scholarly journals Differences in Opioid Overdose Mortality Rates Among Middle-Aged Adults by Race/Ethnicity and Sex, 1999-2018

2020 ◽  
pp. 003335492096880
Author(s):  
Rachel A. Hoopsick ◽  
Gregory G. Homish ◽  
Kenneth E. Leonard
Keyword(s):  
The United States ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Research Database ◽  
Opioid Use ◽  
Middle Aged ◽  
Synthetic Opioids ◽  
Race Ethnicity ◽  
Middle Aged Adults ◽  
Overdose Mortality

Objectives The types of opioids abused in the United States have changed from prescription opioids to heroin to fentanyl. However, the types of opioids abused may differ by demographic factors, especially among middle-aged adults. We examined national trends in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex. Methods Using 1999-2018 data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database, we examined overdose mortality rates per 100 000 population in 2018 among adults aged 45-64 that involved natural and semisynthetic opioids, heroin, synthetic opioids (excluding methadone), and methadone. We tested for significant differences in mortality rates by race/ethnicity and sex. We plotted drug-specific trends by race/ethnicity and sex from 1999 to 2018. Results In 2018, non-Hispanic White adults had the highest rates per 100 000 population of natural and semisynthetic overdose mortality (men: 8.7; women: 7.9; P < .001), and non-Hispanic Black adults had the highest rates of heroin (men: 17.7; women: 5.4; P < .001) and synthetic opioid (men: 36.0; women: 11.2; P < .001) overdose mortality. Men had significantly higher overdose mortality rates than women did for deaths involving natural and semisynthetic opioids, heroin, and synthetic opioids, but not methadone. From 1999 to 2018, mortality rates increased sharply for heroin and synthetic opioids, increased modestly for natural and semisynthetic opioids, and decreased for methadone. The greatest increases were among non-Hispanic Black men for heroin overdose (3.3 in 1999 to 17.7 in 2018) and synthetic opioid overdose (0.1 in 1999 to 36.0 in 2018). Conclusions Policy making should consider unique subgroup risks and alternative trajectories of opioid use other than people being prescribed opioids, developing opioid use disorder, subsequently moving to heroin, and then to fentanyl.

Abstract MP54: Increase in the Urban-Rural Divide in Cerebrovascular Mortality Among Middle-Aged Adults From 2013 to 2018

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Marek Cierny ◽  
Shumei Man ◽  
Ken Uchino
Keyword(s):  
African Americans ◽  
The United States ◽  
Mortality Rates ◽  
Research Database ◽  
Stroke Mortality ◽  
Middle Aged ◽  
Online Data ◽  
Rural Counties ◽  
Urban Rural ◽  
Middle Aged Adults

Introduction: Despite observed overall decline cerebrovascular mortality in the United States over the past 2 decades, geographic pockets of increasing cerebrovascular mortality among middle aged adults have been reported on county-level data; and factors driving this regional increase are poorly understood. Methods: We extracted cerebrovascular mortality rates (ICD tenth revision codes I60-I69) in middle aged adults (age 35-64) from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database from 1999 to 2018. Variations in annual age-adjusted mortality rates, assessed with Joinpoint regression modeling, are expressed as estimated Annual Percentage Change [APC (95% confidence interval)], stratified by urbanization. In regions with increasing stroke mortality, race-ethnicity and gender subgroups were compared. Results: Mid-age cerebrovascular mortality decreased across urbanization strata between 1999 and 2012. Since 2013, stroke mortality has been increasing in Rural counties [APC +1.8% (+1.0% to +2.6%)] and stagnating in Small-to-Medium Metro counties [APC +0.7% (-0.1% to +1.5%)] and Large Metro counties [APC +0.1% (-0.8% to +0.9%)]. Focusing on rural counties, the profound rate difference between non-Hispanic African Americans and non-Hispanic whites decreased between 1999-2012 at Average APC -1.7% (-2.3% to -1.2%) and since then persisted [Average APC -0.2% (-2.1% to 1.8%)]. Both genders were affected. Conclusion: Since 2013, increase in cerebrovascular mortality in middle-aged adults in rural counties contributes to growing urban-rural divide; while the high stroke mortality rate in non-Hispanic African Americans have ceased to converge with non-Hispanic whites. Upstream drivers of stroke mortality in young and middle-aged rural residents and non-Hispanic African Americans should be further elucidated and vigorously targeted by public health initiatives.

