Using Point-in-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015‒2019

2021 ◽  
Vol 111 (12) ◽  
pp. 2212-2222
Author(s):  
Will Nicholas ◽  
Lisa Greenwell ◽  
Benjamin F. Henwood ◽  
Paul Simon
Keyword(s):  
Los Angeles ◽  
Cohort Studies ◽  
Drug Overdose ◽  
Los Angeles County ◽  
Mortality Rates ◽  
Homeless Population ◽  
Medical Examiner ◽  
Mortality Trends ◽  
Demographic Surveys ◽  
Rate Ratios

Objectives. To report trends in mortality rates, mortality rate ratios (MRRs), and causes of death among people experiencing homelessness (PEH) in Los Angeles County, California, by using annual point-in-time homeless counts and to compare findings to published longitudinal cohort studies of homeless mortality. Methods. We enumerated homeless deaths and determined causes by using 2015–2019 medical examiner‒coroner data matched to death certificate data. We estimated midyear homeless population denominators by averaging consecutive January point-in-time homeless counts. We used annual demographic surveys of PEH to estimate age- and gender-adjusted MRRs. We identified comparison studies through a literature review. Results. Mortality rates increased from 2015 to 2019. Drug overdose was the leading cause of death. Mortality was higher among White than among Black and Latino PEH. Compared with the general population, MRRs ranged from 2.8 (95% confidence interval [CI] = 2.7, 3.0) for all causes to 35.1 (95% CI = 31.9, 38.4) for drug overdose. Crude mortality rates and all-cause MRRs from comparison cohort studies were similar to those in the current study. Conclusions. These methods can be adapted by other urban jurisdictions seeking to better understand and reduce mortality in their homeless populations. (Am J Public Health. 2021;111(12):2212–2222. https://doi.org/10.2105/AJPH.2021.306502 )

Evolution of the Psychological Autopsy: Fifty Years of Experience at the Los Angeles County Chief Medical Examiner-Coroner's Office

2013 ◽  
Vol 58 (4) ◽  
pp. 924-926 ◽  
Author(s):  
Timothy Botello ◽  
Thomas Noguchi ◽  
Lakshmanan Sathyavagiswaran ◽  
Linda E. Weinberger ◽  
Bruce H. Gross
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Medical Examiner ◽  
Years Of Experience ◽  
Psychological Autopsy

scholarly journals Emergency Medical Services Responses to Out‐of‐Hospital Cardiac Arrest and Suspected ST‐Segment–Elevation Myocardial Infarction During the COVID‐19 Pandemic in Los Angeles County

2021 ◽  
Author(s):  
Jeffrey Eric Rollman ◽  
Robert A. Kloner ◽  
Nichole Bosson ◽  
James T. Niemann ◽  
Marianne Gausche‐Hill ◽  
...  
Keyword(s):  
Los Angeles ◽  
Emergency Medical Services ◽  
Los Angeles County ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
St Segment Elevation ◽  
Emergency Medical ◽  
St Segment ◽  
Rate Ratios ◽  
At Home

