | |
Gender | |||||||
Male | 141 | 133 | 133 | 8.2 (7.0, 10.0) | 7.8 (7.0, 9.0) | 7.8 (7.0, 9.0) | 8.0 (7.0, 9.0) |
Female | 149 | 114 | 124 | 8.9 (8.0, 10.0) | 7.0 (6.0, 8.0) | 7.6 (6.0, 9.0) | 8.0 (7.0, 9.0) |
Race | |||||||
White | 217 | 161 | 172 | 14.0 (12.0, 16.0) | 11.0 (9.0, 13.0) | 11.0 (9.0, 13.0) | 12.0 (11.0, 13.0) |
Black | 30 | 29 | 25 | 7.0 (5.0, 9.0) | 6.5 (4.0, 9.0) | 5.4 (3.0, 7.0) | 6.2 (5.0, 8.0) |
Hispanic | 21 | 25 | 24 | 2.5 (1.0, 4.0) | 3.3 (2.0, 5.0) | 3.8 (2.0, 5.0) | 3.1 (2.0, 5.0) |
Asian Pacific Islander | NR a | NR | NR | 0.9 (0, 2.0) | 3.0 (1.0, 5.0) | 3.8 (1.0, 6.0) | 2.5 (1.0, 4.0) |
Urbanization level of residence | |||||||
Large central metro b | 230 | 191 | 190 | 9.1 (8.0, 10.0) | 7.8 (7.0, 9.0) | 7.7 (7.0, 9.0) | 8.2 (8.0, 9.0) |
Medium metro c | 34 | 33 | 39 | 6.5 (4.0, 9.0) | 6.5 (4.0, 9.0) | 7.5 (5.0, 10.0) | 6.8 (4.0, 9.0) |
Small metro d | NR | NR | NR | 5.5 (0, 10.0) | 5.0 (0, 10.0) | 3.7 (0, 9.0) | 6.3 (2.0, 10.0) |
Rural e | 16 | 12 | 16 | 7.9 (4.0, 12.0) | 5.5 (2.0, 9.0) | 7.6 (4.0, 11.0) | 6.9 (5.0, 9.0) |
Payer source | |||||||
Nevada Medicaid | 229 | 197 | 190 | 14.0 (12.0, 16.0) | 13.0 (11.0, 15.0) | 12.7 (11.0, 14.0) | 13.2 (11.0, 15.0) |
Private | 48 | 39 | 51 | 3.2 (2.0, 4.0) | 2.6 (2.0, 3.0) | 3.3 (2.0, 4.0) | 3.1 (2.0, 4.0) |
Uninsured f | 15 | 11 | 16 | 6.1 (3.0, 9.0) | 3.7 (2.0, 6.0) | 5.4 (2.0, 6.0) | 5.0 (2.0, 6.0) |
Median household income | |||||||
Quartile 1 (≤$47,999) | 34 | 25 | 21 | 15.9 (11.0, 21.0) | 12.0 (7.0, 17.0) | 10.2 (6.0, 15.0) | 12.8 (8.0, 13.0) |
Quartile 2 ($48,000–$60,999) | 136 | 128 | 125 | 8.4 (7.0, 10.0) | 8.2 (7.0, 10.0) | 7.9 (7.0, 9.0) | 8.2 (7.0, 9.0) |
Quartile 3 ($61,000–$81,999) | 106 | 78 | 91 | 8.5 (7.0, 10.0) | 6.2 (5.0, 8.0) | 7.2 (6.0, 9.0) | 7.3 (6, 8) |
Quartile 4 (≥$82,000) | NR | NR | NR | 5.9 (1.0, 11.0) | 6.0 (1.0, 11.0) | 4.9 (1.0, 9.0) | 5.7 (3.0, 8.0) |
Model | Model 1 | Model 2 | Model 3 |
---|---|---|---|
Model building process | |||
Method | No predictors, just random effect for the intercept | Model 1 + level-1 fixed effects a | Model 2 + level-2 predictors b |
Model fit statistics | |||
AIC c | 9179.62 | 4860.87 | 4792 |
BIC d | 9181.29 | 4880.87 | 4813 |
Hospital clustering statistics | |||
ICC e | 0.065 (6.5%) |
Variable | Odds Ratio a (95% Confidence Interval) | |
---|---|---|
Model 2 | Model 3 | |
