Rural-Urban Disparities In Spillover Effects of COVID-19

摘要 2019年冠状病毒（COVID-19）大流行导致常规医疗服务中断， 心血管和脑血管疾病（CVD）在美国各地，可能会造成毁灭性的下游 在COVID-19得到控制后的很长时间内。COVID的“溢出效应”可能会通过延迟呈现来体现， 急性护理中断、常规门诊护理推迟以及经济状况对健康的负面影响 社会风险加剧。 生活在农村地区的老年人的心血管疾病结果比城市老年人更差， 特别是如果他们也生活在贫困之中或者是 种族或少数民族群体。农村的老年人也可能较少获得潜在的缓解措施 战略，如住院和门诊远程保健，在新的预防措施下重新启动择期手术， 并主动接触患者以管理慢性病。然而，由于农村人口 这一群体规模较小，也不经常被纳入商业和卫生系统数据库，因此研究不足。是 关键是要了解COVID在农村地区的蔓延，以应对它。 这项提议的核心前提是，了解COVID对CVD的溢出效应的程度， 在农村地区，以及关键缓解战略的影响，将使我们能够应对未来的浪潮， 大流行，未来还会爆发其他疫情，更广泛地对农村保健服务提出挑战。我们将 使用国家医疗保险索赔数据，这使我们能够接近完整，长期捕获临床护理， 为美国大约70%的老年人提供成果，以实现三个目标： 目标1：在疫情爆发的前12个月，每月量化COVID的溢出效应，以及 说明农村地区与城市地区相比使用减少外溢战略的情况。 目的2：量化农村与农村急性护理延迟和中断的短期和长期临床影响， 城市地区，并确定缓解战略是否减少了外溢的负面影响。 目的3：量化慢性病护理延期和社会风险恶化的短期和长期临床影响， 农村地区与城市地区，并确定缓解战略是否减少了外溢的负面影响。 拟议的工作将提供国家对COVID溢出及其缓解策略的估计， 与农村老年人的临床心血管和脑血管结局相关， 今后将采用的成功战略。它还将量化是否获得这些战略， 在农村贫困人口或少数民族中实现平等， 今后的努力，以监测和实现平等目标。

Abstract The Coronavirus 2019 (COVID-19) pandemic created disruptions in usual medical care delivery for cardiovascular and cerebrovascular disease (CVD) across the U.S. that could have devastating downstream effects long after COVID-19 is controlled. COVID’s “spillover” could manifest via delays in presentation, disruptions to acute care, deferral of usual outpatient care, and negative health effects of economic conditions and worsening social risk. Older adults living in rural areas experience worse CVD outcomes than their urban counterparts, and may be particularly vulnerable to each of these spillover effects, particularly if they also live in poverty or are members of racial or ethnic minority groups. Rural older adults may also have less access to potential mitigation strategies, such as inpatient and outpatient telehealth, restarting elective procedures under new precautions, and reaching out to patients proactively to manage chronic disease. However, because the rural population is smaller, and less-often included in commercial and health system databases, this group is understudied. It is crucial to understand COVID spillover in rural areas in order to counteract it. The central premise of this proposal is that understanding the magnitude of COVID’s spillover effects on CVD in rural areas, as well as the impact of key mitigation strategies, will enable us to deal with future waves of this pandemic, with other outbreaks in the future, and with challenges to rural care delivery more broadly. We will use national Medicare claims data, which allows us near-complete, long-term capture of clinical care and outcomes for roughly 70% of older adults in the US, to achieve three Aims: Aim 1: Quantify COVID spillover effects on a monthly basis in the first 12 months of the pandemic, and characterize the use of spillover mitigation strategies, among rural compared to urban areas. Aim 2: Quantify the short- and long-term clinical effects of delay and disruption of acute care in rural versus urban areas, and determine if mitigation strategies reduced negative impacts of spillover. Aim 3: Quantify the short- and long-term clinical effects of deferral of chronic care and worsening social risk in rural versus urban areas, and determine if mitigation strategies reduced negative impacts of spillover. The proposed work will provide national estimates of how COVID spillover and its mitigation strategies were associated with clinical cardiovascular and cerebrovascular outcomes among older rural adults, and allow successful strategies to be deployed in the future. It will also quantify whether access to these strategies was equitable among rural individuals living in poverty or those who identify as racial or ethnic minorities, enabling future efforts to monitor and achieve equity goals.