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Multilevel Factors Associated With Hospitalizations in the First-Year Postpartum Among Persons With Opioid Use

Jessica Frankeberger1,2, Robert W S Coulter1, Marian Jarlenski3

  • 1Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.

Substance Use & Addiction Journal
|June 27, 2025
PubMed

Insights

Increased access to opioid use disorder treatment facilities in a county is linked to fewer postpartum hospitalizations for individuals with opioid use disorder. Early postpartum hospitalizations predict later ones, highlighting the need for accessible care.

Area of Science:

  • Public Health
  • Addiction Medicine
  • Perinatal Health

Background:

  • The postpartum period presents unique challenges for individuals with opioid use disorder (OUD), including increased risk of health and drug-related problems due to new responsibilities and changing environments.
  • This study investigates factors contributing to hospitalization among individuals with OUD during their first year postpartum.

Purpose of the Study:

  • To examine county-level and individual-level factors associated with hospitalization in the first year postpartum among individuals with OUD.
  • To identify specific risk factors for all-cause, OUD-related, and mental health-related hospitalizations in early and late postpartum periods.

Main Methods:

  • A cohort of 1966 individuals with OUD at delivery in Pennsylvania was analyzed using hospital discharge data.
  • Multilevel logistic regression models assessed county-level factors (income, rurality, jail rate, OUD treatment facilities, hospital beds) and individual-level factors (demographics, insurance, substance use, mental health conditions).

Main Results:

  • 14% (n=280) of individuals experienced at least one hospitalization in the first year postpartum.
  • Higher county densities of OUD treatment facilities were associated with significantly lower odds of all hospitalization types in early postpartum (0-42 days), particularly OUD-related hospitalizations.
  • Younger maternal age and prior early postpartum hospitalizations were associated with increased odds of later hospitalizations, including mental health-related events.

Conclusions:

  • County-level healthcare and drug treatment systems play a significant role in hospitalizations among individuals with OUD postpartum.
  • Addressing systemic barriers to accessing OUD treatment and postpartum care is crucial for improving health outcomes and reducing drug-related harms for this population.
Abstract

Keywords:
communitiescountiesdrug treatmenthospitalizationsmental healthopioid use disorderpostpartumsocial determinants

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