Misclassification and racial disparities in neonatal abstinence syndrome among American Indians and Alaska Natives

This article was originally published here

J Racial and ethnic disparities in health. August 19, 2021. doi: 10.1007 / s40615-021-01127-z. Online ahead of print.


OBJECTIVES: Maternal substance abuse can lead to neonatal abstinence syndrome (ANS), a drug withdrawal process in newborns exposed in utero to drugs. The purpose of this study was to examine the effect of the erroneous racial classification of Native American Indians and Alaska Natives (AI / AN) on SIN rates in two hospital discharge data sets in the Northwest of the Pacific.

METHODS: We performed probabilistic record linkages between the Northwest Tribal Registry and the Oregon and Washington hospital discharge datasets to correct for the erroneous racial classification of AI / AN individuals. We assessed outcomes using International Classification of Diseases, Ninth Revision / Tenth Revision, Clinical Modification (ICD-9-CM or ICD-10-CM) diagnostic codes.

RESULTS: Linkage increased the number of NAS cases among RN / NA by 8.8% in Oregon and 18.1% in Washington. AI / AN infants were 1.5 and 3.9 times more likely to be diagnosed with NAS than NHW infants from Oregon and Washington, respectively. The results showed that newborns residing in rural Washington areas 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 the quality of data 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 programming efforts tailored to insurance status and rurality for pregnant women who use substances.

PMID: 34410606 | DOI: 10.1007 / s40615-021-01127-z

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