Influence of social vulnerability on buprenorphine treatment and opioid overdoses after an opioid-related emergency department visit among commercially insured and Medicare Advantage beneficiaries

项目总结/摘要 阿片类药物过量继续增加，并不成比例地影响人们经历 更大的社会风险因素。丁丙诺啡是阿片类药物使用障碍（OUD）的一线治疗药物 减少阿片类药物过量，特别是在急诊室（艾德）开始时- 一个高容量的护理点。然而，丁丙诺啡治疗的不公平性存在内外 艾德的工作，方法上的挑战使得很难确定弱势群体， OUD可能受益于改善丁丙诺啡治疗的可及性和质量。 由疾病控制和预防中心开发的社会脆弱性指数（SVI） 预防（CDC）是一种通过捕捉社会风险来识别弱势群体的措施 一个地区影响健康的因素。综合分数是根据一个地区的：1） 社会经济地位; 2）家庭组成和残疾; 3）少数民族地位和语言; 4)住房和交通。审查地区一级社会风险影响的研究 丁丙诺啡治疗和阿片类药物过量的因素是州特异性的或仅限于 县级措施。没有研究探讨社会脆弱性对 阿片类药物相关艾德就诊后丁丙诺啡治疗和阿片类药物过量 拥有商业或医疗保险优势（老年人和残疾人）健康保险的OUD。 本研究将在住宅邮政编码水平上部署SVI，以调查 丁丙诺啡治疗的社会脆弱性和阿片类药物相关 艾德访问使用索赔数据（OptumLabs®数据仓库）从人与商业或 Medicare Advantage健康保险目标1将采用考克斯风险回归分析， 评估社会脆弱性是否与开始丁丙诺啡治疗的时间相关。 目标2将评估社会脆弱性对at 至少180天，以及其他八个丁丙诺啡治疗质量指标， 美国成瘾医学会（ASAM），使用广义估计方程（GEE）。 目标3将使用GEE评估处方实践对阿片类药物过量的影响。的 这项研究的结果将作为未来研究的模型，并为有针对性的政策提供信息， 改善丁丙诺啡治疗的可及性和质量的临床杠杆，以及阿片类药物- 相关结果，在经历更大社会风险因素的OUD患者中。

PROJECT SUMMARY/ABSTRACT Opioid overdoses continue to increase and disproportionately influence people experiencing greater social risk factors. Buprenorphine is a first-line treatment for opioid use disorder (OUD) that decreases opioid overdoses, especially when initiated in the emergency department (ED)— a high volume point-of-care. However, buprenorphine treatment inequities exist in and outside of the ED, and methodological challenges make it difficult to identify vulnerable populations with OUD who may benefit from improved access to, and quality of, buprenorphine treatment. The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention (CDC), is a measure that identifies vulnerable populations by capturing social risk factors in a region that influence health. A composite score is derived based on an area’s: 1) socioeconomic status; 2) household composition and disability; 3) minority status and language; 4) housing and transportation. Studies that examined the influence of area-level social risk factors on buprenorphine treatment and opioid overdoses were state specific or limited to county-level measures. No studies have examined the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit in people with OUD who have commercial or Medicare Advantage (aged and disabled) health insurance. This study will deploy the SVI at the residential zip-code level to investigate the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit using claims data (OptumLabs® Data Warehouse) from people with commercial or Medicare Advantage health insurance. Aim 1 will employ Cox hazard regression analysis to assess whether social vulnerability is associated with time to initiating buprenorphine treatment. Aim 2 will estimate the effect of social vulnerability on buprenorphine treatment retention for at least 180 days, as well as eight other buprenorphine treatment quality measures from the American Society of Addiction Medicine (ASAM), using generalized estimating equations (GEE). Aim 3 will estimate the effect of prescribing practices on opioid overdoses using GEE. The results from this study will serve as a model for future research and inform targeted policy and clinical levers that improve access to, and quality of, buprenorphine treatment, as well as opioid- related outcomes, among people with OUD experiencing greater social risk factors.