OBJECTIVE:To assess trends in polysubstance use among pregnant women with opioid use disorder in the United States.
METHODS:We conducted a time trend analysis of pooled, cross-sectional data from the ...National Inpatient Sample, an annual nationally representative sample of U.S. hospital discharge data. Among 38.0 million females aged 15–44 years with a hospitalization for delivery from 2007 to 2016, we identified 172,335 pregnant women with an International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of opioid use disorder. Polysubstance use among pregnant women with opioid use disorder was defined as at least one co-occurring diagnosis of other substance use, including alcohol, amphetamine, cannabis, cocaine, sedative, or tobacco. We fit weighted multivariable logistic regression models to produce nationally representative estimates, including an interaction between year and rural compared with urban county of residence; controlled for age, race, and insurance type. Average predicted probabilities and 95% CIs were derived from regression results.
RESULTS:Polysubstance use among women with opioid use disorder increased from 60.5% (95% CI 58.3–62.8%) to 64.1% (95% CI 62.8%–65.3%). Differential time trends in polysubstance use among women with opioid use disorder were found in rural compared with urban counties. Large increases in amphetamine use occurred among those in both rural and urban counties (255.4%; 95% CI 90.5–562.9% and 150.7%; 95% CI 78.2–52.7%, respectively), similarly to tobacco use (30.4%; 95% CI 16.9–45.4% and 23.2%; 95% CI 15.3–31.6%, respectively). Cocaine use diagnoses declined among women with opioid use disorder at delivery in rural (−70.5%; 95% CI −80.4% to −55.5%) and urban (−61.9%; 95% CI −67.6% to −55.1%) counties. Alcohol use diagnoses among those with opioid use disorder declined −57% (95% CI −70.8% to −37.7%) in urban counties but did not change among those in rural counties.
CONCLUSION:Over the past decade, polysubstance use among pregnant women with opioid use disorder has increased more rapidly in rural compared with urban counties in the United States, with amphetamines and tobacco use increasing most rapidly.
Introduction A high intake of fast food is associated with increased obesity risk. This study assessed recent changes in caloric content and macronutrient composition in large U.S. fast food ...restaurants. Methods Data from the MenuStat project included 11,737 menu items in 37 fast food restaurants from 2012 to 2014. Generalized linear models were used to examine changes in the caloric content and corresponding changes in the macronutrient composition (non-sugar carbohydrates, sugar, unsaturated fat, saturated fat, and protein) of menu items over time. Additionally, macronutrient composition was compared in menu items newly introduced in 2013 and 2014, relative to 2012. Analyses, conducted in January 2016, controlled for restaurant and were stratified by menu categories. Results Overall, there was a 22-calorie reduction in food items from 2012 to 2014. Beverages had a 46-calorie increase, explained by an increase in calories from sugar (12 calories) and saturated fat (16 calories). Newly introduced main courses in 2014 had 59 calories fewer than those on 2012 menus, explained by a 54-calorie reduction in unsaturated fat, while other macronutrient content remained fairly constant. Newly introduced dessert items in 2014 had 90 calories more than those on 2012 menus, explained primarily by an increase of 57 calories of sugar. Conclusions Overall, there were relatively minor changes in menu items’ caloric and macronutrient composition. Although declines in caloric content among newly introduced fast food main courses may improve the public’s caloric intake, it appears that the macronutrient composition of newly introduced items did not shift to a healthier profile.
Health inequalities, which have been well documented for decades, have more recently become policy targets in developed countries. This review describes time trends in health inequalities (by sex, ...race/ethnicity, and socioeconomic status), commitments to reduce health inequalities, and progress made to eliminate health inequalities in the United States, United Kingdom, and other OECD countries. Time-trend data in the United States indicate a narrowing of the gap between the best- and worst-off groups in some health indicators, such as life expectancy, but a widening of the gap in others, such as diabetes prevalence. Similarly, time-trend data in the United Kingdom indicate a narrowing of the gap between the best- and worst-off groups in some indicators, such as hypertension prevalence, whereas the gap between social classes has increased for life expectancy. More research and better methods are needed to measure precisely the relationships between stated policy goals and observed trends in health inequalities.
