COVID-19 Pandemic Mitigation, Community Economic and Social Vulnerability, and Opioid Use Disorder

COVID-19 流行病缓解、社区经济和社会脆弱性以及阿片类药物使用障碍

• 批准号: 10653238
• 负责人: MEREDITH C. B. ADAMS
• 金额: $ 71.48万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653238
• 关键词: 2019-nCoV; Adherence; Adolescent; Affect; Age; Behavior; COVID-19; COVID-19 impact; COVID-19 morbidity; COVID-19 mortality; COVID-19 pandemic; COVID-19 pandemic effects; Cause of Death; Cessation of life; Cicatrix; Clinical; Color; Communities; Complex; County; Data; Data Set; Development; Diagnosis; Disparate; Disparity; Economic Conditions; Economic Factors; Economics; Elderly; Electronic Health Record; Ethnic Origin; Family; Future; Goals; Health; Healthcare; Healthcare Systems; Incidence; Individual; Inequality; Insurance Coverage; Measures; Medicare/Medicaid; Methods; National Institute of Drug Abuse; Natural experiment; Neighborhoods; Outcome; Outcomes Research; Personal Satisfaction; Persons; Policies; Population; Populations at Risk; Pregnancy; Prevalence; Public Health; Quasi-experiment; Race; Records; Relapse; Research; Risk; Running; Social Distance; Social Network; Social isolation; Stimulus; Subgroup; Testing; Unemployment; United States National Institutes of Health; Vaccination; Vaccines; Vulnerable Populations; Work; clinically relevant; contextual factors; design; disability; economic impact; effective intervention; electronic health data; ethnic minority; experience; health care availability; health care delivery; health disparity; improved; individual patient; medically underserved; minority communities; mortality; opioid epidemic; opioid use disorder; overdose death; pandemic disease; pandemic impact; pandemic response; pre-pandemic; prevent; racial minority; response; side effect; social; social vulnerability; vaccine acceptance; vulnerable community; welfare

PROJECT SUMMARY Opioid use disorder (OUD) is a serious national crisis that affects public health and economic welfare, even prior to the COVID-19 pandemic. The COVID-19 pandemic and the mitigation policies to prevent the spread of SARS-CoV-2 upended social networks, healthcare access, led to historically high unemployment, and amplified pre-existing community and economic vulnerability. Communities of color were hardest hit and highlight pre-pandemic disparities in health, mortality, and well-being, including structural community contextual factors that affect health. The pandemic also led to the highest overdose death toll since 2017. While we know that social isolation can amplify and reinforce OUD, it is unclear which components of SARS- CoV-2 mitigation efforts and resulting social, economic and healthcare disruptions differentially influenced individuals with existing/at-risk of OUD. Additionally, we do not know if the impacts were concentrated in communities with a higher pre-pandemic rate of OUD and/or were disproportionately adversely affected by economic factors or COVID-19 cases/deaths. The goal of this study is to leverage large comprehensive claims and electronic health data, capturing nearly half of the U.S. population from before the pandemic through 2026, to test our hypothesis that social and economic vulnerabilities, as well as economic side effects of the pandemic will escalate the prevalence of OUD and related harms. Building on our extensive existing work, we use quasi-experimental methods to measure adverse OUD-related outcomes and worsening health disparities using existing records capturing longitudinal OUD and COVID-19 incidence at the individual patient and community levels. In Aim 1, we evaluate whether OUD outcomes during the first nine months have been worse among communities that had been harder hit by the opioid epidemic pre-pandemic or have experienced disparately higher incidence of COVID-19 morbidity/mortality during the pandemic. In Aim 2, we evaluate longer-run OUD trajectories for communities that experienced 1) greater degrees of economic loss, 2) higher COVID-19 morbidity/mortality, and 3) have disparate levels of vaccination uptake over the first five years. We further examine disparities in OUD outcomes and leverage individual longitudinal data for particularly vulnerable subpopulations (pregnancy, adolescents, disability, older adults). At the successful completion of the proposed research, the expected outcomes are defined policy relevant factors that will reflect the net health and mortality impacts of the COVID-19 pandemic on OUD diagnoses, treatment initiation and adherence, utilization, and mortality over the short- and longer- terms. Ultimately, this research will support NIH NIDA’s goals, identifying COVID-19’s impact on OUD and populations at risk for being medically underserved in this complex yet vulnerable population.

项目摘要 阿片类药物使用障碍（OUD）是一场严重的民族危机，影响公共卫生和经济福利，甚至 在19日大流行之前。共同19-19大流行和缓解政策，以防止 SARS-COV-2上升的社交网络，医疗保健访问，导致历史上的失业率很高，并且 放大了先前存在的社区和经济脆弱性。有色社区受到最难打击， 突出显示健康，死亡率和福祉的流行前分布，包括结构社区 影响健康的情境因素。大流行还导致自2017年以来的过量死亡人数最高。 尽管我们知道社会隔离可以扩大和加强Oud，但尚不清楚SARS的哪些组成部分 - COV-2缓解工作以及导致的社会，经济和医疗保健受到不同影响 具有OUD现有/处于高风险的人。此外，我们不知道影响是否集中在 大流行率较高和/或受到较高率的社区的影响不成比例 经济因素或共同案件/死亡。这项研究的目的是利用大型综合 索赔和电子健康数据，从前捕获了几乎一半的美国人口 到2026年，大流行，以检验我们的假设，即社会和经济脆弱性以及经济 大流行的副作用将升级OUD和相关危害的流行。建立我们的广泛 现有工作，我们使用准实验方法来衡量与不利的结果和令人担忧的结果 使用现有记录捕获个人纵向Oud和Covid-19事件的健康分布 病人和社区级别。在AIM 1中，我们评估了前九个月的OUD结果是否有 在被阿片类药物流行前遭受更大打击的社区中，情况更糟 在大流行期间，COVID-19的发病率/死亡率较高。在AIM 2中，我们 评估经历经历的社区的长期OUD轨迹1）更大程度的经济损失，2） 较高的COVID-19发病率/死亡率和3）在前五个中具有不同的疫苗接种水平 年。我们进一步检查了Oud结果的分布，并利用个人纵向数据进行 特别脆弱的亚群（怀孕，青少年，残疾，老年人）。在成功 拟议研究的完成，预期的结果是定义的政策相关因素，这些因素将反映 19009年大流行对OUD诊断，治疗计划和 短期和长期的依从性，利用率和死亡率。最终，这项研究将支持NIH NIDA的目标，确定了Covid-19对Oud的影响和有医疗服务不足的风险的影响 在这个复杂但脆弱的人群中。