Suicide Mortality Among Formerly Incarcerated People Compared With the General Population in North Carolina, 2000-2020.

We aimed to compare rates and characteristics of suicide mortality in formerly incarcerated people with those of the general population in North Carolina. We conducted a retrospective cohort study of 266,400 people released from North Carolina state prisons between January 1, 2000, and March 1, 2020. Using direct and indirect standardization by age, sex, and calendar year, we calculated standardized suicide mortality rates and standardized mortality ratios comparing formerly incarcerated people with the North Carolina general population. We evaluated effect modification by race/ethnicity, sex, age, and firearm involvement. Formerly incarcerated people had approximately twice the overall suicide mortality of the general population for 3 years after release, with the highest rate of suicide mortality being observed in the 2-week period after release. In contrast to patterns in the general population, formerly incarcerated people had higher rates of non-firearm-involved suicide mortality than firearm-involved suicide mortality. Formerly incarcerated female, White and Hispanic/Latino, and emerging adult people had a greater elevation of suicide mortality than their general-population peers compared with other groups. These findings suggest a need for long-term support for formerly incarcerated people as they return to community living and a need to identify opportunities for interventions that reduce the harms of incarceration for especially vulnerable groups. This article is part of a Special Collection on Mental Health.

Pregnancy-associated homicide, suicide and unintentional opioid-involved overdose deaths, North Carolina 2018-2019.

OBJECTIVE: Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum. METHODS: We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death. RESULTS: From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment. CONCLUSION: Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.

Opioid Overdose Deaths Among Formerly Incarcerated Persons and the General Population: North Carolina, 2000‒2018.

Objectives. To compare opioid overdose death (OOD) rates among formerly incarcerated persons (FIPs) from 2016 to 2018 with the North Carolina population and with OOD rates from 2000 to 2015. Methods. We performed a retrospective cohort study of 259 861 North Carolina FIPs from 2000 to 2018 linked with North Carolina death records. We used indirectly standardized OOD mortality rates and ratios and present 95% confidence intervals (CIs). Results. From 2017 to 2018, the OOD rates in the North Carolina general population decreased by 10.1% but increased by 32% among FIPs. During 2016 to 2018, the highest substance-specific OOD rate among FIPs was attributable to synthetic narcotics (mainly fentanyl and its analogs), while OOD rates for other opioids were half or less than that from synthetic narcotics. During 2016 to 2018, the OOD risk for FIPs from synthetic narcotics was 50.3 (95% CI = 30.9, 69.6), 20.2 (95% CI = 17.3, 23.2), and 18.2 (95% CI = 15.9, 20.5) times as high as that for the North Carolina population at 2-week, 1-year, and complete follow-up after release, respectively. Conclusions. While nationwide OOD rates declined from 2017 to 2018, OOD rates among North Carolina FIPs increased by about a third, largely from fentanyl and its analogs. (Am J Public Health. 2022;112(2):300-303. https://doi.org/10.2105/AJPH.2021.306621).

Fatalities related to intimate partner violence: towards a comprehensive perspective.

BACKGROUND: In 2015, 1350 people in the US were killed by their current or former intimate partner. Intimate partner violence (IPV) can also fatally injure family members or friends, and IPV may be a risk factor for suicide. Without accounting for all these outcomes, policymakers, funders, researchers and public health practitioners may underestimate the role that IPV plays in violent death. OBJECTIVE: We sought to enumerate the total contribution of IPV to violent death. Currently, no data holistically report on this problem. METHODS: We used Violent Death Reporting System (VDRS) data to identify all IPV-related violent deaths in North Carolina, 2010-2017. These included intimate partner homicides, corollary deaths, homicide-suicides, single suicides and legal intervention deaths. We used the existing IPV variable in VDRS, linked deaths from the same incident and manually reviewed 2440 suicide narratives where intimate partner problems or stalking were a factor in the death. RESULTS: IPV contributes to more than 1 in 10 violent deaths (10.3%). This represents an age-adjusted rate of 1.97 per 100 000 persons. Of the IPV-related violent deaths we identified, 39.3% were victims of intimate partner homicide, 17.4% corollary victims, 11.4% suicides in a homicide-suicide event, 29.8% suicides in a suicide-only event and 2.0% legal intervention deaths. IMPLICATIONS: If researchers only include intimate partner homicides, they may miss over 60% of IPV-related deaths. Our novel study shows the importance of taking a comprehensive approach to prevent IPV and decrease violent deaths. IPV is a risk factor for suicide as well as homicide.

