Social factors and comorbidities in association with maternal substance use disorder: A descriptive cross-sectional...

Perinatal substance use disorder (SUD) is associated with adverse maternal and infant health outcomes. Recent data is limited on the role of maternal characteristics in SUD overall and for opioid use disorder (OUD) and cannabis use disorder (CUD), separately. Statewide hospital discharge data was used to describe recent patterns and examine social factors and comorbidities in association with SUD diagnosis outcomes.

Birth hospitalizations were identified in the State Inpatient Database from the Healthcare Cost and Utilization Project for MI (2019-2022, n = 398,836) to conduct a population-based serial cross-sectional study. SUD, OUD, and CUD were defined using ICD-10-CM diagnosis F codes based on previous research. Comorbidities were identified using the HCUP Elixhauser Comorbidity Software. Logistic regression models estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for each SUD outcome separately.

Overall SUD prevalence was 5.5% (n = 21,849), OUD prevalence was 0.8% (n = 3130), and CUD prevalence was 4.5% (n = 17,944). In models adjusting for age and year, factors associated with increased SUD prevalence included Medicaid (PR=4.06, 95% CI:3.94-4.18), lower zip-code based income (PR for Q1 vs. Q4 =4.74, 95% CI:4.41-5.08), higher total comorbidities (PR for ≥2 comorbidities=2.53, 95% CI:2.45-2.61), depression (PR=2.28, 95% CI:2.20-2.36), and Native American race/ethnicity (PR=2.05, 95% CI:1.78, 2.31). Results were generally similar for OUD and CUD.

We found a higher maternal SUD prevalence for women with lower zip-code based income and with co-occurring medical conditions including depression, which further increases risk of adverse health outcomes. Results highlight the importance of careful monitoring and support of women with SUD.