Supplement to a microsimulation of alcohol control interventions to advance health equity and reverse the current decrease in life expectancy in the US

项目总结 新冠肺炎疫情导致美国人的预期寿命急剧下降， 对低社会经济地位(SES)以及黑人和西班牙裔美国人的影响不成比例 人口。非COVID相关原因的死亡率也显示出显著的增长，这对 预期寿命的损失，包括酒精导致的年龄调整死亡率惊人地增加了27%- 2019年至2020年的相关原因。 本申请请求父母补助金(R01AA028009)的补充以考虑社会， 新冠肺炎大流行引发的人口、经济和行为变化。在父母的资助下， 对成年(18岁以上)普通人群的微观模拟正在开发中，以模拟潜在寿命损失的年数 (Y11)2000至2017年间酒精可归因性死因，时间范围为正向建模 直到2028年。本补充内容旨在通过结合以下各项的作用和效果来增强微观模拟模型 新冠肺炎大流行。具体地说，酒精使用在新冠肺炎期间超额死亡率中的作用 将在不同的人口亚群中调查大流行。心理压力和心理压力的变化 大流行期间与酒精有关的政策将作为酒精使用变化的潜在驱动因素进行调查。 当前基于人群的酒精使用、心理困扰、与酒精相关的政策变化的数据， 死亡率和人口统计数据将被使用。线性样条多水平模型，按性别分层，将被用于 调查酒精使用趋势，条件是SES和种族/民族。年龄、个人层面的心理 国家一级与酒精有关的政策，以及它们与年份的互动，将作为 协变量。具体原因对预期寿命变化的贡献将使用分解来计算 方法。I)饮酒模式和II)教育水平之间的转换概率 新冠肺炎大流行将使用连续时间马尔可夫模型进行估计。调查结果将整合到 一种增强的微观仿真模型。包括酒精使用障碍在内的九种选定死因， 故意和无意伤害、肝病和肝硬变、糖尿病和几种心血管疾病 疾病将被建模。将使用反事实情景来估计i)可归因于过量酒精的YLL 按新冠肺炎大流行期间的人口分组与没有大流行的情景进行比较；二)潜在的 假设酒精可归因性死亡率的长期影响与暂时性变化的比较 过渡概率；和三)长期和短期不同情景下可归因于酒精的长寿 在大流行期间及以后执行与酒精有关的限制性和允许性政策。 这些发现将为了解新冠肺炎大流行对酒精使用和 不同人口亚组的酒精可归因性死亡率。此外，增强的微观模拟 该模型将为在上级赠款下执行的政策和干预建模奠定坚实的基础。

PROJECT SUMMARY The COVID-19 pandemic has led to drastic declines in life expectancy in the United States (US), disproportionately affecting individuals with low socioeconomic status (SES) as well as Black and Hispanic populations. Mortality from non-COVID-related causes has also shown meaningful increases that contributed to the losses in life expectancy, including a striking 27% increase in age-adjusted mortality rates from alcohol- related causes from 2019 to 2020. The current application requests a supplement to the parent grant (R01AA028009) to account for the social, demographic, economic, and behavioral changes induced by the COVID-19 pandemic. Under the parent grant, a microsimulation of the adult (18+) general population is being developed to model years of potential life lost (YLL) from alcohol-attributable causes of death between 2000 and 2017 with a forward modeling time horizon until 2028. This supplement aims to augment the microsimulation model by incorporating the role and effects of the COVID-19 pandemic. Specifically, the role of alcohol use in excess mortality during the COVID-19 pandemic will be investigated among different population subgroups. Changes in psychological distress and alcohol-related policies during the pandemic will be investigated as potential drivers of changes in alcohol use. Current population-based data on alcohol use, psychological distress, alcohol-related policy changes, mortality, and population statistics will be used. Linear spline multilevel models, stratified by sex, will be used to investigate trends in alcohol use, conditional on SES and race/ethnicity. Age, individual-level psychological distress, and state-level alcohol-related policies, along with their interaction with year, will be introduced as covariates. Cause-specific contributions to changes in life expectancy will be calculated using a decomposition method. Transition probabilities between i) drinking patterns and ii) levels of education before and during the COVID-19 pandemic will be estimated using continuous-time Markov models. Findings will be integrated into an augmented microsimulation model. YLL from nine selected causes of death including alcohol use disorders, intentional and unintentional injuries, liver disease and cirrhosis, diabetes mellitus, and several cardiovascular diseases will be modeled. Counterfactual scenarios will be used to estimate i) excess alcohol-attributable YLL by population subgroup during the COVID-19 pandemic compared to a scenario without pandemic; ii) potential long-term effects on alcohol-attributable mortality assuming sustained compared to temporary changes in transition probabilities; and iii) alcohol-attributable YLL under different scenarios of long- and short-term implementation of restrictive and permissive alcohol-related policies during the pandemic and beyond. The findings will provide unique insights into the impact of the COVID-19 pandemic on alcohol use and alcohol-attributable mortality in different population subgroups. Furthermore, the augmented microsimulation model will constitute a robust foundation for policy and intervention modeling performed under the parent grant.