Unsuitable Underlying Causes of Death for Assessing the Quality of Cause-of-death Reporting.

Objectives-This report expands the measures used to evaluate cause-of-death data quality by presenting a novel list of unsuitable underlying causes of death (UCOD). This list is intended to facilitate the measurement of the quality of cause-of-death reporting by medical certifiers in terms of completeness, as assessed by a UCOD that is sufficiently specific. Methods-A list of codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision was developed to classify unsuitable UCODs defined according to three main subtypes: unknown and ill-defined causes, immediate and intermediate causes, and nonspecific UCODs. Unsuitable UCODs and the three subtypes were examined using 2018 death certificate data for both U.S. residents and nonresidents in the 50 states and the District of Columbia. Differences in the frequency of unsuitable UCODs and the subtypes were tested by age group, place of death, and state of occurrence. Trends in unsuitable UCODs and the three subtypes were also investigated by analyzing death certificate data from 2010 to 2018. Results-In 2018, 34.7% of all death records had an unsuitable UCOD: 2.2% had an unknown or ill-defined cause as the UCOD, 12.7% had an immediate or intermediate cause as the UCOD, and 19.8% had a nonspecific UCOD. Unsuitable UCODs and the subtypes varied by age group, place of death, state, and year. No trend in unsuitable UCODs from 2010 to 2013 was seen, but from 2013 to 2018, a decrease of 0.6% per year was observed, which is likely due to a similar decrease in nonspecific UCODs during the same time period. Conclusion-This novel list of unsuitable UCOD codes can be used to assess the quality of cause-of-death data over time and by other various characteristics, with further applications for efforts to improve mortality data quality.

The influence of gender, age, education and household size on meal preparation and food shopping responsibilities.

OBJECTIVE: To examine the extent to which the gendered division of labour persists within households in the USA in regard to meal planning/preparation and food shopping activities. DESIGN: Secondary analysis of cross-sectional data. SETTING: 2007-2008 US National Health and Nutrition Examination Survey. SUBJECTS: Sub-sample of 3195 adults at least 20 years old who had a spouse or partner. RESULTS: Analyses revealed that the majority of women and men reported they shared in both meal planning/preparing and food shopping activities (meal planning/preparation: women 54 % and men 56 %; food shopping: women 60 % and men 57 %). Results from multinomial logistic regression analyses indicated that, compared with men, women were more likely to take primary responsibility than to share this responsibility and less likely to report having no responsibility for these tasks. Gender differences were observed for age/cohort, education and household size. CONCLUSIONS: This study may have implications for public health nutritional initiatives and the well-being of families in the USA.

National Hospital Care Survey Demonstration Projects: Opioid-involved Emergency Department Visits, Hospitalizations, and Deaths.

Objective-This report demonstrates the utility of linking the restricted-use 2014 National Hospital Care Survey (NHCS), 2014-2015 National Death Index (NDI), and 2014-2015 Drug-Involved Mortality (DIM) data to study opioid-involved emergency department (ED) visits, hospitalizations, and mortality within 1 year post-discharge. Example research questions and unweighted results are presented. Results are not nationally representative. Methods-Patient records from the 2014 NHCS with sufficient identifying information were linked to the 2014-2015 NDI and DIM data. Visits were considered opioid-involved if they had International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 304.00-304.02, 304.70-304.72, 305.50-305.52, 760.72, 965.00-965.02, 965.09, 970.1, or E850.0-E850.2 in any diagnosis or external cause of injury code field. Opioid-involved drug overdose deaths were deaths with an International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death code of X40-44, X60-64, X85, or Y10-Y14 and a multiple cause code of T40.0-T40.4 or T40.6. Results-In the 2014 NHCS, there were 15,495 patients with an opioid-involved ED-only visit and 24,059 patients with an opioid-involved hospitalization. Of the 20,962 patients with an opioid-involved hospitalization eligible to be linked to NDI, 1,805 died (9%) within 1 year of discharge. Of these deaths, 341 (19%) resulted from a drug overdose. Of drug overdose deaths, 243 (71%) involved an opioid, where 12% died within 30 days post-discharge, 19% within 31-90 days, and 69% within 91-365 days. Opioids most frequently mentioned included heroin (46%), fentanyl (20%), oxycodone (13%), methadone (12%), and morphine (12%). These categories are not mutually exclusive because a death may involve more than one drug. For approximately 22% of patients who died of an opioid-involved drug overdose in 2014, their last ED-only visit or hospitalization was opioid-involved. Conclusion-While the NHCS data are not nationally representative, these unlinked and linked National Center for Health Statistics data allow for exploratory analyses of ED visits, hospitalizations, and associated mortality outcomes.

Neighborhood Disadvantage, Preconception Health Behaviors and Infant Birthweight: A Preliminary Study.

Prior studies have shown that neighborhood disadvantage and disorder are associated with birth outcomes. This study examined preconception diet and physical activity level, as well as body mass index, as mediators of the association between neighborhood conditions and birthweight. Secondary data analyses were conducted using data from the National Longitudinal Study of Adolescent Health (Add Health). The final analytic sample consisted of 523 adolescent and young adult mothers giving singleton live births between 1997 and 1998. In contrast to previous research, we found that neighborhood characteristics were unrelated to birthweight. Consistent with prior studies, compared to those who were White, on average, Blacks had birthweights that were 163.25 grams lighter. In addition, compared to mothers who were married or living with a partner, mothers who did not have a partner at the time of birth, on average, had offspring that were 127.20 grams lighter. No evidence was found for the mediation hypotheses as there were no associations between neighborhood characteristics and preconception diet or physical activity or between these behavioral variables and birthweight. To the authors' knowledge, this is the first study examining diet and physical activity as possible behavioral pathways between the neighborhood context and birthweight.