Community-Academic Partnership to Assess the Role of Physical Disinvestment on Firearm Violence in Toledo, OH.

Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case-control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95% CI: 1.36, 2.07) higher odds of shooting incidence. Across all other measures, greater disinvestment was associated with higher odds of shooting incidence. Our finding of a strong association between physical disinvestment and firearm violence in Toledo can inform local action. Community-academic partnership could help increase adoption of violence prevention strategies focused on reversing physical disinvestment.

A cross-sectional study of opioid involvement in non-poisoning suicide - risks and prevention opportunities.

OBJECTIVE: To examine prevalence, demographic, and incident factors associated with opioid-positivity in Illinois suicide decedents who died by causes other than poisoning. METHOD: Cross-sectional study of Illinois' suicide decedents occurring between January 2015 and December 2017. Data come from the National Violent Death Reporting System. We used Chi-square tests to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Incident narratives were analyzed to obtain physical and mental health histories and circumstances related to fatal injury events. RESULTS: Of 1007 non-poisoning suicide decedents screened for opioids, 16.4% were opioid-positive. White race, age 75 and over, and widowed or unknown marital status were associated with opioid-positivity. Among opioid-positive decedents, 25% had a history of substance use disorder (SUD), 61% depression, and 19% anxiety. The majority (52%) of opioid-positive decedents died by firearm, a higher percentage than opioid-negative decedents. CONCLUSION: The opioid overdose crisis largely has not overlapped with non-poisoning suicide in this study. Overall, our analyses have not identified additional risk factors for suicide among opioid-positive suicide decedents. However, the overlap between opioid-positivity, SUD, and physical and mental health problems found among decedents in our data suggest several suicide prevention opportunities. These include medication assisted treatment for SUD which has been shown to reduce suicide, screening for opioid/benzodiazepine overlap, and limiting access to lethal means during opioid use. Improved death scene investigations for substances and use of the Prescription Drug Monitoring Program to document prescriptions are needed to further understanding of the role of substances in non-poisoning suicide.

Spatial co-occurrence of firearm homicides and opioid overdose deaths in Chicago by level of COVID-19 mortality, 2017-2021.

BACKGROUND: Firearm homicide and opioid overdoses were already leading causes of death in the U.S. before both problems surged during the COVID-19 pandemic. Firearm violence, overdoses, and COVID-19 have all disproportionately harmed communities that are socially and economically marginalized, but the co-occurrence of these problems in the same communities has received little attention. To describe the co-occurrence of firearm homicides and opioid overdose deaths with COVID-19 mortality we used 2017-2021 medical examiner's data from Chicago, IL. Deaths were assigned to zip codes based on decedents' residence. We stratified zip codes into quartiles by COVID-19 mortality rate, then compared firearm homicide and fatal opioid overdose rates by COVID-19 quartile. FINDINGS: Throughout the study period, firearm homicide and opioid overdose rates were highest in the highest COVID-19 mortality quartile and lowest in the lowest COVID-19 mortality quartile. Increases in firearm homicide and opioid overdose were observed across all COVID-19 mortality quartiles. CONCLUSIONS: High co-occurrence of these deaths at the community level call for addressing the systemic forces which made them most vulnerable before the pandemic. Such strategies should consider the environments where people reside, not only where fatal injuries occur.

Validity of individual self-report oral health measures in assessing periodontitis for causal research applications.

