COVID-19 Case, Death, and Vaccination Rate Disparities by Race and Ethnicity in Virginia.

This paper tracks trends in COVID-19 case, death, and vaccination rate disparities by race and ethnicity in Virginia during the COVID-19 pandemic. COVID-19 case, death, and vaccination rates were obtained from electronic state health department records from March 2020 to February 2022. Rate ratios were then utilized to quantify racial and ethnic disparities for several time periods during the pandemic. The Hispanic population had the highest COVID-19 case and age-adjusted death rates, and the lowest vaccination rates at the beginning of the pandemic in Virginia. These disparities resolved later in the pandemic. COVID-19 case and death rates among the Black population were also higher than those of the White population and these disparities remained throughout the pandemic. Racial and ethnic disparities changed over time in Virginia as vaccination coverage and public health policies evolved. Year 2 of the analysis saw lower case and death rates, and higher vaccination rates for non-White populations in Virginia. Public health strategies need to be addressed during the pandemic and developed before the next pandemic to ensure that large racial and ethnic disparities are not again present at the outset.

COVID-19 Mortality Among American Indian and Alaska Native Persons - 14 States, January-June 2020.

American Indian/Alaska Native (AI/AN) persons experienced disproportionate mortality during the 2009 influenza A(H1N1) pandemic (1,2). Concerns of a similar trend during the coronavirus disease 2019 (COVID-19) pandemic led to the formation of a workgroup* to assess the prevalence of COVID-19 deaths in the AI/AN population. As of December 2, 2020, CDC has reported 2,689 COVID-19-associated deaths among non-Hispanic AI/AN persons in the United States.† A recent analysis found that the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN persons was 3.5 times that among White persons (3). Among 14 participating states, the age-adjusted AI/AN COVID-19 mortality rate (55.8 deaths per 100,000; 95% confidence interval [CI] = 52.5-59.3) was 1.8 (95% CI = 1.7-2.0) times that among White persons (30.3 deaths per 100,000; 95% CI = 29.9-30.7). Although COVID-19 mortality rates increased with age among both AI/AN and White persons, the disparity was largest among those aged 20-49 years. Among persons aged 20-29 years, 30-39 years, and 40-49 years, the COVID-19 mortality rates among AI/AN were 10.5, 11.6, and 8.2 times, respectively, those among White persons. Evidence that AI/AN communities might be at increased risk for COVID-19 illness and death demonstrates the importance of documenting and understanding the reasons for these disparities while developing collaborative approaches with federal, state, municipal, and tribal agencies to minimize the impact of COVID-19 on AI/AN communities. Together, public health partners can plan for medical countermeasures and prevention activities for AI/AN communities.

Deaths and Years of Potential Life Lost From Excessive Alcohol Use - United States, 2011-2015.

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 95,158 alcohol-attributable deaths (261 deaths per day) and 2.8 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (53.7%) were caused by chronic conditions, and 52,921 (55.6%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.8 in New York to 53.1 in New Mexico. YPLL per 100,000 population ranged from 631.9 in New York to 1,683.5 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.

Excessive alcohol use and drug overdose deaths, New Mexico, 2015-2016.

BACKGROUND: Excessive alcohol use is an important component of a person's risk for drug overdose death. But alcohol's contribution to overdose death risk has not been well quantified. We aimed to quantify the role of excessive alcohol use, particularly as defined by a blood alcohol concentration (BAC) ≥0.08 g/dL, in drug overdose deaths in New Mexico (NM). METHODS: The study was conducted in 2018. We abstracted death records (scene investigation, toxicology, pathology) for all drug overdose deaths in NM during 2015-2016, information on BAC, other indications of alcohol, risk factors, comorbidities, and drug type and linked this information with demographic characteristics on death certificates. A Poisson regression model was used to determine independent associations between decedents' characteristics and alcohol involvement among drug overdose decedents. RESULTS: Approximately 18 % (n = 170) of the 946 drug overdose decedents in this study had a BAC ≥ 0.08 g/dL. After adjustment, drug overdose decedents who were American Indian/Alaska Native or had a history of alcohol use disorder were more likely to have had a BAC ≥ 0.08 g/dL at the time of death. However, decedents who had methamphetamine involved in their death or who had a history of diabetes, mental illness, or chronic pain were less likely to have a BAC ≥ 0.08 g/dL at the time of death. CONCLUSIONS: Nearly 1 in 5 overdose decedents had a BAC ≥ 0.08 g/dL at the time of death, suggesting that evidence-based alcohol prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) could reduce the risk of drug overdose death.