scholarly journals Prevalent Misconceptions About Opioid Use Disorders in the United States Produce Failed Policy and Public Health Responses

2018 ◽  
Vol 69 (3) ◽  
pp. 546-551 ◽  
Author(s):  
Robert Heimer ◽  
Kathryn Hawk ◽  
Sten H Vermund
Keyword(s):  
United States ◽  
The United States ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Virus Infections ◽  
Opioid Use ◽  
Illicit Markets ◽  
Oral Consumption ◽  
Immunodeficiency Virus ◽  
Overdose Mortality

Abstract The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication, leading to massive diversion into illicit markets. A peculiar tragedy is that many health professionals prescribed opioids in a misguided response to legitimate concerns that pain was undertreated. The crisis grew not only from overprescribing, but also from other sources, including insufficient research into nonopioid pain management, ethical lapses in corporate marketing, historical stigmas directed against people who use drugs, and failures to deploy evidence-based therapies for opioid addiction and to comprehend the limitations of supply-side regulatory approaches. Restricting opioid prescribing perversely accelerated narco-trafficking of heroin and fentanyl with consequent increases in opioid overdose mortality As injection replaced oral consumption, outbreaks of hepatitis B and C virus and human immunodeficiency virus infections have resulted. This viewpoint explores the origins of the crisis and directions needed for effective mitigation.

scholarly journals Education, Race/Ethnicity, and Causes of Premature Mortality Among Middle-Aged Adults in 4 US Urban Communities: Results From CARDIA, 1985–2017

2020 ◽  
Vol 110 (4) ◽  
pp. 530-536 ◽  
Author(s):  
Brita Roy ◽  
Catarina I. Kiefe ◽  
David R. Jacobs ◽  
David C. Goff ◽  
Donald Lloyd-Jones ◽  
...  
Keyword(s):  
High School ◽  
Black Women ◽  
White Women ◽  
Premature Mortality ◽  
The United States ◽  
Education Level ◽  
Middle Aged ◽  
Or Education ◽  
Race Ethnicity ◽  
Middle Aged Adults

Objectives. To assess causes of premature death and whether race/ethnicity or education is more strongly and independently associated with premature mortality in a diverse sample of middle-aged adults in the United States. Methods. The Coronary Artery Risk Development in Young Adults study (CARDIA) is a longitudinal cohort study of 5114 participants recruited in 1985 to 1986 and followed for up to 29 years, with rigorous ascertainment of all deaths; recruitment was balanced regarding sex, Black and White race/ethnicity, education level (high school or less vs. greater than high school), and age group (18–24 and 25–30 years). This analysis included all 349 deaths that had been fully reviewed through month 348. Our primary outcome was years of potential life lost (YPLL). Results. The age-adjusted mortality rate per 1000 persons was 45.17 among Black men, 25.20 among White men, 17.63 among Black women, and 10.10 among White women. Homicide and AIDS were associated with the most YPLL, but cancer and cardiovascular disease were the most common causes of death. In multivariable models, each level of education achieved was associated with 1.37 fewer YPLL (P = .007); race/ethnicity was not independently associated with YPLL. Conclusions. Lower education level was an independent predictor of greater YPLL.

scholarly journals Invited Commentary: The Association Between Florida’s Opioid Crackdown and Opioid-Related Mortality—The Roles of Economic Factors and Mortality Misclassification