Background Public health emergencies may significantly impact emergency medical services responses to cardiovascular emergencies. We compared emergency medical services responses to out‐of‐hospital cardiac arrest (OHCA) and ST‐segment‒elevation myocardial infarction (STEMI) during the 2020 COVID‐19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020 stay‐at‐home order. Methods and Results We conducted a population‐based cross‐sectional study using Los Angeles County emergency medical services registry data for adult patients with paramedic provider impression (PI) of OHCA or STEMI from February through May in 2018 to 2020. After March 19, 2020, weekly counts for PI‐OHCA were higher (173 versus 135; incidence rate ratios, 1.28; 95% CI, 1.19‒1.37; P <0.001) while PI‐STEMI were lower (57 versus 65; incidence rate ratios, 0.87; 95% CI, 0.78‒0.97; P =0.02) compared with 2018 and 2019. After adjusting for seasonal variation in PI‐OHCA and decreased PI‐STEMI, the increase in PI‐OHCA observed after March 19, 2020 remained significant ( P =0.02). The proportion of PI‐OHCA who received defibrillation (16% versus 23%; risk difference [RD], −6.91%; 95% CI, −9.55% to −4.26%; P <0.001) and had return of spontaneous circulation (17% versus 29%; RD, −11.98%; 95% CI, −14.76% to −9.18%; P <0.001) were lower after March 19 in 2020 compared with 2018 and 2019. There was also a significant increase in dead on arrival emergency medical services responses in 2020 compared with 2018 and 2019, starting around the time of the stay‐at‐home order ( P <0.001). Conclusions Paramedics in Los Angeles County, CA responded to increased PI‐OHCA and decreased PI‐STEMI following the stay‐at‐home order. The increased PI‐OHCA was not fully explained by the reduction in PI‐STEMI. Field defibrillation and return of spontaneous circulation were lower. It is critical that public health messaging stress that emergency care should not be delayed.

scholarly journals Variation in US Drug Overdose Mortality Within and Between Hispanic/Latine Subgroups: A Disaggregation of National Data

2022 ◽  
Author(s):  
Manuel Cano ◽  
Camila Gelpi-Acosta
Keyword(s):  
Educational Attainment ◽  
Puerto Rican ◽  
Drug Overdose ◽  
Puerto Ricans ◽  
Mortality Rates ◽  
Mortality Data ◽  
The Us ◽  
Rate Ratios ◽  
Overdose Mortality ◽  
The Relationship

This study examined differences across Latine heritage groups (i.e., Mexican, Puerto Rican, Cuban, Dominican, Central American, South American) in rates of US drug overdose mortality. The study utilized 2015-2019 mortality data from the National Center for Health Statistics for 29,137 Hispanic individuals who died of drug overdose. Using population estimates from the American Community Survey, age-standardized drug overdose mortality rates were calculated by specific Latine heritage and sex, nativity, educational attainment, and geographic region. Standardized rate ratios (SRRs), incidence rate ratios (IRRs) from negative binomial regression models, and 95% Confidence Intervals (CIs) were calculated, and multiple imputation was used for missing Latine heritage group in select models. Drug overdose mortality rates in the Puerto Rican heritage population were more than three times as high as in the Mexican heritage population (IRR 3.61 [95% CI 3.02-4.30] in unadjusted model; IRR 3.70 [95% CI 3.31-4.15] in model adjusting for age, sex, nativity, educational attainment, and region; SRR 3.23 [95% CI, 3.15-3.32] in age-standardized model with missing Hispanic heritage imputed). Higher age-standardized rates of drug overdose mortality were observed in males than females across all Latine groups, yet the magnitude of the sex differential varied by Latine heritage. The relationship between drug overdose mortality and nativity differed by Latine heritage; in all groups except Puerto Rican, overdose mortality rates were significantly higher in the US-born than those not US-born. In contrast, overdose mortality rates were significantly lower in US-born Puerto Ricans than in Puerto Ricans who were not US-born (e.g., born in Puerto Rico; SRR, 0.84 [95% CI 0.80-0.88]). The relationship between drug overdose mortality and educational attainment (for ages 25+) also varied between Latine groups. The diverse subgroups comprising the US Latine population vary not only in rates of drug overdose mortality, but also in demographic risk factors for fatal drug overdose.

Two Cyclopropyl Fentanyl Case Studies in Los Angeles

2020 ◽  
Author(s):  
Courtney Castellino ◽  
Danielle Van Cleve ◽  
Rubi Cabrera
Keyword(s):  
Los Angeles ◽  
Case Studies ◽  
Los Angeles County ◽  
Medical Examiner ◽  
Medical Evidence ◽  
Death Scene ◽  
First Case ◽  
Fentanyl Analogs ◽  
Multiple Drugs