BACKGROUND: Self-reported measures of periodontitis developed for use in population surveillance are increasingly used in causal research. Numerous studies evaluate the validity of these measures against clinical parameters of periodontitis, yet few include validation parameters outside of multivariable models. Individual item validity is necessary to adequately inform use of these measures in causal research. METHODS: We used data from the National Health and Nutrition Examination Survey 2011-2014 in which dentate participants completed full-mouth periodontal examinations (N = 6966). We evaluated six self-report questionnaire items related to periodontal disease status against periodontitis case definitions developed by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP). We estimated the sensitivity and specificity of individual items using severe and moderate-to-severe periodontitis classifications. We additionally combined items to evaluate the validity of joint measures. RESULTS: Sensitivity was highest when measures were evaluated against severe periodontitis. Self-rated oral health of fair/poor demonstrated the highest sensitivity for severe (0.60) and moderate-to-severe periodontitis (0.48). Specificity was highest when evaluated against moderate-to-severe periodontitis, with self-reported history of tooth mobility as the most specific measure (0.87 for severe disease; 0.92 for moderate-to-severe) followed by a history of bone loss (0.88 for severe; 0.91 for moderate-to-severe). Combining questions generally improved specificity at the expense of sensitivity. CONCLUSIONS: Our findings related to item-specific validity and the associated clinical profiles facilitate needed considerations for the use of self-reported measures of periodontitis in causal research. Additionally, item-specific validity can be used to inform assessments of misclassification bias within such investigations.

Association between youth homicides and state spending: a Chicago cross-sectional case study.

OBJECTIVE: To identify contributing factors associated with rapid spikes and declines in Chicago youth homicide from 2009 to 2018. SETTING: City of Chicago, Illinois, US 2009-2018. PARTICIPANTS: Homicide count data come from the National Violent Death Reporting System. The study included information on 2271 homicide decedents between the ages of 15 and 24 who died between 1 January 2009 and 31 December 2018. Of these decedents, 92.9% were male; 79.1% were non-Hispanic black; and 94.9% died from a firearm injury. PRIMARY AND SECONDARY OUTCOME MEASURES: (A) Temporal shifts in monthly homicide rates and (B) temporal associations between social, environmental and economic conditions/events and fluctuations in homicides. RESULTS: We found statistically significant shifts in homicide rates over time: a 77% rise in monthly youth homicide rates per 100 000 persons from 2015 to 2016 (4.3 vs 7.5); dropping back to pre-2015 rates (4.3) by mid-2017. There was a temporal co-occurrence between the rapid rise in youth homicides and absence of a state budget. Conversely, we found a temporal co-occurrence of the sharp decline in homicides with the reinstatement of a state budget. Adjusting for seasonality, we found death rates were greater in the months without a budget compared with months with a budget (1.48, 95% CI 1.29 to 1.70). CONCLUSIONS: Our findings suggest that state funding may be a potential protective factor against youth homicide.

Educational Attainment of Male Homicide Victims Aged 18 to 24 Years in Chicago: 2006 to 2015.

Homicide is a preventable public health issue that has detrimental effects on both victims and witnesses and increases health care costs. From 2006 to 2015, homicide has been the second leading cause of death for youth aged 15 to 24 years in the United States. Educational attainment has been widely regarded as a protective factor against justice system involvement and violent injury. We conducted a time-trend analysis examining educational attainment levels for male victims of homicide aged 18 to 24 years in the City of Chicago, 2006 to 2015, to describe the educational attainment of youth homicide victims in Chicago. We used data from the Illinois Violent Death Reporting System and the United States Census Bureau from 2006 to 2015. Cases included male victims of homicide, 18 to 24 years of age, the injury leading to death occurred in the City of Chicago, injury leading to death occurred between 2006 and 2015, and whether or not a high school degree or equivalent had been obtained. Data were described over time using percentages and rates per 100,000 with 95% confidence intervals. Chicago male homicide victims aged 18 to 24 years were less likely to have at least a high school degree than the general population of males aged 18 to 24 years in Chicago. The homicide rate for males aged 18 to 24 years without a high school degree was significantly higher than those with a high school degree or equivalent for every time point, except 2007, and also in four of the seven Chicago Planning Regions when compared with the other three. We found there is a concentrated risk pool for undereducated male youth in Chicago.

Adolescent Firearm Homicides in Chicago, 2013-2017.

