Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic.

PURPOSE: This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. METHODS: We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. RESULTS: The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (ß = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (ß = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. CONCLUSIONS: We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.

Disparities in fatal and non-fatal opioid-involved overdoses among middle-aged non-Hispanic Black Men and Women.

The gap in fatal opioid overdose rates has been closing between non-Hispanic Black and non-Hispanic White individuals. The rising opioid-involved mortality rates among non-Hispanic Black adults has been identified by SAMHSA as a critical public health issue. However, further research is needed that utilizes comprehensive surveillance data on both fatal and non-fatal opioid-involved overdoses to better assess the changing trends and evaluate factors contributing to changing disparities. We conducted an analysis of medical examiner and hospital data for years 2016-2021 from the largest county in Illinois (Cook) to (1) evaluate disparities in non-fatal and fatal opioid-involved overdoses between middle-aged non-Hispanic Black adults and Black adults of other age groups stratified by sex, (2) to assess if disparities exist across middle-aged adults of different race-ethnicities specifically non-Hispanic White and Hispanic-Latino adults, and (3) evaluate factors contributing to the disparities. Fatal opioid overdose rates among middle-aged Black men 45-64 years old were on average 5.3 times higher than Black men of other age groups, and 6.2 times higher than middle-aged non-Black men. Similarly, fatal opioid overdose rates among middle-aged Black women were on average 5.0 times higher than Black women of other age groups, and 4.9 times higher than middle-aged non-Black women. Hospital utilization rates for opioid-involved overdoses showed similar disparities between age groups and race-ethnicities. Findings indicate that stark disparities in rates of opioid-involved overdoses among middle-aged Black men and women are likely attributed to exposure to more lethal opioids, drug variability in local markets, differences in concurrent drug exposures, and lower access to harm reduction, emergent and preventative health services.

Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy.

BACKGROUND: Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine potential undercount of opioid-involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount. METHODS: A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid-involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose. RESULTS: Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR = 3.7: 2.1, 6.5), hospitalized for 4+ days (aOR = 2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR = 4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR = 0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR = 0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6% to 15%. CONCLUSIONS: Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20%-40% undercount reported elsewhere. See video abstract at, http://links.lww.com/EDE/B990 .

Performance of Prostate Health Index in Biopsy Naïve Black Men.

PURPOSE: The Prostate Health Index is validated for prostate cancer detection but has not been well validated for Gleason grade group 2-5 prostate cancer detection in Black men. We hypothesize that the Prostate Health Index has greater accuracy than prostate specific antigen for detection of Gleason grade group 2-5 prostate cancer. We estimated probability of overall and Gleason grade group 2-5 prostate cancer across previously established Prostate Health Index ranges and identified Prostate Health Index cutoffs that maximize specificity for Gleason grade group 2-5 prostate cancer with sensitivity >90%. MATERIALS AND METHODS: We recruited a "cancer-free" Black control cohort (135 patients) and a cohort of biopsy naïve Black men (158) biopsied for elevated prostate specific antigen. Descriptive statistics compared the prostate cancer cases and controls and the frequency of Gleason grade group 2-5 prostate cancer across Prostate Health Index scores. Receiver operating characteristics compared the discrimination of prostate specific antigen, Prostate Health Index and other prostate specific antigen related biomarkers. Sensitivity and specificity for Gleason grade group 2-5 prostate cancer detection were assessed at prostate specific antigen and Prostate Health Index thresholds alone and in series. RESULTS: Of biopsied subjects 32.9% had Gleason grade group 2-5 prostate cancer. In Blacks with prostate specific antigen from 4.0-10.0 ng/ml, Prostate Health Index and prostate specific antigen had similar discrimination for Gleason grade group 2-5 prostate cancer (0.63 vs 0.57, p=0.27). In Blacks with prostate specific antigen ≤10.0, a threshold of prostate specific antigen ≥4.0 had 90.4% sensitivity for Gleason grade group 2-5 prostate cancer; a threshold of prostate specific antigen ≥4.0 with Prostate Health Index ≥35.0 in series avoided unnecessary biopsy in 33.0% of men but missed 17.3% of Gleason grade group 2-5 prostate cancer. Prostate specific antigen ≥4.0 with Prostate Health Index ≥28.0 in series spared biopsy in 17.9%, while maintaining 90.4% sensitivity of Gleason grade group 2-5 prostate cancer. CONCLUSIONS: The Prostate Health Index has moderate accuracy in detecting Gleason grade group 2-5 prostate cancer in Blacks, but Prostate Health Index ≥28.0 can be safely used to avoid some unnecessary biopsies in Blacks.

Engaging African American Men as Citizen Scientists to Validate a Prostate Cancer Biomarker: Work-in-Progress.

BACKGROUND: African American men (AAM) are under-represented in prostate cancer (PCa) research despite known disparities. Screening with prostate-specific antigen (PSA) has low specificity for high-grade PCa leading to PCa over diagnosis. The Prostate Health Index (PHI) has higher specificity for lethal PCa but needs validation in AAM. Engaging AAM as citizen scientists (CSs) may improve participation of AAM in PCa research.Results and Lessons Learned: Eight CSs completed all training modules and 139 AAM were recruited. Challenges included equity in research leadership among multiple principal investigators (PIs) and coordinating CSs trainings. CONCLUSIONS: Engaging AAM CSs can support engaging/recruiting AAM in PCa biomarker validation research. Equity among multiple stakeholders can be challenging, but proves beneficial in engaging AAM in research. OBJECTIVES: Assess feasibility of mobilizing CSs to recruit AAM as controls for PHI PCa validation biomarker study. METHODS: We highlight social networks/assets of stakeholders, CSs curriculum development/implementation, and recruitment of healthy controls for PHI validation.

