Stimulant Overdose in the Medicaid Population: Who is at Risk, and When are They at Risk

医疗补助人群中兴奋剂过量：谁有风险，何时有风险

• 批准号: 10392130
• 负责人: Sean Hennessy
• 金额: $ 36.25万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392130
• 关键词: Stimulant; Overdose; Medicaid; Population; Who

The US drug overdose epidemic in the has grown dramatically in the past twenty years, with more than 70,000 fatal drug overdoses in 2019 alone. This growth in overdose deaths is a major contributor to the multiyear decline in US life expectancy that was seen even before the COVID-19 pandemic began. The drugs responsible for the largest increases in overdose deaths are synthetic opioids, cocaine, and other stimulants (primarily methamphetamine). In recognition of the increasing role that cocaine and other stimulants are playing in the drug overdose epidemic, the US Centers for Disease Control and Prevention (CDC) has called for increased surveillance and evidence-based prevention and response strategies to address overdoses involving these agents. While rates of stimulant use and overdose have been reported vary by demographics, physical and mental health conditions, disability, and other factors, no prior research has linked individual-level data on demographics, disability, and social determinants of health together with granular measures derived from healthcare utilization records, with comprehensive, area-level data on social deprivation to develop knowledge about risk and protective factors for stimulant overdose. Further, no prior research has focused on stimulant overdose in Medicaid enrollees, a large, vulnerable, underserved population in whom half of all amphetamine-related hospitalizations occur. This project addresses Objective 2 of RFA-CE-21-002: to assess risk and protective factors for illicit stimulant use, use disorder, or overdose that can contribute to the development or adaptation of intervention strategies. The study will 1) develop and validate a model using both person-level characteristics (including demographic characteristics, household income, diagnoses, prescriptions, and healthcare utilization) and area-level characteristics (including a wide range of measures of socioeconomic deprivation) to identify, among Medicaid enrollees age 15 and older, who is at highest risk of an emergency department (ED) encounter for overdose from cocaine or other stimulants; 2) develop and validate a model to identify, among those Medicaid enrollees age 15 and older at highest risk of an ED encounter for stimulant overdose, when they are at highest risk; and 3) among those Medicaid enrollees age 15 and above with a prior ED encounter for stimulant overdose, to measure the rate of and identify risk and protective factors for a subsequent ED encounter for overdose from stimulants and/or opioids. The results will be useful in at least two ways. First, they will provide generalizable knowledge about the individual-level and social factors that predispose to or protect against stimulant overdose. Such etiologic factors can then be the targets of intervention at the national, state, county, and local levels to ameliorate the effects of these causes, as well serve as the basis of future research to better understand the underlying causal mechanisms. Second, the results can be used pragmatically to identify high-risk individuals for the purpose of targeting scarce resources for evidence-based approaches to overdose prevention.

在过去的二十年中，美国药物过量的流行病已经急剧增长，有超过70,000次致命药物 仅在2019年过量服药。过量死亡的这种增长是美国生活多年下降的主要贡献者 甚至在19009年大流行开始之前就可以看到的期望。负责最大增加的药物 过量死亡是合成阿片类药物，可卡因和其他兴奋剂（主要是甲基苯丙胺）。认可 可卡因和其他兴奋剂在药物过量流行中扮演的作用越来越大，美国的中心是 疾病控制与预防（CDC）呼吁增加监视和基于证据的预防和反应 解决涉及这些代理的过量服用的策略。虽然已经报道了兴奋剂的使用率和过量 因人口统计学，身心健康状况，残疾和其他因素而有所不同，没有先前的研究链接 有关人口统计学，残疾和社会决定因素的个人级别数据以及颗粒状措施 源自医疗保健利用记录，并具有有关社会剥夺的全面的领域级别数据 关于刺激性过量的风险和保护因素的知识。此外，没有先前的研究集中于兴奋剂 Medicaid参与者的过量服用，这是一个大型，脆弱的，服务不足的人群，其中一半与苯丙胺有关 住院发生。该项目解决了RFA-CE-21-002的目标2：评估非法的风险和保护因素 刺激性使用，使用障碍或过量的使用，可以有助于开发或适应干预措施 策略。研究将1）使用两个人级特征开发和验证模型（包括人群 特征，家庭收入，诊断，处方和医疗保健利用率）和区域级特征 （包括广泛的社会经济剥夺措施），以确定15岁和 年龄较大的人，他是可卡因或其他兴奋剂过量服用过量的急诊科（ED）的最高风险； 2）开发和验证一个模型，以识别那些15岁及以上的医疗补助人以ED的最高风险 当刺激性过量时，它们的风险最高时； 3）在那些15岁的医疗补助参与者中 上面的ED遇到刺激性过量的ED相遇，以衡量和确定风险和保护因素的速度和识别 对于随后的ED遇到的兴奋剂和/或阿片类药物过量的遇到。结果至少有两个 方式。首先，他们将提供有关易于或 防止刺激性过量。然后，这种病因学因素可能是国家州的干预目标， 县和地方一级可以改善这些原因的影响，并作为未来研究的基础 了解潜在的因果机制。其次，结果可以务实地使用以识别高风险 个人目的是针对稀缺的资源，以用于基于证据的预防过量的循证方法。