Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
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DOI：
10.1016/j.drugalcdep.2022.109340
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发表时间：
2022-03-01
影响因子：
4.2
通讯作者：
Griffith KN
中科院分区：
文献类型：
--
作者：
Auty SG;Griffith KN
新冠肺炎大流行导致卫生服务提供中断，可能对获得物质使用障碍(SUD)治疗服务产生不利影响。此前，医疗补助计划的扩大与低收入成年人获得SUD服务的机会增加有关。因此，大流行可能对过量用药死亡率产生了不同的影响，这取决于扩张状况。这项研究考察了2013至2020年间全国和各州医疗补助扩大状况下过量用药死亡率的趋势。关于过量用药死亡率的州一级数据来自疾病控制和预防中心的WONDER数据库，2013-2020年(N=10408个州-年)。主要结果是每10万名居民中有药物和阿片类药物过量死亡。主要风险敞口是截至2020年1月1日的医疗补助扩大状况。差值(DID)模型被用来比较新冠肺炎大流行爆发后扩张和非扩张状态之间结果的变化。2020年，美国有91,799人死于药物过量，比2019年相对增加了29.9%。从2019年到2020年，扩展州每10万居民的药物过量死亡人数调整后增加了7.0人(95%CI 3.3，10.7)，非扩展州的死亡人数增加了4.3人(95%CI 1.5，8.2)。阿片类药物过量死亡也有类似的趋势。在DID模型中，扩大医疗补助与药物变化(0.9例死亡，95%CI−2.0，3.7)或阿片类药物过量死亡(0.8例死亡，95%CI−1.8，3.5)无关。在新冠肺炎大流行的第一年，药物或阿片类药物过量死亡的增加在有和没有扩大医疗补助的州是相似的。
The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention’s WONDER database for 2013–2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI −2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI −1.8, 3.5). The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
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影响因子：
82.9
作者：
Wakeman SE;Green TC;Rich J
通讯作者：
Rich J
DOI：
10.1097/ede.0b013e3181a819a1
发表时间：
2009-07
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Schisterman EF;Cole SR;Platt RW
通讯作者：
Platt RW
影响因子：
3.4
作者：
Sohn, Minji;Talbert, Jeffery C.;Freeman, Patricia R.
通讯作者：
Freeman, Patricia R.
影响因子：
3.9
作者：
McCarty, Dennis;Gu, Yifan;McConnell, K. John
通讯作者：
McConnell, K. John
影响因子：
13.8
作者：
Kravitz-Wirtz, Nicole;Davis, Corey S.;Cerda, Magdalena
通讯作者：
Cerda, Magdalena