(1021) Association between Individual versus community-level Social Vulnerability and Neonatal Opiate Withdrawal Syndrome

Individual patient-level measures of adverse social determinants of health are associated with neonatal opioid withdrawal syndrome (NOWS), but the relative impact of community-level adverse social determinants of health remains to be defined. We examined the association between community-level social vulnerability and NOWS among pregnant individuals receiving buprenorphine (BUP) for opioid use disorder.

Study Design:

We conducted a retrospective cohort of pregnant individuals and their infants who participated in a multidisciplinary prenatal/addiction care program from 2013 to 2021. Addresses were geocoded using ArcGIS and then linked at the census tract to the CDC 2018 Social Vulnerability Index (SVI), which incorporates 15 census variables. The primary exposure was the SVI as a composite measure of community-level social vulnerability, and secondarily, individual scores for four thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). The primary outcome was a clinical diagnosis of NOWS defined as signs and symptoms of withdrawal requiring pharmacological treatment following BUP exposure.

Results: Among 703 assessed pregnant individuals receiving BUP, 39.8% (280/703) of their infants were diagnosed with NOWS. With regards to individual risk factors, those who were nulliparous, had PTSD, a term birth (≥ 37 week), breastfed, and had an infant of male sex were more likely to have an infant diagnosed with NOWS. Individuals with and without an infant diagnosed with NOWS had similarly high community-level social vulnerability per composite SVI scores (mean [SD]: 0.6 [0.4-0.7] vs. 0.6 [0.4-0.7], p=0.2]. In adjusted analyses, SVI, including as a composite measure as well as the 4 domains, was not associated with NOWS diagnosis (Table).

Conclusion: Within this cohort individual risk factors that measure adverse social determinants of health were associated with a NOWS diagnosis in the infant, however, community-level social vulnerability as measured by the SVI was not associated with the outcome.