PURPOSE: This study aims to describe how firearm homicides among adolescents change over a five-year period. METHODS: This serial cross-sectional analysis uses surveillance data collected by the Illinois Violent Death Reporting System. Decedent selection criteria included the following: manner of death was homicide, weapon type was firearm, age was 15-19 years, and location of fatal injury was Chicago. Data collected between 2013 and 2017 were used. Multiyear rates per 100,000 and rate ratios were calculated by sex and race/ethnicity. Joinpoint regression analysis and chi-squared tests of linear-by-linear association were used to identify trends over time (by year, month, and weekday). Geographic Information System mapping was used to visualize data. RESULTS: There were 509 victims of firearm homicide aged 15-19 years in Chicago between 2013 and 2017. Overall rates were significantly higher in 2016 than in all other years. Victims were disproportionately black males, comprising 75.6% of total adolescent homicides and increasing by 87.8% across the five years. The rate ratio for black males versus all other adolescents peaked in 2015 at 19.4 (95% confidence interval, 10.9-34.6). For black males, the percentage of fatal injuries occurring on Saturdays and Sundays decreased significantly (p = .048). Among all victims, firearm deaths became less dispersed throughout Chicago, and "hot spots" shifted from the South Side to the West Side. CONCLUSIONS: Adolescent firearm homicides are increasing over time, however, in Chicago, a more accurate narrative would portray their consolidation with regard to spatial and racial/ethnic variances across the city. Such analyses define Chicago's firearm homicide epidemic and can shape targeted and effective interventions.

Modifiable sleep-related risk factors in infant deaths in Cook County, Illinois.

BACKGROUND: Each year, approximately 3500 infants in the United States die from sleep-related deaths. The number of sleep-related infant deaths has decreased overall since the 1990s, but disparities in sleep-related deaths persist among different populations. The purpose of this study was to determine the most common risk factors and locations in Cook County, Illinois for sleep-related deaths in infants under 6 months of age. METHODS: We conducted a retrospective study among infants less than 6 months of age who died in Cook County, Illinois in 2015 and 2016, in which the manner of death was of undetermined intent with at least one modifiable sleeping risk factor present, as reported by the medical examiner. Data were obtained from the Illinois Violent Death Reporting System (IVDRS), a state-based, anonymous, surveillance system. County trends and circumstances of the deaths were also evaluated. Frequencies, percentages, and Chi-square analysis were used to describe and characterize these deaths. RESULTS: In Cook County in 2015 and 2016, 116 infants less than 6 months of age died where the manner of death was classified as undetermined intent. The median age of death was 2 months. Of these deaths, 63 (54.3%) of the infants were boys. African-American and Hispanic infants comprised 71 (65.7%) and 23 (21.3%) of the deaths, respectively. In 84 (72.4%) of the cases, at least one known sleeping risk factor was present and 56 (66.7%) of the infants who died with a known sleeping risk factor were co-sleeping. Notably, 33 (29.7%) of the deaths in Cook County were clustered within six zip codes. CONCLUSIONS: The majority of infants who died unexpectedly in Cook County in 2015 and 2016 did so in the presence of sleeping risk factors, with co-sleeping being the most common. African-American infants, infants under 2 months of age, and several geographical areas within Chicago appear to be at increased risk. Interventions to target these preventable causes in the populations at increased risk should be instituted to prevent future deaths.

Cross sectional analysis of Chicago vs suburban Cook County suicide deaths among 10-24-year-olds in the Illinois violent death reporting system.

