Multi-level associations between opioid use and overdose: Individual, clinical, and population-based risk factors for fatality

阿片类药物使用与过量之间的多层次关联：个体、临床和人群的死亡危险因素

• 批准号: 10203905
• 负责人: Hillary Samples
• 金额: $ 19.61万
• 依托单位: RUTGERS BIOMEDICAL/HEALTH SCIENCES-RBHS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10203905
• 关键词: Accidental Injury; Accounting; Address; Admission activity; Adult; Age; American; Area; Cause of Death; Cessation of life; Characteristics; Clinical; County; Data; Data Files; Data Sources; Death Rate; Development; Development Plans; Disabled Persons; Disadvantaged; Dose; Early Intervention; Education; Eligibility Determination; Enrollment; Ethics; Ethnic Origin; Formulation; Funding; Geography; Goals; Guidelines; Health; Health Resources; Health Services Accessibility; Health Services Research; Health Status; Health system; Healthcare; Healthcare Systems; Hospitals; Improve Access; Income; Individual; Intervention; Knowledge; Life Expectancy; Link; Longitudinal Studies; Measures; Medicaid; Medical; Mental disorders; Mentorship; Methodology; Methods; Minority; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Pain; Pain management; Pathway interactions; Pattern; Patterns of Care; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Research; Population; Population Characteristics; Poverty; Practice Guidelines; Prescription opioid overdose; Public Health; Race; Reporting; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Risk Factors; Secure; Services; Socioeconomic Factors; Strategic Planning; System; Time; Training; Training Support; Unemployment; Universities; Vulnerable Populations; Work; base; beneficiary; career; career development; chronic pain; clinical care; clinical epidemiology; clinical pain; comorbidity; contextual factors; disability; dosage; effective intervention; geographic difference; health care availability; high risk population; improved; indexing; innovation; mortality; non-cancer chronic pain; novel; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose risk; patient population; personalized approach; population based; population health; prescription monitoring program; prescription opioid; prevent; programs; response; rural counties; sex; social; social epidemiology; social structure; sociodemographic factors; sociodemographics; spatial epidemiology; statistics; stem; substance use; tertiary prevention; theories; trend

PROJECT SUMMARY: Over the past two decades, high rates of opioid prescribing have led to widespread opioid use and epidemic levels of adverse opioid-related outcomes. Early interventions focused on reducing opioid prescribing through the development of practice guidelines and implementation of programs and policies to increase prescription opioid management and monitoring. While overall opioid prescribing has declined in recent years and may have contributed to reductions in prescription opioid-involved overdose death rates in 2012 and 2013, the rate has since risen to a new high, comprising 40% of all opioid-related deaths in 2016. Furthermore, prescribing remains elevated in disadvantaged groups and areas, highlighting a need to better understand how individual characteristics intersect with health system and population-level factors in the pathways from opioid use to fatal and non-fatal overdose. Using a multi-level approach, the proposed project examines trajectories from opioid treatment for chronic non-cancer pain to opioid overdose and fatality, accounting for: 1) individual sociodemographic and clinical characteristics (e.g. sex, age, race/ethnicity, comorbidities), 2) opioid treatment patterns (e.g. dosage, duration, formulation), 3) county-level health system (e.g. facilities, services) and population characteristics (e.g. percent poverty, minority, unemployed, disabled), and 4) state-level policies (e.g. Medicaid policies, Prescription Drug Monitoring Programs). Opioid treatment patterns will be assessed using national Medicaid Analytic Extract (MAX) data, adjusting for individual characteristics. Risk of overdose based on individual characteristics and treatment patterns will be assessed using MAX data for medically treated non-fatal opioid overdose and National Death Index (NDI) data for fatal opioid overdose. Overdose outcomes will be further assessed using county-level Area Health Resource File (AHRF) data and state-level policy measures. Contextualizing individual outcomes within wider health care systems and social and geographic settings supports NIDA’s strategic plan to increase the public health impact of research. Additional substantive and methodological training will contribute to the applicant’s long-term goal to develop an independent academic research career and generate and disseminate robust evidence to inform effective interventions to reduce opioid-related morbidity and mortality. The training aims include advanced study and application of: 1) innovative methods to characterize clinical care patterns over time, 2) social and spatial epidemiology theory and methods to study multilevel influences on health, 3) policy drivers of health and health care, and 4) professional development for conducting ethical, independent research. The research and training are supported by an interdisciplinary mentorship team of Columbia University researchers with expertise in substance use and policy research, clinical and spatial epidemiology, and statistics with additional support from external collaborators in health services and policy research methods. This project and career development plan will prepare the applicant to secure R01 funding to extend this line of research.

项目摘要：在过去的二十年中，阿片类药物的高率导致了宽度 卵虫类药物相关结果的流行水平和流行水平。早期干预措施的重点是减少 通过制定实践指南和计划和政策的实施，处方药 增加处方阿片类药物管理和监测。虽然整个阿片类药物的处方已下降 近年来，可能导致处方药涉及阿片类药物的过量死亡率的降低 2012年和2013年，此后的利率已上升到新的高度，占2016年与阿片类药物相关的所有死亡的40％。 此外，在灾难团体和地区的处方仍在提高，强调了需要更好的 了解个人特征如何与卫生系统和人口级别的因素相交 从阿片类药物使用到致命和非致命过量的途径。使用多层次的方法，提议的项目 检查阿片类药物治疗的轨迹慢性非癌症疼痛到阿片类药物过量和死亡， 会计：1）个人社会人口统计学和临床​​特征（例如性别，年龄，种族/种族， 合并症），2）阿片类药物治疗模式（例如剂量，持续时间，配方奶），3）县级卫生系统 （例如，设施，服务）和人口特征（例如贫困百分比，少数民族，失业，残疾）， 和4）州级政策（例如，医疗补助政策，处方药监测计划）。阿片类药物治疗 将使用国家医疗补助分析提取物（MAX）数据评估模式，对个人进行调整 特征。根据个人特征和治疗模式过量的风险将被评估 使用医疗治疗的非致命阿片类药物过量和国家死亡指数（NDI）数据的最大数据进行致命数据 阿片类药物过量。过量的结果将使用县级地区健康资源档案进一步评估 （AHRF）数据和州级政策措施。将更广泛的医疗保健中的个人成果与情境化 系统，社会和地理环境支持NIDA的战略计划，以增加公共卫生影响 研究。额外的实质性和方法学培训将有助于申请人的长期目标 发展独立的学术研究职业，并产生和传播强大的证据以告知 有效的干预措施以降低阿片类药物相关的发病率和死亡率。培训目标包括高级 研究和应用：1）随着时间的推移表征临床护理模式的创新方法，2）社交和 空间流行病学理论和研究对健康的多层次影响的方法，3）健康的政策驱动因素 和医疗保健，以及4）进行道德独立研究的专业发展。研究 培训得到哥伦比亚大学研究人员的跨学科心态团队的支持 在物质使用和政策研究，临床和空间流行病学以及统计学方面的专业知识以及其他 外部合作者在卫生服务和政策研究方法方面的支持。这个项目和职业 开发计划将使申请人为确保R01资金的资金做好准备，以扩展这一研究。