OBJECTIVE:To evaluate temporal trends in medication-assisted treatment use among pregnant women with opioid use disorder.
METHODS:We conducted a retrospective cohort study using Pennsylvania Medicaid ...administrative data. Trends in medication-assisted treatment use, opioid pharmacotherapy (methadone and buprenorphine) and behavioral health counselling, were calculated using pharmacy records and procedure codes. Cochrane-Armitage tests evaluated linear trends in characteristics of pregnant women using methadone compared with buprenorphine.
RESULTS:In total, we evaluated 12,587 pregnancies among 10,741 women with opioid use disorder who had a live birth between 2009 and 2015. Across all years, 44.1% of pregnant women received no opioid pharmacotherapy, 27.1% used buprenorphine, and 28.8% methadone. Fewer than half of women had any behavioral health counseling during pregnancy. The adjusted prevalence of methadone use declined from 31.6% (95% CI 29.3–33.9%) in 2009 to 25.2% (95% CI 23.3–27.1%) in 2015, whereas the adjusted prevalence of buprenorphine use increased from 15.8% (95% CI 13.9–17.8%) to 30.9% (95% CI 28.8–33.0%). Greater increases in buprenorphine use were found in geographic regions with large metropolitan centers, such as the Southwest (plus 24.9%) and the Southeast (plus 12.0%), compared with largely rural regions, such as the New West (plus 5.2%). In 2015, the adjusted number of behavioral health counseling visits during pregnancy was 3.4 (95% CI 2.6–4.1) among women using buprenorphine, 4.0 (95% CI 3.3–4.7) among women who did not use pharmacotherapy, and 6.4 (95% CI 4.9–7.9) among women using methadone.
CONCLUSION:Buprenorphine use among Medicaid-enrolled pregnant women with opioid use disorder increased significantly over time, with a small concurrent decline in methadone use. Behavioral health counseling use was low, but highest among women using methadone.
Aim
To test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal and neonatal outcomes.
Design
Retrospective cohort analysis of claims, ...encounter and pharmacy data.
Setting
Pennsylvania, USA.
Participants
We analyzed 13 320 pregnancies among 10 741 women with opioid use disorder aged 15–44 years enrolled in Pennsylvania Medicaid between 2009 and 2017.
Measurements
We examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (< 37 weeks gestation), (4) term low birth weight (< 2500 g at ≥ 37 weeks) and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy.
Findings
Among 13 320 pregnancies, 306 (2.3%) were complicated by an overdose, 1753 (13.2%) resulted in a preterm birth and 6787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birth weight at term and 7706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS and a decline in term low birth weight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% adjusted odds ratio (aOR) = 0.98; 95% confidence interval (CI) = 0.97, 0.99, preterm birth decreased by 1% (aOR = 0.99; 95% CI = 0.99, 1.00), postpartum MOUD continuation increased by 95% (aOR = 1.95; 95% CI = 1.87, 2.04) and NAS increased by 41% (aOR = 1.41; 95% CI = 1.35, 1.47). The odds of term low birth weight did not change (aOR = 1.00; 95% CI = 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy.
Conclusions
Longer duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.
Large chain restaurants reduced the number of calories in newly introduced menu items in 2013 by about 60 calories (or 12%) relative to 2012. This paper describes trends in calories available in ...large U.S. chain restaurants to understand whether previously documented patterns persist.
Data (a census of items for included restaurants) were obtained from the MenuStat project. This analysis included 66 of the 100 largest U.S. restaurants that are available in all three of the data years (2012-2014; N=23,066 items). Generalized linear models were used to examine: (1) per-item calorie changes from 2012 to 2014 among items on the menu in all years; and (2) mean calories in new items in 2013 and 2014 compared with items on the menu in 2012 only. Data were analyzed in 2014.
Overall, calories in newly introduced menu items declined by 71 (or 15%) from 2012 to 2013 (p=0.001) and by 69 (or 14%) from 2012 to 2014 (p=0.03). These declines were concentrated mainly in new main course items (85 fewer calories in 2013 and 55 fewer calories in 2014; p=0.01). Although average calories in newly introduced menu items are declining, they are higher than items common to the menu in all 3 years. No differences in mean calories among items on menus in 2012, 2013, or 2014 were found.
