scholarly journals Estimating the population-level effects of Ontario's overdose prevention sites and consumption and treatment services: interrupted time series analysis with synthetic controls

2021 ◽  
Author(s):  
Dimitra Panagiotoglou ◽  
Jihoon Lim
Keyword(s):  
Time Series ◽  
Service Use ◽  
Critical Role ◽  
Population Level ◽  
Interrupted Time Series ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Opioid Agonist ◽  
Overdose Prevention ◽  
Treatment Services

Background: Ontario recently implemented overdose prevention sites and consumption and treatment services (OPS/CTS) to stem the harms of the opioid epidemic. We tested whether operating any site improved local opioid-related health service use and mortality rates. Methods: We used monthly counts of all opioid-related emergency department (ED) visits, hospitalizations, and deaths between January 2014 and December 2020 for our outcomes. For each public health unit (PHU) that implemented any OPS/CTS, we created a synthetic control as a weighted combination of unexposed PHU. We estimated the population-level effects of operating any site using controlled interrupted time series with segmented regression and adjusted for time varying confounders (i.e. OPS/CTS capacity, naloxone kits distributed, and persons receiving opioid agonist treatment per 100,000 population). We repeated the analysis using a multiple baseline approach to estimate province-wide effects. Results: Between 2017 and 2020, nine out of 34 PHU implemented at least one OPS/CTS. ED visit (RR=0.96, 95%CI: 0.92-0.99) and hospitalization (RR=0.95, 95%CI: 0.92-0.98) trends declined faster among treated units. Improvements in local ED visit rate trends were observed for the majority of treated units. Hospitalization rates declined faster for London (RR=0.97, 95%CI: 0.95-0.99) and Niagara (RR=0.95, 95%CI: 0.92-0.98); while mortality rates declined faster for Hamilton (RR=0.93, 95%CI: 0.90-0.96), Niagara (RR=0.97, 95%CI: 0.94-0.99) and Guelph (RR=0.94, 95%CI: 0.88-1.00). Conclusion: Although OPS/CTS are not sufficient to stem the harms of the opioid overdose epidemic on their own, they play a critical role in local harm reduction strategies.

A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths

2021 ◽  
pp. 003335492110268
Author(s):  
Amber B. Robinson ◽  
Nida Ali ◽  
Olga Costa ◽  
Cherie Rooks-Peck ◽  
Amy Sorensen-Alawad ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Prevention Program ◽  
Data Access ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Overdose Prevention ◽  
Core Elements ◽  
Specific Activities ◽  
Context Specific ◽  
Overdose Deaths

Objective To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. Methods We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state’s overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. Results In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. Conclusions The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.

scholarly journals Interrupted time series analyses to assess the impact of alcohol control policy on socioeconomic inequalities in mortality in Lithuania: a study protocol

2021 ◽  
Author(s):  
Jakob Manthey ◽  
Domantas Jasilionis ◽  
Huan Jiang ◽  
Olga Mesceriakova-Veliuliene ◽  
Janina Petkeviciene ◽  
...  
Keyword(s):  
Time Series ◽  
Research Ethics ◽  
Interrupted Time Series ◽  
Mortality Rates ◽  
Attributable Mortality ◽  
Population Census ◽  
Combining Data ◽  
Time Series Analyses ◽  
Inequalities In Mortality ◽  
The Impact

Introduction Alcohol use is a major risk factor for mortality. Previous studies suggest that the alcohol-attributable mortality burden is higher in lower socioeconomic strata. This project will test the hypothesis, that the 2017 increase of alcohol excise taxes for beer and wine, which was linked to lower all-cause mortality rates in previous analyses, will reduce socioeconomic mortality inequalities. Methods and analysis Data on all causes of deaths will be obtained from Statistics Lithuania. Record linkage will be implemented using personal identifiers combining data from 1) the 2011 whole-population census, 2) death records between March 1, 2011 (census date) and December 31, 2019, and 3) emigration records, for individuals aged 30 to 70 years. The analyses will be performed separately for all-cause and for alcohol-attributable deaths. Monthly age-standardized mortality rates will be calculated by sex, education, and three measures of socioeconomic status. Inequalities in mortality will be assessed using absolute and relative indicators between low and high SES groups. We will perform interrupted time series analyses, and test the impact of the 2017 rise in alcohol excise taxation using generalized additive mixed models. In these models, we will control for secular trends for economic development. Ethics and dissemination This work is part of project grant 1R01AA028224-01 by the National Institute on Alcohol Abuse and Alcoholism. It has been granted research ethics approval 050/2020 by CAMH Research Ethics Board on April 17, 2020, renewed on March 30, 2021.

