Inequities in the epidemiology and treatment of HCV and other injection-related infections in a national sample of Medicaid enrollees

全国医疗补助参与者样本中 HCV 和其他注射相关感染的流行病学和治疗方面的不平等

• 批准号: 10440686
• 负责人: Shashi Kapadia
• 金额: $ 8.62万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440686
• 关键词: Affect; Antibiotics; Area; Award; Bacterial Infections; Caring; Cellulitis; Characteristics; Dangerousness; Data; Data Set; Data Sources; Databases; Diagnosis; Distant; District of Columbia; Drug user; Endocarditis; Epidemic; Epidemiology; Evidence based treatment; HIV; Health; Health Services Accessibility; Health Status; Health system; Healthcare; Healthcare Systems; Hepatitis C; Hepatitis C Incidence; Hepatitis C Therapy; Hispanics; Hospitalization; Hospitals; Incidence; Individual; Infection; Injecting drug user; Injections; Intervention; K-Series Research Career Programs; Lead; Life; Link; Measures; Medicaid; Methods; Modeling; Morbidity - disease rate; Mycoses; Myositis; Needle-Exchange Programs; Neighborhoods; New York; Operative Surgical Procedures; Osteomyelitis; Outcome; Outpatients; Parents; Patients; Pattern; Policies; Provider; Public Health; Qualitative Methods; Risk; Sampling; Sepsis; Site; Specialist; Structure; Substance Use Disorder; Treatment outcome; United States; United States Centers for Medicare and Medicaid Services; Variant; Work; base; care providers; cohort; effective therapy; experience; health care delivery; health care disparity; health care service utilization; health disparity; health equity; health service use; hospital readmission; improved; injection drug use; insight; medical complication; medical specialties; mortality; parent grant; prior authorization; racial and ethnic disparities; residence; social stigma; therapy design; treatment disparity; uptake; young adult

PROJECT SUMMARY / ABSTRACT: The injection drug use epidemic in the United States has also led to an epidemic of injection-related infections. Infections such as hepatitis C are increasing in incidence, especially among younger adults. Also, severe bacterial infections such as endocarditis and sepsis, which are often life-threatening, have been rising precipitously. People who use drugs are subject to stigma in the healthcare system, and evidence shows that they are less likely to be offered evidence-based treatment such as hepatitis C cure and valve surgery for endocarditis. Additionally, racial and ethnic disparities in the treatment of hepatitis C and of severe bacterial infections have also been described. Understanding how racial and ethnic disparities might manifest in people who inject drugs that are affected by injection-related infections is important to develop both individual and health-system level interventions to mitigate those disparities and provide more equitable treatment. In the parent grant, Dr. Kapadia studies HCV treatment uptake among primary care providers utilizing Medicaid claims data. This includes understanding how new treatments are being taken up by providers of different specialties and offered to patients differentially based on whether they have a substance use disorder. He also examines outcomes of HCV treatment for people treated by primary care providers compared to those treated by specialists. In this supplement, Dr. Kapadia proposes to extend the work in the parent award to examine racial and ethnic disparities for injection-related infections. This work will leverage the national Medicaid claims data he has collected for the parent award to study this critical topic. In the supplement, he will first examine racial and ethnic disparities in treatment initiation for hepatitis C, separating people who use drugs and people who do not, to see if the patterns of disparities differ. Then, he will examine racial and ethnic disparities in the treatment offered to people who inject drugs with severe bacterial infections, examine factors that may explain the pattern of disparities, and determine if these factors differ from the ones identified in patients with hepatitis C. He will use multilevel regression models to account for individual-level, hospital-level, and area- level variables that may explain the observed racial-ethnic disparities. Together, these aims will leverage the unique data sources and expertise that Dr. Kapadia is using in the parent award to answer important questions about health equity for injection-related infections. The results will be important to clinicians, public health agencies, and policymakers, and lead to interventions designed to improve health equity for these important and dangerous health conditions.

项目总结/摘要： 美国的注射吸毒流行也导致了注射相关感染的流行。 丙型肝炎等感染的发病率正在增加，特别是在年轻人中。此外，严重 心内膜炎和脓毒症等细菌感染常常危及生命， 突然地吸毒者在医疗系统中会受到污名化，证据表明， 他们不太可能得到循证治疗，如丙型肝炎治愈和瓣膜手术， 心内膜炎此外，在丙型肝炎和严重细菌性肝炎的治疗中， 感染也有描述。了解种族和民族差异如何在人们身上表现出来 注射受注射相关感染影响的药物的人对发展个人和 卫生系统一级的干预措施，以减少这些差距，提供更公平的待遇。 在父母补助金中，Kapadia博士研究了初级保健提供者利用 医疗补助索赔数据。这包括了解新的治疗方法是如何被提供者采用的。 不同的专业，并根据患者是否患有物质使用障碍而区别对待。 他还检查了初级保健提供者治疗的人与那些接受初级保健提供者治疗的人相比， 由专家治疗。 在这一补充，博士卡帕迪亚建议延长工作，在家长奖，以审查种族和民族 注射相关感染的差异。这项工作将利用国家医疗补助索赔数据，他有 为家长奖收集来研究这个重要的话题。在增刊中，他将首先审查种族和 丙型肝炎治疗开始时的种族差异，将使用药物的人和使用药物的人分开 而不是去看差异的模式是否不同。然后，他将研究种族和民族差异， 治疗提供给人谁注射药物与严重的细菌感染，检查因素，可能解释 差异的模式，并确定这些因素是否与患者中确定的因素不同， 丙型肝炎他将使用多层次回归模型来解释个人水平，医院水平和地区- 水平变量，可以解释观察到的种族-民族差异。 总之，这些目标将利用Kapadia博士在父母中使用的独特数据源和专业知识 该奖项旨在回答有关注射相关感染的健康公平性的重要问题。结果将 重要的临床医生，公共卫生机构和决策者，并导致干预措施， 改善这些重要和危险健康状况的健康公平性。