Rose A. Rudd

Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015

The U.S. opioid epidemic is continuing, and drug overdose deaths nearly tripled during 1999-2014. Among 47,055 drug overdose deaths that occurred in 2014 in the United States, 28,647 (60.9%) involved an opioid (1). Illicit opioids are contributing to the increase in opioid overdose deaths (2,3). In an effort to target prevention strategies to address the rapidly changing epidemic, CDC examined overall drug overdose death rates during 2010-2015 and opioid overdose death rates during 2014-2015 by subcategories (natural/semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone).* Rates were stratified by demographics, region, and by 28 states with high quality reporting on death certificates of specific drugs involved in overdose deaths. During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid. There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states. A multifaceted, collaborative public health and law enforcement approach is urgently needed. Response efforts include implementing the CDC Guideline for Prescribing Opioids for Chronic Pain (4), improving access to and use of prescription drug monitoring programs, enhancing naloxone distribution and other harm reduction approaches, increasing opioid use disorder treatment capacity, improving linkage into treatment, and supporting law enforcement strategies to reduce the illicit opioid supply.

Increases in Drug and Opioid Overdose Deaths-United States, 2000-2014.

The United States is experiencing an epidemic of drug overdose (poisoning) deaths. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin). CDC analyzed recent multiple cause-of-death mortality data to examine current trends and characteristics of drug overdose deaths, including the types of opioids associated with drug overdose deaths. During 2014, a total of 47 055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100 000 persons in 2013 to 14.7 per 100 000 persons in 2014. The rate of drug overdose deaths increased significantly for both sexes, persons aged 25–44 years and ≥55 years, non-Hispanic whites and non-Hispanic blacks, and in the Northeastern, Midwestern, and Southern regions of the United States. Rates of opioid overdose deaths also increased significantly, from 7.9 per 100 000 in 2013 to 9.0 per 100 000 in 2014, a 14% increase. Historically, CDC has programmatically characterized all opioid pain reliever deaths (natural and semisynthetic opioids, methadone, and other synthetic opioids) as “prescription” opioid overdoses (1). Between 2013 and 2014, the age-adjusted rate of death involving methadone remained unchanged; however, the ageadjusted rate of death involving natural and semisynthetic opioid pain relievers, heroin, and synthetic opioids, other than methadone (e.g. fentanyl) increased 9%, 26%, and 80%, respectively. The sharp increase in deaths involving synthetic opioids, other than methadone, in 2014 coincided with law enforcement reports of increased availability of illicitly manufactured fentanyl, a synthetic opioid; however, illicitly manufactured fentanyl cannot be distinguished from prescription fentanyl in death certificate data. These findings indicate that the opioid overdose epidemic is worsening. There is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl.

Gender differences in seeking care for falls in the aged Medicare population.

BACKGROUND One third of adults aged ≥65 years fall annually, and women are more likely than men to be treated for fall injuries in hospitals and emergency departments. PURPOSE The aim of this study was to examine how men and women differed in seeking medical care for falls and in the information about falls they received from healthcare providers. METHODS This study, undertaken in 2010, analyzed population-based data from the 2005 Medicare Current Beneficiary Survey (MBCS), the most recent data available in 2010 from this survey. A sample of 12,052 community-dwelling Medicare beneficiaries aged ≥65 years was used to examine male-female differences among 2794 who reported falling in the previous year, sought medical care for falls and/or discussed fall prevention with a healthcare provider. Multivariable logistic regression analyses were conducted to determine the factors associated with falling for men and women. P-values ≤0.05 were considered significant. RESULTS Nationally, an estimated seven million Medicare beneficiaries (22%) fell in the previous year. Among those who fell, significantly more women than men talked with a healthcare provider about falls and also discussed fall prevention (31.2% [95% CI=28.8%, 33.6%] vs 24.3% [95% CI=21.6%, 27.0%]). For both genders, falls were most strongly associated with two or more limitations in activities of daily living and often feeling sad or depressed. CONCLUSIONS Women were significantly more likely than men to report falls, seek medical care, and/or discuss falls and fall prevention with a healthcare provider. Providers should consider asking all older patients about previous falls, especially older male patients who are least likely to seek medical attention or discuss falls with their doctors.