scholarly journals 03 Opioid overdose death in wales from 2012 to 2015: a linked data autopsy study

2019 ◽  
Vol 36 (10) ◽  
pp. e3.1-e3
Author(s):  
Matthew Jones ◽  
Alan Watkins ◽  
Jenna Bulger ◽  
Ann John ◽  
Helen Snooks ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Service Use ◽  
Mental Health Problems ◽  
Public Health Problem ◽  
Opioid Overdose ◽  
Care Providers ◽  
National Statistics ◽  
Treatment Services ◽  
Overdose Deaths ◽  
Observation Period

BackgroundOpioids account for more fatalities by overdose than any other drug. Fatal opioid overdose is a growing public health problem, with incidence rising in western countries especially. We sought to describe the deaths, sociodemographic characteristics, and service usage patterns of decedents of opioid overdose in Wales.MethodsWe carried out a retrospective cross-sectional analysis of opioid related deaths in Wales identified from Office for National Statistics data between 01/01/2012 and 31/12/2015, in Wales, UK.Routine data were captured from Office of National Statistics (ONS), the Welsh Demographic Service and National Health Service datasets for the preceding three years and linked using a deterministic algorithm. Demographic, socioeconomic, clinical and service use characteristics were detailed using descriptive statistics.ResultsThe majority of opioid overdose deaths (n=312) occurred at home (n=253, 81.09%) and were accidental (n=262, 83.97%). A third (31.09%) involved heroin as the main object of injury (n=97). Decedents were mostly male (n=228, 73.1%) and lived in socioeconomically deprived (lacking in material and social opportunities and/or resources) areas at the time of their death (n=199, 63.75%). The majority of decedents changed address at least once during the 36 month observation period prior to death (n=169, 53.85%), but rarely moved far geographically (e.g. were resident in more than two postcode areas). The majority of decedents visited the emergency department (n=227, 72.76%), were admitted to hospital (n=199, 63.78%) – usually for mental health problems – and were recorded at least one General Practitioner episode (n=258, 82.69%) during the observation period. A minority of decedents used drug treatment services (n=72, 23.08%).ConclusionsOpioid overdose deaths occur most commonly secondary to heroin use. Decedents demonstrate a peripatetic lifestyle and are rarely engaged with drug treatment services. Frequent contact with unscheduled care providers might present a target for preventative interventions.

scholarly journals Changes in the dollar value of per capita alcohol, essential, and non-essential retail sales in Canada during COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel T. Myran ◽  
Brendan T. Smith ◽  
Nathan Cantor ◽  
Lennon Li ◽  
Sudipta Saha ◽  
...  
Keyword(s):  
Time Series ◽  
Alcohol Use ◽  
Population Level ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Retail Sales ◽  
Ongoing Research ◽  
Per Capita ◽  
Statistics Canada ◽  
Alcohol Sales

Abstract Background Multiple survey reports suggest that alcohol use has increased in Canada during the COVID-19 pandemic. However, less is known about how per capita alcohol sales, which predict population-level alcohol use, have changed and whether changes in alcohol sales differ from changes in sales of other products due to pandemic factors. Methods We obtained monthly retail sales data by industry from Statistics Canada, for the six largest provinces in Canada (containing 93% of the national population), between January 2010 and November 2020, representing time before and 9 months after the start of the pandemic in Canada. We used an interrupted time series analysis to estimate pandemic impacts on the dollar value of monthly per capita (per individuals 15+ years) alcohol, essential and non-essential retail sales. We adjusted our analyses for pre-pandemic sales trends, inflation, seasonality and changing population demographics over time. Results During the first 9 months of the pandemic, the values of per capita alcohol, essential and non-essential sales were, respectively, 13.2% higher, 3.6% higher and 13.1% lower than the average values during the same period in the prior 3 years. Interrupted time series models showed significant level change for the value of monthly per capita alcohol sales (+$4.86, 95% CIs: 2.88, 6.83), essential sales (−$59.80, 95% CIs: − 78.47, − 41.03) and non-essential sales (−$308.70, 95% CIs: − $326.60, − 290.79) during the pandemic. Alcohol sales were consistently elevated during the pandemic, and the pre- and post-pandemic slopes were comparable. In contrast, essential and non-essential retail sales declined in the early months of the pandemic before returning to regular spending levels. Conclusion During the first 9 months of the pandemic, per capita alcohol sales were moderately elevated in Canada. In contrast, non-essential sales were lower than prior years, driven by large decreases during the initial months of the pandemic. These findings suggest that the pandemic was associated with increased population-level alcohol consumption, which may lead to increased alcohol-related harms. Ongoing research is needed to examine how factors, including pandemic-related stressors and specific alcohol sales-related policies, may have influenced changes in alcohol use and harms.

