Multiscale dimensions of county-level disparities in opioid use disorder rates among older Medicare beneficiaries.
Multiscale dimensions of county-level disparities in opioid use disorder rates among older Medicare beneficiaries.
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DOI：
10.3389/fpubh.2022.993507
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发表时间：
2022
影响因子：
5.2
通讯作者：
Sun, Feinuo
中科院分区：
文献类型：
--
作者：
Yang, Tse-Chuan;Shoff, Carla;Choi, Seung-won Emily;Sun, Feinuo
关键词：
老年人（年龄 ≥ 65 岁）中的阿片类药物使用障碍 (OUD) 是一个日益增长但尚未得到充分研究的公共卫生问题，之前的研究主要假设人口健康结果地理模式背后的空间过程在整个空间中是恒定的。本研究是第一个应用本地模型视角来研究老年医疗保险受益人县级 OUD 比率的地理差异以及决定因素和 OUD 比率之间关系的空间非平稳性的研究之一。数据来自多个国家来源，包括医疗保险和医疗补助服务中心 2020 年汇总到县级和县级同等水平的受益人数据，以及 2016-2020 年美国社区调查 (ACS) 对美国 3,108 个相邻县的 5 年估计。我们使用多尺度地理加权回归来研究空间过程的三个维度，即“影响水平”（受某个决定因素影响的老年医疗保险受益人的百分比）、“可扩展性”（全球、区域或局部决定因素的空间过程）和“特异性”（与 OUD 率关联性最强的决定因素）。结果表明 OUD 率分布存在很大的空间异质性。受益人的特征，包括平均年龄、种族/族裔构成和平均等级状况类别 (HCC) 评分，在影响 OUD 比率方面发挥着重要作用，因为它们被认为是美国各县的主要影响因素（影响超过 50% 的人口）和最主要的决定因素。此外，非西班牙裔白人受益人的百分比、心理健康状况的平均数量以及平均 HCC 评分与 OUD 率的关联显示出空间非平稳性，表明这些变量在某些县比其他县更重要。我们的研究结果强调了从当地角度解决老年人 OUD 率地理差异的重要性。旨在降低美国各县 OUD 率的干预措施可以采用基于地点的方法，该方法可以考虑当地的需求和空间过程的不同规模。
Opioid use disorder (OUD) among older adults (age ≥ 65) is a growing yet underexplored public health concern and previous research has mainly assumed that the spatial process underlying geographic patterns of population health outcomes is constant across space. This study is among the first to apply a local modeling perspective to examine the geographic disparity in county-level OUD rates among older Medicare beneficiaries and the spatial non-stationarity in the relationships between determinants and OUD rates. Data are from a variety of national sources including the Centers for Medicare & Medicaid Services beneficiary-level data from 2020 aggregated to the county-level and county-equivalents, and the 2016–2020 American Community Survey (ACS) 5-year estimates for 3,108 contiguous US counties. We use multiscale geographically weighted regression to investigate three dimensions of spatial process, namely “level of influence” (the percentage of older Medicare beneficiaries affected by a certain determinant), “scalability” (the spatial process of a determinant as global, regional, or local), and “specificity” (the determinant that has the strongest association with the OUD rate). The results indicate great spatial heterogeneity in the distribution of OUD rates. Beneficiaries' characteristics, including the average age, racial/ethnic composition, and the average hierarchical condition categories (HCC) score, play important roles in shaping OUD rates as they are identified as primary influencers (impacting more than 50% of the population) and the most dominant determinants in US counties. Moreover, the percentage of non-Hispanic white beneficiaries, average number of mental health conditions, and the average HCC score demonstrate spatial non-stationarity in their associations with the OUD rates, suggesting that these variables are more important in some counties than others. Our findings highlight the importance of a local perspective in addressing the geographic disparity in OUD rates among older adults. Interventions that aim to reduce OUD rates in US counties may adopt a place-based approach, which could consider the local needs and differential scales of spatial process.
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DOI：
10.1016/j.trsl.2021.03.018
发表时间：
2021-08
期刊：
Translational research : the journal of laboratory and clinical medicine
影响因子：
--
作者：
Marks C;Carrasco-Escobar G;Carrasco-Hernández R;Johnson D;Ciccarone D;Strathdee SA;Smith D;Bórquez A
通讯作者：
Bórquez A
影响因子：
3.4
作者：
Oshan, Taylor M.;Li, Ziqi;Fotheringham, A. Stewart
通讯作者：
Fotheringham, A. Stewart
DOI：
10.1111/1467-9884.00145
发表时间：
1998-01-01
期刊：
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES D-THE STATISTICIAN
影响因子：
--
作者：
Brunsdon, C;Fotheringham, S;Charlton, M
通讯作者：
Charlton, M
影响因子：
4.4
作者：
Kolak, Marynia A.;Chen, Yen-Tyng;Pho, Mai T.
通讯作者：
Pho, Mai T.
影响因子：
6
作者：
Cerda, Magdalena;Gaidus, Andrew;Gruenewald, Paul
通讯作者：
Gruenewald, Paul