Abstract Illicit fentanyl occurrence in Los Angeles, California has increased along with the emergence of several fentanyl analogs (fentalogs). The following two case studies address the original identification of cyclopropyl fentanyl in cases investigated by the Los Angeles County Department of Medical Examiner—Coroner in the summer of 2017. In the first case study, cyclopropyl fentanyl was the only drug detected in the decedent’s system and was also identified in medical evidence collected at the death scene. Medical evidence is classified as any medical device, prescription(s), drug(s) and/or paraphernalia collected by the Los Angeles Medical Examiner—Coroner. The decedent in the second case study had multiple drugs present in combination with 14 ng/mL of cyclopropyl fentanyl. However, cyclopropyl fentanyl was not identified in any of the collected medical evidence. Both deaths were classified as accidental due to effects of cyclopropyl fentanyl (and/or other drugs). Due to limitations in screening methodology, it is possible to overlook fentalogs. Therefore, it is important to be hyper vigilant when assessing negative toxicology results or when many other drugs are also found. Maintaining adequate and up-to-date library databases, along with constant drug monitoring, and validation of new methodologies can help identify Novel Psychoactive Substances as they emerge. However, many of the fentalogs are only prevalent for a short amount of time as they are constantly changing to avoid detection and criminality. No other fatal cyclopropyl fentanyl cases have been identified in Los Angeles County Medical Examiner—Coroner cases since the fall 2017.

Abstract P209: Heterogeneity of Absolute/Relative Measures of Cardiovascular Mortality Among Cohorts in an Individual Participant Data Meta-Analysis: An EPOCH-JAPAN Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Yoshitaka Murakami ◽  
Tomonori Okamura ◽  
Katsuyuki Miura ◽  
Hirotsugu Ueshima ◽  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Individual Participant Data ◽  
Individual Participant ◽  
Rate Ratios ◽  
Meta Analyses

Introduction: Individual participant data (IPD) meta-analyses involve participant-level data from multiple cohort studies. However, these cohorts have different periods (years) of follow-up, target regions, and distributions of risk factors (including patient age). It remains unclear if these variations affect the heterogeneity of absolute/relative measures of mortality in cardiovascular disease (CVD), stroke, and coronary heart disease (CHD) among cohorts. Hypothesis: There is diverse heterogeneity in absolute measures of mortality, but negligible heterogeneity in relative measures among cohorts in IPD meta-analyses. Methods: The Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN) study is an IPD meta-analysis of cardiovascular epidemiology. This project comprises 14 cohort studies with 105,945 Japanese subjects (total CVD deaths: 5,314). First, we examined the correlation between the follow-up periods of the baseline surveys and multivariate-adjusted mortality rates (CVD, stroke, and CHD) among the cohorts. Next, we estimated the cohort-specific mortality rates that adjusted for the stated follow-up periods, regions, age, and other risk factors using Poisson regression. Finally, we explored the heterogeneity of multivariate-adjusted mortality rates, mortality rate ratios, and rate ratios of 10-mmHg increases in systolic blood pressure using Higgins’s I 2 , which measures heterogeneity in meta-analyses. Results: High correlations were observed between the stated follow-up periods of the cohorts and their mortality rates (CVD [men, -0.70; women, -0.79], stroke [men, -0.65; women, -0.73], CHD [men, -0.24; women, -0.89]). In the multivariate-adjusted mortality rates, we observed clear heterogeneity in mortality rates among the cohorts (CVD [I 2 : men, 98.6%; women, 99.3%], stroke [I 2 : men, 98.5%; women, 98.3%], and CHD [I 2 : men, 98.2%; women 92.4%]). In the rate ratio comparison of 10-mmHg increases in systolic blood pressure, no heterogeneity was detected among the cohorts (CVD [I 2 : men, 0.0%; women, 17.9%]). Our results indicated that the ratio measure, which shows the magnitude of each risk factor, was stable even in the heterogeneity of absolute measures. Conclusions: A clear heterogeneity in mortality was observed in absolute measures, but not in relative measures, among cohorts after adjusting for the periods of follow-up, regions, and other risk factors.

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