Understanding County-Level Relationships between the Opioid Epidemic and Child Outcomes in the United States

Background/Purposes:

The recent US opioid epidemic is alarming and is considered a national emergency for adults, as well as children. In 2017, an estimated 2.2 million US children were exposed to household opioid use. Despite the potential impact of the opioid crisis on US children, we do not fully understand what linkages may exist between the opioid epidemic and child outcomes in the US. Literature suggests that opioid abuses within a household and within a community raise the risk of adverse birth outcome, child disability, and teen birth. However, most prior studies are confined to local and regional data, limiting generalizability for what is a national crisis. To address this knowledge gap, we examined county-level associations between four opioid/drug indicators (i.e., prescription, hospitalization, arrest, and death) and four child outcomes (i.e., child disability, low birth weight [LBW], preterm birth [PTB], and teen birth) in the US.

Methods:

We used county-level data linking eleven US-national databases from 2002-2016. Four county-level opioid/drug indicators included opioid prescription rates (per 100 persons), opioid-related hospitalization rates (per 1,000 persons), opioid/cocaine-related arrest rates (per 1,000 persons), and drug overdose death rates (per 100,000 persons). For arrest and death rates, opioid-specific counts were unavailable unfortunately while the majority of these incidents involved opioids. We assessed four county-level child outcomes, including child disability rates (per 1,000 children), LBW rates (per 1,000 live births), PTB rates (per 1,000 live births), and teen birth rates (per 1,000 live births). We estimated the county-level relationships between opioid indicators and child outcomes while controlling for a range of county demographic/socioeconomic characteristics and state policies. We used linear mixed models with year fixed effects to manage the nesting of county-year observations in counties and states. The bootstrap method was used for estimating confidence intervals (CI).

Results:

All four opioid/drug indicators showed statistically significant associations with increased county rates of negative child outcomes while adjusting for various county-level and state-level variables. One increase in opioid prescription rates was associated with increasing child disability rates by 0.037 (95% CI = 0.029-0.044), LBW rates by 0.095 (0.085-0.106), PTB rates by 0.141 (0.123-0.158), and teen birth rates by 0.345 (0.324-0.367). Opioid-related hospitalization rates were associated with heightened rates of child disability (0.841, 0.583-1.127), LBW (1.024, 0.657-1.346), PTB (0.597, 0.156-1.075), and teen birth (1.977, 1.408-2.492). Opioid/cocaine-related arrest rates were related to increased rates of child disability (1.291, 0.972-1.618), LBW (0.441, 0.312-0.582), PTB (0.426, 0.242-0.630), and teen birth (1.927, 1.597-2.247). Higher drug overdose death rates were associated with higher rates of child disability (0.136, 0.089-0.175), LBW (0.214, 0.174-0.254), PTB (0.151, 0.080-0.222), and teen birth (0.827, 0.740-0.921).

Conclusions/Implications:

We found that for all opioid/drug indicators, counties with higher opioid rates showed higher rates of child disability, LBW, PTB, and teen birth in the US in 2002-2016, while controlling for a variety of confounders. These findings contribute to the growing body of evidence suggesting that the opioid crisis may pose great risk to US children. Further research is necessary to differentiate individual-level and contextual-level mechanisms of our area-level findings.