Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine ...potential undercount of opioid-involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount.
A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid-involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose.
Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR = 3.7: 2.1, 6.5), hospitalized for 4+ days (aOR = 2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR = 4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR = 0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR = 0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6% to 15%.
Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20%-40% undercount reported elsewhere. See video abstract at, http://links.lww.com/EDE/B990 .
Violence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries ...resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy.
Outpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables.
The annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15–34-year-olds, and Chicago residents.
During SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To describe individuals coded as homeless in state-level data comprising of outpatient and inpatient cases over a multi-year period to provide public health surveillance data on the health care ...utilization and needs of this population.
In this cross-sectional study, outpatient and inpatient visits coded for homelessness were identified from the Illinois Hospital Discharge Database from January 1, 2011 through December 31, 2018. Demographic characteristics, primary diagnosis and comorbid conditions, and hospital course of treatment were described. Predictors of discharge to a health care facility versus routine discharge to home or self-care were evaluated using multivariable logistic regression.
There were 154,173 patient visits predominantly involving males, those aged 25-64 years, and non-Hispanic Whites and African Americans. The majority had comorbidities of depression, psychosis, and/or substance abuse (70.2%) and a routine discharge to home or self-care (81.9%). Discharge to home or self-care relative to another health care institution was associated with having charity coverage and being Black/African American.
Those experiencing homelessness experience a high burden of health concerns. Hospital billing records can be used to prioritize the distribution of limited public health resources for health care programs and interventions among those experiencing homelessness.
It is predicted that heat waves will increase as climate changes. Related public health interventions have expanded over the past decades but are primarily targeted at health outcomes occurring ...during heat waves. However, heat adaptation is dynamic and adverse outcomes related to heat injuries occur with moderate increases in temperature throughout the summertime. We analyzed outpatient and inpatient heat related injuries from 2013 to 2019. National Weather Service event summaries were used to characterize reported heat wave days and weather data was linked to individual cases. Despite the higher rate of heat injury on heat wave days, only 12.7% of the 17,662 heat-related injuries diagnosed from 2013 to 2019 occurred during reported heat waves. In addition, the National Weather Service surveillance system monitoring heat related injuries only captured 2.1% of all heat related injuries and 30.6% of heat related deaths. As climate changes and warmer conditions become more common, public health response to moderate increases in temperature during summertime needs to be strengthened as do the surveillance systems used to monitor adverse heat related health events. Improved surveillance systems, long-term interventions and strategies addressing climate change may help mitigate adverse health outcomes attributable to heat related injuries over the summertime.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
IMPORTANCE: National anatomic triage criteria prescribe specific transport rules for injured patients. However, there is limited information about patients with firearm-related injuries undertriaged ...to nondesignated facilities (ie, hospitals without specialized trauma teams or units), including what clinical outcomes are achieved and how many are transferred to a higher level of care. Without these data, it is difficult to make informed regional or national policy decisions about triage practices. Undertriage of firearm-related injuries is a good model for evaluating the undertriage of patients with trauma because the anatomic triage criteria for patients with firearm-related injuries are simple. OBJECTIVE: To evaluate the prevalence, spatial distribution, and clinical outcomes of undertriage of firearm-related injuries. DESIGN, SETTING, AND PARTICIPANTS: This study is a retrospective analysis of firearm-related injuries in residents of Cook County, Illinois, from January 1, 2009, to December 31, 2013. Outpatient and inpatient hospital databases were used. Participants included patients with International Classification of Diseases, Ninth Revision, Clinical Modification firearm-related cause-of-injury codes. Data were collected all at once in August 2014. Data analysis took place from March 12, 2015, to February 1, 2016. MAIN OUTCOMES AND MEASURES: Undertriaged cases were defined as patients who met the national anatomic triage criteria for transfer to higher-level trauma center care. Spatial distribution, injury severity, and clinical outcomes, including death, were analyzed. RESULTS: Of the 9886 patients included in this analysis, 8955 (90.6%) were male, 7474 (75.6%) were African American, and 5376 (54.4%) were aged 15 to 24 years.In Cook County, Illinois, where there are 19 trauma centers, 2842 of 9886 (28.7%) firearm-related injuries were initially treated in nondesignated facilities. Among the 4934 cases with firearm-related injury who met the anatomic triage criteria, 884 (17.9%) received initial treatment at a nondesignated facility and only 92 (10.4%) were transferred to a designated trauma center. Significant spatial clustering was identified on the west side of Chicago and in the southern parts of Chicago and Cook County. In the multivariable models, patients treated in nondesignated facilities were less likely to die than were patients treated in designated trauma centers. CONCLUSIONS AND RELEVANCE: Undertriage of firearm-related injuries was much more prevalent than expected. Although the likelihood of dying during hospitalization was greater among patients treated in designated trauma centers, these patients were substantially in worse condition across all measures of injury severity. A smaller proportion of patients treated in designated trauma centers died during the first 24 hours of hospitalization. This study highlights the need for better regional coordination, especially with interhospital transfers, as well as the importance of assessing the distribution of emergency medical services resources to make the trauma care system more effective and equitable.
This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems.
We examined opioid-involved ...overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases.
The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses.
We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•We estimate WTP for EV and PHEV based on a survey carried out in the US and Japan.•US consumers are more sensitive to fuel cost and fuel station availability.•WTP for fuel cost reduction in CA is ...greater than those in TX, MI, and NY.•Purchase price subsidies significantly affect the market shares of EV and PHEV.