Deaths and Years of Potential Life Lost From Excessive Alcohol Use - United States, 2011-2015.

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 93,296 alcohol-attributable deaths (255 deaths per day) and 2.7 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (54.7%) were caused by chronic conditions, and 52,361 (56.0%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.3 in New Jersey and New York to 52.3 in New Mexico. YPLL per 100,000 population ranged from 613.8 in New York to 1,651.7 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.

Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping - United States, 2019.

Electronic cigarettes (e-cigarettes), also called vapes, e-hookas, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS), are electronic devices that produce an aerosol by heating a liquid typically containing nicotine, flavorings, and other additives; users inhale this aerosol into their lungs (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis (1). Use of e-cigarettes is commonly called vaping. Lung injury associated with e-cigarette use, or vaping, has recently been reported in most states (2-4). CDC, the Food and Drug Administration (FDA), state and local health departments, and others are investigating this outbreak. This report provides data on patterns of the outbreak and characteristics of patients, including sex, age, and selected substances used in e-cigarette, or vaping, products reported to CDC as part of this ongoing multistate investigation. As of September 24, 2019, 46 state health departments and one territorial health department had reported 805 patients with cases of lung injury associated with use of e-cigarette, or vaping, products to CDC. Sixty-nine percent of patients were males, and the median age was 23 years (range = 13-72 years). To date, 12 deaths have been confirmed in 10 states. Among 514 patients with information on substances used in e-cigarettes, or vaping products, in the 30 days preceding symptom onset, 76.9% reported using THC-containing products, and 56.8% reported using nicotine-containing products; 36.0% reported exclusive use of THC-containing products, and 16.0% reported exclusive use of nicotine-containing products. The specific chemical exposure(s) causing the outbreak is currently unknown. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. CDC will continue to work in collaboration with FDA and state and local partners to investigate cases and advise and alert the public on the investigation as additional information becomes available.

Development of Indicators for Public Health Surveillance of Substance Use and Mental Health.

Substance use and mental health disorders can result in disability, death, and economic cost. In the United States, rates of death from suicide, drug overdose, and chronic liver disease (a marker for alcohol abuse) have been rising for the past 15 years. Good public health surveillance for these disorders, their consequences, and their risk factors is crucially important for their prevention and control, but surveillance has not been conducted consistently in the states. In 2015, the Council of State and Territorial Epidemiologists convened a workgroup to develop a set of uniformly defined surveillance indicators that could be used by state and local health departments to monitor these disorders and to compare their occurrence in various jurisdictions. This report briefly describes the indicators and outlines the process used to develop them.

Alcohol Consumption and Chronic Liver Disease Mortality in New Mexico and the United States, 1999-2013.

OBJECTIVE: Current chronic liver disease (CLD) mortality surveillance methods may not adequately capture data on all causes of CLD mortality. The objective of this study was to calculate and compare CLD death rates in New Mexico and the United States by using both an expanded definition of CLD and estimates of the fractional impact of alcohol on CLD deaths. METHODS: We defined CLD mortality as deaths due to alcoholic liver disease, cirrhosis, viral hepatitis, and other liver conditions. We estimated alcohol-attributable CLD deaths by using national and state alcohol-attributable fractions from the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. We classified causes of CLD death as being alcohol-attributable, non-alcohol-attributable, or hepatitis C. We calculated average annual age-adjusted CLD death rates during five 3-year periods from 1999 through 2013, and we stratified those rates by sex, age, and race/ethnicity. RESULTS: By cause of death, CLD death rates were highest for alcohol-attributable CLD. By sex and race/ethnicity, CLD death rates per 100 000 population increased from 1999-2001 to 2011-2013 among American Indian men in New Mexico (67.4-90.6) and the United States (38.9-49.4), American Indian women in New Mexico (48.4-63.0) and the United States (27.5-39.5), Hispanic men in New Mexico (48.6-52.0), Hispanic women in New Mexico (16.9-24.0) and the United States (12.8-13.1), non-Hispanic white men in New Mexico (17.4-21.3) and the United States (15.9-18.4), and non-Hispanic white women in New Mexico (9.7-11.6) and the United States (7.6-9.7). CLD death rates decreased among Hispanic men in the United States (30.5-27.4). CONCLUSIONS: An expanded CLD definition and alcohol-attributable fractions can be used to create comprehensive data on CLD mortality. When stratified by CLD cause and demographic characteristics, these data may help states and jurisdictions improve CLD prevention programs.

