DEMOGRAPHIC DISPARITIES IN OPIOID USE DISORDER AND TREATMENT ACCESS DURING PREGNANCY AMONG KENTUCKY MEDICAID BENEFICIARIES
Author(s)
Sepideh Poursafargholi, Phd, Mohadese Alizadeh, PhD, Hamid Zarei, PhD, Venetia Aranha, PhD, Eliana Lopez Baron, PhD, Jovita Murillo, PhD, Seyed M. Karimi, MS, PhD;
University of Louisville, Louisville, KY, USA
University of Louisville, Louisville, KY, USA
OBJECTIVES: (1) To assess opioid use disorder (OUD) and access to medication for OUD (MOUD: buprenorphine, methadone, or naltrexone prescription or receiving medication-assisted treatment) during pregnancy among Medicaid beneficiaries in Kentucky; (2) to measure demographic disparities in OUD incidence and MOUD; and (3) to inform policy interventions aimed at improving maternal and neonatal outcomes.
METHODS: A retrospective cohort study was conducted using Kentucky Medicaid claims 2016-2022. The dataset included 244,167 pregnancies of 167,394 unique beneficiaries. Pregnancies were identified using validated claims-based algorithms, and OUD diagnosis and MOUD utilization were captured during the pregnancy episode. The proportion of pregnancies with OUD and the shares of them with at least one and two MOUD claims were calculated by age, race, and ethnicity.
RESULTS: Among all pregnancies, 17,118 (7.01%) involved OUD: 11,267 (65.82%) had at least one MOUD claim, and 7,993 (46.69%) had at least two MOUD claims. The rate of reporting OUD increased with maternal age: 1.47% for 15-19, 12.19% and 10.80% for 30-34 and 35-50 year-old mothers. Utilizing MOUD was highest in ages 30-34 (70.20%) and lowest in ages 15-19 (42.08%). Racial differences were substantial: OUD prevalence was 8.54% among White pregnant beneficiaries versus 2.20% among Black beneficiaries. Hispanic pregnancies had the lowest OUD prevalence (0.75%).
CONCLUSIONS: This study advances the literature by leveraging comprehensive Kentucky Medicaid claims data and the most comprehensive set of ICD, CPT, HCPCS, and DRG codes based on an extensive literature review to identify pregnancy episodes, and by using standardized CCW algorithms to accurately capture OUD and MOUD utilization. Using a large statewide cohort, the analysis provides robust, population-level estimates of treatment patterns. These findings underscore the need for targeted policy and outreach strategies to improve MOUD coverage to strengthen maternal and neonatal outcomes.
METHODS: A retrospective cohort study was conducted using Kentucky Medicaid claims 2016-2022. The dataset included 244,167 pregnancies of 167,394 unique beneficiaries. Pregnancies were identified using validated claims-based algorithms, and OUD diagnosis and MOUD utilization were captured during the pregnancy episode. The proportion of pregnancies with OUD and the shares of them with at least one and two MOUD claims were calculated by age, race, and ethnicity.
RESULTS: Among all pregnancies, 17,118 (7.01%) involved OUD: 11,267 (65.82%) had at least one MOUD claim, and 7,993 (46.69%) had at least two MOUD claims. The rate of reporting OUD increased with maternal age: 1.47% for 15-19, 12.19% and 10.80% for 30-34 and 35-50 year-old mothers. Utilizing MOUD was highest in ages 30-34 (70.20%) and lowest in ages 15-19 (42.08%). Racial differences were substantial: OUD prevalence was 8.54% among White pregnant beneficiaries versus 2.20% among Black beneficiaries. Hispanic pregnancies had the lowest OUD prevalence (0.75%).
CONCLUSIONS: This study advances the literature by leveraging comprehensive Kentucky Medicaid claims data and the most comprehensive set of ICD, CPT, HCPCS, and DRG codes based on an extensive literature review to identify pregnancy episodes, and by using standardized CCW algorithms to accurately capture OUD and MOUD utilization. Using a large statewide cohort, the analysis provides robust, population-level estimates of treatment patterns. These findings underscore the need for targeted policy and outreach strategies to improve MOUD coverage to strengthen maternal and neonatal outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH153
Topic
Epidemiology & Public Health
Disease
SDC: Reproductive & Sexual Health