Identifying Prenatal Opioid Exposure in Health Administrative Data for Public Health Surveillance and Epidemiologic Research

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Andi Camden
Teresa To
Joel G Ray
Tara Gomes
Li Bai
Kinwah Fung
Astrid Guttmann


Accurate estimation of prenatal opioid exposure (POE) is needed for population-based surveillance & research but can be challenging with health administrative data due to varying definitions & methods. Prior research has relied primarily on infant records with a diagnosis of neonatal abstinence syndrome (NAS).

Objectives and Approach
1) Evaluate the impact of using different definitions of maternal opioid use in the estimation of POE; 2) Investigate whether maternal characteristics vary by the type of definition used. Population-based cross-sectional study of all hospital births (N= 454,746) from 2014-2017 in Ontario, Canada. Multiple linked population-based health administrative databases were used to identify opioid-related pre- & perinatal Emergency Department visits & hospitalizations & opioid prescriptions. We examined how pre-conception & in-pregnancy maternal characteristics varied by using different approaches to ascertain POE.

There were 9624 live/still births with POE. Ascertainment of POE was highest using maternal prescription drug data (79%) & infant hospital records with NAS (45%). Maternal characteristics varied by data source used for POE ascertainment. Opioid-related health care during pregnancy identified a high-risk phenotype, contrasted with those ascertained through prescription data, with respective rates of 64% vs. 54% for social assistance, 37% vs. 12% for polydrug use, 23% vs. 6% for alcohol use, 26% vs. 19% for 3+ live births, 13% vs. 5% for victim of violence, 12% vs. 6% for involvement in criminal justice system & 64% vs. 17% for mental health & addictions hospital care.

Conclusion / Implications
POE ascertainment differs by health administrative data source & ability to link both across maternal records and with infant. Prescription drug data identified the highest number of opioid-exposed births and, with linked healthcare records, is useful to identify illicit opioid use & additional risk factors. Clinically meaningful differences in maternal characteristics of opioid users exist by POE ascertainment method.

Article Details

How to Cite
Camden, A., To, T., Ray, J. G., Gomes, T., Bai, L., Fung, K. and Guttmann, A. (2020) “Identifying Prenatal Opioid Exposure in Health Administrative Data for Public Health Surveillance and Epidemiologic Research”, International Journal of Population Data Science, 5(5). doi: 10.23889/ijpds.v5i5.1453.

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