Leveraging Trajectories of Health and Services Use to Improve the Health of Autistic Young Persons

利用健康和服务使用轨迹来改善自闭症年轻人的健康

• 批准号: 10698141
• 负责人: Diana Schendel
• 金额: $ 28.66万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-06 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10698141
• 关键词: Accidental Injury; Address; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Advocate; Age; Aging; Ambulatory Care; Behavioral; Biological; Brain; Categories; Cessation of life; Child; Childhood; Communities; Data; Development; Diagnosis; Disparity; Emergency Care; Emergency Situation; Emergency medical service; Enrollment; Equity; Ethnic Origin; Ethnic Population; Event; Future; Goals; Health; Health Services; Health system; Healthcare; Heterogeneity; Individual; Inpatients; Intervention; Knowledge; Life; Life Cycle Stages; Literature; Medicaid; Methods; Modeling; Outcome; Outpatients; Participant; Pathway interactions; Pattern; Persons; Pharmaceutical Preparations; Phase; Population; Population Heterogeneity; Prevalence; Process; Public Health; Quality of life; Race; Recording of previous events; Research; Risk; Sampling Studies; Science; Services; Social Change; Socioeconomic Status; Subgroup; Suicide; System; Vulnerable Populations; Work; World Health; adolescent with autism spectrum disorder; age group; aged; autism spectrum disorder; autistic; behavioral health; burden of illness; community engagement; contextual factors; disability-adjusted life years; ethnic disparity; ethnic diversity; experience; follow-up; health inequalities; health knowledge; implementation efforts; improved; individuals with autism spectrum disorder; innovation; mortality; multimodality; novel; premature; pressure; prevent; public health research; racial disparity; racial diversity; racial population; service delivery; service utilization; sex; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; study population; years lived with disability; years of life lost; young adult

PROJECT ABSTRACT With increasing prevalence of autism spectrum disorder (ASD) in childhood, autistic young persons (10-24 years) are a growing, yet understudied group. The research gap promotes autistic young person’s vulnerability to long-term poor health due to limited understanding of their health care needs and rising pressure on services. Elevated cross-sectional rates of co-occurring conditions and service utilization are well-documented in autistic young persons, but knowledge gaps remain regarding health and services patterns across age, and relevant targets and their timing needed to guide interventions. Further, prior work suggests socioeconomically disadvantaged or race/ethnically diverse groups are particularly at risk for compounded health effects and sub- optimal service patterns. We hypothesize that there are distinct patterns of health conditions and health services across age in autistic young persons which, together, impact future health, and the impact is potentially magnified by socioeconomic disadvantage or race/ethnic disparities. Using national 2008-2023 Medicaid data for a diverse US population aged 10-24 years (1.5 million with 5-years continuous enrollment; 600,000 ASD, 975,000 non-ASD), we will model longitudinal trajectories over a 5-year period of health conditions and services and quantify the combined effect of health and health services history on health over the next 10 years. We will apply group-based multi-trajectory methods to (Aim 1) determine age-specific health conditions trajectory classes (3 domains: brain; physical; behavioral health), and (Aim 2) health services trajectory classes (3 domains: inpatient/emergency; outpatient; medications). We will also quantify impact of health and services class combinations (Aim 3) on study participants’ health in the next 10 years using (a) burden of disease metrics (disability adjusted life years, years of life lived with disability, years of life lost due to premature death, health loss proportion), (b) risk of inpatient/emergency services utilization, and (c) mortality (all-cause mortality; suicide; death due to unintentional injury). Across all Aims, we assess ASD vs. non-ASD overall, as well as heterogeneity by sex, race/ethnicity, and socioeconomic status groups. As part of PHASES’ public health approach, we employ robust, 2-way community engagement methods in all study years for critical input from our community advocates, including autistic individuals, regarding all phases of our research. Our team has the experience and study population knowledge to conduct these novel state-of-the-art trajectory methods and health metrics, in this unique and diverse population based on 15-years of nation-wide Medicaid data. This project will provide critical evidence on multi-domain ‘real world’ health and services experiences and their effects on long term health, needed to optimize health interventions and outcomes for autistic young persons aging into adulthood.

项目摘要 随着儿童时期自闭症谱系障碍 (ASD) 患病率的增加，患有自闭症的青少年（10-24 岁） 年）是一个不断增长但尚未得到充分研究的群体。研究差距加剧了自闭症年轻人的脆弱性。 由于对其医疗保健需求了解有限以及不断增加的压力而导致长期健康状况不佳 共存条件和服务利用率升高的横截面率已得到充分记录。 在患有自闭症的年轻人中，但在跨年龄层的健康和服务模式方面仍然存在知识差距，并且 此外，先前的工作从社会经济角度提出了指导干预措施所需的相关目标及其时机。 弱势群体或种族/族裔群体尤其面临复合健康影响和亚健康影响的风险 我们认为健康状况和健康有不同的模式。 为自闭症青少年提供跨年龄段的服务，这些服务共同影响未来的健康，其影响是 使用 2008-2023 年国家数据可能会因社会经济劣势或种族/民族差异而放大。 10-24 岁不同美国人口的医疗补助数据（150 万人连续 5 年参保； 600,000 个 ASD，975,000 个非 ASD），我们将对 5 年健康期间的纵向轨迹进行建模 条件和服务，并量化健康和健康服务史对健康的综合影响 未来 10 年，我们将应用基于群体的多轨迹方法来（目标 1）确定特定年龄的健康状况。 条件类别轨迹（3 个领域：大脑；身体；行为健康）和（目标 2）卫生服务 轨迹类别（3 个领域：住院/急诊；门诊；药物）。 健康和服务类别组合（目标 3）对研究参与者未来 10 年的健康状况使用 (a) 疾病负担指标（残疾调整生命年、残疾寿命年、因疾病而损失的生命年） (b) 使用住院/急诊服务的风险，以及 (c) 死亡率 （全因死亡率；自杀；意外伤害造成的死亡）在所有目标中，我们评估自闭症谱系障碍与非自闭症谱系障碍。 总体而言，以及性别、种族/民族和社会经济地位群体的异质性。 公共卫生方法，我们在所有研究年中采用稳健的双向社区参与方法来应对关键的 我们的社区倡导者（包括自闭症患者）对我们研究的各个阶段的意见。 团队拥有经验和研究人口知识来进行这些新颖的最先进的轨迹 基于 15 年全国医疗补助的独特且多样化的人群的方法和健康指标 该项目将为多领域“现实世界”健康和服务经验提供关键证据。 及其对长期健康的影响，需要优化自闭症青少年的健康干预措施和结果 进入成年期的人。