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COVID-19 Pandemic Mitigation, Community Economic and Social Vulnerability, and Opioid Use Disorder

COVID-19 流行病缓解、社区经济和社会脆弱性以及阿片类药物使用障碍

基本信息

批准号：
10653238
负责人：
MEREDITH C. B. ADAMS
金额：
$ 71.48万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10653238
关键词：
2019-nCoV Adherence Adolescent Affect Age Behavior COVID-19 COVID-19 impact COVID-19 morbidity COVID-19 mortality COVID-19 pandemic COVID-19 pandemic effects Cause of Death Cessation of life Cicatrix Clinical Color Communities Complex County Data Data Set Development Diagnosis Disparate Disparity Economic Conditions Economic Factors Economics Elderly Electronic Health Record Ethnic Origin Family Future Goals Health Healthcare Healthcare Systems Incidence Individual Inequality Insurance Coverage Measures Medicare/Medicaid Methods National Institute of Drug Abuse Natural experiment Neighborhoods Outcome Outcomes Research Personal Satisfaction Persons Policies Population Populations at Risk Pregnancy Prevalence Public Health Quasi-experiment Race Records Relapse Research Risk Running Social Distance Social Network Social isolation Stimulus Subgroup Testing Unemployment United States National Institutes of Health Vaccination Vaccines Vulnerable Populations Work clinically relevant contextual factors design disability economic impact effective intervention electronic health data ethnic minority experience health care availability health care delivery health disparity improved individual patient medically underserved minority communities mortality opioid epidemic opioid use disorder overdose death pandemic disease pandemic impact pandemic response pre-pandemic prevent racial minority response side effect social social vulnerability vaccine acceptance vulnerable community welfare

项目摘要

PROJECT SUMMARY Opioid use disorder (OUD) is a serious national crisis that affects public health and economic welfare, even prior to the COVID-19 pandemic. The COVID-19 pandemic and the mitigation policies to prevent the spread of SARS-CoV-2 upended social networks, healthcare access, led to historically high unemployment, and amplified pre-existing community and economic vulnerability. Communities of color were hardest hit and highlight pre-pandemic disparities in health, mortality, and well-being, including structural community contextual factors that affect health. The pandemic also led to the highest overdose death toll since 2017. While we know that social isolation can amplify and reinforce OUD, it is unclear which components of SARS- CoV-2 mitigation efforts and resulting social, economic and healthcare disruptions differentially influenced individuals with existing/at-risk of OUD. Additionally, we do not know if the impacts were concentrated in communities with a higher pre-pandemic rate of OUD and/or were disproportionately adversely affected by economic factors or COVID-19 cases/deaths. The goal of this study is to leverage large comprehensive claims and electronic health data, capturing nearly half of the U.S. population from before the pandemic through 2026, to test our hypothesis that social and economic vulnerabilities, as well as economic side effects of the pandemic will escalate the prevalence of OUD and related harms. Building on our extensive existing work, we use quasi-experimental methods to measure adverse OUD-related outcomes and worsening health disparities using existing records capturing longitudinal OUD and COVID-19 incidence at the individual patient and community levels. In Aim 1, we evaluate whether OUD outcomes during the first nine months have been worse among communities that had been harder hit by the opioid epidemic pre-pandemic or have experienced disparately higher incidence of COVID-19 morbidity/mortality during the pandemic. In Aim 2, we evaluate longer-run OUD trajectories for communities that experienced 1) greater degrees of economic loss, 2) higher COVID-19 morbidity/mortality, and 3) have disparate levels of vaccination uptake over the first five years. We further examine disparities in OUD outcomes and leverage individual longitudinal data for particularly vulnerable subpopulations (pregnancy, adolescents, disability, older adults). At the successful completion of the proposed research, the expected outcomes are defined policy relevant factors that will reflect the net health and mortality impacts of the COVID-19 pandemic on OUD diagnoses, treatment initiation and adherence, utilization, and mortality over the short- and longer- terms. Ultimately, this research will support NIH NIDA’s goals, identifying COVID-19’s impact on OUD and populations at risk for being medically underserved in this complex yet vulnerable population.

项目总结