Heat-related deaths among construction workers in the United States.

BACKGROUND: Heat is a severe hazard for construction workers and may be worsening with global warming. This study sought to explore heat-related deaths among U.S. construction workers and a possible association with climate change. METHODS: Heat-related deaths in the Census of Fatal Occupational Injuries from 1992 to 2016 were analyzed. Denominators estimated from the Current Population Survey were matched with demographic and occupational categories in rate calculations. Statistical tests were used to examine heat-related deaths in relation to time, geographic region, and temperature. RESULTS: Construction workers, comprising 6% of the total workforce, accounted for 36% (n = 285) of all occupational heat-related deaths from 1992 to 2016 in the U.S. Mean temperatures from June to August increased gradually over the study period. Increasing summer temperatures from 1997 to 2016 were associated with higher heat-related death rates (r = 0.649; 95% confidence interval: 0.290, 0.848). Compared to all construction workers (risk index = 1), statistically significant elevated risk of heat-related death was found among Hispanics (1.21), in particular workers born in Mexico (1.91). Occupations with a high risk index included cement masons (10.80), roofers (6.93), helpers (6.87), brick masons (3.33), construction laborers (1.93) and heating, air conditioning, and refrigeration mechanics (1.60). CONCLUSIONS: U.S. construction workers are at a high risk of heat-related death, and this risk has increased with climate change over time. Effective workplace interventions, enhanced surveillance, and improved regulations and enforcement should accompany broader efforts to combat global warming. The construction industry can help reduce global warming through increased implementation of green building principles.

A 5-Year Retrospective Analysis of Legal Intervention Injuries and Mortality in Illinois.

There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement-related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.

Risk factors associated with legal interventions.

BACKGROUND: Current research regarding injuries caused during interactions between police officers and civilians is conducted intermittently or on a very narrow sample frame which provides very little clinical information about the injuries suffered or the adverse outcomes. The aim of this study is to identify comorbid risk factors and describe acute outcomes of medically treated traumatic injuries occurring as a result of contact with law enforcement personnel. METHODS: For this retrospective study, patients injured as a result of contact with law enforcement personnel were identified using ICD-9 external cause of injury codes from medical record databases of patients treated in all hospitals and trauma units in Illinois between 2000 and 2009. RESULTS: A total of 836 cases injured as a result of contact with law enforcement personnel were identified. These patients were more likely to suffer from substance abuse, depression, schizophrenia, and paralytic disorders compared to the reference cases. Persons injured as a result of contact with law enforcement personnel were predominately injured from being man-handled, unarmed blows, firearms or being struck by a blunt object. Although the injury severity did not differ from the comparison group, these patients had longer lengths of hospitalization, a greater proportion of injuries to the back and spine, and a greater proportion required extended care in an intermediate care facility (not a jail) following discharge. CONCLUSIONS: Although medical record data do not explain the detailed circumstances of the face-to-face encounters between law enforcement personnel and civilians, the data provide valuable information regarding who may be at risk of injury and the clinical features of injuries that are suffered following a legal intervention. Similar data systems should be considered to augment existing data systems.

Occupational Injury Surveillance Among Law Enforcement Officers Using Workers' Compensation Data, Illinois 1980 to 2008.

OBJECTIVE: Injuries among law enforcement officers are common, but poorly understood; workers' compensation (WC) data are an underutilized tool for occupational surveillance. METHODS: A stratified analysis of WC claims among four categories of law enforcement officers used descriptive techniques, linear and robust regression. RESULTS: Eighteen thousand eight hundred ninety-two officers filed claims from 1980 to 2008. Correctional officers had the highest rates, with leading causes of falls and assaults; motor vehicle crashes were the most common cause of injury among state police. Total monetary compensation was lower for correctional officers, but was explained by lower time lost and lower average weekly wage. CONCLUSION: The rate and types of injuries varied by subgroups, with correctional officers having the majority of injuries, but lower severity. WC data elucidate causes and outcomes of occupational injuries, which can guide prevention.

More than training: Community-based participatory research to reduce injuries among hispanic construction workers.

BACKGROUND: Workplace mortality and severe injury are disproportionately distributed among foreign born and Hispanic construction workers. Worker Centers (WCs) provide services and advocacy for low-wage workers and a way for investigators to reach them. The goal of this project is to prevent occupational injuries by increasing awareness of hazards and self-efficacy among foreign born, Hispanic construction workers and by expanding the agenda of WCs to include occupational health and safety (H&S). METHODS: Investigators partnered with eight WCs in seven cities to train worker leaders to deliver a modified OSHA 10-hr curriculum to their peers. RESULTS: Thirty-two worker leaders trained 446 workers over 3 years. There was a demonstrated improvement in knowledge, hazard identification, self-efficacy, and sustainable H&S activities. CONCLUSIONS: This study provides evidence for successful implementation of a training intervention for low wage, low literacy Hispanic construction workers using a community-based participatory research approach.