BACKGROUND: In 2014, suicide was the second leading cause of death among 10- to 24-year-olds in the US. Studies note disparities in youth suicide based on sex, race/ethnicity, and urban vs rural settings. This study investigates demographics, mental health indicators, and other circumstances surrounding youth/young adult deaths by suicide, comparing Chicago and suburban Cook County from 2005 to 2010. METHODS: Using the Illinois Violent Death Reporting System (IVDRS), we employed a cross-sectional design to provide descriptive analysis of decedents in three age groups (10-14, 15-19, and 20-24 years) in two geographic areas: urban (city of Chicago) and suburban (suburban Cook County) between January 1, 2005 and December 31, 2010. We used chi-square testing to test for significant differences in each age group by demographics, mental health indicators, and suicide markers in each area. RESULTS: Between 2005 and 2010, the IVDRS reported 299 deaths by suicide among 10-24-year-olds, 52% in Chicago, and 48% in suburban Cook County. Of these deaths, 5.7%, 33.4% and 60.9% were ages 10-14, 15-19, and 20-24 years, respectively. Non-Hispanic (NH) whites comprised 50.7% of the totals, NH Blacks 26.5%, Hispanics 16.8%, and Asians 5.7%. In Chicago, males were 84% of suicides and 62.7% in suburban Cook County among 15-19-year-olds (p < 0.05). White race was significantly different in 10-14-year-olds: 0% in Chicago, 54% in suburban Cook County (p < 0.05). Racial and ethnic differences in suicides among 15-19-year-olds in Chicago vs suburban Cook County were: NH White 22.4% vs 74.5% (p < 0.001), NH Black 46.9% vs 13.7% (p < 0.05), Hispanic 24.5% vs 7.8% (p < 0.05). There were also differences for 20-24-year-olds with NH White 43% vs 65.4% and NH Black 32% vs 13.6% (p < 0.05 for both). For mechanism of death, in 15-19-year-olds, there were differences between city and suburban in firearm deaths (42.9% vs 20%, p < 0.05) and in poisoning (0 vs 14%, p < 0.05). CONCLUSIONS: Our analyses detected significant location-related differences in the characteristics of decedents within the Chicago region indicating that local data are needed to inform suicide prevention efforts so that those at most risk can be prioritized for services. IVDRS is a potent tool in identifying these variations.

Child deaths of undetermined intent: An analysis of circumstances using Illinois Violent Death Reporting System data.

BACKGROUND: There is little information available about the circumstances surrounding the deaths of children aged 0 to 14 years in which the manner of death is of undetermined intent. METHODS: We analyzed data collected in the Illinois Violent Death Reporting System to describe victim demographics, location of injury, seasonality, day of week, and circumstances surrounding the victims' deaths. RESULTS: From 2005 to 2010 in Cook County, Illinois, 192 cases were identified of children aged 0 to 14 years, in which the manner of death was of undetermined intent. The majority of cases were younger than 1 year (81%), male (62%), and non-Hispanic black (66%); occurred in the City of Chicago (65%); and also occurred most frequently during the months of May (15%) and July (13%) and on Sunday (19%). Circumstances of note were having information on the location of death available for the victim (90%); scene investigation was not performed/unknown/not documented (81%); and the victim not presenting with red petechiae (84%). By ethnicity, a lower proportion of Hispanic victims had parental drug information available compared with non-Hispanic victims (17% and 40%, respectively; p = 0.017); Hispanic victims were more likely than non-Hispanic victims to have a documented acute illness at the time of injury leading to death (57% and 33%, respectively; p = 0.015). The availability of scene information and the successful contact of one or both parents of the victim following the victim's death varied by location. CONCLUSIONS: No public health surveillance system exists for the collection of this type of death. There is not enough information provided to develop an effective intervention. The systematic, thorough collection of information surrounding these deaths is necessary to pinpoint possible contributing mechanisms of death for these children. LEVEL OF EVIDENCE: Epidemiologic, level IV.

Factors associated with intimate partner homicide in Illinois, 2005-2010: Findings from the Illinois Violent Death Reporting System.

