Stimulant Overdose in the Medicaid Population: Who is at Risk, and When are They at Risk

医疗补助人群中兴奋剂过量：谁有风险，何时有风险

• 批准号: 10392130
• 负责人: Sean Hennessy
• 金额: $ 36.25万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392130
• 关键词: Stimulant; Overdose; Medicaid; Population; Who

The US drug overdose epidemic in the has grown dramatically in the past twenty years, with more than 70,000 fatal drug overdoses in 2019 alone. This growth in overdose deaths is a major contributor to the multiyear decline in US life expectancy that was seen even before the COVID-19 pandemic began. The drugs responsible for the largest increases in overdose deaths are synthetic opioids, cocaine, and other stimulants (primarily methamphetamine). In recognition of the increasing role that cocaine and other stimulants are playing in the drug overdose epidemic, the US Centers for Disease Control and Prevention (CDC) has called for increased surveillance and evidence-based prevention and response strategies to address overdoses involving these agents. While rates of stimulant use and overdose have been reported vary by demographics, physical and mental health conditions, disability, and other factors, no prior research has linked individual-level data on demographics, disability, and social determinants of health together with granular measures derived from healthcare utilization records, with comprehensive, area-level data on social deprivation to develop knowledge about risk and protective factors for stimulant overdose. Further, no prior research has focused on stimulant overdose in Medicaid enrollees, a large, vulnerable, underserved population in whom half of all amphetamine-related hospitalizations occur. This project addresses Objective 2 of RFA-CE-21-002: to assess risk and protective factors for illicit stimulant use, use disorder, or overdose that can contribute to the development or adaptation of intervention strategies. The study will 1) develop and validate a model using both person-level characteristics (including demographic characteristics, household income, diagnoses, prescriptions, and healthcare utilization) and area-level characteristics (including a wide range of measures of socioeconomic deprivation) to identify, among Medicaid enrollees age 15 and older, who is at highest risk of an emergency department (ED) encounter for overdose from cocaine or other stimulants; 2) develop and validate a model to identify, among those Medicaid enrollees age 15 and older at highest risk of an ED encounter for stimulant overdose, when they are at highest risk; and 3) among those Medicaid enrollees age 15 and above with a prior ED encounter for stimulant overdose, to measure the rate of and identify risk and protective factors for a subsequent ED encounter for overdose from stimulants and/or opioids. The results will be useful in at least two ways. First, they will provide generalizable knowledge about the individual-level and social factors that predispose to or protect against stimulant overdose. Such etiologic factors can then be the targets of intervention at the national, state, county, and local levels to ameliorate the effects of these causes, as well serve as the basis of future research to better understand the underlying causal mechanisms. Second, the results can be used pragmatically to identify high-risk individuals for the purpose of targeting scarce resources for evidence-based approaches to overdose prevention.

在过去的二十年里，美国药物过量流行病急剧增长，超过70，000种致命药物 仅在2019年就出现了过量用药。吸毒过量死亡人数的增长是美国寿命多年下降的主要原因 甚至在COVID-19大流行开始之前就看到了这种预期。导致最大增长的药物 过量死亡是合成阿片类药物、可卡因和其他兴奋剂（主要是甲基苯丙胺）。以表彰 可卡因和其他兴奋剂在药物过量流行病中发挥着越来越大的作用，美国药物管制中心 疾病控制和预防中心（CDC）呼吁加强监测和循证预防和应对 解决涉及这些药物的过量问题的战略。虽然据报道， 由于人口统计学、身体和精神健康状况、残疾和其他因素的不同，以前的研究没有将其与之联系起来。 关于人口统计学、残疾和健康的社会决定因素的个人层面数据以及粒度测量 来自医疗保健利用记录，全面的，地区一级的数据，社会剥夺发展 了解兴奋剂过量的风险和保护因素。此外，没有先前的研究集中在兴奋剂 过量的医疗补助登记者，一个庞大的，脆弱的，服务不足的人口，其中一半的安非他明相关 发生住院。该项目涉及RFA-CE-21-002的目标2：评估非法药物的风险和保护因素。 兴奋剂使用、使用障碍或过量，可能导致干预措施的制定或适应 战略布局该研究将1）使用个人层面的特征（包括人口统计学特征） 特征、家庭收入、诊断、处方和医疗保健利用）和地区水平特征 （包括广泛的社会经济剥夺措施），以确定，在医疗补助登记者年龄15岁， 老年人，因可卡因或其他兴奋剂过量而在急诊室（艾德）遇到的风险最高; 2)开发并验证一个模型，以识别15岁及以上的医疗补助注册者中艾德风险最高的人群 遇到兴奋剂过量，当他们处于最高风险时;和3）在15岁的医疗补助注册者中， 以上与既往艾德遇到兴奋剂过量，以测量率，并确定风险和保护因素 随后因兴奋剂和/或阿片类药物过量而遭遇艾德。这些结果将在至少两个方面有所帮助。 的方式首先，他们将提供有关个人水平和社会因素的普遍知识，这些因素易患或 防止兴奋剂过量。这样的病因因素可以成为国家，州， 县和地方各级，以改善这些原因的影响，以及作为未来研究的基础，以更好地 了解潜在的因果机制。第二，结果可以务实地用于识别高风险 这是为了将稀缺资源用于预防过量用药的循证方法。