Declining hip fracture rates in the United States

SIR—Unintentional falls are a common occurrence among older adults, affecting ∼30% of persons aged 65 years and older annually [1]. One of the most serious fall outcomes is hip fracture, an injury that often results in long-term functional impairment, nursing home admission and increased mortality [2]. More than 90% of hip fractures are caused by falls [3], usually by falling onto the hip [4]. In 2006 there were ∼293,000 hospital admissions for hip fracture [5]. Osteoporosis, a metabolic disease characterised by low bone mineral density (BMD) and bone structure deterioration, greatly increases the chances that a person who falls will sustain a hip fracture [6]. The National Osteoporosis Foundation estimates that more than 10 million people over age 50 in the United States have osteoporosis and another 34 million have low BMD and are at risk for the disease [7]. Extending an earlier and less comprehensive analysis [8], this study used hospital discharge data to analyse the national trends in hip fracture rates from 1990 to 2006 for people aged 65 years and older by both sex and 10-year age groups.

Asthma Prevalence Among US Children in Underrepresented Minority Populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian

OBJECTIVES. The purpose of this work was to estimate asthma prevalence among US children in racial minority subgroups who have been historically underrepresented in the pediatric asthma literature. These subgroups include American Indian/Alaska Native, Chinese, Filipino, and Asian Indian children. We also explored the association between these race categories and asthma after adjusting for demographic and sociodemographic characteristics and explored the effect of place of birth as it relates to current asthma. PATIENTS AND METHODS. Data on all 51944 children aged 2 to 17 years from the 2001–2005 National Health Interview Survey were aggregated and analyzed to estimate the prevalence of current asthma, lifetime asthma, and asthma attacks according to race and place of birth. Logistic regression was used to determine adjusted odds ratios for current asthma according to race and place of birth while controlling for other demographic and sociodemographic variables. RESULTS. National estimates of current asthma prevalence among the children in the selected minority subgroups ranged from 4.4% in Asian Indian children to 13.0% in American Indian/Alaska Native children. Overall, children born in the United States had greater adjusted odds of reporting current asthma than did children born outside of the United States. CONCLUSIONS. Smaller racial and ethnic minority groups are often excluded from asthma studies. This study reveals that, among children from different Asian American subgroups, wide variation may occur in asthma prevalence. We also found that children born in the United States were more likely than children born outside of the United States to have current asthma.

Asthma incidence: data from the National Health Interview Survey, 1980-1996.

Objective. To obtain historical estimates of US asthma incidence from 17 years of health survey data. Methods. The 1980 through 1996 National Health Interview Survey contained a question asking about the time of asthma onset in persons with asthma. Annual past year incidence estimates were calculated from self-reports of asthma status. Results. Incidence increased from 2.5 per 1,000 (SE 0.37) in 1980 to 6.0 per 1,000 (SE 0.75) in 1996. Incidence increased faster in children than in adults and increased in females but not in males during this time. Conclusion. These findings suggest that increasing asthma incidence contributed to the increasing prevalence during this time.

All-terrain vehicle-related nonfatal injuries among young riders in the United States, 2001-2010.

OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)–related nonfatal injuries among riders aged ≤15 years treated in hospital emergency departments (EDs) in the United States during 2001–2010. METHODS: National Electronic Injury Surveillance System–All Injury Program data for 2001–2010 were analyzed. Numbers and rates of injuries were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: During 2001–2010, an estimated 361 161 ATV riders aged ≤15 years were treated in EDs for ATV-related injuries. The injury rate peaked at 67 per 100 000 children in 2004 and then declined to 42 per 100 000 children by 2010. The annualized injury rate for boys was double that of girls (73 vs 37 per 100 000). Children aged 11 to 15 years accounted for two-thirds of all ED visits and hospitalizations. Fractures accounted for 28% of ED visits and 45% of hospitalizations. CONCLUSIONS: The reasons for the decline in ATV-related injuries among young riders are not well understood but might be related to the economic recession of the mid-2000s and decreased sales of new ATVs. Although many states have regulations governing children’s use of ATVs, their effectiveness in reducing injuries is unclear. Broader use of known effective safety measures, including prohibiting children aged ≤15 years from riding adult-sized ATVs, always wearing a helmet while riding, not riding on paved roads, and not riding as or carrying a passenger could additionally reduce ATV-related injuries among children. Last, more research to better understand ATV crash dynamics might lead to safer designs for ATVs.