scholarly journals Evaluation of statistical methods used in the analysis of interrupted time series studies: a simulation study

2020 ◽  
Author(s):  
Simon L Turner ◽  
Andrew B Forbes ◽  
Amalia Karahalios ◽  
Monica Taljaard ◽  
Joanne E McKenzie
Keyword(s):  
Time Series ◽  
Statistical Methods ◽  
Simulated Data ◽  
Population Level ◽  
Interrupted Time Series ◽  
Ordinary Least Squares ◽  
In Series ◽  
Time Series Studies ◽  
Unbiased Estimates ◽  
Biased Estimates

AbstractInterrupted time series (ITS) studies are frequently used to evaluate the effects of population-level interventions or exposures. To our knowledge, no studies have compared the performance of different statistical methods for this design. We simulated data to compare the performance of a set of statistical methods under a range of scenarios which included different level and slope changes, varying lengths of series and magnitudes of autocorrelation. We also examined the performance of the Durbin-Watson (DW) test for detecting autocorrelation. All methods yielded unbiased estimates of the level and slope changes over all scenarios. The magnitude of autocorrelation was underestimated by all methods, however, restricted maximum likelihood (REML) yielded the least biased estimates. Underestimation of autocorrelation led to standard errors that were too small and coverage less than the nominal 95%. All methods performed better with longer time series, except for ordinary least squares (OLS) in the presence of autocorrelation and Newey-West for high values of autocorrelation. The DW test for the presence of autocorrelation performed poorly except for long series and large autocorrelation. From the methods evaluated, OLS was the preferred method in series with fewer than 12 points, while in longer series, REML was preferred. The DW test should not be relied upon to detect autocorrelation, except when the series is long. Care is needed when interpreting results from all methods, given confidence intervals will generally be too narrow. Further research is required to develop better performing methods for ITS, especially for short series.

scholarly journals Assessment of the Impact of COVID-19 pandemic on population level interest in Skincare: Evidence from a google trends-based Infodemiology study

2020 ◽  
Author(s):  
Hasan Symum ◽  
Md. F. Islam ◽  
Habsa K. Hiya ◽  
Kh M. Ali Sagor
Keyword(s):  
Time Series ◽  
Moving Average ◽  
Arima Model ◽  
Population Level ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Search Volume ◽  
Quasi Experimental ◽  
Relative Search Volume ◽  
The Impact

AbstractBackgroundCOVID-19 pandemic created an unprecedented disruption of daily life including the pattern of skin related treatments in healthcare settings by issuing stay-at-home orders and newly coronaphobia around the world.ObjectiveThis study aimed to evaluate whether there are any significant changes in population interest for skincare during the COVID-19 pandemic.MethodsFor the skincare, weekly RSV data were extracted for worldwide and 23 counties between August 1, 2016, and August 31, 2020. Interrupted time-series analysis was conducted as the quasi-experimental approach to evaluate the longitudinal effects of COVID-19 skincare related search queries. For each country, autoregressive integrated moving average (ARIMA) model relative search volume (RSV) time series and then testing multiple periods simultaneously to examine the magnitude of the interruption. Multivariate linear regression was used to estimate the correlation between countries’ relative changes in RSV with COVID-19 confirmed cases/ per 10000 patients and lockdown measures.ResultsOut of 23 included countries in our study, 17 showed significantly increased (p<0.01) RSVs during the lockdown period compared with the ARIMA forecasted data. The highest percentage of increments occurs in May and June 2020 in most countries. There was also a significant correlation between lockdown measures and the number of COVID-19 cases with relatives changes in population interests for skincare.ConclusionUnderstanding the trend and changes in skincare public interest during COVID-19 may assist health authorities to promote accessible educational information and preventive initiatives regarding skin problems.

