Table 1.
Cohort characteristics of pregnancies with or without exposure to opioids after vaginal delivery in Medicaid Analytic eXtract 2009–2013
| Characteristic | Before matching | After matching | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Opioid prescription after delivery | Standardized difference | Opioid prescription after delivery | Standardized difference | |||||||
| Exposed N=140,807 | Unexposed N=319,022 | Exposed N=118,508 | Unexposed N=118,508 | |||||||
| N | %* | N | %* | N | %* | N | %* | |||
| Year | ||||||||||
| 2009 | 35992 | 25.6 | 78344 | 24.6 | 0.02 | 30249 | 25.5 | 30032 | 25.3 | 0.00 |
| 2010 | 33891 | 24.1 | 75188 | 23.6 | 0.01 | 28436 | 24.0 | 28587 | 24.1 | 0.00 |
| 2011 | 34793 | 24.7 | 82255 | 25.8 | −0.03 | 29722 | 25.1 | 30203 | 25.5 | −0.01 |
| 2012 | 19598 | 13.9 | 54061 | 16.9 | −0.08 | 16339 | 13.8 | 15760 | 13.3 | 0.01 |
| 2013 | 16533 | 11.7 | 29174 | 9.1 | 0.09 | 13762 | 11.6 | 13926 | 11.8 | 0.00 |
| Maternal demographic | ||||||||||
| Age, mean (SD) | 24.35 | 5.5 | 24.72 | 5.7 | −0.07 | 24.29 | 5.4 | 24.27 | 5.7 | 0.00 |
| Race/Ethnicity † | ||||||||||
| White | 77327 | 54.9 | 124874 | 39.1 | 0.32 | 60538 | 51.1 | 60767 | 51.3 | 0.00 |
| Black | 42153 | 29.9 | 92261 | 28.9 | 0.02 | 37594 | 31.7 | 38668 | 32.6 | −0.02 |
| Hispanic | 14086 | 10.0 | 69073 | 21.7 | −0.32 | 13477 | 11.4 | 12433 | 10.5 | 0.03 |
| Other/Unknown | 7241 | 5.1 | 32814 | 10.3 | −0.19 | 6899 | 5.8 | 6640 | 5.6 | 0.01 |
| Region | ||||||||||
| Midwest | 44109 | 31.3 | 93421 | 29.3 | 0.04 | 40426 | 34.1 | 41871 | 35.3 | −0.03 |
| Northeastern | 12800 | 9.1 | 108743 | 34.1 | −0.64 | 12448 | 10.5 | 11002 | 9.3 | 0.04 |
| South | 63115 | 44.8 | 54477 | 17.1 | 0.63 | 46031 | 38.8 | 46317 | 39.1 | −0.01 |
| West | 20783 | 14.8 | 62381 | 19.6 | −0.13 | 19603 | 16.5 | 19318 | 16.3 | 0.01 |
| CDC county level opioid prescribing rate, per 100 people, Mean (SD) | 104.83 | 49.5 | 70.56 | 40.0 | 0.76 | 96.92 | 42.7 | 97.68 | 47.8 | −0.02 |
| Delivery characteristics and opioid indications | ||||||||||
| Bilateral tubal ligation | 12325 | 8.8 | 4015 | 1.3 | 0.35 | 5103 | 4.3 | 3662 | 3.1 | 0.06 |
| Periurethral trauma | 5880 | 4.2 | 13022 | 4.1 | 0.01 | 5168 | 4.4 | 5477 | 4.6 | −0.01 |
| High vaginal laceration | 1801 | 1.3 | 4582 | 1.4 | −0.01 | 1597 | 1.4 | 1660 | 1.4 | −0.01 |
| Third-degree laceration or anal sphincter tear | 1919 | 1.4 | 3663 | 1.1 | 0.02 | 1554 | 1.3 | 1586 | 1.3 | 0.00 |
| Fourth-degree laceration | 859 | 0.6 | 716 | 0.2 | 0.06 | 538 | 0.5 | 494 | 0.4 | 0.01 |
| Episiotomy | 16251 | 11.5 | 32793 | 10.3 | 0.04 | 13261 | 11.2 | 12646 | 10.7 | 0.02 |
| Chronic comorbid conditions | ||||||||||
| Depression | 6808 | 4.8 | 12024 | 3.8 | 0.05 | 5465 | 4.6 | 5671 | 4.8 | −0.01 |
| Anxiety | 3754 | 2.7 | 5947 | 1.9 | 0.05 | 2930 | 2.5 | 2951 | 2.5 | 0.00 |
| Post Traumatic Stress Disorder | 657 | 0.5 | 1136 | 0.4 | 0.02 | 536 | 0.5 | 564 | 0.5 | 0.00 |
| Sleep disorders | 506 | 0.4 | 577 | 0.2 | 0.03 | 375 | 0.3 | 373 | 0.3 | 0.00 |
| Obstetric comorbidity score | 0.67 | 1.2 | 0.53 | 1.1 | 0.12 | 0.62 | 1.2 | 0.65 | 1.3 | −0.02 |
