The Impact of Remoteness on the Outcomes of Children With Prenatal Drug Exposure: A Population-Based Cohort Study

Remote residents have worse health outcomes than metropolitan residents, but whether geography impacts the outcomes of children with prenatal drug exposure (PDE) is uncertain.

Linked population data was used to compare rates of death, hospitalisation, emergency department (ED) encounters and placement in Out-of-Home Care (OOHC) for children with (n = 208 492) and without (n = 1 607 662) smoking, alcohol or substance exposure in NSW, Australia, born between 2001 and 2020. The relationship between remoteness of residence, PDE, service utilisation and death was determined with interaction terms after adjusting for confounders (First Nations status, maternal age, maternal mental illness, social disadvantage). Outcomes are reported as adjusted incidence rate ratios with 95% confidence intervals.

Compared to other NSW children, children with PDE were more likely to die (2.90; 2.33-3.61), be placed in OOHC (52.43; 50.14-54.84), be hospitalised (1.22; 1.10-1.36) and attend ED (1.06; 1.03-1.09). Compared to metropolitan children with PDE, regional children were more likely to die (1.12; 0.78-1.61) but less likely to be hospitalised (0.82; 0.72-0.94), placed in OOHC (0.41; 0.37-0.44) and attend ED (0.93; 0.89-0.98). ED encounters increased up to 2.5-fold for regional children with PDE from 2001 to 2020.

Children with PDE in regional areas are likely to use fewer hospital resources than their metropolitan counterparts, but are more likely to die, mainly from preventable causes. Equitable access to preventative health and psychosocial support must be prioritised to improve outcomes of these children.