(1218) The social vulnerability (SV) index is related to toxicology testing during pregnancy

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Virginia Lijewski, MPH (she/her/hers)

Research Services Principal Clinical Science Professional
University of Colorado, School of Medicine
Aurora, Colorado, United States

Coauthor(s)

JS

Jeanelle Sheeder, MSPH, PhD

University of Colorado School of Medicine
Aurora, Colorado, United States
Heather Straub, MD

Associate Professor
University of Colorado School of Medicine
Aurora, Colorado, United States

Objective: To compare the demographic profiles and SV of pregnant patients who did and did not receive urine toxicology (uTox) testing. We also wished to determine if the declaration of the opioid epidemic as a National Public Health Emergency (PHE) on 10/27/17 led to increased testing rates. We hypothesized that patients receiving uTox testing were more likely to be SV than those who did not and that testing rates would increase post-PHE declaration.

Study Design: Patients receiving prenatal care and delivered within a multihospital academic healthcare system with urban, suburban, and rural hospitals from 8/23/2016-12/31/2018 were included. Patient addresses were matched to the CDC Social Vulnerability Index to obtain overall and domain-specific (Household Composition, Socioeconomic Status, Racial/Ethnic Minority Status, and Housing/Transportation) SV scores. Scores ≥0.75 indicate high SV. Chi-squared or Fisher’s exact tests were used to compare categorical variables, and Mann-Whitney U tests were used to compare continuous variables.

Results: 3,938 were included; 3,405 (86%) did not receive uTox testing, and 533 (14%) did. Testing rates did not differ pre- and post-PHE (14% vs 13%; p=0.25). Patients with uTox testing were more likely to be non-Hispanic Black or Hispanic, older, unmarried, without private insurance (Table 1). Overall elevated SV scores were significantly higher among those who received uTox testing and individually in all domains except for racial/ethnic minority status (Table 1). Those who received testing were more likely to have inadequate prenatal care, fetal or neonatal demise, abruption, PPROM and poor pregnancy outcomes (Table 2).

Conclusion:

The PHE declaration did not impact testing rates. Demographic and other clinical differences in uTox testing may highlight provider biases. A high SV score may be a helpful tool for investigating other ways to make substance use testing in pregnancy more reliable.