Rural-Urban Disparities In Spillover Effects of COVID-19

COVID-19 溢出效应的城乡差异

• 批准号: 10523385
• 负责人: Karen Ellen Joynt Maddox
• 金额: $ 59.37万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-21 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10523385
• 关键词: Adult; Ambulatory Care; COVID-19; COVID-19 impact; COVID-19 pandemic; Cardiovascular Diseases; Cardiovascular system; Caring; Cerebrovascular Disorders; Chronic Care; Chronic Disease; Clinical; Coronavirus; Data; Database Management Systems; Disease Outbreaks; Disease Outcome; Economic Conditions; Economics; Elderly; Future; Goals; Health; Health Services Accessibility; Health system; Hospitals; Individual; Inpatients; Medical; Medicare claim; Monitor; Outcome; Outpatients; Patients; Persons; Poverty; Procedures; Resources; Risk; Rural; Rural Community; Rural Hospitals; Rural Population; Social Conditions; Social isolation; Subgroup; Travel; Work; acute care; care delivery; care outcomes; cerebrovascular; clinical care; clinical effect; coronavirus disease; ethnic minority; ethnic minority population; experience; health care delivery; health management; member; pandemic disease; population health; racial and ethnic; racial minority; rural area; rural healthcare; social; telehealth; urban area; urban disparity

Abstract The Coronavirus 2019 (COVID-19) pandemic created disruptions in usual medical care delivery for cardiovascular and cerebrovascular disease (CVD) across the U.S. that could have devastating downstream effects long after COVID-19 is controlled. COVID’s “spillover” could manifest via delays in presentation, disruptions to acute care, deferral of usual outpatient care, and negative health effects of economic conditions and worsening social risk. Older adults living in rural areas experience worse CVD outcomes than their urban counterparts, and may be particularly vulnerable to each of these spillover effects, particularly if they also live in poverty or are members of racial or ethnic minority groups. Rural older adults may also have less access to potential mitigation strategies, such as inpatient and outpatient telehealth, restarting elective procedures under new precautions, and reaching out to patients proactively to manage chronic disease. However, because the rural population is smaller, and less-often included in commercial and health system databases, this group is understudied. It is crucial to understand COVID spillover in rural areas in order to counteract it. The central premise of this proposal is that understanding the magnitude of COVID’s spillover effects on CVD in rural areas, as well as the impact of key mitigation strategies, will enable us to deal with future waves of this pandemic, with other outbreaks in the future, and with challenges to rural care delivery more broadly. We will use national Medicare claims data, which allows us near-complete, long-term capture of clinical care and outcomes for roughly 70% of older adults in the US, to achieve three Aims: Aim 1: Quantify COVID spillover effects on a monthly basis in the first 12 months of the pandemic, and characterize the use of spillover mitigation strategies, among rural compared to urban areas. Aim 2: Quantify the short- and long-term clinical effects of delay and disruption of acute care in rural versus urban areas, and determine if mitigation strategies reduced negative impacts of spillover. Aim 3: Quantify the short- and long-term clinical effects of deferral of chronic care and worsening social risk in rural versus urban areas, and determine if mitigation strategies reduced negative impacts of spillover. The proposed work will provide national estimates of how COVID spillover and its mitigation strategies were associated with clinical cardiovascular and cerebrovascular outcomes among older rural adults, and allow successful strategies to be deployed in the future. It will also quantify whether access to these strategies was equitable among rural individuals living in poverty or those who identify as racial or ethnic minorities, enabling future efforts to monitor and achieve equity goals.

抽象的 冠状病毒2019（Covid-19）大流行在通常的医疗服务中造成了干扰 美国的心血管和脑血管疾病（CVD），可能在下游毁灭性 效果很长一段时间在COVID-19控制之后。 Covid的“溢出”可能会通过演示延迟表现出来， 急性护理的中断，通常门诊护理的延期以及经济状况的负面影响 并担心社会风险。 居住在农村地区的老年人的CVD结果比城市的成果差，并且可能是 特别容易受到每种Spilover效应的影响，特别是如果它们也生活在贫困中或成员 种族或少数民族群体。农村老年人也可能较少使用潜在的缓解措施 策略，例如住院和门诊远程医疗，在新的预防措施下重新启动选修程序， 并主动与患者接触以治疗慢性疾病。但是，因为粗糙的人口是 较小且通常不包含在商业和卫生系统数据库中，该组被理解为。这是 为了抵消它，要理解在粗糙区域中的共晶至关重要。 该提议的主要前提是了解Covid Spilover对CVD的幅度 在粗糙的地区以及关键缓解策略的影响，将使我们能够应对以后的浪潮 大流行，将来会有其他爆发，并且面临更广泛地照顾分娩的挑战。我们将 使用国家医疗保险索赔数据，这使我们几乎完整地捕获了临床护理和 大约70％在美国的老年人的结果实现了三个目标： AIM 1：在大流行的前12个月每月量化COVID Spilover效应，并且 与城市地区相比，大约是使用Spilover缓解策略的使用。 目标2：量化农村急性护理延迟和破坏急性的短期和长期临床影响 城市地区，并确定缓解策略是否减少了Spilover的负面影响。 目标3：量化慢性护理延期的短期和长期临床影响，并担心社会风险 农村与城市地区，并确定缓解策略是否减少了Spilover的负面影响。 拟议的工作将提供有关Covid Spilover及其缓解策略的全国估计 与年龄较大的农村成年人中的临床心血管和脑血管结局相关，并允许 未来将要采取的成功策略。它还将量化是否访问这些策略 生活在贫困或认定为种族或少数民族的农村个人中 未来监视和实现平等目标的努力。