Midlife Health and Service Utilization Associated with Early Life Drug Use

描述（由申请人提供）：非法药物使用在年轻人中很常见。在18 - 34岁的普通人群中，报告去年使用非法药物的人数（30 - 34%）几乎与报告饮酒"风险"水平（30 - 44%）一样多，其中不到一半的人有滥用或依赖诊断。国家筛查、短暂干预和转诊政策倡议，相当于1.085亿美元的联邦投资，目前针对吸毒和酗酒。然而，基于证据的共识机构仅认可针对高危饮酒的此类干预措施，并报告称，证据仍不足以支持针对普通人群吸毒的此类干预措施。缩小证据和联邦政策之间令人不安的差距将需要证明普通人群中成年人的药物使用与更差的健康和服务结果相关，并且使用的改变与这些结果的变化相关。迄今为止，健康结果数据主要来自成瘾者的临床样本，可能无法为接受初级保健的普通人群提供信息。因此，我们建议通过分析一项为期20年的前瞻性社区成人队列研究来缩小这一证据差距，该队列研究是在年轻成人冠状动脉风险发展（CARDIA）研究中招募的。这5115名健康的年轻人在1985/86年招募时年龄在18 - 30岁之间，从那时起接受了反复的亲自检查以及详细的心理社会评估。CARDIA中药物和酒精使用的流行率与同期国家样本相当。我们建议对CARDIA现有数据进行分析，以：（1）描述青年期药物使用轨迹与中年期（40 - 52岁）健康结果之间的关联，以及（2）描述青年期药物使用轨迹与中年期卫生服务利用之间的关联，包括住院和获得初级医疗保健。假设驱动的分析将考虑大麻和非大麻药物的轨迹与一般健康结果之间的关联（死亡率、健康相关生活质量和医疗状况计数）;特定药物的特定健康结局（可卡因引起的高血压，大麻引起的肺功能下降）;和卫生服务利用率（住院、急诊利用率和获得初级保健）。该队列的大规模以及详细的药物、健康、健康服务和心理社会数据的前瞻性收集使得CARDIA非常适合此目的。由于药物使用在生命过程中发生变化，因此本申请的关键创新是应用基于组的轨迹分析来最佳地捕获药物使用随时间的动态特征。

DESCRIPTION (provided by applicant): Illicit drug use is common among young adults. Among 18-34 year olds in the general population, nearly as many report past-year use of an illicit drug (30-34%) as report "at-risk" levels of drinking (30-44%), and fewer than half of these qualify as having either an abuse or dependence diagnosis. National policy initiatives for Screening, Brief Intervention and Referral (SBIR), representing a $108.5 million federal investment, presently target both drug and alcohol use. However, evidence-based consensus bodies endorse such interventions only for at-risk drinking, and have reported that the evidence remains insufficient to support such interventions in regard to drug use in the general population. Closing this troubling gap between evidence and federal policy will require a demonstration that drug use among adults in the general population is associated with worse health and service outcomes, and that alterations in use are associated with changes in these outcomes. To date, health outcomes data have principally been accrued from clinical samples of persons with addictions and may not be informative for persons in the general population seen in primary care. We therefore propose to close this evidentiary gap through the analysis of a geographically and racially-diverse 20-year prospective community-based cohort of adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. These 5115 healthy young adults were 18-30 years old when recruited in 1985/86 and have undergone repeated in-person examinations as well as detailed psychosocial assessments since that time. Drug and alcohol use in CARDIA are comparable in prevalence to contemporaneous national samples. We propose analysis of CARDIA's existing data to: (1) Characterize associations between drug use trajectories in young adulthood and health outcomes in middle age (ages 40-52), and (2) Characterize associations between drug use trajectories in young adulthood and health service utilization in middle age, including hospitalization and access to primary medical care. Hypotheses-driven analyses will consider associations between the trajectories of marijuana and nonmarijuana drugs and general health outcomes (mortality, health-related quality of life, and count of medical conditions); specific health outcomes for particular drugs (hypertension in relation to cocaine, pulmonary function decline in relation to marijuana); and health service utilization (hospitalization, emergency department utilization, and access to primary care.) The large size of this cohort, and the prospective collection of detailed drug, health, health service and psychosocial data make CARDIA uniquely well-suited for this purpose. Because drug use changes over the life-course, a key innovation for the present application is the application of group-based trajectory analysis to optimally capture the dynamic character of drug use over time.