2020 ◽  
Vol 189 (9) ◽  
pp. 894-897 ◽  
Author(s):  
Sotiris Vandoros
Keyword(s):  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Crash ◽  
Future Research ◽  
Opioid Overdose ◽  
Policy Reforms ◽  
Opioid Use ◽  
Car Crashes ◽  
Overdose Mortality ◽  
Related Mortality

Abstract Opioid overdose mortality has been increasing in the United States, and other types of mortality, such as motor vehicle crash deaths, may also be linked to opioid use. In this issue of the Journal, Feder et al. (Am J Epidemiol. 2020;189(9):885–893) examine the association between Florida’s opioid crackdown laws, implemented in 2010–2011, and opioid-related mortality. They found a decrease in numbers of opioid-overdose and car-crash deaths compared with what would have been expected in the absence of such policies. They also found no evidence of any unintended increase in suicides due to poor pain management. The results were robust to alternative methodological approaches. Florida’s opioid policy reforms coincided with the state’s convergence towards national unemployment rates, as well as a new state law prohibiting texting while driving. Because opioid overdose mortality is often associated with economic conditions and because car crashes and suicides may also be linked to the macroeconomic environment, future research should take such factors into account when studying the outcomes of opioid prescribing laws. Another data-related aspect to consider is the misclassification of suicides as car crashes or opioid overdoses. Overall, the findings by Feder et al. are encouraging and can inform policy in other countries facing increasing numbers of opioid overdose deaths.

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

scholarly journals Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns

2019 ◽  
Vol 8 (2) ◽  
pp. 89-100 ◽  
Author(s):  
Gopal K Singh ◽  
Isaac E. Kim, Jr. ◽  
Mehrete Girmay ◽  
Chrisp Perry ◽  
Gem P. Daus ◽  
...  
Keyword(s):  
Pain Management ◽  
Social Determinants ◽  
Drug Overdose ◽  
The United States ◽  
Opioid Epidemic ◽  
The Us ◽  
Drug Overdoses ◽  
Race Ethnicity ◽  
Overdose Mortality ◽  
Racial Ethnic

Objectives: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population. Methods: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peerreviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018. Results: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities. Conclusions and Global Health Implications: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioidepidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction. Key words: • Opioids • Drug overdose • Mortality • Pain management • Treatment • Race/Ethnicity • Social determinants • Health disparities Copyright © 2019 Singh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Incidence and risk of major heart diseases in middle-aged adults with moderate to severe vision impairment: a population-based cohort study

2018 ◽  
Vol 103 (8) ◽  
pp. 1054-1059 ◽  
Author(s):  
Chun-Mei Hsueh ◽  
Jing-Hwa Wey ◽  
Jong-Shiuan Yeh ◽  
Chien-Hua Wu ◽  
Tsan-Hon Liou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Diseases ◽  
Population Based ◽  
Vision Impairment ◽  
Major Adverse Cardiovascular Events ◽  
Research Database ◽  
Middle Aged ◽  
Visual Disability ◽  
Aged People ◽  
Middle Aged Adults

Background/aimTo estimate the incidence and risk of major adverse cardiovascular events (MACEs), including heart failure and ischaemic heart disease, among middle-aged people with a visual disability (VD).MethodsWe used a national health insurance research database to conduct a population-based cohort study from 1 January 2000 to 31 December 2013. Patients with VD aged 35~65 years were recruited. For each VD patient, five age-matched, sex-matched and comorbidity-matched patients were randomly selected and recruited as controls. Control patients had no documented disability.ResultsThis study recruited 978 patients with VD (mean age±SD, 55.1±7.8 years; 48.9% male) and 4677 controls. Compared with the same sex of the controls, women with VD had higher incidence of MACE 1 (7.9 vs 2.8/1000 person-years, p<0.001), MACE 2 (27.5 vs 16.9/1000 person-years, p<0.001), MACE 3 (3.7 vs 1.4/1000 person-years, p<0.005) and MACE 4 (4.5 vs 2.5/1000 person-years, p<0.05), and men with VD had higher incidence of MACE 1 (4.6 vs 2.0/1000 person-years, p<0.005). Compared with the controls, patients with VD had lower cumulative MACE 1~MACE 4-free probabilities and had an independently higher risk of MACE 1~MACE 4 during the 13-year study, yielding an adjusted hazard ratio range of 1.31~2.75. Those persons with VD who had diabetes and hypertension had greater risks of MACE 1~MACE 4.ConclusionsMiddle-aged adults with VD were at risk of MACEs. A programme for MACE prevention is important for middle-aged people with VD. This is especially true for women and for those who also have diabetes and hypertension.