The impact of the COVID-19 pandemic on the utilization of emergency department services for the treatment of injuries.

CONTEXT: The global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized. OBJECTIVE: This study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic. METHODS: Data were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020. Frequencies of January - November 2020 NC ED visits were compared to frequencies of 2019 visits for selected injury mechanisms, classified according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) injury diagnosis and mechanism codes. RESULTS: In 2020, the total number of injury-related visits declined by 19.5% (N = 651,158) as compared to 2019 (N = 809,095). Visits related to motor vehicle traffic crashes declined by a greater percentage (29%) and falls (19%) declined by a comparable percentage to total injury-related visits. Visits related to assault (15%) and self-harm (10%) declined by smaller percentages. Medication/drug overdose visits increased (10%), the only injury mechanism studied to increase during this period. CONCLUSION: Both ED avoidance and decreased exposures may have contributed to these declines, creating implications for injury morbidity and mortality. Injury outcomes exacerbated by the pandemic should be addressed by timely public health responses.

Intimate Partner Homicides in North Carolina: 2011-2015.

BACKGROUND Research on intimate partner homicide (IPH), when someone is killed by a current or former intimate partner, in North Carolina is limited, making it difficult to understand the magnitude of IPHs and identify strategies for prevention.METHOD We used North Carolina Violent Death Reporting System (NC-VDRS) data to assess IPHs among North Carolina residents between 2011 and 2015. Homicides were considered IPHs if intimate partner violence was identified and the victim was the suspect's current or former intimate partner. Proportions and rates of demographic characteristics and circumstances were assessed.RESULTS Of the 2,299 homicides that occurred between 2011 and 2015, 350 were IPHs (0.9 per 100,000 person-years). Most (72.3%) IPH victims were female (n = 253). Among all female homicides almost half (48.2%) were IPHs, while only 5.4% of all male homicides were IPHs. The highest rate of IPH occurred among women aged 20-44 (2.1 per 100,000 person-years). Most victims were non-Hispanic (NH) white (54.0%, n = 189), although rates for NH American Indians and NH blacks were 1.8 and 2.0 times those among NH whites respectively. Most victims, 86.6% male and 82.6% female, were the suspect's current partner. Firearms were the most common weapon used (62.6%, n = 219).LIMITATIONS NC-VDRS data are not representative of all IPHs in the United States. Circumstance data were sometimes incomplete and categories of circumstance variables restrictive, limiting available information on IPHs.CONCLUSION Future interventions focused on women aged 20-44, NH American Indian and NH Black communities, and firearm access could be effective in preventing IPHs in North Carolina.

Opioid Overdose Mortality Among Former North Carolina Inmates: 2000-2015.

OBJECTIVES: To examine differences in rates of opioid overdose death (OOD) between former North Carolina (NC) inmates and NC residents and evaluate factors associated with postrelease OOD. METHODS: We linked NC inmate release data to NC death records, calculated OOD standardized mortality ratios to compare former inmates with NC residents, and calculated hazard ratios to identify predictors of time to OOD. RESULTS: Of the 229 274 former inmates released during 2000 to 2015, 1329 died from OOD after release. At 2-weeks, 1-year, and complete follow-up after release, the respective OOD risk among former inmates was 40 (95% confidence interval [CI] = 30, 51), 11 (95% CI = 9.5, 12), and 8.3 (95% CI = 7.8, 8.7) times as high as general NC residents; the corresponding heroin overdose death risk among former inmates was 74 (95% CI = 43, 106), 18 (95% CI = 15, 21), and 14 (95% CI = 13, 16) times as high as general NC residents, respectively. Former inmates at greatest OOD risk were those within the first 2 weeks after release, aged 26 to 50 years, male, White, with more than 2 previous prison terms, and who received in-prison mental health and substance abuse treatment. CONCLUSIONS: Former inmates are highly vulnerable to opioids and need urgent prevention measures.

Child Maltreatment Surveillance Improvement Opportunities: A Wake County, North Carolina Pilot Project.

