INROADS-A: Intersecting Research on Addiction and Disability Services - Alcohol

INROADS-A：成瘾和残疾服务的交叉研究 - 酒精

• 批准号: 10777298
• 负责人: Rachel Sayko Adams
• 金额: $ 72.07万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-20 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10777298
• 关键词: Acceleration; Acute; Address; Adult; Affect; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; Americans with Disabilities Act; Brain Injuries; Caring; Cognition; Communities; Data; Data Set; Data Sources; Diagnosis; Disabled Persons; Discrimination; Disparity; Drug usage; Foundations; Future; Health; Health Services Accessibility; Healthcare; Hearing; Household; Impairment; Independent Living; Institute of Medicine (U.S.); Insurance; Intellectual functioning disability; Knowledge; Literature; Measures; Medicaid; Medical; Mental Health; Methodology; Methods; Morbidity - disease rate; Outcome; Pain; Patient Self-Report; Pattern; Personal Satisfaction; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Quasi-experiment; Recording of previous events; Research; Research Personnel; Risk; Risk Factors; Sampling; Self Care; Social isolation; Socioeconomic Status; Spinal cord injury; Stigmatization; Surveys; Transportation; Trauma; Traumatic Brain Injury; Treatment outcome; Update; Vision; Visual impairment; Woman; Work; access disparities; addiction; alcohol abstinence; alcohol abuse therapy; alcohol availability; alcohol consequences; alcohol risk; alcohol screening; alcohol services; alcohol use disorder; barrier to care; blind; comorbidity; cost; deaf; disability; experience; hard of hearing; health care disparity; health care quality; health care settings; health data; health definition; health disparity; health disparity populations; health inequalities; high risk; high risk drinking; improved; interest; intersectionality; low socioeconomic status; men; opioid use disorder; physical conditioning; severe mental illness; social health determinants; social stigma; theories; treatment comparison; treatment services; women with disabilities

Abstract People with disabilities (PWD) are an overlooked health disparity population who routinely experience stigma, discrimination, ableism, and lower socioeconomic status. Barriers to health care are generally high for PWD, and despite over three decades of the Americans with Disabilities Act, many health care settings including addiction treatment are not fully accessible for PWD. Recent studies have found that PWD abstain from alcohol more frequently than people without disabilities (PWoD); however, among current drinkers, PWD have elevated rates of at-risk alcohol use. Furthermore, PWD have greater risk for addiction, given higher rates of mental and physical health comorbidities, social isolation, trauma history and adverse social determinants of health. Despite this constellation of risk factors, very little is known about risk for alcohol use disorder (AUD) or alcohol-related morbidity or consequences among PWD, or whether disparities exist for PWD in accessing or engaging in AUD treatment compared to PWoD. We will use rigorous quasi-experimental methods to compare PWD to PWoD, using household survey data (National Survey on Drug Use and Health) and complementary medical claims datasets (Medicaid in 13 states; commercial insurance in MarketScan) to examine alcohol use, AUD indicators, morbidity and consequences, AUD treatment services, quality measures and outcomes by disability status. Disability status is defined by functional limitations in survey data and by diagnoses of disabling conditions in claims. Because disability is not homogeneous, analyses will consider any disability and types of disability. Analyses will be replicated to investigate outcomes for women with disabilities, an understudied and further stigmatized population. Our approach is organized by the cascade of care framework, and informed by intersectionality, critical disability theory, and the Institute of Medicine definition of health care disparities that separates needs-related differences from true disparities. The proposed specific aims are to: 1) identify differences in alcohol use, alcohol-related morbidity, and AUD diagnoses, by disability status; 2) among people with AUD, investigate disparities by disability status in alcohol-related morbidity, consequences, and access to AUD treatment; and 3) among people receiving AUD treatment, assess disparities by disability status in receiving quality-aligned AUD treatment and experiencing acute alcohol-related outcomes. Our multifaceted approach to data source selection and focus on disparities between PWD and PWoD will allow a more comprehensive picture of how the disability community is affected by alcohol problems. Findings are expected to provide policy makers, researchers, and clinicians with critical information to address disparities in access to, engagement in, and outcomes of AUD treatment for PWD, helping to reduce alcohol-related morbidity and improve the health of this commonly overlooked health disparity population.

抽象的 残疾人 (PWD) 是一个被忽视的健康差异人群，他们经常经历 耻辱、歧视、体能歧视和较低的社会经济地位。医疗保健的障碍普遍较高 残疾人士，尽管《美国残疾人法案》已经出台了三十多年，但许多医疗保健机构 包括成瘾治疗在内的残疾人士无法完全获得治疗。最近的研究发现，残疾人士不 比正常人 (PWoD) 更频繁地酗酒；然而，在目前的饮酒者中，PWD 有较高风险饮酒的比例较高。此外，考虑到残疾人士成瘾的风险更大 精神和身体健康合并症、社会孤立、创伤史和不良社交的发生率较高 健康的决定因素。尽管存在一系列风险因素，但人们对饮酒的风险知之甚少 残疾人士中的疾病（AUD）或酒精相关的发病率或后果，或者是否存在差异 与 PWoD 相比，PWD 获得或参与 AUD 治疗的情况。我们将使用严格的准实验 使用家庭调查数据（全国药物使用和健康调查）比较 PWD 和 PWoD 的方法 以及补充医疗索赔数据集（13 个州的医疗补助；MarketScan 中的商业保险） 检查酒精使用情况、AUD 指标、发病率和后果、AUD 治疗服务、质量措施 以及按残疾状况划分的结果。残疾状况由调查数据中的功能限制和 索赔中残疾状况的诊断。由于残疾不是同质的，分析将考虑任何 残疾和残疾类型。将重复分析以调查患有以下疾病的女性的结果 残疾，是一个未被充分研究和进一步受到污名化的人群。 我们的方法是由级联护理框架组织的，并以交叉性、关键性为基础 残疾理论和医学研究所对医疗保健差异的定义将需求相关的 与真实差异的差异。拟议的具体目标是：1）确定酒精使用的差异， 按残疾状况划分的酒精相关发病率和 AUD 诊断； 2) 在 AUD 患者中进行调查 酒精相关发病率、后果和获得 AUD 治疗的残疾状况之间的差异；和 3) 在接受 AUD 治疗的人群中，评估接受质量一致的残疾状况的差异 AUD 治疗和经历急性酒精相关后果。我们的数据源多方面方法 选择并关注 PWD 和 PWoD 之间的差异将有助于更全面地了解 酒精问题如何影响残疾人群体。调查结果有望提供政策 制造商、研究人员和临床医生提供关键信息，以解决获取、参与、 AUD 治疗残疾人士的效果和结果，有助于减少与酒精相关的发病率并改善健康状况 这个经常被忽视的健康差异人群。