scholarly journals Racial/Ethnic Disparities in Mortality: Contributions and Variations by Rurality in the United States, 2012–2015

2019 ◽  
Vol 16 (3) ◽  
pp. 436 ◽  
Author(s):  
Jeffrey Hall ◽  
Ramal Moonesinghe ◽  
Karen Bouye ◽  
Ana Penman-Aguilar
Keyword(s):  
Rural Areas ◽  
Ethnic Disparities ◽  
The United States ◽  
Mortality Rates ◽  
Malignant Neoplasms ◽  
Ethnic Populations ◽  
Asian Pacific Islanders ◽  
Race Ethnicity ◽  
Asian Pacific ◽  
Racial Ethnic

The value of disaggregating non-metropolitan and metropolitan area deaths in illustrating place-based health effects is evident. However, how place interacts with characteristics such as race/ethnicity has been less firmly established. This study compared socioeconomic characteristics and age-adjusted mortality rates by race/ethnicity in six rurality designations and assessed the contributions of mortality rate disparities between non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in each designation to national disparities. Compared to NHWs, age-adjusted mortality rates for: (1) NHBs were higher for all causes (combined), heart disease, malignant neoplasms, and cerebrovascular disease; (2) American Indian and Alaska Natives were significantly higher for all causes in rural areas; (3) Asian Pacific islanders and Hispanics were either lower or not significantly different in all areas for all causes combined and all leading causes of death examined. The largest contribution to the U.S. disparity in mortality rates between NHBs and NHWs originated from large central metropolitan areas. Place-based variations in mortality rates and disparities may reflect resource, and access inequities that are often greater and have greater health consequences for some racial/ethnic populations than others. Tailored, systems level actions may help eliminate mortality disparities existing at intersections between race/ethnicity and place.

scholarly journals Lead Exposure and Cardiovascular Disease among Young and Middle-Aged Adults

2019 ◽  
Vol 7 (11) ◽  
pp. 103 ◽  
Author(s):  
Emmanuel Obeng-Gyasi
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Lead Exposure ◽  
Binary Logistic Regression ◽  
The United States ◽  
Gamma Glutamyl Transferase ◽  
Middle Aged ◽  
The Mean ◽  
Glutamyl Transferase ◽  
Middle Aged Adults

Lead and its effects on cardiovascular-related markers were explored in this cross-sectional study of young adults (18–44 years) and middle-aged adults (45–65 years) from the United States using the National Health and Nutrition Examination Survey (NHANES), 2009–2016. Degrees of exposure were created using blood lead level (BLL) as the biomarker of exposure based on the epidemiologically relevant threshold of BLL > 5 μg/dL. The mean values, in addition to the percentages of people represented for the markers of interest (systolic blood pressure [SBP], diastolic blood pressure [DBP], gamma-glutamyl transferase [GGT], non-high-density lipoprotein cholesterol [non-HDL-C]) were explored. Among those exposed to lead, the likelihood of elevated clinical markers (as defined by clinically relevant thresholds of above normal) were examined using binary logistic regression. In exploring exposure at the 5 μg/dL levels, there were significant differences in all the mean variables of interest between young and middle-aged adults. The binary logistic regression showed young and middle-aged adults exposed to lead were significantly more likely to have elevated markers (apart from DBP). In all, lead affects cardiovascular-related markers in young and middle-aged U.S. adults and thus we must continue to monitor lead exposure to promote health.

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