Recognition and response to opioid overdose deaths-New Mexico, 2012.

PURPOSE: Drug overdose deaths are epidemic in the U.S. Prescription opioid pain relievers (OPR) and heroin account for the majority of drug overdoses. Preventing death after an opioid overdose by naloxone administration requires the rapid identification of the overdose by witnesses. This study used a state medical examiner database to characterize fatal overdoses, evaluate witness-reported signs of overdose, and identify opportunities for intervention. METHODS: We reviewed all unintentional drug overdose deaths that occurred in New Mexico during 2012. Data were abstracted from medical examiner records at the New Mexico Office of the Medical Investigator. We compared mutually exclusive groups of OPR and heroin-related deaths. RESULTS: Of the 489 overdose deaths reviewed, 49.3% involved OPR, 21.7% involved heroin, 4.7% involved a mixture of OPR and heroin, and 24.3% involved only non-opioid substances. The majority of OPR-related deaths occurred in non-Hispanic whites (57.3%), men (58.5%), persons aged 40-59 years (55.2%), and those with chronic medical conditions (89.2%). Most overdose deaths occurred in the home (68.7%) and in the presence of bystanders (67.7%). OPR and heroin deaths did not differ with respect to paramedic dispatch and CPR delivery, however, heroin overdoses received naloxone twice as often (20.8% heroin vs. 10.0% OPR; p<0.01). CONCLUSION: OPR overdose deaths differed by age, health status, and the presence of bystanders, yet received naloxone less often when compared to heroin overdose deaths. These findings suggest that naloxone education and distribution should be targeted in future prevention efforts.

Using Hospital Inpatient Discharge Data to Supplement Active Surveillance for Invasive Pneumococcal Disease: Is the Extract Worth the Exertion?

OBJECTIVE: Invasive pneumococcal disease (IPD) surveillance systems monitor morbidity, mortality, and vaccine impact; accurate surveillance is important to detect changes in epidemiology. We evaluated completeness of IPD reporting in New Mexico by comparing data from the Hospital Inpatient Discharge Database (HIDD) and the New Mexico Active Bacterial Core Surveillance (ABCs) program. METHODS: We linked data from the HIDD and the ABCs program. We defined cases of IPD in the HIDD among New Mexico residents with hospitalizations during 2007-2009 as specific (320.1 or 038.2) or nonspecific (481, 320.2, or 041.2) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. To validate if HIDD records that could not be matched to ABCs data were true IPD cases, we reviewed laboratory data and determined if Streptococcus pneumoniae (S. pneumoniae) had been isolated from a sterile body site. RESULTS: We examined 732 HIDD records for cases that were not matched in the ABCs database; of such records, S. pneumoniae was isolated from a sterile body site in 10 HIDD records. CONCLUSION: ABCs data detected the majority of IPD cases in New Mexico. Laboratory and medical record review is essential when using HIDD data because ICD-9-CM coding alone does not ensure data accuracy. The addition of IPD cases to the ABCs program from the HIDD was minimally beneficial to active surveillance and reporting completeness in New Mexico. States that rely exclusively on passive reporting and that have access to HIDD data might use linkages of pneumococcal and IPD-specific ICD-9-CM-coded HIDD data to improve IPD surveillance and case ascertainment.

Incidence of notifiable diseases among American Indians/Alaska Natives - United States, 2007-2011.