BACKGROUND: Critical elements in intimate partner homicides (IPH) often go undocumented. Previous studies have highlighted precipitating causes, but few have examined the place of injury that led to the victim's death. We sought to describe IPH cases in Illinois and in particular to examine factors surrounding the location of injury that led to the victim's death. METHODS: We analyzed data collected in the Illinois Violent Death Reporting System to assess victim demographics, perpetrator characteristics, the victim/perpetrator relationship, and circumstances surrounding the location of injury that led to the victim's death. RESULTS: From 2005 to 2010, 275 cases were identified as IPH. Women comprised 60.4% of victims and men 39.6%. Among perpetrators, 78.5% were identified as male and 21.5% as female. Of the 31 corollary victims, 54.8% were less than 18 years and 58.1% were injured in front of a family member. Females were 1.6 times more likely to have the injury that led to their death occur at their residence, as compared to males (OR 1.6, 95% CI 1.1-2.9). Cases in which the perpetrator had documented history of abuse were 2.4 times more likely to have the fatal injury occur at the victim's residence compared to those that did not have previous history (OR 2.4, 95% CI 1.2-4.8). IPH cases in which the perpetrator was the current partner of the victim were twice as likely to have the injury leading to the victim's death occur at the victim's residence compared to those perpetrators who were not a current partner (OR 2.1, 95% CI 1.2-3.5). CONCLUSIONS: Considering the increased risk of IPH occurring at the place of residence for women at the hands of current intimate partners and by perpetrators with a previous history of abuse, prevention efforts may wish to prioritize in-home and relocation intervention strategies. LEVEL OF EVIDENCE: Epidemiologic, level IV.

Enlarged subarachnoid spaces and intracranial hemorrhage in children with accidental head trauma.

OBJECTIVE Benign external hydrocephalus (BEH) is an enlargement of the subarachnoid spaces (SASs) that can be seen in young children. It is controversial whether children with BEH are predisposed to developing subdural hemorrhage (SDH) with or without trauma. This issue is clinically relevant as a finding of unexplained SDH raises concerns about child abuse and often prompts child protection and law enforcement investigations. METHODS This retrospective study included children (1-24 months of age) who underwent head CT scanning after an accidental fall of less than 6 feet. Head CT scans were reviewed, cranial findings were documented, and the SAS was measured and qualitatively evaluated. Enlarged SAS was defined as an extraaxial space (EAS) greater than 4 mm on CT scans. Clinical measurements of head circumference (HC) were noted, and the head circumference percentile was calculated. The relationship between enlarged SAS and HC percentile, and enlarged SAS and intracranial hemorrhage (ICH), were investigated using bivariate analysis. RESULTS Of the 110 children included in this sample, 23 had EASs greater than 4 mm. The mean patient age was 6.8 months (median 6.0 months). Thirty-four patients (30.9%) had ICHs, including subarachnoid/subpial (6.2%), subdural (6.2%), epidural (5.0%), and unspecified extraaxial hemorrhage (16.5%). Enlarged SAS was positively associated with subarachnoid/subpial hemorrhage; there was no association between enlarged SASs and either SDH or epidural hemorrhage. A larger SAS was positively associated with larger HC percentile; however, HC percentile was not independently associated with ICH. CONCLUSIONS Enlarged SAS was not associated with SDH, but was associated with other ICHs. The authors' findings do not support the theory that BEH predisposes children to SDH with minor accidental trauma.

Factors associated with suicide among adolescents and young adults not in mental health treatment at time of death.

BACKGROUND: Suicide is the third-leading cause of death among Illinois residents aged 15 to 24 years. The Illinois Violent Death Reporting System (IVDRS) was developed to help prevent these deaths by providing timely, complete data. Understanding the circumstances surrounding suicide for those aged 15 to 24 years who are not receiving mental health treatment can help others: (1) recognize signs of potential crisis and (2) connect them to mental health treatment. METHODS: The IVDRS data were collected from five Illinois counties-Cook, DuPage, Kane, McHenry, and Peoria-from 2005 to 2010. All cases with the manner suicide, aged 15 to 24 years, were extracted for analysis. Data were described using frequencies and percentages, and statistical differences between groups were determined using χ analysis. RESULTS: There were a total of 386 suicides in those aged 15 to 24 years in IVDRS from 2005 to 2010. Most 15- to 19-year-olds (67%) and 20- to 24-year-olds (78%) were not receiving mental health treatment at the time of death. Among those not receiving mental health treatment, 22% and 13% of those aged 15 to 19 and 20 to 24 years, respectively, had disclosed their intent to commit suicide to another. One third were identified as being depressed or in a depressed mood (not necessarily a clinical diagnosis) in both age groups. One quarter in both age groups experienced a crisis (current, acute precipitating, or forthcoming event) within 2 weeks of their suicides. CONCLUSIONS: The majority of adolescents and young adults were not in mental health treatment at the time death. Among those not in mental health treatment at the time of death, the 15- to 19-year-olds were more likely to share their suicidal intentions than the 20- to 24-year-olds. LEVEL OF EVIDENCE: Epidemiological study, level IV.