BACKGROUND As child maltreatment often occurs in private, child welfare numbers underestimate its true prevalence. Child maltreatment surveillance systems have been used to ascertain more accurate counts of children who experience maltreatment. This manuscript describes the results from a pilot child maltreatment surveillance system in Wake County, North Carolina.METHODS We linked 2010 and 2011 data from 3 sources (Child Protective Services, Raleigh Police Department, and Office of the Chief Medical Examiner) to obtain rates of definite and possible child maltreatment. We separately analyzed emergency department visits from 2010 and 2011 to obtain counts of definite and possible child maltreatment. We then compared the results from the surveillance systems to those obtained from Child Protective Services (CPS) data alone.RESULTS In 2010 and 2011, rates of definite child maltreatment were 11.7 and 11.3 per 1,000 children, respectively, when using the linked data, compared to 10.0 and 9.5 per 1,000 children using CPS data alone. The rates of possible maltreatment were 25.3 and 23.8 per 1,000, respectively. In the 2010 and 2011 emergency department data, there were 68 visits and 84 visits, respectively, that met the case definition for maltreatment.LIMITATIONS While 4 data sources were analyzed, only 3 were linked in the current surveillance system. It is likely that we would have identified more cases of maltreatment had more sources been included.CONCLUSION While the surveillance system identified more children who met the case definition of maltreatment than CPS data alone, the rates of definite child maltreatment were not considerably higher than official reports. Rates of possible child maltreatment were much higher than both the definite case definition and child welfare records. Tracking both definite and possible case definitions and using a variety of data sources provides a more complete picture of child maltreatment in North Carolina.

Mortality Rates and Cause of Death Among Former Prison Inmates in North Carolina.

BACKGROUND Inmates face challenges upon release from prison, including increased risk of death. We examine mortality among former inmates in North Carolina, including both violent and nonviolent deaths.METHODS A retrospective cohort study among former North Carolina inmates released between 2008 and 2010 were linked with North Carolina mortality data to determine cause of death. Inmates were followed through December 31, 2012. Mortality rates among former inmates were compared with deaths among North Carolina residents using standardized mortality ratios (SMRs).RESULTS Among former inmates (N = 41,495), there were 926 deaths during the study period. Compared to the North Carolina general population, SMRs were higher for all-cause mortality for total deaths (SMR = 2.10, 95% CI: 1.97-2.24), heart disease (SMR = 4.45, 95% CI: 3.64-5.34), cancer (SMR = 3.92, 95% CI: 3.34-4.62), suicide (SMR = 14.46, 95% CI: 10.28-19.76), and homicide (SMR = 7.98, 95% CI: 6.34-10.03).DISCUSSION The death rate among former North Carolina inmates is significantly higher than that of other North Carolina residents. Although more research is needed, identifying areas for interventions is essential for reducing the risk of death among this population.

Assessing Injury and Violence Prevention in North Carolina's Local Health Departments.

BACKGROUND: Injury and violence-related morbidity and mortality present a major public health problem in North Carolina. However, the extent to which local health departments (LHDs) engage in injury and violence prevention (IVP) has not been well described. OBJECTIVES: One objective of the current study is to provide a baseline assessment of IVP in the state's LHDs, describing capacity, priorities, challenges, and the degree to which programs are data-driven and evidence-based. The study will also describe a replicable, cost-effective method for systematic assessment of regional IVP. DESIGN: This is an observational, cross-sectional study that was conducted through a survey of North Carolina's 85 LHDs. RESULTS: Representatives from 77 LHDs (91%) responded. Nearly one-third (n = 23; 30%) reported that no staff members were familiar with evidence-based interventions in IVP, and over one-third (n = 29; 38%) reported that their LHD did not train staff in IVP. Almost one-half (n = 37; 48%) had no dedicated funding for IVP. On average, respondents said that about half of their programs were evidence-based; however, there was marked variation (mean, 52%; standard deviation = 41). Many collaborated with diverse partners including law enforcement, hospitals, and community-based organizations. There was discordance between injury and violence burden and programming. Overall, 53% of issues listed as top local problems were not targeted in their LHDs' programs. CONCLUSIONS: Despite funding constraints, North Carolina's LHDs engaged in a broad range of IVP activities. However, programming did not uniformly address state injury and violence priorities, nor local injury and violence burden. Staff members need training in evidence-based strategies that target priority areas. Multisector partnerships were common and increased LHDs' capacity. These findings are actionable at the state and local level.

