Social determinants of health associated with newly documented opioid-related postpartum readmissions

Peripartum opioid-related mortality has increased in recent years, and social determinants of health (SDOH) are associated with adverse maternal outcomes. We sought to identify risk factors (including SDOH risk factors) for 180-day postpartum readmissions related to opioid use among individuals without a documented diagnosis of opioid use at delivery.

We performed a retrospective cohort study using 2016-2021 data from the Nationwide Readmissions Database. Delivery hospitalizations and subsequent 180-day postpartum readmissions with a new opioid-use diagnosis were identified. Newly documented opioid use was defined as opioid dependence, abuse, or overdose documented at readmission without evidence of opioid use disorder at or prior to delivery. SDOH exposures were categorized into domains reflecting education/employment, physical environment, and social factors using International Classification of Diseases (ICD)-10 codes. Temporal trends in opioid use-related postpartum readmissions were evaluated using joinpoint regression to estimate average annual percent change (AAPC) with 95% confidence intervals (CIs). Multivariable logistic regression was used to estimate associations between SDOH and 180-day newly documented opioid use readmission, adjusting for demographic and clinical factors.

Among 10,278,674 delivery hospitalizations, 3129 individuals (3.0 per 10,000) experienced a postpartum readmission with newly documented opioid use. The rate of 180-day postpartum opioid-related readmission declined from 3.7 to 2.2 per 10,000 delivery hospitalizations between 2016 and 2021 (AAPC, -10.4%; 95% CI, -13.5% to -7.8%). In unadjusted models, education- or employment-related SDOH (odds ratio [OR], 6.26; 95% CI, 2.70-14.51), SDOH related to the physical environment, housing, or economic circumstances (OR, 20.93; 95% CI, 14.81-29.57), and social SDOH (OR, 4.09; 95% CI, 2.51-6.65) were associated with opioid-related readmission. In adjusted models, only SDOH related to the physical environment, housing, or economic circumstances remained independently associated with opioid-related readmission (adjusted odds ratio [aOR], 4.87; 95% CI, 3.35-7.09).

Although postpartum readmissions for newly documented opioid use have declined nationally, individuals experiencing adverse physical environment-related SDOH remain at significantly elevated risk. Early identification of structural vulnerability and linkage to supportive services may help reduce opioid-related postpartum morbidity.