Racial and ethnic differences and COVID-19 pandemic-related changes in drug overdose deaths in North Carolina.

PURPOSE: To examine racial and ethnic differences and COVID-19 pandemic-related changes in key characteristics of drug overdose deaths in North Carolina. METHODS: We used North Carolina State Unintentional Drug Overdose Reporting System data to describe specific drug-involvement, bystander presence, and naloxone administration for drug overdose deaths by race and ethnicity during pre-COVID-19 (May 2019-February 2020) and COVID-19 periods (March 2020-December 2020). RESULTS: For all racial and ethnic groups, drug overdose death rates and the percentage with fentanyl and alcohol involvement increased from the pre-COVID-19 to COVID-19 period, with fentanyl involvement highest among American Indian and Alaska Native (82.2%) and Hispanic (81.4%) individuals and alcohol involvement highest among Hispanic individuals (41.2%) during the COVID-19 period. Cocaine involvement remained high among Black non-Hispanic individuals (60.2%) and increased among American Indian and Alaska Native individuals (50.6%). There was an increase in the percentage of deaths with a bystander present from the pre-COVID-19 to COVID-19 period for all racial and ethnic groups, with more than half having a bystander present during the COVID-19 period. There was a decrease in the percentage of naloxone administered for most racial and ethnic groups, with the lowest percentage among Black non-Hispanic individuals (22.7%). CONCLUSIONS: Efforts to address increasing inequities in drug overdose deaths, including expanded community naloxone access, are needed.

The Impact of the COVID-19 Pandemic on Disparities in Motor Vehicle Traffic Deaths and Injuries among North Carolina American Indians.

A Periodic Feature to Inform North Carolina Health Care Professionals About Current Topics in Health Statistics.

Impact of COVID-19 on injury-related emergency department visits in North Carolina, USA

BackgroundThe global COVID-19 pandemic impacted population-level emergency department (ED) utilization patterns for treatment of acute injuries. We examined the frequency and proportion of North Carolina, USA (NC) ED visits for injury during the first two years of the COVID-19 pandemic.MethodsData for the years 2019–2021 were obtained from NC DETECT, NC’s statewide syndromic surveillance system. Frequencies and proportions of injury-related ED visits overall and for selected injury mechanisms were compared, along with counts and proportions of COVID-Like-Illness (CLI) ED visits.ResultsAs compared to 2019 (N=924,663), the total number of injury-related ED visits declined in 2020 (N=748,427) and 2021 (N=766,794). As a proportion of total ED visits, injury-related ED visits decreased only slightly from 2019–2021 (18.7% to 17.8%). Most injury mechanisms saw a decrease in the number of ED visits in 2020 with a partial rebound in numbers in 2021. Drug overdoses, however, increased each year, with a total 14.9% increase from 2019 to 2021;the proportion of overdose visits to all ED visits only increased in 2020. Firearm injury spiked alarmingly in 2020 then fell somewhat in 2021. Early in the pandemic, injury-related ED visits decreased sharply as CLI ED visits increased. While CLI visits remained high, injury-related visits rebounded but generally did not return to pre-pandemic levels.ConclusionBoth ED avoidance and decreased exposures may have contributed to declines, while increases in select injury mechanisms may reflect unanticipated impacts of COVID-19 mitigation strategies.Learning OutcomesInjury outcomes exacerbated by the pandemic require timely public health responses.

Innovative use of syndromic surveillance system for injury prevention and practice

ContextInjury prevention requires data to inform policy and practice through surveillance, research and evaluation. NC DETECT, a syndromic surveillance system originally developed for bioterrorism and infectious disease identification and response, provides timely, population-based data for injury prevention efforts.PurposeWe use this system to monitor and respond to both long-standing prevalent injury issues and emerging threats, including COVID-19’s impact on injury.ProcessEstablished in 2002 and legislatively mandated in 2005, NC DETECT uses statewide near-real-time emergency department (ED) and EMS data for North Carolina, USA (population >10.5 million). Data are available to users through a Web-based portal that includes options to generate custom data reports and personalize data dashboards. Targeted injury reports are sent to public health practitioners and prevention partners. New surveillance case-definitions and reports are added within hours of a request.AnalysisStatewide, all 24/7, acute care, civilian, hospital-affiliated EDs (currently N=130) submit data 3-times daily, while all EMS encounters are submitted daily. Over 4.5 million ED visits and over 1.5 million EMS encounters are added to NC DETECT each year.OutcomesNC DETECT informs prevention efforts related to road safety, falls, overdose, violence, suicide, firearms, disaster response and climate resiliency. Weekly reports track trends for heat-related illness during summer months, monthly reports help counties monitor opioid overdoses and evaluate community-based interventions, and NC DETECT health outcomes data, integrated with motor vehicle crash report data, inform road safety policies and priorities.Learning OutcomesInjury control professionals can use syndromic surveillance data to further prevention and practice efforts.

Mental health emergency department visits: An exploration of case definitions in North Carolina.

BACKGROUND: Mental health (MH) disorders comprise a high disease burden and have long-lasting impacts. To improve MH, it is important to define public health MH surveillance. METHODS: We compared MH related definitions using ICD-10-CM codes: The Council of State and Territorial Epidemiologists' (CSTE) surveillance indicators for all MH, mood or depressive, schizophrenic, and drug/alcohol-induced disorders; and North Carolina's (NC) syndromic surveillance system's definition for anxiety/mood/psychotic disorders, and suicide/self-harm. We compared code definitions and frequent codes in 2019 emergency department (ED) data for those age ≥ 10 years. RESULTS: CSTE's definition resulted in over one million MH-related visits (23% of all ED visits) and NC's definitions in 451,807 MH-related visits (9% of all ED visits). Using CSTE's broadest definition, nicotine use was the most common visit type; using NC's definitions, it was major depressive disorder. CONCLUSIONS: Standardizing population-level MH indicators benefits surveillance efforts. Given its prevalence, efforts should focus on documenting MH to improve treatment and prevention.

The impact of the COVID-19 pandemic on the utilization of emergency department services for the treatment of injuries.

CONTEXT: The global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized. OBJECTIVE: This study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic. METHODS: Data were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020. Frequencies of January - November 2020 NC ED visits were compared to frequencies of 2019 visits for selected injury mechanisms, classified according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) injury diagnosis and mechanism codes. RESULTS: In 2020, the total number of injury-related visits declined by 19.5% (N = 651,158) as compared to 2019 (N = 809,095). Visits related to motor vehicle traffic crashes declined by a greater percentage (29%) and falls (19%) declined by a comparable percentage to total injury-related visits. Visits related to assault (15%) and self-harm (10%) declined by smaller percentages. Medication/drug overdose visits increased (10%), the only injury mechanism studied to increase during this period. CONCLUSION: Both ED avoidance and decreased exposures may have contributed to these declines, creating implications for injury morbidity and mortality. Injury outcomes exacerbated by the pandemic should be addressed by timely public health responses.