Need for Improved Timeliness of Reporting on Drug Overdose Fatalities: The HEALing Communities Study.

OBJECTIVE: Timely data on drug overdose deaths can help identify community needs, evaluate the effectiveness of interventions, and allocate resources. We identified variations in death investigation and reporting systems within and between states that affect the timeliness and accuracy of death certificate information. METHODS: The HEALing Communities Study (HCS) is a community-engaged, data-driven approach to combating the opioid crisis in 67 communities in 4 states: Kentucky, Massachusetts, New York, and Ohio. HCS conducted a survey of coroners and medical examiners to understand variability in drug overdose death data. We compared survey results in Massachusetts, New York, and Ohio with national data to investigate the completeness of provisional death counts by type of death investigation system. RESULTS: Communities in each HCS state had different ways of collecting and reporting mortality data. Completion of death certificates for drug overdoses ranged from <2 weeks in 23% (7 of 31) of those surveyed to more than 3 months in 10% (3 of 31) of those surveyed. Variabilities in the timeliness of reporting drug overdose deaths were not associated with type of coroner or medical examiner office in each state, urban versus rural setting, or specificity of drug information on the death certificate. CONCLUSION: Having specific drug information on the death certificate may increase death certificate quality, comparability, and accuracy. We recommend the following: (1) all coroners and medical examiners should be trained on conducting death investigations, interpreting toxicology reports, and completing death certificates; (2) 1 office in each state should oversee all coroners and medical examiners to increase data consistency; and (3) communities should identify and address barriers to timely death certification.

Individual and County-Level Disparities in Drug and Opioid Overdose Mortality for Hispanic Men in Massachusetts and the Northeast United States.

BACKGROUND: This study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region. METHODS: The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast United States; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (from 2015-2019 American Community Survey data). RESULTS: At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of educational attainment, birthplace, urbanicity, substance use disorder treatment history, and specific drugs involved in death. At the county level, in the Northeast region, each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality. CONCLUSIONS: Findings underscore the importance of equitable interventions and efforts to address inequalities in social determinants of health for Hispanic populations in the Northeast.

Linking Ambulance Trip and Emergency Department Surveillance Data on Opioid-Related Overdose, Massachusetts, 2017.

OBJECTIVES: Studies describing linkage of ambulance trips and emergency department (ED) visits of patients with opioid-related overdose (ORO) are limited. We linked records of patients experiencing ORO from ambulance trip and ED visit records in Massachusetts during April 1-June 30, 2017. METHODS: We estimated the positive predictive value of ORO-capturing definitions by examining the narratives and triage notes of a sample of OROs from each data source. Because of a lack of common unique identifiers, we deterministically linked OROs to records in the counter data set on date of birth, incident date, facility, and sex. To validate the linkage strategy, we compared ambulance trip narratives with ED triage notes and chief complaints for a sample of pairs. RESULTS: Of 3203 ambulance trips for ORO and 3046 ED visits for ORO, 82% and 63%, respectively, matched a record in the counter data set on date of birth, incident date, facility, and sex. In 200 randomly selected linked pairs from a final linked data set of 3006 paired records, only 5 (3%) appeared to be false matches. PRACTICE IMPLICATIONS: This exercise demonstrated the feasibility of linking ORO records between 2 data sets without a unique identifier. Future analyses of the linked data could produce insights not available from analyzing either data set alone. Linkage using 2 rapidly available data sets can actively inform the state's public health opioid overdose response and allow for de-duplicating counts of OROs treated by ambulance, in an ED, or both.