Suicide Among Adults Age 55 and Older, 2021.

Suicide is a leading cause of mortality in the United States, with an ageadjusted rate of 14.1 deaths per 100,000 population in 2021 (1). Older adults tend to have higher rates of suicide, although they represent a low percentage of the total number of suicides (2). Factors that specifically affect older adults can include declines in physical and cognitive functioning, changes in mental health, and other factors often associated with getting older, like bereavement, loneliness, and lack of social connectedness (3-8). This report presents suicide rates for adults age 55 and older by sex and mechanism of suicide.

Repetitive Strain Injuries in Adults in the Past 3 Months: United States, 2021.

Objectives-This report describes the percentage of adults aged 18 and over who reported injuries from repetitive strain in the past 3 months by selected sociodemographic characteristics, including age, sex, race and Hispanic origin, and family income. The impacts of these injuries-limitation of usual activity for at least 24 hours and whether a medical professional was consulted for the injuries-are also examined. Methods-Data from the 2021 National Health Interview Survey were used to estimate the percentage of adults who had repetitive strain injuries in the past 3 months by sociodemographic characteristics. Among those who had a repetitive strain injury in the past 3 months, 24-hour limitation of activity and consultation of a medical professional are also examined by sociodemographic characteristics. Results-In 2021, for adults aged 18 and over in the United States, 9.0% had repetitive strain injuries in the past 3 months. Adults aged 35-49 (10.3%) and 50-64 (11.6%), White non-Hispanic adults (subsequently, White; 9.5%), and adults with family income at 400% or more of the federal poverty level (9.8%) tended to have higher percentages. For those who had repetitive strain injuries, 44.2% limited their activities for at least 24 hours, with the highest percentages among White adults (47.0%), women (47.1%), and adults with a family income less than 200% of the federal poverty level (51.0%). For those who limited their activity for at least 24 hours due to a repetitive strain injury, 51.4% consulted a doctor or medical professional, with the highest percentages among women (56.3%) and Black non-Hispanic adults (66.2%).

Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants, 2011-2021.

Drug overdose deaths involving cocaine and psychostimulants with abuse potential (that is, drugs such as methamphetamine, amphetamine, and methylphenidate) have risen in the past several years (1-4). A recent report highlighted that drug overdose deaths involving cocaine rose 22% and drug overdose deaths involving psychostimulants rose 33% from 2020 through 2021 (1). By the end of 2021, the report counted 24,486 drug overdose deaths involving cocaine and 32,537 drug overdose deaths involving psychostimulants (1,5). This report presents trends from 2011 through 2021 in death rates involving cocaine and psychostimulants, with and without opioid co-involvement, and by U.S. Census region in 2021.

Suicide and Homicide Death Rates Among Youth and Young Adults Aged 10-24: United States, 2001-2021.

Deaths due to suicide and homicide, often referred to collectively as violent deaths, have been a leading cause of premature death to people aged 10-24 in the United States (1-3). A previous version of this report with data through 2017 showed that suicide and homicide rates for people aged 10-24 were trending upward (4). This report updates the previous report using the most recent data from the National Vital Statistics System and presents trends from 2001 through 2021 in suicide and homicide rates for people aged 10-24 and for age groups 10-14, 15-19, and 20-24.

Suicide Mortality in the United States, 2001-2021.

In 2021, suicide was the 11th leading cause of death in the United States, changing from the 10th leading cause in 2019 and the 12th leading cause in 2020 (1). As the second leading cause of death in people aged 10-34 and the fifth in people aged 35-54, suicide contributes to premature mortality (1). After peaking in 2018, rates declined through 2020 but then increased again in 2021, according to provisional data (2,3). This report updates previous data by presenting final suicide rates from 2001 through 2021 by sex and age as well as rates by race and Hispanic origin for 2020 and 2021.

Unintentional Fall Deaths Among Adults Aged 65 and Over: United States, 2020.