This paper conducts a comparative discrete choice analysis to estimate consumers’ willingness to pay (WTP) for electric vehicles (EVs) and plug-in hybrid electric vehicles (PHEVs) on the basis of the same stated preference survey carried out in the US and Japan in 2012. We also carry out a comparative analysis across four US states. We find that on average US consumers are more sensitive to fuel cost reductions and alternative fuel station availability than are Japanese consumers. With regard to the comparative analysis across the four US states, consumers’ WTP for a fuel cost reduction in California is considerably greater than in the other three states. We use the estimates obtained in the discrete choice analysis to examine the EV/PHEV market shares under several scenarios. In a base case scenario with relatively realistic attribute levels, conventional gasoline vehicles still dominate both in the US and Japan. However, in an innovation scenario with a significant purchase price reduction, we observe a high penetration of alternative fuel vehicles both in the US and Japan. We illustrate the potential use of a discrete choice analysis for forward-looking policy analysis, with the future opportunity to compare its predictions against actual revealed choices. In this case, increased purchase price subsidies are likely to have a significant impact on the market shares of alternative fuel vehicles.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Civilian injuries caused during contact with law enforcement personnel erode community trust in policing, impact individual well-being, and exacerbate existing health inequities. We assessed the ...relationship between ZIP code-level rates of civilian injuries caused during legal interventions and community-level sociodemographic characteristics using Illinois hospital data from 2016 to 2022. We developed multivariable Poisson regression models to examine whether legal intervention injury rates differed by race-ethnicity and community economic disadvantage across three geographic regions of Illinois representing different levels of urbanization. Over the study period, 4976 civilian injuries were treated in Illinois hospitals (rate of 5.6 per 100,000 residents). Compared to non-Hispanic white residents, non-Hispanic Black residents demonstrated 5.5–10.5 times higher injury rates across the three geographic regions, and Hispanic-Latino residents demonstrated higher rates in Chicago and suburban Cook County, but lower rates in the rest of the state. In most regions, models showed that as the percent of minority residents in a ZIP code increased, injury rates among non-Hispanic Black and Hispanic-Latino residents decreased. As community economic disadvantage increased at the ZIP code level, civilian injury rates increased. Communities with the highest injury rates involving non-Hispanic white residents were significantly more economically unequal and disadvantaged. While the injury rates were consistently and substantially higher among non-Hispanic Black residents throughout the state, the findings illustrate that the association between overall civilian injuries caused during contact with law enforcement and community sociodemographic characteristics varied across regions. Data on local law enforcement agency policies and procedures are needed to better identify appropriate interventions.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In this study, we provide a detailed analysis of entropy measures calculated for fixation eye movement trajectories from the three different datasets. We employed six key metrics (Fuzzy, Increment, ...Sample, Gridded Distribution, Phase, and Spectral Entropies). We calculate these six metrics on three sets of fixations: (1) fixations from the GazeCom dataset, (2) fixations from what we refer to as the "Lund" dataset, and (3) fixations from our own research laboratory ("OK Lab" dataset). For each entropy measure, for each dataset, we closely examined the 36 fixations with the highest entropy and the 36 fixations with the lowest entropy. From this, it was clear that the nature of the information from our entropy metrics depended on which dataset was evaluated. These entropy metrics found various types of misclassified fixations in the GazeCom dataset. Two entropy metrics also detected fixation with substantial linear drift. For the Lund dataset, the only finding was that low spectral entropy was associated with what we call "bumpy" fixations. These are fixations with low-frequency oscillations. For the OK Lab dataset, three entropies found fixations with high-frequency noise which probably represent ocular microtremor. In this dataset, one entropy found fixations with linear drift. The between-dataset results are discussed in terms of the number of fixations in each dataset, the different eye movement stimuli employed, and the method of eye movement classification.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Rideshare drivers have a higher risk of involvement in Motor vehicle crashes (MVCs).•MVC risk is associated with work and demographic factors and safety behaviors.•Precarious workers and health and ...safety requires further research.
Introduction: Motor vehicle crashes (MVCs) are the leading cause of work-related deaths in the United States. The increasing popularity of the competitive rideshare market and the lack of oversight over workforce health and safety limits understanding of the current occupational hazards and associated risk factors faced by this precarious workforce. The objective of this analysis was to determine what the personal, social and occupational risk factors for work-related crashes in rideshare drivers are in the United States and suggest further research required to understand occupational health risks and opportunities for interventions. Material and Methods: We conducted a survey of a convenience sample of rideshare and taxi drivers using an online questionnaire. Rideshare respondents (n = 277) were recruited through an email that was distributed to people who subscribe to TheRideshareGuy.com. We examined the general characteristics of rideshare drivers by history of work-related MVCs and logistic regression models were used to determine major predictors of MVCs. Results: Of 276 rideshare drivers that reported their crash history, one-third (n = 91, 33%) reported being involved in a work-related crash. Results from a multivariable logistic regression model showed rideshare MVCs were more likely in older drivers (aOR for 10 year increases in age, 1.55, p = 0.001), if drivers undertook 10 or more rideshare trips per day (aOR 1.84, p = 0.041), frequently or very frequently were driving on unfamiliar roads (aOR 1.72, p = 0.048) and driving whilst tired (aOR 3.03, p = 0.003). Conclusion: Precarious workers and health and safety is emerging as a major area of research focus. There is a unique opportunity to explore the occupational health risks in rideshare drivers to provide interventions that encourage growth of a healthy and fit rideshare workforce and promote work practices and future regulations aimed at improving safe work practices. Practical applications: This analysis paints a complex picture of personal and occupational factors that are associated with MVCs in rideshare drivers suggesting that additional policy development related to occupational health and safety of rideshare drivers could be constructive.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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