Motorcycle crash-related emergency department visits and hospitalizations for traumatic brain injury in North Carolina.

OBJECTIVE: To examine statewide emergency department (ED) visit data for motorcycle crash morbidity and healthcare utilization due to traumatic brain injuries (TBIs) and non-TBIs. SETTING: North Carolina ED data (2010-2012) and hospital discharge data (2009-2011). POPULATION: Statewide ED visits and hospitalizations due to injuries from traffic-related motorcycle crashes stratified by TBI status. DESIGN: Descriptive study. MAIN MEASURES: Descriptive statistics include age, sex, mode of transport, disposition, expected source of payment, hospital length of stay, and hospital charges. RESULTS: Over the study period, there were 18 780 ED visits and 3737 hospitalizations due to motorcycle crashes. Twelve percent of ED visits for motorcycle crashes and 26% of hospitalizations for motorcycle crashes had a diagnosis of TBI. Motorcycle crash-related hospitalizations with a TBI diagnosis had median hospital charges that were nearly $9000 greater than hospitalizations without a TBI diagnosis. CONCLUSIONS: Emergency department visits and hospitalizations due to motorcycle crashes with a TBI diagnosis consumed more healthcare resources than motorcycle crash-related ED visits and hospitalizations without a TBI diagnosis. Increased awareness of motorcyclists by other road users and increased use of motorcycle helmets are 2 strategies to mitigate the incidence and severity of motorcycle crash injuries, including TBIs.

Violent Death Rates and Risk for Released Prisoners in North Carolina.

Released prisoners face high risk of early mortality. The risk of violent death, specifically homicide and suicide, are addressed in this study. Data on inmates released from the North Carolina Division of Adult Corrections (N = 476) matched to the Violent Death Reporting System are analyzed to estimate rates and demographic and criminal justice-related predictors. Violent death rates for persons released from prison were more than 7 times higher than for the general adult population. Results from multinomial logistic regression indicate decreased homicide risk for every year of age, whereas male gender and minority race increased risk. For suicide, minority race, release without supervision, and substance abuse treatment in prison decreased fatality risk. By contrast, a history of mental illness increased suicide risk. Implications for practice and research are discussed.

Impact of North Carolina's motorcycle helmet law on hospital admissions and charges for care of traumatic brain injuries.

BACKGROUND North Carolina requires motorcyclists of all ages to wear federally approved safety helmets. The purpose of this article is to estimate the impact of this state law in terms of hospital admissions for traumatic brain injury (TBI) and associated hospital charges. METHODS Hospital admissions of North Carolina motorcyclists with TBIs and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. We estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). RESULTS North Carolina's universal helmet law prevented an estimated 190 to 226 hospital admissions of North Carolina motorcyclists with TBI in 2011. Averted hospital charges to taxpayer-funded sources (ie, government and public charges) were estimated to be between $9.5 million and $11.6 million for 2011, and total averted hospital charges for 2011 were estimated to be between $25.3 million and $31.0 million. LIMITATIONS Cost estimates are limited to inpatients during the initial period of hospital care. This study was unable to capture long-term health care costs and productivity losses incurred by North Carolina's TBI patients and their caregivers. CONCLUSIONS North Carolina's universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.

Increases in heroin overdose deaths - 28 States, 2010 to 2012.

Nationally, death rates from prescription opioid pain reliever (OPR) overdoses quadrupled during 1999-2010, whereas rates from heroin overdoses increased by <50%. Individual states and cities have reported substantial increases in deaths from heroin overdose since 2010. CDC analyzed recent mortality data from 28 states to determine the scope of the heroin overdose death increase and to determine whether increases were associated with changes in OPR overdose death rates since 2010. This report summarizes the results of that analysis, which found that, from 2010 to 2012, the death rate from heroin overdose for the 28 states increased from 1.0 to 2.1 per 100,000, whereas the death rate from OPR overdose declined from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012. Heroin overdose death rates increased significantly for both sexes, all age groups, all census regions, and all racial/ethnic groups other than American Indians/Alaska Natives. OPR overdose mortality declined significantly among males, persons aged <45 years, persons in the South, and non-Hispanic whites. Five states had increases in the OPR death rate, seven states had decreases, and 16 states had no change. Of the 18 states with statistically reliable heroin overdose death rates (i.e., rates based on at least 20 deaths), 15 states reported increases. Decreases in OPR death rates were not associated with increases in heroin death rates. The findings indicate a need for intensified prevention efforts aimed at reducing overdose deaths from all types of opioids while recognizing the demographic differences between the heroin and OPR-using populations. Efforts to prevent expansion of the number of OPR users who might use heroin when it is available should continue.

