474 - Perceived Discrimination in Medical Settings Among Pregnant Women with Opioid-Use Disorder

Poster Number: 474
Publication Number: 474.129

Scott A. Lorch, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Jamie E. Newman, RTI International, Carrboro, NC, United States; Sara B. DeMauro, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Leslie A. Clarke, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Deanne Wilson-Costello, Rainbow Babies and Children's Hospital, Cleveland, OH, United States; Catherine Limperopoulos, Children's National Health System, Washington, DC, United States; myriam Peralta, University of Alabama at Birmingham, Birmingham, AL, United States; Brenda Poindexter, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States; Michele Walsh, NICHD, Bethesda, MD, United States; Carla Bann, RTI International, Research Triangle Park, NC, United States

Background: Perceived discrimination, or the perception of unfair treatment based on a particular characteristic, has been reported by 10-30% of patients of racial/ethnic minority background and 10% of pregnant women, with associated adverse health outcomes. There is limited information on whether opioid use is associated with perceptions of discrimination in health care during pregnancy.

Objective: To determine the prevalence of perceived discrimination in women during pregnancy and the association between opioid use during pregnancy and perceived discrimination in medical settings after accounting for other sociodemographic factors

Design/Methods: As part of the Outcomes of Babies with Opioid Exposure (OBOE) study (NCT04149509), 106 women (84 with opioid use, 24 controls) were administered the 7-item Everyday Discrimination Scale (Peek 2011) adapted for health care.  Discrimination was defined as a score of 2 (“rarely”) or higher for each item.   Any discrimination was defined as a mean score of 2 or higher on the overall scale.   Logistic regression models determined the association of opioid use with any discrimination based on the overall scale and for discrimination on each item, after adjusting for non-white race, public insurance, and maternal age.

Results: The cohort was predominantly white  and receiving public insurance (Table 1).  The Everyday Discrimination Scale had excellent internal reliability within the sample with a Cronbach alpha of 0.87.  Overall, 49% of mothers of exposed infants reported discrimination compared to 17% of the controls (p=0.008).  Mothers of exposed infants were more likely to report discrimination on 4 of the 7 items (Table 2), including questions about courtesy, respect, and intelligence. Both groups reported concerns of health care professionals not listening to their concerns.  In adjusted results, mothers of exposed infants had 4.5 times higher odds of perceiving discrimination compared to controls (95% CI 1.3-15.7).  Non-white race, public insurance, and maternal age were not associated with differences in perceived discrimination in this cohort (Figure 1), although the sample size for these comparisons was small.Conclusion(s): Mothers who took opioids during pregnancy reported higher rates of perceived discrimination compared to control patients after accounting for differences in other sociodemographic factors.  Identifying specific care practices that may result in discrimination and medical care that differ because of discrimination may improve the outcomes of this high-risk population of mothers and infants.
Sample Demographic Characteristics
Percentages of Mothers Experiencing Discrimination in Medical Settings During Pregnancy by Opioid Exposure Group