Leveraging Trajectories of Health and Services Use to Improve the Health of Autistic Young Persons

利用健康和服务使用轨迹来改善自闭症年轻人的健康

• 批准号: 10523864
• 负责人: Diana Schendel
• 金额: $ 23.07万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-06 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10523864
• 关键词: Accidental Injury; Address; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Advocate; Age; Aging; Ambulatory Care; Behavioral; Biological; Brain; Categories; Cessation of life; Child; Childhood; Communities; Data; Development; Diagnosis; Emergency Care; Emergency Situation; Emergency medical service; Enrollment; Ethnic Origin; Ethnic group; Event; Future; Goals; Health; Health Services; Health system; Healthcare; Heterogeneity; Individual; Inpatients; Intervention; Knowledge; Life; Life Cycle Stages; Literature; Medicaid; Methods; Modeling; Outcome; Outpatients; Participant; Pathway interactions; Pattern; Persons; Pharmaceutical Preparations; Phase; Population; Population Heterogeneity; Prevalence; Process; Public Health; Quality of life; Race; Recording of previous events; Research; Risk; Sampling Studies; Science; Services; Social Change; Socioeconomic Status; Subgroup; System; Vulnerable Populations; Work; World Health; adolescent with autism spectrum disorder; age group; aged; autism spectrum disorder; autistic; base; behavioral health; burden of illness; community engagement; contextual factors; disability; disability-adjusted life years; ethnic disparity; ethnic diversity; experience; follow-up; health care delivery; health inequalities; health knowledge; health service use; implementation efforts; improved; individuals with autism spectrum disorder; innovation; mortality; multimodality; novel; population based; premature; pressure; prevent; public health research; racial and ethnic; service delivery; service utilization; sex; socioeconomic disadvantage; socioeconomics; study population; suicidal morbidity; years of life lost; young adult

PROJECT ABSTRACT With increasing prevalence of autism spectrum disorder (ASD) in childhood, autistic young persons (10-24 years) are a growing, yet understudied group. The research gap promotes autistic young person’s vulnerability to long-term poor health due to limited understanding of their health care needs and rising pressure on services. Elevated cross-sectional rates of co-occurring conditions and service utilization are well-documented in autistic young persons, but knowledge gaps remain regarding health and services patterns across age, and relevant targets and their timing needed to guide interventions. Further, prior work suggests socioeconomically disadvantaged or race/ethnically diverse groups are particularly at risk for compounded health effects and sub- optimal service patterns. We hypothesize that there are distinct patterns of health conditions and health services across age in autistic young persons which, together, impact future health, and the impact is potentially magnified by socioeconomic disadvantage or race/ethnic disparities. Using national 2008-2023 Medicaid data for a diverse US population aged 10-24 years (1.5 million with 5-years continuous enrollment; 600,000 ASD, 975,000 non-ASD), we will model longitudinal trajectories over a 5-year period of health conditions and services and quantify the combined effect of health and health services history on health over the next 10 years. We will apply group-based multi-trajectory methods to (Aim 1) determine age-specific health conditions trajectory classes (3 domains: brain; physical; behavioral health), and (Aim 2) health services trajectory classes (3 domains: inpatient/emergency; outpatient; medications). We will also quantify impact of health and services class combinations (Aim 3) on study participants’ health in the next 10 years using (a) burden of disease metrics (disability adjusted life years, years of life lived with disability, years of life lost due to premature death, health loss proportion), (b) risk of inpatient/emergency services utilization, and (c) mortality (all-cause mortality; suicide; death due to unintentional injury). Across all Aims, we assess ASD vs. non-ASD overall, as well as heterogeneity by sex, race/ethnicity, and socioeconomic status groups. As part of PHASES’ public health approach, we employ robust, 2-way community engagement methods in all study years for critical input from our community advocates, including autistic individuals, regarding all phases of our research. Our team has the experience and study population knowledge to conduct these novel state-of-the-art trajectory methods and health metrics, in this unique and diverse population based on 15-years of nation-wide Medicaid data. This project will provide critical evidence on multi-domain ‘real world’ health and services experiences and their effects on long term health, needed to optimize health interventions and outcomes for autistic young persons aging into adulthood.

项目摘要 随着自闭症谱系障碍（ASD）的增加，自闭症年轻人（10-24岁） 几年）是一个越来越多的群体。研究差距促进了自闭症年轻人的脆弱性 由于对他们的医疗保健需求的了解有限和对压力的不断增加，因此长期健康状况不佳 服务。同时存在条件和服务利用率的横截面升高是有据可查的 在加速的年轻人中，但是知识差距仍然关于各个年龄段的健康和服务模式，以及 相关目标及其定时需要指导干预措施。此外，先前的工作在社会经济上暗示 弱势群体或种族/种族不同的群体尤其面临更复杂的健康影响和子的风险 最佳服务模式。我们假设有不同的健康状况和健康模式 跨年龄的服务在加速的年轻人中，这共同影响未来的健康，影响的影响是 通过社会经济灾难或种族/族裔分布的潜在磁性。使用国家2008-2023 10-24岁的美国人口的医疗补助数据（150万，连续入学5年； 600,000 ASD，975,000非ASD），我们将在5年的健康期间对纵向轨迹进行建模 条件和服务，并量化健康和卫生服务历史对健康的综合影响 接下来的10年。我们将把基于组的多个标点方法应用于（AIM 1）确定特定年龄的健康 条件轨迹类（3个领域：大脑；身体健康），（目标2）健康服务 轨迹类（3个域：住院/紧急情况；门诊；药物）。我们还将量化 卫生与服务课程组合（AIM 3）在未来10年使用（a）对研究参与者的健康 疾病指标的负担（残疾调整了生命年，生活年的残疾年生活，由于 过早死亡，健康损失比例），（b）住院/紧急服务利用的风险；（c）死亡率 （全因死亡率；自杀；由于无意伤害而死亡）。在所有目标中，我们评估ASD与非ASD 总体而言，以及性别，种族/种族和社会经济地位群体的异质性。作为阶段的一部分 公共卫生方法，我们在所有研究年份都采用健壮的2向社区参与方法 我们社区倡导者（包括令人印象深刻的人）对我们研究的所有阶段的投入。我们的 团队具有经验和研究人群知识来进行这些新颖的最新轨迹 方法和健康指标，在这个独特的和潜水员的人口中，基于全国范围内的15年 数据。该项目将提供有关多域“现实世界”健康和服务经验的关键证据 以及它们对长期健康的影响，需要优化加速Young的健康干预措施和结果 成年后老化的人。