Rates of firearm homicide by Chicago region, age, sex, and race/ethnicity, 2005-2010.

BACKGROUND: The United States reports the highest levels of firearm homicide incidences compared to other high income countries, and the focus and causes of these incidences within the US differ by demographic characteristics and location such as urban versus rural environment. Despite these findings, few studies have published on rates varied by region within a city. OBJECTIVE: This study aims to provide descriptive analysis of the rates of firearm homicide by age, sex, and race/ethnicity in each of the seven City of Chicago regions, and to determine if the rates of firearm homicide differ by demographics among the seven City of Chicago regions. METHODS: The Illinois Violent Death Reporting System conducts routine surveillance of violent deaths. Decedents were selected according to the following criteria: manner of death was homicide, weapon type was firearm, and location of injury that led to death was the City of Chicago. Location of injury was broken down by regions: North, Northwest, Center, West, South, Southwest, and Far South. Multiyear rates per 100,000 and corresponding 95% confidence intervals were calculated. RESULTS: There were 2,254 victims of homicide by firearm in the City of Chicago. The overall rate across Chicago for all demographics was 12.9 (12.1-13.5 per 100,000) with an average age of 27.4. The highest age group (20-24) for firearm homicide rates was 43.2 (39.7-46.7) per 100,000. For the youngest age group (10-14), only the Southwest (3.3-10.4) region reported any firearm incidence. The 20 to 24 age group reported the highest rates of all age groups within the South (107.9-151.7), West (80.3-108.2), and Far South (69.6-105.3) regions, whereas the North and Northwest reported the lowest rates for all regions by age. Black firearm homicide rates were 33.5 (31.9-35.1) per 100,000 versus Hispanic and non-Hispanic white firearm homicide rates of 8.5 (7.7-9.3) and 1.2 (1-1.5) per 100,000, respectively. Lastly, the West reported the highest firearm rates at 29.1 (657). CONCLUSION: In conclusion, Chicago is a large city that has high variation in firearm homicide rates among its constituent regions; therefore, an overall firearm homicide rate for the city of Chicago as a whole is not an accurate representation of the true nature of firearm homicides. Policy implementation may be made more effective by providing more regional analysis and targeted interventions via multipronged initiatives to help reduce future firearm rates, and funding for issues that address systemic poverty and adequate access to care and medical facilities. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

Suicide in Illinois, 2005-2010: A reflection of patterns and risks by age groups and opportunities for targeted prevention.

BACKGROUND: Suicide accounts for two thirds of all deaths from intentional or violence-related injury and is a leading cause of death in the United States. Patterns of suicide have been well described among high-risk groups, but few studies have compared the circumstances related to suicides across all age groups. We sought to understand the epidemiology of suicide cases in Illinois and to characterize the risks and patterns for suicide among different age groups. METHODS: We used suicide data collected from the Illinois Violent Death Reporting System to assess demographics, method of suicide, circumstances, and mental health status among different age groups. RESULTS: Between 2005 and 2010, 3,016 suicides were reported; 692 (23%) were female, and the median age (n = 3,013) was 45 years (range, 10-98 years). The most common method/weapon types were hanging/strangulation (33%), firearm (32%) and poisoning (21%). Hanging was more common (74%) among young people aged 10 to 19 years, while firearm use was more common among elderly persons age 65 years and older (55%). The percentage of victims within an age group experiencing a crisis within two weeks before committing suicide was highest among 10- to 14-year-olds, while the risk factor of having a family member or friend die in the past 5 years was highest among older victims. CONCLUSION: The final analysis demonstrated age-related trends in suicide in Illinois, suggesting prevention programs should tailor services by age. LEVEL OF EVIDENCE: Epidemiologic study, level IV.