County social isolation and opioid use disorder among older adults: A longitudinal analysis of Medicare data, 2013-2018.
County social isolation and opioid use disorder among older adults: A longitudinal analysis of Medicare data, 2013-2018.
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DOI：
10.1016/j.socscimed.2022.114971
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发表时间：
2022-05
影响因子：
5.4
通讯作者：
Shaw, Benjamin A.
中科院分区：
文献类型：
--
作者：
Yang, Tse-Chuan;Shoff, Carla;Kim, Seulki;Shaw, Benjamin A.
关键词：
本研究旨在填补三个知识空白：（1）生态因素在影响老年人阿片类药物使用障碍（OUD）风险中的作用尚不清楚，（2）老年人 OUD 研究缺乏纵向视角，（3）老年人 OUD 决定因素中的种族/民族差异尚未得到充分探索。本研究利用纵向数据分析估计了县级社会隔离、集中劣势和收入不平等对老年人 OUD 风险的影响。我们将 2013-2018 年医疗保险人口（65 岁以上）数据与美国社区调查 5 年县级估计数据合并，创建人年数据集（N = 47,291,217 人年），并使用条件 Logit 固定效应模型来测试个人和县级协变量的变化是否会改变老年人的 OUD 风险。此外，我们还建立了种族/民族特定模型来比较这些关联在不同种族/民族群体之间的差异。在县一级，社会隔离度每增加一个单位（平均值 = −0.197，SD = 0.511），OUD 风险就会增加 5.5%（OR = 1.055；95% CI = [1.018, 1.094]），第一产业就业人口每增加 1 个百分点，OUD 风险就会减少 1%（OR = 0.990；95% CI = [1.018, 1.094]）。 95% CI = [0.985, 0.996]）。在个人层面，医疗保险分级状况类别风险评分、身体合并症和精神合并症的增加都会增加 OUD 的风险。县级社会隔离与 OUD 之间的关系是由非拉美裔白人驱动的，而拉美裔受益人对县级因素变化的敏感度低于任何其他种族群体。 2013年至2018年间，美国老年人的OUD风险与生态和个人因素相关，这对干预具有影响。需要进一步研究来了解为什么个体因素与 OUD 的关联在不同种族/族裔群体中具有可比性，但县级社会隔离仅与非西班牙裔白人受益人中的 OUD 相关。
This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults’ risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults’ risk of OUD using longitudinal data analysis. We merged the 2013–2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and used conditional logit fixed-effects modeling to test whether changes in individual- and county-level covariates alter older adults’ risk of OUD. Moreover, we conducted race/ethnicity-specific models to compare how these associations vary across racial/ethnic groups. At the county-level, a one-unit increase in social isolation (mean = −0.197, SD = 0.511) increased the risk of OUD by 5.5 percent (OR = 1.055; 95% CI = [1.018, 1.094]) and a one-percentage-point increase in the working population employed in primary industry decreases the risk of OUD by 1 percent (OR = 0.990; 95% CI = [0.985, 0.996]). At the individual-level, increases in the Medicare Hierarchical Condition Categories risk score, physical comorbidity, and mental comorbidity all elevate the risk of OUD. The relationship between county-level social isolation and OUD is driven by non-Hispanic whites, while Hispanic beneficiaries are less sensitive to the changes in county-level factors than any other racial ethnic groups. Between 2013 and 2018, US older adults’ risk of OUD was associated with both ecological and individual factors, which carries implications for intervention. Further research is needed to understand why associations of individual factors with OUD are comparable across racial/ethnic groups, but county-level social isolation is only associated with OUD among non-Hispanic white beneficiaries.
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DOI：
10.1097/jgp.0b013e318190b8ef
发表时间：
2009-03
期刊：
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
影响因子：
--
作者：
Blazer DG;Wu LT
通讯作者：
Wu LT
影响因子：
5.5
作者：
Besser LM;McDonald NC;Song Y;Kukull WA;Rodriguez DA
通讯作者：
Rodriguez DA
影响因子：
4.2
作者：
Huhn, Andrew S.;Strain, Eric C.;Dunn, Kelly E.
通讯作者：
Dunn, Kelly E.
影响因子：
4.7
作者：
Hudson, Christopher G.;Doogan, Nathan J.
通讯作者：
Doogan, Nathan J.
影响因子：
33.9
作者：
Guy, Gery P., Jr.;Zhang, Kun;Dowell, Deborah
通讯作者：
Dowell, Deborah