Disparities in Maternal-Infant Drug Testing, Social Work Assessment, and Custody at 5 Hospitals.

Autor: Cohen S; MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass; Department of Pediatrics, Boston Medical Center (S Cohen), Boston, Mass. Electronic address: samuel.cohen2@bmc.org., Nielsen T; Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney (T Nielsen), Sydney, Australia., Chou JH; MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass., Hoeppner B; Department of Psychiatry, Harvard Medical School (B Hoeppner and T Wilens), Boston, Mass., Koenigs KJ; BWH/MGH Integrated Residency Program in Obstetrics and Gynecology (KJ Koenigs and N Perlman), Boston, Mass., Bernstein SN; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital (SN Bernstein), Boston, Mass., Smith NA; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital (NA Smith), Boston, Mass., Perlman N; BWH/MGH Integrated Residency Program in Obstetrics and Gynecology (KJ Koenigs and N Perlman), Boston, Mass., Sarathy L; MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass., Wilens T; Department of Psychiatry, Harvard Medical School (B Hoeppner and T Wilens), Boston, Mass., Terplan M; Friends Research Institute (M Terplan), Baltimore, Md., Schiff DM; MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass.
Jazyk: angličtina
Zdroj: Academic pediatrics [Acad Pediatr] 2023 Aug; Vol. 23 (6), pp. 1268-1275. Date of Electronic Publication: 2023 Feb 07.
DOI: 10.1016/j.acap.2023.01.012
Abstrakt: Objective: To evaluate for disparities in peripartum toxicology testing among maternal-infant dyads across a hospital network and subsequent child protective services (CPS) involvement.
Methods: Retrospective chart review of 59,425 deliveries at 5 hospitals in Massachusetts between 2016 and 2020. We evaluated associations between maternal characteristics, toxicology testing, and child welfare involvement with disproportionality risk ratios and hierarchical logistical regression.
Results: Toxicology testing was performed on 1959 (3.3%) dyads. Younger individuals and individuals of color were more likely to be tested for cannabis use or maternal medical complications compared to white non-Hispanic individuals. Among those without a substance use disorder, age <25 (adjusted odds ratio [aOR] 2.81; 95% confidence interval [CI], 2.43-3.26), race and ethnicity (non-Hispanic Black (aOR 1.80; 95% CI, 1.52-2.13), Hispanic (aOR 1.23; 95% CI, 1.05-1.45), mixed race/other (aOR 1.40; 95% CI, 1.04, 1.87), unavailable race (aOR 1.92; 95% CI, 1.32-2.79), and public insurance (Medicaid [aOR 2.61; 95% CI, 2.27-3.00], Medicare [aOR 13.76; 95% CI, 9.99-18.91]) had increased odds of toxicology testing compared to older, white non-Hispanic, and privately insured individuals. The disproportionality ratios in testing were greater than 1.0 for individuals under 25 years old (3.8), Hispanic individuals (1.6), non-Hispanic Black individuals (1.8), individuals of other race (1.2), unavailable race (1.8), and individuals with public insurance (Medicaid 2.6; Medicare 10.6). Among dyads tested, race and ethnicity was not associated with CPS involvement.
Conclusions: Peripartum toxicology testing is disproportionately performed on non-white, younger, and poorer individuals and their infants, with cannabis use and medical complications prompting testing more often for patients of color than for white non-Hispanic individuals.
(Copyright © 2023 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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