American Indian/Alaska Native (AI/AN) populations experience substantial disparities in the incidence of multiple diseases compared with other racial/ethnic groups in the United States. A major goal of Healthy People 2020 is to eliminate health disparities, monitor disease trends, and identify population groups and diseases for targeted interventions. High rates of certain infectious diseases continue to be a major problem facing AI/AN populations. During 1990-2011, incidence rates for some infectious diseases declined among AI/AN populations, but disparities remain and AI/AN populations are still disproportionately affected. To describe disparities in selected notifiable diseases among AI/ANs, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for 2007-2011, the most recent 5 years for which data are available. The results of this analysis of 26 infectious diseases indicate that incidence rates of 14 diseases were higher for AI/ANs than for whites. Interventions are needed to address and reduce disparities in chlamydia, gonorrhea, West Nile virus, spotted fever rickettsiosis, and other infections among AI/ANs.

Rules and values: a coordinated regulatory and educational approach to the public health crises of chronic pain and addiction.

Chronic pain and opioid addiction are 2 pressing public health problems, and prescribing clinicians often lack the skills necessary to manage these conditions. Our study sought to address the benefits of a coalition of an academic medical center pain faculty and government agencies in addressing the high unintentional overdose death rates in New Mexico. New Mexico's 2012-2013 mandated chronic pain and addiction education programs studied more than 1000 clinicians. Positive changes were noted in precourse and postcourse surveys of knowledge, self-efficacy, and attitudes. Controlled substance dispensing data from the New Mexico Board of Pharmacy also demonstrated safer prescribing. The total morphine and Valium milligram equivalents dispensed have decreased continually since 2011. There was also a concomitant decline in total drug overdose deaths.

Alcohol-attributable mortality among American Indians and Alaska Natives in the United States, 1999-2009.

OBJECTIVES: We describe the relative burden of alcohol-attributable death among American Indians/Alaska Natives (AI/ANs) in the United States. METHODS: National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We calculated age-adjusted alcohol-attributable death rates from 1999 to 2009 for AI/AN and White persons by sex, age, geographic region, and leading causes; individuals of Hispanic origin were excluded. RESULTS: AI/AN persons had a substantially higher rate of alcohol-attributable death than Whites from 2005 to 2009 in IHS Contract Health Service Delivery Area counties (rate ratio = 3.3). The Northern Plains had the highest rate of AI/AN deaths (123.8/100,000), and the East had the lowest (48.9/100,000). For acute causes, the largest relative risks for AI/AN persons compared with Whites were for hypothermia (14.2) and alcohol poisoning (7.6). For chronic causes, the largest relative risks were for alcoholic psychosis (5.0) and alcoholic liver disease (4.9). CONCLUSIONS: Proven strategies that reduce alcohol consumption and make the environment safer for excessive drinkers should be further implemented in AI/AN communities.

Hypersensitivity pneumonitis with Mycobacterium avium complex among spa workers.

BACKGROUND: The New Mexico Department of Health (NMDOH) investigated the cause of two cases of hypersensitivity pneumonitis (HP) in spa maintenance workers with laboratory confirmed Mycobacterium avium complex (MAC). The investigation occurred in tandem with worker protection and swimming pool regulatory investigations by the New Mexico Environment Department at the spa where the workers were employed. OBJECTIVES: The investigation was conducted in order to identify unreported cases, exposure source(s), and to prevent further worker exposure. METHODS: NMDOH surveyed 57 spa employees about symptoms and exposures, categorized jobs according to self-reported exposure to water, and computed odds ratios for symptom reporting by exposure category. Environmental isolates from spa water and filter swabs were cultured and compared to patient isolates by the Environmental and Applied Microbiology Team, Centers for Disease Control and Prevention (CDC). RESULTS: Workers with the highest exposure reported more HP-like symptoms (OR = 9.6), as did intermediate exposure workers (OR = 6.5), compared to workers with no aerosolized water exposure. Two of 13 environmental isolates were closely related to one of the patient isolates. CONCLUSIONS: Workers were likely exposed during spray cleaning of cartridge filters in a poorly ventilated work space. Recommendations include inhibiting organism growth in spa systems, assuring the use of respiratory protection, and adequately ventilating work spaces where filters and equipment are cleaned.

Does outpatient laboratory testing represent influenza burden and distribution in a rural state?

