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：在过去的二十年里，阿片类药物处方的高比率导致了广泛的 阿片类药物使用和与阿片类药物有关的不良后果的流行程度。早期干预的重点是减少 通过制定实践指南和执行方案和政策来开出阿片类药物 加强处方阿片类药物管理和监测。虽然阿片类药物处方总量在#年有所下降 近年来，这可能有助于降低处方阿片类药物的过量死亡率。 2012年和2013年，这一比例升至新高，占2016年阿片类药物相关死亡人数的40%。 此外，在弱势群体和地区，处方开药量仍然较高，突出表明有必要更好地 了解个人特征如何与卫生系统和人口层面的因素在 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，拟议的项目 检查从阿片类药物治疗慢性非癌症疼痛到阿片类药物过量和死亡的轨迹， 说明：1)个人社会人口学和临床特征(例如性别、年龄、种族/民族、 合并症)，2)阿片类药物治疗模式(如剂量、持续时间、配方)，3)县级卫生系统 (如设施、服务)和人口特征(如贫困、少数民族、失业、残疾人的百分比)， 和4)州一级的政策(如医疗补助政策、处方药监测计划)。阿片类药物治疗 模式将使用国家医疗补助分析提取(MAX)数据进行评估，并根据个人进行调整 特点。将根据个人特征和治疗模式评估过量用药的风险 使用医疗治疗非致命阿片类药物过量的MAX数据和致命的国家死亡指数(NDI)数据 阿片类药物过量。将使用县级地区卫生资源文件进一步评估过量用药的结果 (AHRF)数据和州一级的政策措施。将个人结果与更广泛的医疗保健联系起来 系统以及社会和地理环境支持NIDA增加公共卫生影响的战略计划 研究的成果。额外的实质性和方法学培训将有助于申请者的长期目标 发展独立的学术研究事业，并产生和传播可靠的证据以提供信息 减少阿片类药物相关发病率和死亡率的有效干预措施。培训目标包括高级 研究和应用：1)描述随时间推移的临床护理模式的创新方法，2)社会和 空间流行病学理论和方法研究对健康的多层次影响，3)健康的政策驱动因素 和医疗保健，以及4)进行道德的、独立的研究的专业发展。这项研究 和培训由哥伦比亚大学研究人员组成的跨学科导师团队提供支持， 在物质使用和政策研究、临床和空间流行病学以及其他统计方面的专业知识 在卫生服务和政策研究方法方面得到外部合作者的支持。这个项目和职业生涯 发展计划将使申请者做好准备，以获得R01资金来扩展这一研究领域。