Characteristics of Persons Who Died with COVID-19 - United States, February 12-May 18, 2020.

During January 1, 2020-May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19-associated deaths were reported in the United States (1). Understanding the demographic and clinical characteristics of decedents could inform medical and public health interventions focused on preventing COVID-19-associated mortality. This report describes decedents with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, using data from 1) the standardized CDC case-report form (case-based surveillance) (https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html) and 2) supplementary data (supplemental surveillance), such as underlying medical conditions and location of death, obtained through collaboration between CDC and 16 public health jurisdictions (15 states and New York City).

Surveillance of Opioid Prescribing as a Public Health Intervention: Washington State Bree Collaborative Opioid Metrics.

CONTEXT: To address risks associated with prescription opioid medications, guidelines recommend lower dose, shorter duration of use, and avoidance of concurrent sedatives. Monitoring opioid-prescribing practices is critical for assessing guideline impact, comparing populations, and targeting interventions to reduce risks. OBJECTIVE: To describe development of Washington (WA) State opioid-prescribing metrics, provide purpose and definitions, and apply metrics to prescription data for WA health care organizations. DESIGN: We describe the development and testing of opioid-prescribing metrics by the WA State Bree Collaborative opioid work group. SETTING: Washington State. PARTICIPANTS: Kaiser Permanente of Washington (KPW) Integrated Group Practice, KPW-contracted care providers, and WA Medicaid. MAIN OUTCOME MEASURES: Set of 6 strategic metrics tested across 3 different health systems adopted by WA State in 2017 for uniform tracking of opioid-prescribing guidelines and state policies. These metrics include (1) overall prevalence of any opioid use, (2) chronic use, (3) high-dose chronic use, (4) concurrent chronic sedative use, (5) days' supply of new prescriptions, and (6) transition from acute to chronic use. RESULTS: In the first quarter of 2010, 10% to 12% of KPW and 14% of Medicaid patients received at least 1 opioid prescription. Among opioid users, 22% to 24% of KPW and 36% of Medicaid patients received chronic opioids. Among patients receiving chronic opioids, 16% to 22% of KPW and 32% of Medicaid patients received high doses (≥90 morphine-equivalent dose per day) and 20% to 23% of KPW and 33% of Medicaid patients received concurrent chronic sedatives. Five percent of Medicaid and 2% to 3% of KPW patients receiving new opioid prescriptions transitioned to chronic opioid use. CONCLUSIONS: The metrics are relatively easy to calculate from electronic health care data and yield meaningful comparisons between populations or health plans. These metrics can be used to display trends over time and to evaluate the impact of opioid-prescribing policy interventions.

A comprehensive approach to address the prescription opioid epidemic in Washington State: milestones and lessons learned.

An epidemic of morbidity and mortality has swept across the United States related to the use of prescription opioids for chronic noncancer pain. More than 100,000 people have died from unintentional overdose, making this one of the worst manmade epidemics in history. Much of health care delivery in the United States is regulated at the state level; therefore, both the cause and much of the cure for the opioid epidemic will come from state action. We detail the strong collaborations across executive health care agencies, and between those public agencies and practicing leaders in the pain field that have led to a substantial reversal of the epidemic in Washington State.

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.

Increasing rates of methamphetamine/amphetamine-involved overdose hospitalizations in Washington State, 2010-2017.

BACKGROUND AND AIMS: In the United States, overdose deaths resulting from methamphetamine and other amphetamine-type stimulants (METH/AMPH) have been increasing. We describe rates and characterize patients hospitalized after a METH/AMPH-involved overdose in Washington State, to guide prevention and control measures. DESIGN SETTING PARTICIPANTS: We conducted a trend analysis of hospitalized Washington State residents aged ≥15 years who received a METH/AMPH-involved overdose diagnosis in Washington's civilian hospitals and reported in the Comprehensive Hospital Abstract Reporting System. MEASUREMENTS: We used Joinpoint regression analysis to study trends in rates of hospitalized patients who received a METH/AMPH-involved overdose diagnosis during 2010-2017. We used 2016-2017 data to describe characteristics of patients with nonfatal and fatal outcomes and used chi-square test (for categorical variables) and Wilcoxon rank-sum test (for continuous variables) to compare characteristics of patients by outcome. FINDINGS: During 2010-2017, 3587 patients were hospitalized and received a METH/AMPH-involved overdose diagnosis. The age-adjusted rate for METH/AMPH-involved overdose hospitalization increased from 6.3/100,000 persons in 2010 to 8.5/100,000 persons in 2017. Patients aged ≥55 years had the greatest increase in rate of overdose hospitalizations. Among these patients, 86% also had a substance use disorder diagnosis involving substances other than METH/AMPH, and 35% experienced a polysubstance overdose. CONCLUSIONS: We observed increasing rates of METH/AMPH-involved overdose hospitalizations in Washington State, particularly among persons aged ≥55 years. Approximately a third of patients also experienced a polysubstance overdose, which can be considered when designing interventions to address increasing rates of overdose hospitalizations in Washington State.