Circumstances and Contributing Causes of Fall Deaths among Persons Aged 65 and Older: United States, 2010

To determine whether the increasing fall death rate among people aged 65 and older is due in part to temporal changes in recording the underlying cause of death.

Unintentional childhood injuries in the United States: key findings from the CDC childhood injury report.

On December 10, 2008, theWorld Health Organization (WHO), in collaborationwith United Nations Childrens Fund (UNICEF), launched theWorld ReportonChild InjuryPrevention (WHO/UNICEF, 2008) todrawattention to thepreventable loss of 830,000 childrenandadolescents to anunintentional injury annually throughout theworld. To coincidewith the global report, the Centers for Disease Control and Prevention (CDC) also analyzed deaths and non-fatal injuries to children and adolescents and inDecember 2008, released theCDCChildhood Injury Report: Patterns of Unintentional Injuries among 019 year olds in the United States, 2000-2006 (Borse et al., 2008). This article summarizes some of the key findings of this report. Impact of Industry: The CDC childhood injury report can inform thework of practitioners, policy-makers, elected officials, and researchers to better understand the problem and take the necessary steps to reduce the devastating burden childhood injuries place on this nation. The CDC Childhood Injury Report provides an overview of patterns of childhood unintentional injuries in the United States, related to drowning, falls, fires or burns, transportation (e.g., motor-vehicle crashes), poisoning, and suffocation, among other injuries such as overexertion, and being struck by or against an object (Borse et al., 2008). The burden of deaths and nonfatal injuries due to each cause is shown in this report by age group and sex, as well as the geographic distributionof injurydeath rates by state. Thedataused in this reportwere obtained fromtwosources. Injury deathdata from 2000 – 2005 were derived from the National Center for Health Statistics (NCHS), National Vital Statistics System (CDC, 2008). Non-fatal injury data from 2001-2006 were derived from the National Electronic Injury Surveillance System All Injury Program (U.S. Consumer Product Safety Commission, 2000). We summarize this report in three sub-headings: Leading causes of Deaths and Nonfatal Injuries, Injury Deaths, and Nonfatal Injuries. The methodology used for analysis is available at www.cdc.gov/SafeChild/ChildhoodInjuryReport.

The impact of alcohol and road traffic policies on crash rates in Botswana, 2004-2011: A time-series analysis

In Botswana, increased development and motorization have brought increased road traffic-related death rates. Between 1981 and 2001, the road traffic-related death rate in Botswana more than tripled. The country has taken several steps over the last several years to address the growing burden of road traffic crashes and particularly to address the burden of alcohol-related crashes. This study examines the impact of the implementation of alcohol and road safety-related policies on crash rates, including overall crash rates, fatal crash rates, and single-vehicle nighttime fatal (SVNF) crash rates, in Botswana from 2004 to 2011. The overall crash rate declined significantly in June 2009 and June 2010, such that the overall crash rate from June 2010 to December 2011 was 22% lower than the overall crash rate from January 2004 to May 2009. Additionally, there were significant declines in average fatal crash and SVNF crash rates in early 2010. Botswanas recent crash rate reductions occurred during a time when aggressive policies and other activities (e.g., education, enforcement) were implemented to reduce alcohol consumption and improve road safety. While it is unclear which of the policies or activities contributed to these declines and to what extent, these reductions are likely the result of several, combined efforts.