The previously observed declines in newly introduced menu items among large restaurant chains have been maintained, which suggests the beginning of a trend toward reducing calories.
Supply-side reductions to the calories in chain restaurants are a possible benefit of upcoming menu labeling requirements.
To describe trends in calories available in large U.S. restaurants.
Data ...were obtained from the MenuStat project, a census of menu items in 66 of the 100 largest U.S. restaurant chains, for 2012 and 2013 (N=19,417 items). Generalized linear models were used to calculate (1) the mean change in calories from 2012 to 2013, among items on the menu in both years; and (2) the difference in mean calories, comparing newly introduced items to those on the menu in 2012 only (overall and between core versus non-core items). Data were analyzed in 2014.
Mean calories among items on menus in both 2012 and 2013 did not change. Large restaurant chains in the U.S. have recently had overall declines in calories in newly introduced menu items (-56 calories, 12% decline). These declines were concentrated mainly in new main course items (-67 calories, 10% decline). New beverage (-26 calories, 8% decline) and children's (-46 calories, 20% decline) items also had fewer mean calories. Among chain restaurants with a specific focus (e.g., burgers), average calories in new menu items not core to the business declined more than calories in core menu items.
Large chain restaurants significantly reduced the number of calories in newly introduced menu items. Supply-side changes to the calories in chain restaurants may have a significant impact on obesity prevention.
Medicare is the primary source of health insurance coverage for reproductive-age people with Social Security Disability Insurance. However, Medicare does not require contraceptive coverage for ...pregnancy prevention, and little is known about contraceptive use in traditional Medicare and Medicare Advantage. We analyzed Medicare and Optum data to assess variations in contraceptive use and methods used by traditional Medicare and Medicare Advantage enrollees, as well as among enrollees with and without noncontraceptive clinical indications. Clinically indicated contraceptives are used for reasons other than pregnancy prevention, including menstrual regulation or to treat acne, menorrhagia, and endometriosis. Contraceptive use was higher among Medicare Advantage enrollees than traditional Medicare enrollees, but use in both populations was low compared with contraceptive use among Medicaid enrollees. We found significant variation by Medicare type with respect to contraceptive methods used. Relative to traditional Medicare, the probability of long-acting reversible contraception was more than three times higher in Medicare Advantage, and the probability of tubal sterilization was more than ten times higher. Overall, Medicare enrollees with noncontraceptive clinical indications had twice the probability of contraceptive use as those without them. Medicare coverage of all contraceptive methods without cost sharing would help address financial barriers to contraceptives and support the reproductive autonomy of disabled enrollees.
Consuming too much sodium is associated with increased risk for cardiovascular disease, and restaurant foods are a primary source of sodium. This study assessed recent trends in sodium content of ...menu items in U.S. chain restaurants.
Data from 21,557 menu items in 66 top-earning chain restaurants available from 2012 to 2016 were obtained from the MenuStat project and analyzed in 2017. Generalized linear models were used to examine changes in calorie-adjusted, per-item sodium content of menu items offered in all years (2012–2016) and items offered in 2012 only compared with items newly introduced in 2013, 2014, 2015, and 2016.
Overall, calorie-adjusted sodium content in newly introduced menu items declined by 104 mg from 2012 to 2016 (p<0.02). However, the magnitude and direction of these changes varied by menu category and restaurant type; sodium content, particularly for main course items, was high. Sodium declined by 83 mg in fast food restaurants, 19 mg in fast casual restaurants, and 163 mg in full service restaurants. Sodium in appetizer and side items newly introduced in 2016 increased by 266 mg compared with items on the menu in 2012 only (p<0.01). Sodium in main courses newly introduced in 2016 declined by 124 mg compared with items on the menu in 2012 only (p=0.01), with the greatest decline, 207 mg (p=0.03), among salads.
Average, adjusted, per-item sodium content was lower in newly introduced items in large chain restaurants. However, sodium content of core and new menu items remain high, and reductions are inconsistent across menu categories and restaurant types.
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