Chronic Disease or Injury

Philadelphia is in the midst of a drug epidemic that killed 702 Philadelphians in 2015, 907 in 2016, and is on trajectory to kill 1,200 in 2017. Opioids are involved in the majority of fatal overdoses, contributing to 80% of overdose deaths in 2016. In 2016, the age-adjusted death rate for opioid-involved overdoses was 40.4 deaths per 100,000 residents, up from 17.9 deaths per 100,000 residents in 2010. Despite the epidemiologic work accomplished to date, gaps in knowledge still exist, especially for vulnerable populations such as those with serious mental illness or those who were ever incarcerated, homeless, or within the juvenile justice system. Matching individuals who died of an overdose across city systems could provide insight into missed opportunities for interventions. Findings will help inform policy for those systems that serve clients at highest risk for overdose.

Objective:

To match fatal overdose information across city data sources to understand which systems overdose decedents may have interacted with prior to their death

Hospitalization rates for mental health disorders provide important information to help us prioritize community needs for mental health and urgent care plantation. In Saint Louis County, there were over 13,000 hospitalizations for mental disorders between 2010 and 2014. For all age groups, depressive disorders, including major depression and mood disorder not-otherwise-specified, were the most common primary diagnostic grouping for hospitalizations among mental disorders, followed by bipolar disorder. In 2012, The Saint Louis County Department of Planning defined 5 geographic areas (Inner North, Outer North, South, West and Central) within and crossing Saint Louis County’s borders. Among them, the Inner North has the greatest poverty, as opposed to the West which has the least. These geographic areas, along with neighborhood poverty level, were analyzed to better understand the demographics of Saint Louis County residents experiencing mental disorders.

Objective:

We used hospitalization rates for mental disorders to determine utilization patterns and the need for community-based mental health services.

Although effective preventive measures for heat-related illness have been recommended and mandated for military personnel, there continues to be incident cases. In 2016, there were 401 incident cases of heat stroke and 2,135 incident cases of “other heat illness” among all active component service members. Current military guidelines utilize the wet bulb globe temperature (WBGT) index to measure heat risk, guiding work/rest and hydration practices. The WBGT requires calibrated instrumentation and is based on fixed cutoff values. We propose using readily available meteorological data inputs and EHI cases to identify and validate an EHI risk prediction model. Prior studies have found that combinations of WBGT and the previous day’s WBGT and relative humidity and temperature have predictive value for EHI. We build upon prior work by using generalized additive models (GAMs).

Objective:

To identify predictors of the risk of developing exertional heat illness (EHI) among basic training populations in the Department of Defense.

Like many other states in the U.S., Missouri has experienced large increases in opioid abuse resulting in hundreds dying each year and thousands of ED visits due to overdose. Missouri has two major urban areas, St. Louis and Kansas City and a few smaller cities, while the remainder of the state is more rural in nature. The opioid epidemic has impacted all areas in the state but the magnitude of that impact varies as well as the type of opioid used. Missouri Department of Health and Senior Services (MODHSS) maintains the Patient Abstract System (PAS) which contains data from hospitals and ambulatory surgical centers throughout the state. PAS includes data from ED visits including information on diagnoses, patient demographics, and other information about the visit. MODHSS also participates in the Enhanced State Surveillance of Opioid-involved Morbidity and Mortality project (ESOOS). One major aspect of this surveillance project is the collection of data on non-fatal opioid overdoses from ED visits. Through this collection of data, MODHSS analyzed opioid overdose visits throughout the state, how rates compare across urban and rural areas, and how those rates have changed over time.

Objective:

Compare rate changes over time for Emergency Department (ED) visits due to opioid overdose in urban versus rural areas of the state of Missouri.