Prescription histories and dose strengths associated with overdose deaths.

OBJECTIVE: Misuse, abuse, and diversion of prescription drugs are large and growing public health problems that have resulted in an overdose epidemic. We investigated whether short-acting or extended-release opioids were more frequently prescribed to those who died of an overdose and whether there was a linear relationship between dose strength and associated overdose deaths. METHODS: The study population was North Carolina residents in 2010. We conducted a retrospective, population-based, descriptive study of medication histories of overdose decedents using data from vital statistics, medical examiner records, and a prescription drug monitoring program. RESULTS: Unintentional or undetermined drug overdoses were responsible for 892 deaths. Out of 191 deaths involving methadone, only two were patients in opioid treatment programs. Immediate-release oxycodone was involved in the greatest number of opioid-related deaths. Out of 221 oxycodone deaths, 134 (61%) of the decedents filled a prescription for oxycodone in the 60 days prior to death. The most common strength dispensed within 60 days to a decedent who died of an oxycodone overdose was 10 mg for immediate-release (72 prescriptions). Immediate-release oxycodone products (rho = 1.00, P < 0.01) and extended-release fentanyl products (rho = 1.00, P < 0.01) showed strong increasing linear trends between dose strength and proportion of prescriptions dispensed to decedents. CONCLUSIONS: A significant proportion of overdose decedents had been prescribed the same type of drugs that contributed to their death, especially for decedents who died from overdoses involving oxycodone, hydrocodone, and alprazolam. Higher dose strengths for certain opioids had higher associated mortality, and certain immediate-release opioids may be considered for public health prevention efforts.

The epidemiology of traumatic brain injuries treated in emergency departments in North Carolina, 2010-2011.

BACKGROUND: Traumatic brain injuries (TBIs) are a leading cause of injury morbidity and mortality in the United States. An estimated 1.7 million TBIs occur each year, and TBIs may lead to severe lifelong disability and death; even mild-to-moderate TBIs may have long-term consequences. North Carolina's population-wide data on TBIs are limited, so it is important to analyze the available data regarding TBI-related emergency department (ED) visits. METHODS: Statewide data on TBI-related ED visits were obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), an electronic public health surveillance system. Counts and rates were produced by sex, age, county of residence, disposition, mode of transport, and mechanism of injury. RESULTS: In 2010-2011, there were 140,234 TBI-related ED visits in North Carolina, which yields a rate of 7.3 ED visits per 1,000 person-years. The rate was higher for men (7.9 visits per 1,000 person-years) than for women (6.8 visits per 1,000 person-years). Rates were highest in individuals aged 0-4 years (13.1 visits per 1,000 person-years), 15-19 years (10.6 visits per 1,000 person-years), 75-79 years (11.3 visits per 1,000 person-years), 80-84 years (17.9 visits per 1,000 person-years), and 85 years or older (30.6 visits per 1,000 person-years). TBI-related ED visits were principally the result of falls (39.0%), being struck by a person or object (17.6%), or motor vehicle traffic-related crashes (14.1%). LIMITATIONS: This study utilizes data collected primarily for administrative purposes, such as hospital billing. CONCLUSION: TBIs are a common cause of ED visits in North Carolina. These descriptive statistics demonstrate needs for statewide ED surveillance to monitor the incidence of TBIs and for the development of prevention strategies.

Endocarditis, drug use and biological sex: A statewide analysis comparing sex differences in drug use-associated infective endocarditis with other drug-related harms.