Unintentional fall injuries occur most frequently among people in older age groups, with over 2 million fall events treated in emergency departments each year among adults aged 65 and over (1,2). A variety of factors contribute to the risk of falling, including difficulties in seeing, walking, and balance; disabilities; medication effects; and environmental walking obstacles, among other factors (3-6). Deaths due to unintentional falls are a leading cause of unintentional injury deaths among adults aged 65 and over (7). Reducing unintentional fall-related deaths among older adults is a key objective for Healthy People 2030 (8). This report presents unintentional fall death rates for adults aged 65 and over, by demographic characteristics.

Alcohol-induced Death Rates in the United States, 2019-2020.

Alcohol use is a known risk factor for mortality, and the rates of alcohol induced deaths have risen over the past several years (1). Alcohol use in the United States increased during the first year of the Coronavirus Disease 2019 (COVID-19) pandemic, which may have affected mortality rates, especially for alcohol-induced deaths (2). Understanding trends in alcohol-induced mortality, with a particular focus on differences from 2019 to 2020, may help identify groups particularly affected during the COVID-19 pandemic. This report presents overall and sex-specific trends in alcohol-induced death rates from 2000 to 2020, and then focuses on the rates for 2019 and 2020 by sex, age group, and underlying cause of death.

Psychological distress and the risk of drug overdose death.

BACKGROUND: Previous research has shown an association between psychological distress and overdose death among specific populations. However, few studies have examined this relationship in a large US population-based cohort. METHODS: Data from the 2010-2018 NHIS were linked to mortality data from the National Death Index through 2019. Psychological distress was measured using the Kessler 6 scale. Drug overdose deaths were examined, and deaths from all other causes were included as a comparison group. Cox proportional hazards regression was used to estimate mortality risk by psychological distress level. RESULTS: The study population included 272,561 adults. Adjusting for demographic covariates and using no psychological distress as the reference, distress level was positively associated with the risk of overdose death: low (HR = 1.8, 95 % CI = 1.1-2.8), moderate (HR = 4.1, 95 % CI = 2.5-6.7), high (HR = 10.3, 95 % CI = 6.5-16.1). A similar pattern was observed for deaths from all other causes: low (HR = 1.2, 95 % CI = 1.1-1.2), moderate (HR = 1.9, 95 % CI = 1.7-2.0), high (HR = 2.6, 95 % CI = 2.4-2.8). LIMITATIONS: Limited substance use information prevented adjustment for this potentially important covariate. DISCUSSION: Adults with psychological distress were at greater risk of drug overdose death, relative to those without psychological distress. Adults with psychological distress were also at increased risk of death due to other causes, though the association was not as strong.

Urban-Rural Differences in Drug Overdose Death Rates, 2020.

Drug overdose death rates, which have been rising over the past decade, differ by urban and rural counties across the United States (1-4). A previous report demonstrated higher drug overdose death rates in urban counties by various demographic and geographic characteristics (4). This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to describe urban and rural differences in drug overdose death rates in 2020 by sex, race and Hispanic origin, and selected types of opioids and stimulants.

Suicide Mortality in the United States, 2000-2020.

In 2020, suicide was the 12th leading cause of death for all ages in the United States, changing from the 10th leading cause in 2019 due to the emergence of COVID-19 deaths and increases in deaths from chronic liver disease and cirrhosis (1). As the second leading cause of death in people aged 10-34 and the fifth leading cause in people aged 35-54, suicide is a major contributor to premature mortality (1). Suicide rates increased from 2000 to 2018 (2-5), but recent data have shown declines between 2018 and 2020 (6,7). This report presents final suicide rates from 2000 through 2020, in total and by sex, age group, and means of suicide, using mortality data from the National Vital Statistics System (NVSS). This report updates a provisional 2020 report and a previous report with final data through 2019 (6,7).

Hodgkin Lymphoma Presenting With Spinal Cord Compression: Challenges for Diagnosis and Initial Management.

