TY - JOUR
T1 - Racial Misclassification and Disparities in Neonatal Abstinence Syndrome Among American Indians and Alaska Natives
AU - Lan, Chiao Wen
AU - Joshi, Sujata
AU - Dankovchik, Jenine
AU - Jimenez, Candice
AU - Needham Waddell, Elizabeth
AU - Lutz, Tam
AU - Lapidus, Jodi
N1 - Funding Information:
This project was produced with funding support from the National Institute on Drug Abuse of the National Institute of Health under award number (R21 DA047940).
Publisher Copyright:
© 2021, W. Montague Cobb-NMA Health Institute.
PY - 2022/10
Y1 - 2022/10
N2 - Objectives: Maternal substance misuse can result in neonatal abstinence syndrome (NAS), a drug withdrawal process in newborns exposed in utero to drugs. This study aimed to examine the effect of racial misclassification of American Indians and Alaska Natives (AI/AN) on rates of NAS in two hospital discharge datasets in the Pacific Northwest. Methods: We conducted probabilistic record linkages between the Northwest Tribal Registry and Oregon and Washington hospital discharge datasets to correct racial misclassification of AI/AN people. We assessed outcomes using International Classification of Disease, Ninth Revision/Tenth Revision, Clinical Modification (ICD-9-CM or ICD-10-CM) diagnosis codes. Results: Linkage increased ascertainment of NAS cases among AI/AN by 8.8% in Oregon and by 18.1% in Washington. AI/AN newborns were 1.5 and 3.9 times more likely to be diagnosed with NAS than NHW newborns in Oregon and Washington, respectively. The results showed that newborns residing in rural Washington were 1.4 times more likely to be diagnosed with NAS than those living in urban areas. Conclusions: Correct racial classification is an important factor in improving data quality for AI/AN populations and establishing accurate surveillance to help address the disproportionate burden of neonatal abstinence syndrome among AI/AN. The results highlight the need for programing efforts tailored by insurance status and rurality for pregnant women using substances.
AB - Objectives: Maternal substance misuse can result in neonatal abstinence syndrome (NAS), a drug withdrawal process in newborns exposed in utero to drugs. This study aimed to examine the effect of racial misclassification of American Indians and Alaska Natives (AI/AN) on rates of NAS in two hospital discharge datasets in the Pacific Northwest. Methods: We conducted probabilistic record linkages between the Northwest Tribal Registry and Oregon and Washington hospital discharge datasets to correct racial misclassification of AI/AN people. We assessed outcomes using International Classification of Disease, Ninth Revision/Tenth Revision, Clinical Modification (ICD-9-CM or ICD-10-CM) diagnosis codes. Results: Linkage increased ascertainment of NAS cases among AI/AN by 8.8% in Oregon and by 18.1% in Washington. AI/AN newborns were 1.5 and 3.9 times more likely to be diagnosed with NAS than NHW newborns in Oregon and Washington, respectively. The results showed that newborns residing in rural Washington were 1.4 times more likely to be diagnosed with NAS than those living in urban areas. Conclusions: Correct racial classification is an important factor in improving data quality for AI/AN populations and establishing accurate surveillance to help address the disproportionate burden of neonatal abstinence syndrome among AI/AN. The results highlight the need for programing efforts tailored by insurance status and rurality for pregnant women using substances.
KW - American Indians and Alaska Natives
KW - Neonatal abstinence syndrome
KW - Racial disparities
KW - Racial misclassification
UR - http://www.scopus.com/inward/record.url?scp=85112837164&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112837164&partnerID=8YFLogxK
U2 - 10.1007/s40615-021-01127-z
DO - 10.1007/s40615-021-01127-z
M3 - Article
C2 - 34410606
AN - SCOPUS:85112837164
SN - 2197-3792
VL - 9
SP - 1897
EP - 1904
JO - Journal of Racial and Ethnic Health Disparities
JF - Journal of Racial and Ethnic Health Disparities
IS - 5
ER -