ABSTRACT
Introduction: Suicide represents a significant worldwide disease burden disproportionately affecting younger patients in their prime working years. Mortality by suicide remains within the five leading causes of death up to the age of 60. Compounding this, alcohol use disorder (AUD) is known to be a risk factor for death by suicide and has been on the rise over the last 20 years, particularly during the COVID-19 pandemic. The emergency department (ED) is often the first point of health care contact for those patients that have suicidal thoughts or behaviours and understanding their acute risk of death by suicide when presenting intoxicated with alcohol remains a challenge for ED physicians. While the chronic disease of AUD elevates their lifetime risk for death by suicide, it has not been established how a presentation for suicidality accompanied by acute alcohol intoxication affects this risk. Method(s): This was a retrospective cohort study using population-based linked health administrative data for adult patients aged 18 or above who presented to Alberta (ED) between 2011 and 2021 for suicidal attempt or self-harm behavior. Patients who were acutely intoxicated with alcohol were identified and analyses compared patients with and without alcohol intoxication. The primary outcome was six-month death by suicide. Categorical variables were summarized using proportions, whereas continuous variables were summarized using means and standard deviations (SD) or medians and interquartile ranges (IQR), as appropriate. Competing risk analysis was performed to explore the cumulative incidence of death by suicide within 180 days after their index ED visit and examine the association between death by suicide and alcohol intoxication. Result(s): Patients presenting to the ED for suicide attempt or self-harm behaviour were intoxicated with alcohol in 30% of cases as determined by diagnostic coding and blood alcohol measurements. Intoxicated patients were more likely to be placed under involuntary mental health hold (26% vs 16%) and had on average a longer length of stay in the ED (411 min vs 277 min) but were less frequently admitted (10.8% vs 15.4%). As a departure from previous literature, those intoxicated with alcohol were more likely to be consulted to psychiatry (15.8% vs 12.6%). Mortality due to suicide in the 6 months following the patient' index ED visit were similar between the intoxicated and non-intoxicated groups (0.3% vs 0.3%) however there was a significant increase in all-cause mortality at 6 months in the nonintoxicated group (1.5% vs 2.1%). Discussion(s): This study examined the patient and ED treatment characteristics of patients presenting to the ED with suicide attempt or self-harm behaviour. It found that the 6-month risk of death by suicide was no different in those who presented with acute alcohol intoxication vs those without. While these results differ from other studies discussing how alcohol use disorder confers a chronically increased risk of death by suicide, they provide new evidence for the emergency department providers to consider when assessing the patient who presents with suicidal behaviours while intoxicated.
ABSTRACT
Purpose of Study: Clinical trial participation remains low among US minority groups, who account for <1/10 of trial participants.1,2 Diverse, equitable and inclusive participation is needed to lessen disparities in health status and clinical outcomes.3 Community-based participatory research (CBPR) strategies identify salient community issues, and may be useful for understanding and addressing participation barriers among minority groups.4,5 The Louisiana Community Engagement Alliance Against COVID-19 Disparities (LA-CEAL) - a partnership of universities, community pharmacies, faith-based organizations (FBOs), and federally qualified health centers (FQHCs) - aims to strengthen and leverage community relationships to address barriers to uptake of preventive/therapeutic strategies in underserved populations. This study examines the utility of LA-CEAL's CBPR approach in facilitating inclusive participation in clinical trials. Methods Used: Listening forums were held with a diverse group of LA community stakeholders, including healthcare providers, community pharmacists, FBO leaders and other trusted community members, to gather views on the need for and challenges to inclusive trial participation. Ongoing discussions between community representatives and leaders, academics and program staff facilitated outreach and guided development of informational strategies targeting minority groups. Summary of Results: Listening forums (N = 4;20 participants) revealed limited awareness, mistrust and fear stemming from historical and present injustices, and difficulty accessing opportunities as key themes underlying barriers to participation. To address identified barriers, 8 video testimonials featuring participants, investigators, and health advocates (62.5% Black;12.5% Hispanic;50% female) were developed to educate on expectations and experiences, motivations to participate, human subject protections, and the importance of diversity. Two animated videos featuring trusted community leaders and cultural ambassadors (e. g., New Orleans cultural icon, Irma Thomas) were created to explain trial processes, discuss participation benefits, and address the history of racism in medicine. Finally, connections between the Tulane Clinical Translational Unit and rural FQHCs enabled clinical trial study buses to visit and recruit in diverse LA communities. Conclusion(s): Via LA community stakeholder discussions, targeted strategies to address barriers to minority participation in clinical trials were developed and applied. Use of CBPR strategies was critical to developing intentional action reflective of LA community needs. Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
Background: While several studies have explored hospitalization risk factors with the novel coronavirus (COVID-19) infection, the risk of poor outcomes during hospitalization has primarily relied upon laboratory or hospital-acquired data. Our goal was to identify clinical characteristics associated with intubation or death within 7 days of admission. Methods: The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed CoVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median heightfor patients' sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction. Results: Participants had a mean(SD) age 55(17), BMI 30.9(8.2), 55% were male and 80% were ethnic/racial minorities. Unadjusted comparisons by outcome are shown (Table 1). Male sex (aOR: 1.60, 95% CI (1.02, 2.54)), increasing age (aOR: 1.25(1.08, 1.47);per 10 years), higher BMI (aOR 1.03(1.00, 1.06) and poorly controlled diabetes (hemoglobin A1C ≥8) (aOR 2.33(1.27, 4.27) were significantly (p< 0.05) associated with greater odds of intubation or death. Minority status tended to be associated with higher odds (aOR:1.8(1.01,3.36);p=0.052). Surprisingly, need for hospital interpreter was associated with decreased odds (OR: 0.58(0.35, 0.95)) of intubation/death. Our final MCP model included indicators of A1C≥8, age >65, sex and minority status, but predicted intubation/death only slightly better than random chance (AUC= 0.61(0.56, 0.67)). Conclusion: In a hospitalized patient cohort with COVID-19, male sex, poorly controlled diabetes, increasing age and BMI were significantly associated with early intubation or death. These results complement larger cohort studies, and highlight risk differences across metropolitan areas with varying COVID-19 prevalence, demographics, and comorbid disease burden. Notably, our predictive model had limited success, which may suggest unmeasured factors also contribute to disease severity differences.