Social determinants of substance use disorder treatment outcomes in a vulnerable population

项目总结/摘要 物质使用障碍（SUD）不成比例地影响多个弱势群体， 包括有心理健康问题的人。虽然长期以来人们一直认为， 在患有自闭症谱系障碍的个体中，风险并没有升高，最近的出版物， 相反，包括《美国医学会杂志》的研究， 在患有自闭症谱系障碍（ASD）的青年和成年人中， 多项国际研究。例如，在一项针对台湾SUD患者的研究中， ASD的存在显示死亡率增加三倍，SUD症状的严重程度增加， 加快他们的进程。在美国，对SUD的脆弱性升高知之甚少 在患有ASD的年轻人和成年人中，可能会产生一个“隐藏”的弱势群体， 目前的药物使用治疗系统服务不足。 这项拟议研究的总体目标是分析世界上最大的医疗保健数据集， 美国国家医疗补助数据，以（1）比较 患有和不患有ASD的个体，11岁及以上;和（2）分析SUD的差异 治疗使用和SUD的严重程度之间的物质使用的个人和没有ASD。 为了确定上述关系的可塑性主持人，我们将首次合并 医疗补助患者的健康的社会决定因素的数据（例如，社会隔离和 经济不稳定），这是一个国家级的个人社会经济数据库。 数据（仅适用于成人）。我们还将测试国家政策的调节作用， 具体的SUD和ASD干预措施的报销。 更具体地说，拟议的研究将检查SUD的患病率、严重程度、模式 并且SU相关的不良事件因ASD状态而加重。它还将审查 健康的社会决定因素，人口因素和国家一级的治疗政策， 缓冲或放大ASD对物质使用相关结果的影响。

Project Summary/Abstract Substance use disorders (SUD) disproportionately affect multiple vulnerable populations, including individuals with mental health problems. Although it had been long assumed that SUD risks are not elevated among individuals with autism spectrum disorders, recent publications, including those in JAMA, highlighted, on the contrary, a disproportionate vulnerability to SUD among youth and adults with autism spectrum disorder (ASD), as independently reported in several international studies. For example, in a study of individuals with SUD in Taiwan, the presence of ASD was shown to triple mortality rates, increase severity of SUD symptoms and escalate their progression. In the US, very little is known about the elevated vulnerability to SUD among youth and adults with ASD, potentially creating a “hidden” vulnerable population underserved by the current substance use treatment systems. The overall goal of the proposed study is to analyze the world’s largest healthcare data set, the US national Medicaid data, to (1) compare the likelihood of having various SUDs among individuals with and without ASD, aged 11 and older; and (2) analyze differences in SUD treatment usage and SUD severity among substance-using individuals with and without ASD. To identify malleable moderators of the above relationships, we will for the first time merge Medicaid patient with data on patients’ social determinants of health (e.g. social isolation and economic instability) from TransUnion, a national repository of individual-level socio-economic data (available only for adults). We will also test moderating effects of state policies regarding reimbursement of specific SUD and ASD interventions. More specifically, the proposed study will examine whether SUD prevalence, severity, patterns and SU- related adverse events are exacerbated by ASD status. It will also examine the role of social determinants of health, demographic factors, and state-level treatment policies in buffering or amplifying the effects of ASD on substance use related outcomes.