Abstract

Purpose: This study compared well-child visits (WCVs) and immunization encounters from birth through age three among rural and urban South Carolina (SC) Medicaid-enrolled children with neonatal abstinence syndrome (NAS).

Method: We conducted a retrospective cohort study with SC Medicaid data, using logistic and Poisson regression models adjusting for infant and maternal characteristics to examine associations between rural status and the number of WCVs, WCVs adherence, and immunization encounters.

Results: The sample included 833 urban and 161 rural children born between 2006-2014 with NAS. There were significant differences in the number of WCVs and immunization encounters each year (P = <0.01 for all comparisons) and in the number of WCVs and immunization encounters from birth through age 3 (P = <0.01 for all comparisons). After covariate adjustment, rural status was associated with decreased WCVs from birth through 11 months (IRR: 0.86; 95% CI: 0.80-0.93), 12-23 months (IRR: 0.86; 95% CI: 0.76-0.97), 24-35 months (IRR: 0.78; 95% CI: 0.64-0.96), and 34% lower odds of WCVs adherence from 12-23 months (OR: 0.66; 95% CI: 0.44-0.99). Rural status was associated with decreased immunization encounters from birth through 11 months (IRR: 0.60; 95% CI: 0.54-0.68), 12-23 months (IRR: 0.61; 95% CI: 0.53-0.70), and 24-35 months (IRR: 0.51; 95% CI: 0.39-0.67).

Conclusion: Rural status is associated with decreased WCVs and immunization encounters in a population of SC Medicaid-enrolled children. Infants with NAS have overall lower rates of WCV adherence and immunization encounters. Expanded services, including enhanced Medicaid access, could improve WCVs and immunization rates among children with a history of NAS residing in SC.