Rural-Urban Disparities In Spillover Effects of COVID-19

COVID-19 溢出效应的城乡差异

• 批准号: 10612486
• 负责人: Karen Ellen Joynt Maddox
• 金额: $ 47.4万
• 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/10612486
• 关键词: Adult; Ambulatory Care; COVID-19; COVID-19 impact; 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; Equity; 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; cerebrovascular; clinical care; clinical effect; coronavirus disease; ethnic minority; ethnic minority population; experience; health care delivery; health management; member; pandemic disease; poor health outcome; population health; racial minority; racial minority population; 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 2019 年冠状病毒 (COVID-19) 大流行扰乱了常规医疗服务的提供 美国各地的心血管和脑血管疾病（CVD）可能对下游造成毁灭性影响 在 COVID-19 得到控制后很长一段时间内，影响可能会通过延迟表现而显现出来， 急症护理的中断、常规门诊护理的推迟以及经济状况对健康的负面影响 以及社会风险恶化。 生活在农村地区的老年人比城市地区的老年人经历的心血管疾病结果更糟，并且可能 特别容易受到这些溢出效应的影响，特别是如果他们也生活在贫困中或者是成员 农村老年人也可能较少获得潜在的缓解措施。 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择性手术、 并主动接​​触患者以控制慢性病。然而，由于农村人口 由于该群体规模较小，且很少被纳入商业和卫生系统数据库，因此研究不足。 了解新冠病毒在农村地区的蔓延情况以应对疫情至关重要。 该提案的核心前提是了解新冠疫情对 CVD 溢出效应的严重程度 农村地区的气候变化以及关键缓解战略的影响将使我们能够应对未来的这一波浪潮 大流行，以及未来的其他疫情爆发，以及更广泛的农村护理服务面临的挑战。 使用国家医疗保险索赔数据，这使我们能够近乎完整地长期捕获临床护理和 为美国约 70% 的老年人提供结果，以实现三个目标： 目标 1：在大流行的前 12 个月中每月量化新冠病毒溢出效应，以及 描述农村地区与城市地区相比溢出缓解策略的使用情况。 目标 2：量化农村地区急症护理延迟和中断与其他地区相比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溢出效应的负面影响。 目标 3：量化慢性病护理延期和社会风险恶化的短期和长期临床影响 农村地区与城市地区，并确定缓解策略是否减少了溢出效应的负面影响。 拟议的工作将提供对新冠病毒溢出效应及其缓解策略的全国性估计 与农村老年人的临床心脑血管结局相关，并允许 它还将量化是否可以使用这些策略。 在生活贫困的农村个人或被认为是少数种族或族裔的人中享有公平待遇，使 未来监测和实现公平目标的努力。