Hodgkin lymphoma (HL) can present with extra-nodal disease, but spinal cord compression is exceptionally rare. We describe a 15-year-old presenting with hip/back pain with normal initial examination. Persistent pain and raised inflammatory markers prompted further investigation with MRI, which revealed an epidural mass causing spinal cord compression. On examination, there was no palpable lymphadenopathy or cauda equina syndrome, but absent lower limb reflexes were noted. Following multidisciplinary discussion, it was determined that cauda equina syndrome was imminent and therefore surgical debulking was undertaken, both to prevent this complication and establish a diagnosis. At surgery, the tumor was highly vascular. Frozen section confirmed lesional material. Following surgery, and given the frozen section findings, a short course of steroids was commenced to reduce any peri-surgical edema. Unfortunately, histopathology was ultimately non-diagnostic, due to failure of immunohistochemistry on technically challenging material. Consequently, ultrasound-guided excision biopsy of a (non-palpable) cervical lymph node was performed five days later; histopathology showed typical effacement of the normal architecture and a conspicuous population of CD15/CD30-positive larger pale cells present, confirming nodular sclerosis classic HL, despite recent steroids. We review the available literature for HL presenting with spinal cord compression and describe the challenges for diagnosis and initial management in such cases.

Urban-rural Differences in Unintentional Injury Death Rates Among Children Aged 0-17 Years: United States, 2018-2019.

Unintentional injuries are the leading cause of death among children aged 0-17 years (1). In 2018-2019, 14% of children in the United States aged 0-17 years resided in rural areas but accounted 24% of all childhood injury deaths (1). Urban-rural differences in injury mortality have been associated with a variety of factors, including differences in types of activities, use of safety equipment, practice of safety-related behaviors, built environments, and access to care (2-9). This report presents rates of unintentional injury death among children aged 0-17 for 2018-2019, highlighting the differences in rates by mechanism of injury and urban-rural status.

A Revised ICD-10-CM Surveillance Case Definition for Injury-related Emergency Department Visits.

Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition.

Using Crash Outcome Data Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a motor vehicle crash in New York State.

BACKGROUND: In New York State (NYS), motor vehicle (MV) injury to child passengers is a leading cause of hospitalization and emergency department (ED) visits in children aged 0-12 years. NYS laws require appropriate child restraints for ages 0-7 years and safety belts for ages 8 and up while traveling in a private passenger vehicle, but do not specify a seating position. METHODS: Factors associated with injury in front-seated (n = 11,212) compared to rear-seated (n = 93,092) passengers aged 0-12 years were examined by age groups 0-3, 4-7 and 8-12 years using the 2012-2014 NYS Crash Outcome Data Evaluation System (CODES). CODES consists of Department of Motor Vehicle (DMV) crash reports linked to ED visits and hospitalizations. The front seat was row 1 and the rear rows 2-3. Vehicle towed from scene and air bag deployed were proxies for crash severity. Injury was dichotomized based on Maximum Abbreviated Injury Severity (MAIS) scores greater than zero. Multivariable logistic regression (odds ratios (OR) with 95% CI) was used to examine factors predictive of injury for the total population and for each age group. RESULTS: Front-seated children had more frequent injury than those rear-seated (8.46% vs. 4.92%, p < 0.0001). Children in child restraints experienced fewer medically-treated injuries compared to seat belted or unrestrained children (3.80, 6.50 and 13.62%, p < 0.0001 respectively). A higher proportion of children traveling with an unrestrained vs. restrained driver experienced injury (14.50% vs 5.26%, p < 0.0001). After controlling for crash severity, multivariable adjusted predictors of injury for children aged 0-12 years included riding in the front seat (1.20, 1.10-1.31), being unrestrained vs. child restraint (2.13, 1.73-2.62), being restrained in a seat belt vs. child restraint (1.20, 1.11-1.31), and traveling in a car vs. other vehicle type (1.21, 1.14-1.28). Similarly, protective factors included traveling with a restrained driver (0.61, 0.50-0.75), a driver aged < 25 years (0.91, 0.82-0.99), being an occupant of a later vehicle model year 2005-2008 (0.68, 0.53-0.89) or 2009-2015 (0.55, 0.42-0.71) compared to older model years (1970-1993). CONCLUSIONS: Compared to front-seated children, rear-seated children and children in age-appropriate restraints had lower adjusted odds of medically-treated injury.

