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

Introduction: During the postpartum period, new parental responsibilities may compound changing social, community, and health care environments to increase risk of health and drug-related problems. This study examines both county-level and individual-level factors associated with hospitalization among individuals with opioid use disorder (OUD) throughout the first-year postpartum.

Methods: A cohort of individuals with OUD at delivery were identified in Pennsylvania hospital discharge data (n = 1966). Multilevel logistic regression models examined county-level (median household income, rurality, jail rate, OUD treatment facilities, hospital beds) and individual-level (demographics, insurance, tobacco use, other substance use disorders, mental health conditions) factors associated with inpatient hospitalizations (all-cause, OUD-related, mental health-related) in the early (0-42 days) and late (43-365 days) postpartum periods.

Results: In total, 280 individuals (14%) with OUD had at least 1 hospitalization in the first-year postpartum. After adjustment, higher county densities of OUD treatment facilities were associated with lower odds of all 3 types of hospitalizations in early postpartum, including 80% to 86% reduced odds of OUD-related hospitalizations for those in counties with the 3 highest quartiles of treatment facility densities compared with the lowest quartile. These associations did not remain significant in late postpartum. All maternal age groups, compared with those aged 25 to 29, had increased odds of a mental health-related hospitalization in early postpartum, and the youngest age group (17-24 years) had increased odds in late postpartum. Experiencing any hospitalization from 0 to 42 days postpartum was positively associated with all 3 types of hospitalizations in late postpartum.

Discussion: County health care and drug treatment systems are associated with hospitalizations among individuals with OUD throughout the first-year postpartum. Addressing policy, sociocultural, and structural barriers to accessing these services should be a priority for improving postpartum health and reducing drug-related harms in this period.