Tobacco use is the leading global cause of preventable death, killing more than five million people per year. In addition, exposure to secondhand smoke is estimated to kill an additional 600,000 people globally each year. In 1986, the US Surgeon General’s Report declared secondhand smoke to be a cause of lung cancer in healthy nonsmokers. The first law restricting smoking in public places was enacted in 1973 in Arizona that followed the 1972 Surgeon General’s Report providing awareness of the negative health effects associated with the exposure to air pollution from tobacco smoke. Smoke-free laws were slowly enacted after this time point with most occurring after the year 2000. In July 2007, the Smoke Free Illinois Act (SB0500, Public Act 095-0017) was passed in IL. The ban went into effect on Jan 1, 2008 and Illinois joined 22 other states in prohibiting smoking in virtually all public places and workplaces including offices, theaters, museums, libraries, schools, commercial establishments, retail stores, bars, private clubs, and gaming facilities. While many studies have examined the effect of smoking bans on hospitalizations, this study would be the first to examine the effect of the comprehensive smoking ban in IL on ED visits by utilizing chronic disease categories created with ED chief complaint data captured by syndromic surveillance. The author hypothesizes that the comprehensive smoking ban in IL significantly reduced the ED visits associated with AMI, ACS, stroke, and COPD in adults in Cook County, IL.

Objective:

To utilize ED chief complaint data obtained from syndromic surveillance to quantify the effect of the Illinois smoking ban on acute myocardial infarction (AMI), acute coronary syndrome (ACS), stroke, and chronic obstructive pulmonary disease (COPD) related ED visits in adults in Cook County, IL.

Opioid overdoses are a growing cause of mortality in the United States. Medical prescriptions for opioids are a risk factor for overdose. This observation raises concerns that patients may seek multiple opioid prescriptions, possibly increasing their overdose risk. One route for obtaining those prescriptions is visiting the emergency department (ED) for pain-related complaints. Here, two hypotheses related to prescription seeking and overdoses are tested. (1) Overdose patients have a larger number of prior ED visits than matched controls. (2) Overdose patients have distinct patterns of pain-related complaints compared to matched controls.

Objective:

Identifying text features of emergency department visits associated with risk of future drug overdose.

Nationally and in Wisconsin, heroin is the leading cause of opioid related death and hospitalization. Opioids are commonly prescribed for pain. Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids. In 2015, more than 15,000 people died from overdoses involving prescription opioids. Approximately, three out of four heroin users report having abused prescription opioids prior to using heroin. In Wisconsin from 2010 to 2014 the number of deaths involving any opioid increased by 51% and for heroin increased by 192%. Through the federal government funding and support Wisconsin has established a statewide tool to help combat the ongoing prescription drug abuse epidemic by providing valuable information about controlled substance prescriptions that are dispensed in the state. PDMP is continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.

Objective:

Using the Wisconsin Enhanced Opioid Surveillance System, the present study evaluates the heroin hospitalization risk among the opioid recipients using the Prescription Drug Monitoring Data (PDMP) with following specific objectives: 1. Evaluate the risk of heroin overdose hospitalization following the prescription of opioid. 2. Assess the time elapsed between last prescribed opioid and first heroin overdose hospitalization. 3. Identify the main predictors of heroin overdose hospitalization among prescribed opioid users.

On October 2016, the Indian Ocean Regional Health Agency was alerted about an increase in ED visits related to adverse reactions associated with use of SC on Mayotte Island. In this context, an investigation based on a syndromic surveillance system was implemented by the regional unit of the French national public health agency.

Objective:

To confirm and to characterize the increase in emergency department (ED) visits related to the use of synthetic cannabinoids (SC).

Syndromic Surveillance (SS), traditionally applied to infectious diseases, is more recently being adapted to chronic disease prevention. Its usefulness rests on the large number of diverse individuals visiting emergency rooms with the possibility of real-time monitoring of acute health effects, including effects from environmental events and its potential ability to examine more long-term health effects and trends of chronic diseases on a local level.

Objective:

To create chronic disease categories for emergency department (ED) chief complaint data and evaluate the categories for validity against ED data with discharge diagnoses and hospital discharge data.