A map of transcriptional heterogeneity and regulatory variation in human microglia.

Microglia, the tissue-resident macrophages of the central nervous system (CNS), play critical roles in immune defense, development and homeostasis. However, isolating microglia from humans in large numbers is challenging. Here, we profiled gene expression variation in primary human microglia isolated from 141 patients undergoing neurosurgery. Using single-cell and bulk RNA sequencing, we identify how age, sex and clinical pathology influence microglia gene expression and which genetic variants have microglia-specific functions using expression quantitative trait loci (eQTL) mapping. We follow up one of our findings using a human induced pluripotent stem cell-based macrophage model to fine-map a candidate causal variant for Alzheimer's disease at the BIN1 locus. Our study provides a population-scale transcriptional map of a critically important cell for human CNS development and disease.

Lower Breakpoint of Intracranial Amplitude-Pressure Relationship in Normal Pressure Hydrocephalus.

The relationship between intracranial pulse amplitude (AMP) and mean intracranial pressure (ICP) has been previously described. Generally, AMP increases proportionally to rises in ICP. However, at low ICP a lower breakpoint (LB) of amplitude-pressure relationship can be observed, below which pulse amplitude stays constant when ICP varies. Theoretically, below this breakpoint, the pressure-volume relationship is linear (good compensatory reserve, brain compliance stays constant); above the breakpoint, it is exponential (brain compliance decreases with rising ICP).Infusion tests performed in 169 patients diagnosed for idiopathic normal pressure hydrocephalus (iNPH) during the period 2004-2013 were available for analysis. A lower breakpoint was observed in 62 patients diagnosed for iNPH. Improvement after shunt surgery in patients in whom LB was recorded was 77% versus 90% in patients where LB was absent (p < 0.02). There was no correlation between improvement and slope of amplitude-pressure line above LB.The detection of a lower breakpoint is associated with less frequent improvement after shunting in NPH. It may be interpreted that cerebrospinal fluid dynamics of patients working on the flat part of the pressure-volume curve and having a 'luxurious' compensatory reserve, are more frequently caused by brain atrophy, which is obviously not responding to shunting.

Single Center Experience in Cerebrospinal Fluid Dynamics Testing.

Normal pressure hydrocephalus is more complex than a simple disturbance of the cerebrospinal fluid (CSF) circulation. Nevertheless, an assessment of CSF dynamics is key to making decisions about shunt insertion, shunt malfunction, and for further management if a patient fails to improve. We summarize our 25 years of single center experience in CSF dynamics assessment using pressure measurement and analysis. 4473 computerized infusion tests have been performed. We have shown that CSF infusion studies are safe, with incidence of infection at less than 1%. Raised resistance to CSF outflow positively correlates (p < 0.014) with improvement after shunting and is associated with disturbance of cerebral blood flow and its autoregulation (p < 0.02). CSF infusion studies are valuable in assessing possible shunt malfunction in vivo and for avoiding unnecessary revisions. Infusion tests are safe and provide useful information for clinical decision-making for the management of patients suffering from hydrocephalus.

Differences in Cerebrospinal Fluid Dynamics in Posttraumatic Hydrocephalus Versus Atrophy, Including Effect of Decompression and Cranioplasty.