BACKGROUND: Laboratory testing results are often used to monitor influenza illness in populations, but results may not be representative of illness burden and distribution, especially in populations that are geographically, socioeconomically, and racially/ethnically diverse. OBJECTIVES: Descriptive epidemiology and chi-square analyses using demographic, geographic, and medical condition prevalence comparisons were employed to assess whether a group of individuals with outpatient laboratory-confirmed influenza illness during September-November 2009 represented the burden and distribution of influenza illness in New Mexico (NM). PATIENTS/METHODS: The outpatient group was identified via random selection from those with positive influenza tests at NM laboratories. Comparison groups included those with laboratory-confirmed H1N1-related influenza hospitalization and death identified via prospective active statewide surveillance, those with self-reported influenza-like illness (ILI) identified through random digit dialing, and the NM population. RESULTS: This analysis included 334 individuals with outpatient laboratory-confirmed influenza, 888 individuals with laboratory-confirmed H1N1-related hospitalization, 39 individuals with laboratory-confirmed H1N1-related death, 334 individuals with ILI, and NM population data (N = 2,036,112). The outpatient laboratory-confirmed group had a different distribution of demographic and geographic factors, as well as prevalence of certain medical conditions as compared to the groups of laboratory-confirmed H1N1-related hospitalization and death, the ILI group, and the NM population. CONCLUSIONS: The outpatient laboratory-confirmed group may reflect provider testing practices and potentially healthcare-seeking behavior and access to care, rather than influenza burden and distribution in NM during the H1N1 pandemic.

The decrease in the unintentional injury mortality disparity between American Indians/Alaska Natives and non-American Indians/Alaska Natives in New Mexico, 1980 to 2009.

OBJECTIVES: We tracked the unintentional injury death disparity between American Indians/Alaska Natives and non-American Indians/Alaska Natives in New Mexico, 1980 to 2009. METHODS: We calculated age-adjusted rates and rate ratios for unintentional injury deaths and their external causes among American Indians/Alaska Natives and non-American Indians/Alaska Natives. We tested trend significance with the Mann-Kendall test. RESULTS: The unintentional injury death rate ratio of American Indians/Alaska Natives to non-American Indians/Alaska Natives declined from 2.9 in 1980-1982 to 1.5 in 2007-2009. The rate among American Indians/Alaska Natives decreased 47.2% from 1980-1982 to 1995-1997. Among non-American Indians/Alaska Natives, the rate declined 25.3% from 1980-1982 to 1992-1994, then increased 31.9% from 1992-1994 to 2007-2009. The motor vehicle traffic and pedestrian death rates decreased 57.8% and 74.6%, respectively, among American Indians/Alaska Natives from 1980-1982 to 2007-2009. CONCLUSIONS: The unintentional injury death rate disparity decreased substantially from 1980-1982 to 2007-2009 largely because of the decrease in motor vehicle crash and pedestrian death rates among American Indians/Alaska Natives and the increase in the poisoning death rate among non-American Indians/Alaska Natives.

WITHDRAWN: The influence of living along the U.S.-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

The influence of living along the U.S.-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009.

BACKGROUND: The objective of this study was to characterize unintentional drug overdose death patterns among Hispanic ethnicity/sex strata by residence in New Mexico counties that border Mexico and non-border counties. METHODS: We analyzed medical examiner data for all unintentional drug overdose death in New Mexico during 2005-2009. Logistic and Poisson regression was used to examine the relationship of unintentional drug overdose death with border residence and demographics. Risk of overdose death was examined by the interactions of ethnicity, sex and border residence. RESULTS: During 2005-2009, the statewide drug overdose death rate was 17.6 per 100,000 (n=1812). Border decedents were more likely to have died from overdose of prescription opioids other than methadone (Schedule II, Adjusted Odds Ratio (aOR)=1.98; Schedule III/IV, aOR=1.56) but less likely to have died from heroin overdose (aOR=0.35), compared to non-border decedents. In population-based analyses, people living in border counties had lowest rates of overall overdose death and from illicit drugs, particularly heroin and cocaine. Hispanic males (adjusted incidence rate ratio [aRR]=2.41), Hispanic females (aRR=1.77) and non-Hispanic males (aRR=1.37) from non-border counties had higher risk of drug overdose death than their counterparts from border counties. Border residence had no effect on risk of drug overdose death among non-Hispanic females. CONCLUSIONS: Residents in border counties incurred a protective effect for drug overdose death, most pronounced among Hispanics. There is a component of overdose death risk for which border residence is a proxy, likely an array of cultural and healthcare-related factors.

