(HealthDay News) — Rural US communities are seeing a sharp increase in infants with neonatal abstinence syndrome (NAS), according to a research letter published in JAMA Pediatrics.

Researchers analyzed hospital discharge data collected between 2004 and 2013 by the US Agency for Healthcare Research and Quality for all neonatal births and obstetric deliveries.

During that time, diagnoses of NAS rose from 1.2 per 1,000 hospital births to 7.5 per 1,000 hospital births among rural infants. In urban areas, the rates increased from 1.4 per 1,000 to 4.8 per 1,000 hospital births. The research team found that while rural infants accounted for just 12.9% of all NAS cases in the country in 2003, that figure had risen to 21.2% a decade later.

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“We know that patients in rural areas tend to be poorer, have higher rates of chronic diseases, are more likely to smoke, drink alcohol, and suffer from drug addiction,” lead author Nicole Villapiano, MD, of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor, told HealthDay. “This in combination with the poor access to medical care…make patients in rural areas especially vulnerable to poor health outcomes.”


  1. Villapiano NLG, Winkelman TNA, Kozhimannil KB, et al. Rural and urban differences in neonatal abstinence syndrome and maternal opioid use, 2004 to 2013. JAMA Pediatr. 2016. doi:10.1001/jamapediatrics.2016.3750