INTRODUCTION: Challenges in diagnosing post-traumatic hydrocephalus (PTH) have created a need for an accurate diagnostic tool. We aim to report CSF dynamics in PTH and atrophy, along with differences before and after cranioplasty. METHODS: We retrospectively analyzed traumatic brain injury patients with ventriculomegaly who had infusion studies. We divided patients depending on CSF dynamics into two groups: 'likely PTH' (A) and 'likely atrophy' (B). A group of idiopathic normal pressure hydrocephalus shunt-responsive patients was used for comparison (C). RESULTS: Group A consisted of 36 patients who were non-decompressed or had a cranioplasty in situ for over 1 month. Group B included 16 patients with low Rout, AMP, and dAMP, 9 of whom were decompressed. Rout and dAMP were significantly higher in Group A than B, but significantly lower than Group C (45 iNPH patients). RAP change during infusion in group A indicated depleted compensatory reserve compared to ample reserve in group B. Repeat studies in five decompressed patients post-cranioplasty showed all parameters increased. CONCLUSIONS: Infusion tests are not useful in decompressed patients, whilst cranioplasty allowed differentiation between possible PTH and atrophy. Rout and AMP were significantly lower in PTH compared to iNPH and did not always reflect the degree of hydrocephalus reported on imaging.

Global Cerebral Autoregulation, Resistance to Cerebrospinal Fluid Outflow and Cerebrovascular Burden in Normal Pressure Hydrocephalus.

INTRODUCTION: We previously examined the relationship between global autoregulation pressure reactivity index (PRx), mean arterial blood pressure (ABP), Resistance to cerebral spinal fluid (CSF) outflow (Rout) and their possible effects on outcome after surgery on 83 shunted patients. In this study, we aimed to quantify the relationship between all parameters that influence Rout, their interaction with the cerebral vasculature, and their role in shunt prognostication. METHODS: From 423 patients having undergone infusion tests for possible NPH, we selected those with monitored ABP and calculated its mean and PRx. After shunting, 6 months patients' outcome was marked using a simple scale (improvement, temporary improvement, and no improvement). We explored the relationship between age, different CSF dynamics variables, and vascular parameters using multivariable models. RESULTS: Rout had a weaker predictive value than ABP (Fisher Discrimination Ratio of 0.02 versus 0.42). ABP > 98 was an independent predictor of shunt outcome with odd ratio 6.4, 95% CI: 1.8-23.4 and p-value = 0.004. There was a strong and significant relationship between the interaction of age, PRx, ABP, and Rout (R = 0.53 with p = 7.28 × 10-0.5). Using our linear model, we achieved an AUC 86.4% (95% CI: 80.5-92.3%) in detecting shunt respondents. The overall sensitivity was 94%, specificity 75%, positive predictive value (PPV) of 54%, and negative predictive value of 97%. CONCLUSION: In patients with low Rout and high cerebrovascular burden, as described by high ABP and disturbed global autoregulation, response to shunting is less likely. The low PPV of high resistance, preserved autoregulation and absence of hypertension could merit further exploration.

Comparison of Assessment for Shunting with Infusion Studies Versus Extended Lumbar Drainage in Suspected Normal Pressure Hydrocephalus.

INTRODUCTION: Tools available for diagnosis of normal pressure hydrocephalus (NPH) and prediction of shunt-response are overnight ICP monitoring, infusion studies, and extended lumbar drainage (ELD). We investigated the shunt-response predictive value by infusion tests versus ELD. MATERIAL AND METHODS: We retrospectively recruited 83 patients who had undergone both infusion study and ELD assessments and compared infusion study hydrodynamics with improvement at clinic follow-up after ELD and after shunting. RESULTS: 62 patients had Rout >11 mmHg/mL/min. 28 Showed physiotherapy-documented improvement following ELD, and were selected for shunting, of which 21 were shunted. Of these, 19 showed improvement. Eight patients with Rout >20 mmHg/mL/min showed no response to ELD and were not shunted.There were 21 patients with Rout <11 mmHg/mL/min: five were shunted, showed improvement at follow-up, and had Rout >6 mmHg/mL/min. ICP amplitude did not differ at baseline or plateau between responders and non-responders. CONCLUSIONS: ELD response and CSF dynamics differed remarkably. All patients with Rout <6 mmHg/mL/min showed no improvement with ELD, indicating that ELD and shunting might be contraindicated in these subjects. High Rout patients with no response to ELD could merit further consideration.