Infections and Drug Use-Related Morbidity and Mortality among People Who Use Drugs

吸毒者中感染和吸毒相关的发病率和死亡率

基本信息

批准号：
10593896
负责人：
Mary Charlot Figgatt
金额：
$ 2.11万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10593896
关键词：
Abscess Address Antibiotic Therapy Applied Research Area Bacteria Bacterial Infections Behavior Black Populations Cardiac Surgery procedures Caring Cellulitis Cessation of life Characteristics Clinical Clinical effectiveness Communicable Diseases Complex Comprehensive Health Care Data Data Set Death Certificates Diagnosis Disparity Drug usage Drug user Epidemiologic Methods Epidemiology Equipment Ethnic Origin Event FDA approved Face Foundations Gender Goals Harm Reduction Health Health Care Costs Healthcare Heart Hispanic Populations Hospitalization Individual Inequity Infection Infective endocarditis Injecting drug user Injections Injury Intervention Knowledge Link Medicare/Medicaid Medicine Mentorship Methodology Methods Modeling Morbidity - disease rate Mycoses Operative Surgical Procedures Outcome Overdose Patients Personal Satisfaction Pharmaceutical Preparations Population Preparation Principal Investigator Privatization Public Health Race Records Reporting Research Research Design Research Personnel Research Training Resource Allocation Role Sample Size Skin Skin Care Skin Tissue Socioeconomic Status Soft Tissue Infections Substance Use Disorder Surface Symptoms Time Training Training Programs Translational Research United States Woman access disparities adverse outcome career community setting cost effective therapy effectiveness evaluation epidemiology study experience fungus health care settings improved improved outcome infection burden infection rate infection risk injection drug use intersectionality knowledge base long term hospitalization medication for opioid use disorder men mortality multidisciplinary opioid use disorder overdose death people of color research and development research data dissemination skills substance use treatment effect

项目摘要

PROJECT ABSTRACT Bacterial and fungal infections associated with drug use are increasing substantially in the United States. Two such infections, skin and soft tissue infections (SSTI) and infective endocarditis (IE), can lead to significant illness or death among people who use drugs (PWUD). SSTIs, such as abscesses and cellulitis, are highly prevalent with up to 65% of people who inject drugs reporting recent SSTIs. IE is an infection of the heart that typically requires long-term hospitalization. In addition to these infections, some PWUD face other pressing health concerns, most notably opioid use disorder and overdose. Infection-related mortality may be a substantial contributor to all-cause mortality among PWUD. However, from a population perspective, little is known about the determinants and burden of infection-related mortality relative to drug overdose among PWUD. Among some PWUD, opioid use disorder is a potentially serious yet treatable condition. FDA approved medications are known to reduce opioid use disorder symptoms and modify underlying behaviors that may increase risk of infections and overdose, such as injection drug use. Race, ethnicity, and gender inequities in access to and use of medication for opioid use disorder (MOUD) exist, and the role of intersectionality of these identities in MOUD access or use are not known among those receiving care for infectious diseases. The overall objective of this proposal is to expand the knowledge base concerning infection-related mortality, fatal and nonfatal drug overdose, and all-cause mortality in PWUD diagnosed with SSTIs and IE, with a particular focus on opioid use disorder. Primarily, the project will document the burden and predictors of infection and drug overdose mortality among PWUD with a particular focus on those facing these infections. Additionally, we will quantify the effect of MOUD on increasing survival and improving health outcomes in PWUD with SSTIs and IE. Finally, the project will examine disparities in MOUD by race, ethnicity, and gender. The project will utilize an extensive dataset of healthcare records for over half of North Carolinians linked with death certificate data. The specific aims of this study are to (1) assess predictors of infection-related mortality and drug overdose among PWUD, (2) estimate the effect of MOUD on infection-related mortality and drug overdose mortality among PWUD diagnosed with SSTIs or IE, and (3) examine receipt of MOUD and continuation among PWUD diagnosed with SSTIs or IE by race, ethnicity, and gender. Accompanying the proposed research, a specialized training plan for the principal investigator will enhance her skill set in: (1) study design of drug use-related health outcomes, (2) robust methodological approaches to the use of administrative data in translational research, and (3) professional development and research dissemination in scientific and community settings. Through the proposed research and mentorship from a multidisciplinary team, the principal investigator will undertake a specialized training program that will lay the foundation for a career as an independent researcher in the areas of substance use epidemiology and translational research.

项目摘要在美国，与吸毒相关的细菌和真菌感染正在大幅增加。二皮肤和软组织感染（SSTI）和感染性心内膜炎（IE）等感染可导致严重的吸毒者患病或死亡 (PWUD)。脓肿和蜂窝织炎等 SSTI 非常常见高达 65% 的注射吸毒者报告近期发生 SSTI。 IE 是一种心脏感染，通常需要长期住院治疗。除了这些感染之外，一些残疾人士还面临其他紧迫的问题健康问题，最明显的是阿片类药物使用障碍和过量。感染相关死亡率可能是是造成残疾人全因死亡率的重要因素。但从人口角度来看，几乎没有了解与药物过量相关的感染相关死亡率的决定因素和负担在 PWUD 中。在一些残疾人士中，阿片类药物使用障碍是一种潜在严重但可以治疗的病症。美国FDA 已知批准的药物可以减少阿片类药物使用障碍症状并改变潜在行为这可能会增加感染和用药过量的风险，例如注射吸毒。种族、民族和性别在获取和使用治疗阿片类药物使用障碍 (MOUD) 的药物方面存在不平等现象，并且这些身份在 MOUD 访问或使用中的交叉性在接受护理的人中并不知晓传染病。该提案的总体目标是扩大有关的知识库被诊断患有以下疾病的 PWUD 中与感染相关的死亡率、致死性和非致死性药物过量以及全因死亡率 SSTI 和 IE，特别关注阿片类药物使用障碍。首先，该项目将记录负担 PWUD 中感染和药物过量死亡率的预测因素，特别关注那些面临困难的人这些感染。此外，我们将量化 MOUD 对提高生存率和改善健康状况的影响患有 SSTI 和 IE 的 PWUD 的结果。最后，该项目将研究按种族、族裔、和性别。该项目将利用超过一半北卡罗来纳州人的广泛医疗记录数据集与死亡证明数据相关联。本研究的具体目的是（1）评估感染相关的预测因素 PWUD 中的死亡率和药物过量，(2) 估计 MOUD 对感染相关死亡率的影响和诊断患有 SSTI 或 IE 的 PWUD 中药物过量死亡率，以及 (3) 检查 MOUD 的收据和诊断患有 SSTI 或 IE 的 PWUD 中按种族、民族和性别划分的持续情况。伴随着拟议的研究，主要研究者的专门培训计划将提高她在以下方面的技能：（1）与药物使用相关的健康结果的研究设计，（2）使用稳健的方法学方法转化研究中的行政数据，以及（3）专业发展和研究传播科学和社区环境。通过多学科的拟议研究和指导团队中，首席研究员将开展专门培训计划，为后续研究奠定基础作为物质使用流行病学和转化研究领域的独立研究员。