A history of being prescribed controlled substances and risk of drug overdose death.

OBJECTIVE: The abuse of prescription drugs has increased dramatically since 1990. Persons who overdose on such drugs frequently consume large doses and visit multiple providers. The risk of fatal overdose for different patterns of use of opioid analgesics and sedative/hypnotics has not been fully quantified. DESIGN: Matched case-control study. Cases were 300 persons who died of unintentional drug overdoses in New Mexico during 2006-2008, and controls were 5,993 patients identified through the state prescription monitoring program with matching 6-month exposure periods. OUTCOME MEASURES: Death from drug overdose or death from opioid overdose. Exposures were demographic variables and characteristics of prescription history. Crude and adjusted odds ratios (AOR) were calculated. RESULTS: Increased risk was associated with male sex (AOR 2.4, 95% confidence interval [CI] 1.8-3.1), one or more sedative/hypnotic prescriptions (AOR 3.0, CI 2.2-4.2), greater age (AOR 1.3, CI 1.2-1.4 for each 10-year increment), number of prescriptions (AOR 1.1, CI 1.1-1.1 for each additional prescription), and a prescription for buprenorphine (AOR 9.5, CI 3.0-30.0), fentanyl (AOR 3.5, CI 1.7-7.0), hydromorphone (AOR 3.3, CI 1.4-7.5), methadone (AOR 4.9, CI 2.5-9.6), or oxycodone (AOR 1.9, CI 1.4-2.6). Patients receiving a daily average of >40 morphine milligram equivalents had an OR of 12.2 (CI 9.2-16.0). CONCLUSIONS: Patients being prescribed opioid analgesics frequently or at high dosage face a substantial overdose risk. Prescription monitoring programs might be the best way for prescribers to know their patients' prescription histories and accurately assess overdose risk.

Increased fall-related mortality rates in New Mexico, 1999-2005.

OBJECTIVE: In 2000, fall injuries affected 30% of U.S. residents aged ≥65 years and cost $19 billion. In 2005, New Mexico (NM) had the highest fall-related mortality rate in the United States. We described factors associated with these elevated fall-related mortality rates. METHODS: To better understand the epidemiology of fatal falls in NM, we used state and national (Web-based Injury Statistics Query and Reporting System) vital records data for 1999-2005 to identify unintentional falls that were the underlying cause of death. We calculated age-adjusted mortality rates, rate ratios (RRs), and 95% confidence intervals (CIs) by sex, ethnicity, race, and year. RESULTS: For 1999-2005 combined, NM's fall-related mortality rate (11.7 per 100,000 population) was 2.1 times higher than the U.S. rate (5.6 per 100,000 population). Elevated RRs persisted when stratified by sex (male RR=2.0, female RR=2.2), ethnicity (Hispanic RR=2.5, non-Hispanic RR=2.1), race (white RR=2.0, black RR=1.7, American Indian RR=2.3, and Asian American/Pacific Islander RR=3.1), and age (≥50 years RR=2.0, <50 years RR=1.2). Fall-related mortality rates began to increase exponentially at age 50 years, which was 15 years younger than the national trend. NM non-Hispanic individuals had the highest demographic-specific fall-related mortality rate (11.8 per 100,000 population, 95% CI 11.0, 12.5). NM's 69.5% increase in fall-related mortality rate was approximately twice the U.S. increase (31.9%); the increase among non-Hispanic people (86.2%) was twice that among Hispanic people (43.5%). CONCLUSIONS: NM's fall-related mortality rate was twice the U.S. rate; exhibited a greater increase than the U.S. rate; and persisted across sex, ethnicity, and race. Fall-related mortality disproportionately affects a relatively younger population in NM. Characterizing fall etiology will assist in the development of effective prevention measures.