Racial Misclassification and Disparities in Neonatal Abstinence Syndrome Among American Indians and Alaska Natives

Chiao Wen Lan, Sujata Joshi, Jenine Dankovchik, Candice Jimenez, Elizabeth Waddell, Tam Lutz, Jodi Lapidus

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1897-1904
Number of pages8
JournalJournal of Racial and Ethnic Health Disparities
Volume9
Issue number5
DOIs
StatePublished - Oct 2022

Keywords

  • American Indians and Alaska Natives
  • Neonatal abstinence syndrome
  • Racial disparities
  • Racial misclassification

ASJC Scopus subject areas

  • Health(social science)
  • Anthropology
  • Sociology and Political Science
  • Health Policy
  • Public Health, Environmental and Occupational Health

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