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

• 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
• 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

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.

项目概要 阿片类药物使用障碍（OUD）是一场严重的国家危机，影响公众健康和经济福利，甚至 在 COVID-19 大流行之前。 COVID-19 大流行和防止传播的缓解政策 SARS-CoV-2 颠覆了社交网络、医疗保健服务，导致失业率创历史新高， 加剧了现有的社区和经济脆弱性。有色人种社区受到的打击最严重 强调大流行前健康、死亡率和福祉方面的差异，包括结构性社区 影响健康的背景因素。这场大流行还导致了自 2017 年以来最高的服药过量死亡人数。 虽然我们知道社会隔离可以放大和加强 OUD，但尚不清楚 SARS 的哪些组成部分- 缓解 CoV-2 疫情的努力以及由此产生的社会、经济和医疗保健中断受到不同程度的影响 患有 OUD/有 OUD 风险的个人。此外，我们不知道影响是否集中在 大流行前 OUD 率较高和/或受到不成比例的不利影响的社区 经济因素或 COVID-19 病例/死亡。本研究的目标是利用大型综合 索赔和电子健康数据，涵盖了疫情之前近一半的美国人口 到 2026 年大流行，以检验我们的假设，即社会和经济脆弱性以及经济 大流行的副作用将加剧 OUD 的流行和相关危害。建立在我们广泛的 在现有的工作中，我们使用准实验方法来衡量与 OUD 相关的不良结果和恶化情况 使用捕获个体纵向 OUD 和 COVID-19 发病率的现有记录来确定健康差异 患者和社区层面。在目标 1 中，我们评估前 9 个月的 OUD 结果是否有 在大流行前受阿片类药物流行病打击更严重的社区或已经发生的社区中情况更糟 在大流行期间，COVID-19 发病率/死亡率明显升高。在目标 2 中，我们 评估经历过 1) 较大程度经济损失、2) 的社区的长期 OUD 轨迹 COVID-19 发病率/死亡率较高，并且 3) 前五个时期的疫苗接种率存在差异 年。我们进一步研究 OUD 结果的差异，并利用个人纵向数据 特别脆弱的亚人群（孕妇、青少年、残疾人、老年人）。在成功的 完成拟议的研究后，预期结果被定义为政策相关因素，将反映 COVID-19 大流行对 OUD 诊断、治疗开始和治疗的净健康和死亡率影响 短期和长期的依从性、利用率和死亡率。最终，这项研究将支持 NIH NIDA 的目标，确定 COVID-19 对 OUD 和面临医疗服务不足风险的人群的影响 在这个复杂而脆弱的人群中。