| Pain related conditions | ||||||||||
| Sciatica | 605 | 0.4 | 1079 | 0.3 | 0.02 | 480 | 0.4 | 496 | 0.4 | 0.00 |
| Arthritis/arthropathies, and musculoskeletal pain | 6106 | 4.3 | 10239 | 3.2 | 0.06 | 4767 | 4.0 | 4918 | 4.2 | −0. 01 |
| Back or neck pain | 11309 | 8.0 | 16984 | 5.3 | 0.11 | 8724 | 7.4 | 8872 | 7.5 | −0.01 |
| Migraine | 5826 | 4.1 | 8881 | 2.8 | 0.07 | 4481 | 3.8 | 4582 | 3.9 | 0.00 |
| Orthopedic injury | 2840 | 2.0 | 4803 | 1.5 | 0.04 | 2310 | 2.0 | 2426 | 2.1 | −0.01 |
| Neuropathy /neuralgia | 891 | 0.6 | 1436 | 0.5 | 0.03 | 683 | 0.6 | 736 | 0.6 | −0.01 |
| Fibromyalgia | 560 | 0.4 | 767 | 0.2 | 0.03 | 437 | 0.4 | 434 | 0.4 | 0.00 |
| Other pain | 2451 | 1.7 | 1413 | 0.4 | 0.13 | 1407 | 1.2 | 1230 | 1.0 | 0.01 |
| Infection | 12542 | 8.9 | 28457 | 8.9 | 0.00 | 10613 | 9.0 | 10738 | 9.1 | 0.00 |
| Substance use disorder or dependence | ||||||||||
| Alcohol abuse or dependence | 386 | 0.3 | 820 | 0.3 | 0.00 | 324 | 0.3 | 359 | 0.3 | −0.01 |
| Tobacco use | 23369 | 16.6 | 28723 | 9.0 | 0.23 | 17174 | 14.5 | 17508 | 14.8 | −0.01 |
| Cocaine use | 156 | 0.1 | 284 | 0.1 | 0.01 | 125 | 0.1 | 138 | 0.1 | 0.00 |
| Marijuana use | 738 | 0.5 | 1517 | 0.5 | 0.01 | 604 | 0.5 | 645 | 0.5 | −0.01 |
| Amphetamine use | 199 | 0.1 | 388 | 0.1 | 0.01 | 176 | 0.2 | 190 | 0.2 | 0.00 |
| Medications | ||||||||||
| Number of opioid prescriptions in the 90 days prior to index | ||||||||||
| 0 | 127072 | 90.2 | 303847 | 95.2 | −0.19 | 108503 | 91.6 | 108411 | 91.5 | 0.00 |
| 1 | 11617 | 8.3 | 13747 | 4.3 | 0.16 | 8711 | 7.4 | 8899 | 7.5 | −0.01 |
| 2 | 1857 | 1.3 | 1304 | 0.4 | 0.10 | 1162 | 0.9 | 1081 | 0.9 | 0.01 |
| 3+ | 261 | 0.2 | 124 | 0.0 | 0.04 | 132 | 0.1 | 117 | 0.1 | 0.00 |
| Total morphine equivalents for all opioid prescriptions | 32.1 | 1723.3 | 31.6 | 1848.1 | 0.00 | 30.1 | 1726.3 | 25.8 | 1364.7 | 0.00 |
| Antidepressant | 6907 | 4.9 | 7415 | 2.3 | 0.14 | 4900 | 4.1 | 4910 | 4.1 | 0.00 |
| Benzodiazepine | 1101 | 0.8 | 866 | 0.3 | 0.07 | 674 | 0.6 | 628 | 0.5 | 0.01 |
| Other hypnotics | 6161 | 4.4 | 7876 | 2.5 | 0.11 | 4546 | 3.8 | 4493 | 3.8 | 0.00 |
| Barbiturates | 1607 | 1.1 | 1408 | 0.4 | 0.08 | 1030 | 0.9 | 1016 | 0.9 | 0.00 |
| Anxiolytics | 425 | 0.3 | 307 | 0.1 | 0.05 | 250 | 0.2 | 238 | 0.2 | 0.00 |
| Mood stabilizers | 534 | 0.4 | 699 | 0.2 | 0.03 | 379 | 0.3 | 369 | 0.3 | 0.00 |
| Typical antipsychotics | 60 | 0.0 | 126 | 0.0 | 0.00 | 50 | 0.04 | 43 | 0.04 | 0.00 |
| Atypical antipsychotics | 468 | 0.3 | 669 | 0.2 | 0.02 | 364 | 0.3 | 365 | 0.3 | 0.00 |
| Stimulants | 439 | 0.3 | 388 | 0.1 | 0.04 | 307 | 0.3 | 293 | 0.3 | 0.00 |
*
Percentages may not total 100 because of rounding. Abbreviation: CDC - Centers for Disease Control and Prevention.
†
Race/ethnicity was determined based on information submitted to the Centers for Medicare & Medicaid Services by individual states, which was based on information that had been collected and coded from Medicaid applications. Other/Unknown category includes American Indian or Alaskan native, Asian, native Hawaiian or other pacific islander, more than one race, and unknown.