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: 10662407
• 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/10662407
• 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.

美国药物过量流行病在过去二十年里急剧增长，超过7万人因吸毒而死亡 仅2019年就发生了用药过量事件。服药过量死亡人数的增长是美国寿命多年下降的主要原因 甚至在 COVID-19 大流行开始之前就已经出现了这种预期。增幅最大的药物 过量死亡的是合成阿片类药物、可卡因和其他兴奋剂（主要是甲基苯丙胺）。为了表彰 可卡因和其他兴奋剂在药物过量流行中发挥着越来越大的作用，美国中心 疾病控制与预防 (CDC) 呼吁加强监测以及循证预防和应对 解决涉及这些药物的过量用药的策略。虽然兴奋剂使用率和过量服用率已有报道 因人口统计、身心健康状况、残疾和其他因素而异，之前没有研究将其与 有关人口统计、残疾和健康社会决定因素的个人数据以及精细测量 来自医疗保健利用记录，并开发有关社会剥夺的全面的地区级数据 有关兴奋剂过量的风险和保护因素的知识。此外，之前没有研究关注兴奋剂 医疗补助参与者服用过量药物，这是一个庞大、脆弱、服务不足的人群，其中一半与安非他明相关 发生住院治疗。该项目涉及 RFA-CE-21-002 的目标 2：评估非法行为的风险和保护因素 兴奋剂的使用、使用障碍或过量可能有助于干预措施的制定或适应 策略。该研究将 1) 开发并验证一个使用个人层面特征（包括人口统计特征）的模型 特征、家庭收入、诊断、处方和医疗保健利用）和地区特征 （包括各种社会经济剥夺措施）以确定 15 岁和 年龄较大，因服用可卡因或其他兴奋剂过量而进入急诊室 (ED) 的风险最高； 2) 开发并验证一个模型，以识别 15 岁及以上的 Medicaid 参保者中 ED 风险最高的人群 当他们面临最高风险时，会遇到兴奋剂过量的情况； 3) 15 岁的 Medicaid 参保者以及 以上与先前因兴奋剂过量而遇到的急诊室情况相同，以测量其发生率并识别风险和保护因素 因兴奋剂和/或阿片类药物过量而随后出现 ED。结果至少在两个方面有用 方式。首先，他们将提供有关个人层面和社会因素的普遍知识，这些因素倾向于或 防止兴奋剂过量。这些病因因素可以成为国家、州、国家和地区的干预目标。 县和地方各级改善这些原因的影响，并作为未来研究的基础，以更好地 了解潜在的因果机制。其次，结果可以实用地用来识别高风险 旨在将稀缺资源用于基于证据的药物过量预防方法。