High prevalence of cobalamin deficiency in Guatemalan schoolchildren: associations with low plasma holotranscobalamin II and elevated serum methylmalonic acid and plasma homocysteine concentrations.

BACKGROUND: Studies conducted in Guatemala, Mexico, and Venezuela have found high prevalences of low plasma cobalamin (vitamin B-12) concentrations in infants and children. It is not known whether these low cobalamin concentrations are accompanied by altered metabolic functions. OBJECTIVE: We sought to assess the prevalence of cobalamin deficiency in Guatemalan children by using sensitive and specific markers of deficiency. DESIGN: Children (n = 553) were screened for low plasma cobalamin. Those with low plasma cobalamin (< 162 pmol/L) were matched by age, grade, and sex to those with marginal (162-221 pmol/L) and adequate (> 221 pmol/L) concentrations. In this matched subset (n = 180), additional biochemical indicators of cobalamin deficiency were measured. RESULTS: Of the 553 children screened, 11% had low plasma cobalamin and an additional 22% had marginal concentrations. The prevalences of elevated serum methylmalonic acid (MMA), plasma homocysteine, or both were significantly higher in children with low and marginal plasma cobalamin than in children with adequate plasma cobalamin. Mean serum MMA was high in all groups compared with values reported in other populations. Mean plasma holotranscobalamin II concentrations were significantly lower in children with low rather than marginal or adequate plasma cobalamin. However, holotranscobalamin II was a less sensitive indicator of cobalamin depletion than was MMA. CONCLUSION: Biochemical markers of cobalamin deficiency confirmed that the cobalamin status of children with low and marginal plasma cobalamin is inadequate to support normal metabolic function.

Associations between adolescent drinking and driving involvement and self-reported risk and protective factors in students in public schools in Washington State.

OBJECTIVE: This study examines associations between self-reported drinking and driving or being a passenger of a drinking driver and risk and protective factors in a general population of adolescents. METHOD: We used a two-staged sampling procedure to survey 2,955 students in Washington State public schools in Grades 9-12. Students were asked if they were a passenger of, or had been, a drinking driver in the previous month. They were also asked about individual, parent, school and community risk and protective factors. Comparisons were made using hierarchical polychotomous logistic regression, entering age and gender and parent, school and community protective factors at the first step and individual risk factors at the second step. RESULTS: Driving after drinking in the previous month was reported by 12.1% of respondents and riding with a drinking driver was reported by an additional 17.6% of respondents. At the first step, driving after drinking was more likely and riding with a drinking driver was less likely among youth who were age 16 or older, and male students were more likely than female students to report driving after drinking. Parent, school and community support were each significantly associated with less driving after drinking, and school support was significantly associated with less riding with drinking drivers. At the second step, higher quantity and frequency of drinking, more smoking cigarettes and drug use and less seat belt use were each associated with both drinking and driving and riding with drinking drivers. Gun carrying was also associated with driving after drinking. CONCLUSIONS: Drinking and driving behaviors were associated with risk and protective factors in the community, school, family and individual. Pilot prevention programs should test the effectiveness of reducing drinking and driving involvement by addressing such factors.

Maternal drug use and its effect on neonates: a population-based study in Washington State.

OBJECTIVE: To estimate the effect of maternal illicit and prescription drug use on neonates in Washington State between 2000 and 2008. METHODS: We used state-linked birth certificate and hospital discharge (mother and neonate) data to calculate prenatal drug exposure and neonatal abstinence syndrome rates, and compared state neonatal abstinence syndrome rates with national-level data from the Nationwide Inpatient Sample. We identified the drugs of exposure, examined predictors of drug exposure and neonatal abstinence syndrome, and assessed perinatal outcomes among drug-exposed and neonatal abstinence syndrome-diagnosed neonates compared with unexposed neonates. RESULTS: Drug exposure and neonatal abstinence syndrome rates increased significantly between 2000 and 2008, neonatal abstinence syndrome rates being consistently higher than national figures (3.3 compared with 2.8 per 1,000 births in 2008; P<.05). The proportion of neonatal abstinence syndrome-diagnosed neonates exposed prenatally to opioids increased from 26.4% in 2000 to 41.7% in 2008 (P<.05). Compared with unexposed neonates, drug-exposed and neonatal abstinence syndrome-diagnosed neonates had a lower mean birth weight, longer birth hospitalization, were more likely to be born preterm, experience feeding problems, and have respiratory conditions (all P<.001). CONCLUSION: Maternal use of illicit and prescription drugs was associated with considerable neonatal morbidity and significantly higher rates of drug exposure and neonatal abstinence syndrome in recent years. Data suggest that opioid analgesics contributed to the increase in prenatal drug exposure and neonatal abstinence syndrome in Washington State. In accordance with current guidelines, our findings emphasize the need for clinicians to screen pregnant women for illicit and prescription drug use and minimize use of opioid analgesics during pregnancy. LEVEL OF EVIDENCE: II.