OBJECTIVES: Hospitalizations for drug use-associated infective endocarditis (DUA-IE) have risen sharply across the United States over the past decade. The sex composition of DUA-IE remains less clear, and studies have indicated a possible shift to more females. We aimed to compare more recent statewide hospitalization rates for DUA-IE in females versus males and contextualize them among other drug-related harms in North Carolina (NC). METHODS: This study was a retrospective analysis using public health datasets of all NC hospital discharges for infective endocarditis from 2016 to 2020. Drug use-related hospitalizations were identified using ICD-10-CM codes. Discharge rates by year and sex for DUA-IE and non-DUA-IE were calculated and compared to fatal overdoses and acute hepatitis C (HCV). Temporal, demographic, and pregnancy trends were also assessed. RESULTS: Hospitalizations rates for DUA-IE were 9.7 per 100,000 over the five-year period, and 1.2 times higher among females than males. Females composed 57% of DUA-IE hospitalizations over the period. Conversely, fatal overdose, acute HCV, and non-DUA-IE hospitalization rates were higher among males. Age, county of residence, and pregnancy status did not explain the higher DUA-IE among females. CONCLUSION: Females now comprise the majority of DUA-IE hospitalizations in NC, unlike other drug-related harms. No clear demographic or geographic associations were found, and further research is needed to explain this phenomenon. Preventing invasive infections among females who inject drugs should be prioritized.

Surveillance of injuries in Eastern North Carolina following Hurricane Irene using emergency department data.

OBJECTIVE: Our objective was to characterize nonfatal injuries, by age groups, that were seen in emergency departments (EDs) in 29 selected counties in Eastern North Carolina following Hurricane Irene. METHODS: A descriptive evaluation using data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) was performed to identify the numbers and types of nonfatal injuries among individuals who sought treatment at hospital EDs. Percentages of reported ED visits related to external injuries in the 7 most severely impacted counties were compared with results in the entire 29-county region and with data from a reference period in 2010. RESULTS: The total number of individuals who sought treatment at an ED for an external cause of injury was 22.3% greater during the week following Hurricane Irene than during the 2010 reference week. In the 29-county region, the increases were primarily due to falls; in the 7-county region, they were primarily due to cutting and piercing incidents. Following the storm, injuries related to falls, adverse effects of health care, or being struck by an object accounted for higher proportions of injury-related ED visits in the 7-county disaster region than in the 29-county region. LIMITATIONS: The inability to identify the patient's home address and the county where treatment was sought was a spatial limitation. Furthermore, data for urgent care visits, primary care doctor visits, and injuries treated at home were not included. Additionally, cautious inference should be made to distinguish between injuries that occurred as a direct result of the storm and those that occurred incidentally. CONCLUSION: Data from NC DETECT can be used to estimate the most common types of injuries seen in EDs following a natural disaster.

Disparities in firearms ownership and storage practices in North Carolina.

OBJECTIVE: Because household firearms pose a risk to children, this study examined firearms accessibility in North Carolina households with children. METHODS: In 2008, parents completing the North Carolina Child Health Assessment and Monitoring Program survey were asked how many firearms they owned and their firearms storage practices. Weighted analyses provided estimates of ownership and storage practices and examined variation by sociodemographics. RESULTS: A total of 37% of 2885 parents reported owning firearms. Whites (adjusted odds ratio [aOR] 3.9 [95% confidence interval {CI} 2.9-5.2]), households with income >200% of the federal poverty level (aOR 1.7 [95% CI 1.2-2.5]) and married parents (aOR 2.4 [95% CI 1.8-3.4]) were more likely to own firearms. Ownership of more than one firearm was greater among whites (aOR 2.2 [95% CI 1.4-3.4]) and married parents (aOR 1.8 [95% CI 1.5-2.8]) than other groups. The number of firearms owned increased with children's age. Although most parents reported keeping firearms locked and unloaded (57%), many reported unsafe storage practices, which varied by race/ethnicity. Whites were more likely (45%) to store firearms unlocked and/or loaded than other groups (35%). CONCLUSIONS: Many North Carolina youth have access to household firearms, with white youth being more likely to have firearms, a greater number of firearms, and less safely stored firearms than other race/ethnicity groups. Further interventions and policies to reduce youth access to household firearms are needed. Future research should examine and address why whites, married couples, and those with socioeconomic advantages are more likely than individuals not belonging to these groups to own household firearms and store them unsafely.