The Impact of the Affordable Care Act on Burn Outcomes

2020 ◽  
Author(s):  
Justin E Dvorak ◽  
Erica L W Lester ◽  
Patrick J Maluso ◽  
Leah C Tatebe ◽  
Faran Bokhari
Keyword(s):  
Time Series ◽  
Low Socioeconomic Status ◽  
Affordable Care Act ◽  
Population Level ◽  
Interrupted Time Series ◽  
Home Health ◽  
Interrupted Time Series Analysis ◽  
Post Discharge ◽  
The Affordable Care Act ◽  
The Impact

Abstract Uninsured and low socioeconomic status patients who suffer burn injuries have disproportionately worse morbidity and mortality. The Affordable Care Act was signed into law with the goal of increasing access to insurance, with Medicaid expansion in January 2014 having the largest impact. To analyze the population-level impact of the Affordable Care Act on burn outcomes, and investigate its impact on identified at-risk subgroups, a retrospective time series of patients was created using data from the Healthcare Cost and Utilization Project National Inpatient Sample database between 2011 and 2016. An interrupted time series analysis was conducted to examine mortality, length of stay, and the probabilities of discharge home, home with home health, and to another facility before and after January 2014. There were no changes in burn mortality detected. There was a statistically significant reduction in the probability of being discharged home (−0.000967, P &lt; .01; 95% confidence interval [CI] −0.0015379 to −0.0003962) or discharged home with home health (−0.000709, P &lt; .01; 95% CI −0.00110 to 0.000317) after 2014. There was an increase in the probability of being discharged to another facility (0.00108, P = .01; 95% CI 0.000282–0.00188). While the enactment of the major provisions of the Affordable Care Act in 2014 was not associated with a change in mortality for burn patients, it was associated with more patients being discharged to a facility: This may represent a significant improvement in access to care and rehabilitation. Future studies will assess the societal and economic impact of improved access to post-discharge facilities and rehabilitation.

scholarly journals Modeling historical tuberculosis epidemics among Canadian First Nations: effects of malnutrition and genetic variation

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1237 ◽  
Author(s):  
Sarah F. Ackley ◽  
Fengchen Liu ◽  
Travis C. Porco ◽  
Caitlin S. Pepperell
Keyword(s):  
Time Series ◽  
First Nations ◽  
Census Data ◽  
Population Level ◽  
Mortality Rates ◽  
Mortality Data ◽  
Individual Level ◽  
Epidemic Dynamics ◽  
Susceptibility To Infection ◽  
Time Period

Late 19th century epidemics of tuberculosis (TB) in Western Canadian First Nations resulted in peak TB mortality rates more than six times the highest rates recorded in Europe. Using a mathematical modeling approach and historical TB mortality time series, we investigate potential causes of high TB mortality and rapid epidemic decline in First Nations from 1885 to 1940. We explore two potential causes of dramatic epidemic dynamics observed in this setting: first, we explore effects of famine prior to 1900 on both TB and population dynamics. Malnutrition is recognized as an individual-level risk factor for TB progression and mortality; its population-level effects on TB epidemics have not been explored previously. Second, we explore effects of heterogeneity in susceptibility to TB in two ways: modeling heterogeneity in susceptibility to infection, and heterogeneity in risk of developing disease once infected. Our results indicate that models lacking famine-related changes in TB parameters or heterogeneity result in an implausibly poor fit to both the TB mortality time series and census data; the inclusion of these features allows for the characteristic decline and rise in population observed in First Nations during this time period and confers improved fits to TB mortality data.

scholarly journals Reduction of maternal mortality due to preeclampsia in Colombia-an interrupted time-series analysis

2014 ◽  
pp. 25-31 ◽  
Author(s):  
Julian Alberto Herrera Herrera ◽  
Rodolfo Herrera-Miranda ◽  
Juan Pablo Herrera-Escobar ◽  
Aníbal Nieto-Díaz
Keyword(s):  
Time Series ◽  
Prenatal Care ◽  
Time Series Analysis ◽  
Maternal Mortality ◽  
Care Program ◽  
Interrupted Time Series ◽  
Mortality Rates ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

Introduction. Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002–2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR= 0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR= 0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

Sign in / Sign up

Export Citation Format

Share Document