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Preventive Care Uptake and Long-Term Healthcare Use Among Children with Fetal Opioid Exposure in Ontario, Canada: A
Arum Han1, Gabrielle Pratt Tremblay1,2, Michael Pugliese3
1School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Insights
Children exposed to opioids before birth had fewer well-child visits and more emergency care. This highlights the need for better preventive care access for these children throughout their lives.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Limited data exists on healthcare use patterns in children with prenatal opioid exposure.
- Early healthcare engagement can influence long-term health service utilization.
Purpose of the Study:
- To characterize early and long-term healthcare service visits in children with prenatal opioid exposure.
- To understand the impact of prenatal opioid exposure on healthcare utilization across childhood.
Main Methods:
- Population-based retrospective cohort study in Ontario, Canada.
- Linked health administrative databases used for live-born infants (2007-2018).
- Examined uptake of well-child visits and rates of inpatient, outpatient, and emergency visits up to 13 years of age.
Main Results:
- Prenatal opioid exposure (0.99% of cohort) was linked to reduced well-child visit uptake (IRR: 0.82).
- Exposed children had lower rates of enhanced 18-month visits (RR: 0.89).
- Increased rates of emergency visits, specialist visits, and hospitalizations were observed in exposed children, with differences most pronounced in early childhood.
Conclusions:
- Prenatal opioid exposure is associated with decreased preventive care and increased ambulatory care use.
- Early gaps in preventive care may shape later healthcare utilization patterns.
- Effective strategies are needed to improve access to and engagement with preventive care for opioid-exposed children.
Introduction:
Data on preventive care visits and long-term healthcare use patterns among children with prenatal opioid exposure remain limited. From a life course perspective, early impacts on health care engagement may shape patterns of health service use across childhood.
Objective:
To characterise early and long-term healthcare service visits among children with prenatal opioid exposure using linked population-based health administrative databases from Ontario, Canada.
Methods:
We conducted a population-based retrospective cohort study of live-born infants born between April 1, 2007, and March 31, 2018, who were born to mothers aged 15-50 years and who were eligible for provincial health insurance for at least 3 months before conception. Prenatal opioid use identified during routine prenatal care was extracted from clinical and perinatal health records. The primary outcome was the uptake of well-child visits until 24 months of age, an important early life preventive care period. Rates of all-cause inpatient, outpatient, and emergency department visits were examined and compared across the follow-up period and within specific time intervals up to 13 years of age.
Results:
The final cohort totalled 1,343,653 live births, of whom 13,290 children (0.99%) had documented prenatal exposure to opioids. Prenatal opioid exposure was associated with reduced incidence of well-child visits (adjusted incidence rate ratio: 0.82 (95% CI: 0.81, 0.83)) from birth to 2 years. Exposed children were less likely to receive an enhanced 18-month well-child visit (adjusted risk ratio: 0.89 (95% CI: 0.88, 0.90)). Prenatal exposure was associated with increased rates of emergency department visits, specialist visits, hospitalisations and same-day surgery visits over the follow-up period. Differences in rates of health care visits were most pronounced in early childhood and attenuated for some services at older ages.
Conclusions:
Prenatal opioid exposure was associated with reduced uptake of preventive health services and greater use of ambulatory care. This finding is consistent with a life course model, in which early gaps in preventive care may influence later-life care use patterns, and highlights the need for effective strategies to promote access to and engagement with preventive care services for opioid-exposed children.
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