Patient characteristics | ||
Female | Reference | Reference |
Male | 0.97 (0.8–1.1) | 0.97 (0.8–1.2) |
Race | ||
Hispanic | Reference | Reference |
White | 6.69 (5.1–8.7) | 6.16 (4.7–8.1) |
Black | 1.73 (1.2–2.4) | 1.64 (1.2–2.3) |
Asian or Pacific islander | 1.32 (0.8–2.2) | 1.22 (0.71–2.11) |
Payer | ||
Self-pay/uninsured | Reference | Reference |
Private | 0.56 (0.4–0.8) | 0.54 (0.4–0.8) |
Nevada Medicaid | 2.87 (2.0–4.2) | 2.88 (2.0–4.2) |
Comorbidities | ||
Feeding difficulty | 4.60 (3.7–5.7) | 4.54 (3.6–5.7) |
Neonatal Jaundice | 3.30 (2.8–4.0) | 3.32 (2.8–4.0) |
Seizures | 2.90 (1.3–6.7) | 2.96 (1.3–6.9) |
Transient Tachypnoea | 2.50 (2.0–3.1) | 2.43 (1.9–3.1) |
RDS b | 1.12 (0.9–1.4) | 1.11 (0.9–1.4) |
Sepsis | 1.65 (1.2–2.3) | 1.67 (1.2–2.3) |
Meconium Aspiration Syndrome | 1.00 (0.3–2.4) | 0.98 (0.3–2.4) |
Respiratory problems | 0.53 (0.2–1.3) | 0.53 (0.2–1.3) |
Low birth weight | 0.97 (0.7–1.4) | 0.97 (0.7–1.4) |
Hospital factors | ||
Bed size | - | - |
≥300 | - | Reference |
101–299 | - | 0.92 (0.5–1.7) |
≤100 | - | 0.98 (1.0–2.1) |
Location | ||
Rural | - | Reference |
Urban | - | 1.37 (0.5–3.0) |
Status | - | - |
Non-teaching | - | Reference |
Teaching | - | 0.93 (0.4–1.2) |
Type | - | - |
Non-private | - | Reference |
Private | - | 0.56 (0.6–1.1) |
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Batra, K.; Cruz, P.; Cross, C.L.; Bhandari, N.; Abdulla, F.; Pharr, J.R.; Buttner, M.P. Incidence of Neonatal Abstinence Syndrome Epidemic and Associated Predictors in Nevada: A Statewide Audit, 2016–2018. Int. J. Environ. Res. Public Health 2021, 18, 232. https://doi.org/10.3390/ijerph18010232
Batra K, Cruz P, Cross CL, Bhandari N, Abdulla F, Pharr JR, Buttner MP. Incidence of Neonatal Abstinence Syndrome Epidemic and Associated Predictors in Nevada: A Statewide Audit, 2016–2018. International Journal of Environmental Research and Public Health. 2021; 18(1):232. https://doi.org/10.3390/ijerph18010232
Chicago/Turabian StyleBatra, Kavita, Patricia Cruz, Chad L. Cross, Neeraj Bhandari, Farooq Abdulla, Jennifer R. Pharr, and Mark P. Buttner. 2021. "Incidence of Neonatal Abstinence Syndrome Epidemic and Associated Predictors in Nevada: A Statewide Audit, 2016–2018" International Journal of Environmental Research and Public Health 18, no. 1: 232. https://doi.org/10.3390/ijerph18010232