Spatio-temporal Methods for Surveillance of the Opioid Syndemic

项目摘要/摘要 由于阿片类药物的持续使用，美国正处于一场公共健康危机之中。阿片类药物 包括阿片类药物滥用、致命性和非致命性过量、人类免疫fi效价等相互关联的流行病 病毒(HIV)和丙型肝炎(丙型肝炎)。阿片类药物滥用的后果在俄亥俄州特别严重，因为 该州的服药过量比率是全国平均水平的两倍，疫情风险也增加了 艾滋病毒和丙型肝炎病毒水平。解决综合症的一个关键需要是改进监视科学方法 更好地衡量阿片类药物滥用的社区水平，并能够识别和瞄准新出现的风险领域 有了资源。然而，目前公共卫生监测系统没有完全观察到的单一数据源 在相关的空间和时间支持下表现出阿片类药物滥用的特征。需要新的统计方法来 更好地利用现有数据，并在不同环境中适当集成多个不完美的监控结果 空间尺度，以全面估计阿片类药物滥用的程度，并在空间和时间上模拟合并症。 这样做将能够在与当地政策制定者和公众相关的小范围内进行评估和推断 在计入测量误差的同时，fiCals的运行状况。有几个方法论的挑战将 完成以下目标：1)开发和评估时空因素模型 这估计了一个可以在纵向上有意义地解释的因素，2)开发和评估空间因素 允许结果具有不同空间支持的模型，以及3)开发和评估多变量空间- 评估潜在阿片类药物滥用地区流行率的时间模型。成功开发了一种全面的 阿片类药物综合征的模型将促进监测科学，并将产生阿片类药物滥用的估计 这促进了对流行病学的了解，并为决策者和公共卫生提供了有价值的信息 fiCals的。

PROJECT SUMMARY/ABSTRACT The United States is in the midst of a public health crisis due to the ongoing opioid syndemic. The opioid syndemic consists of the inter-related epidemics of opioid misuse, fatal and non-fatal overdose, human immunodeficiency virus (HIV), and hepatitis C (HCV). The consequences of opioid misuse are particularly severe in Ohio as the state has experienced overdose rates that are double the national average as well as elevated risk for epidemic levels of HIV and HCV. A key need for addressing the syndemic is to improve surveillance science methodology to better measure community-levels of opioid misuse and be able to identify and target areas of emerging risk with resources. However, no single data source currently observed by the public health surveillance system fully characterizes opioid misuse at relevant spatial and temporal supports. Novel statistical methods are needed to better leverage existing data and appropriately integrate multiple imperfect surveillance outcomes across different spatial scales to comprehensively estimate levels of opioid misuse and model the syndemic over space and time. Doing so will enable estimation and inference at small areas that are relevant to local policymakers and public health officials while accounting for measurement error. There are several methodological challenges that will be overcome with achievement of the following aims: 1) develop and assess a spatio-temporal factor model that estimates a factor that can be meaningfully interpreted longitudinally, 2) develop and assess a spatial factor model that allows for outcomes to have different spatial supports, and 3) develop and assess a multivariate spatio- temporal model to estimate areal prevalence of latent opioid misuse. Successful development of a comprehensive model of the opioid syndemic will advance surveillance science and will produce estimates of opioid misuse that advance epidemiological understanding and provide valuable information to policymakers and public health officials.