Psychological distress and the risk of drug overdose death.

BACKGROUND: Previous research has shown an association between psychological distress and overdose death among specific populations. However, few studies have examined this relationship in a large US population-based cohort. METHODS: Data from the 2010-2018 NHIS were linked to mortality data from the National Death Index through 2019. Psychological distress was measured using the Kessler 6 scale. Drug overdose deaths were examined, and deaths from all other causes were included as a comparison group. Cox proportional hazards regression was used to estimate mortality risk by psychological distress level. RESULTS: The study population included 272,561 adults. Adjusting for demographic covariates and using no psychological distress as the reference, distress level was positively associated with the risk of overdose death: low (HR = 1.8, 95 % CI = 1.1-2.8), moderate (HR = 4.1, 95 % CI = 2.5-6.7), high (HR = 10.3, 95 % CI = 6.5-16.1). A similar pattern was observed for deaths from all other causes: low (HR = 1.2, 95 % CI = 1.1-1.2), moderate (HR = 1.9, 95 % CI = 1.7-2.0), high (HR = 2.6, 95 % CI = 2.4-2.8). LIMITATIONS: Limited substance use information prevented adjustment for this potentially important covariate. DISCUSSION: Adults with psychological distress were at greater risk of drug overdose death, relative to those without psychological distress. Adults with psychological distress were also at increased risk of death due to other causes, though the association was not as strong.

Proposed ICD-10-CM Surveillance Case Definitions for Injury Hospitalizations and Emergency Department Visits.

This report describes a collaboration between the National Center for Health Statistics and the National Center for Injury Prevention and Control to develop proposed surveillance case definitions for injury hospitalizations and emergency department (ED) visits for use with administrative data sets coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The proposed ICD-10-CM surveillance case definitions were developed by applying General Equivalence Mappings to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) definitions. As with the ICD-9-CM definitions, there are slight differences between the proposed ICD-10-CM surveillance case definition for injury hospitalizations and the one for ED visits. The inclusion criteria for an injury hospitalization requires a case to have a principal diagnosis of one of the included nature-of-injury (injury diagnosis) codes. The inclusion criteria for an injury ED visit requires the case to have either a principal diagnosis of one of the included nature-of-injury codes or the presence of selected external-cause codes. The ICD-10-CM nature-of-injury and external-cause codes included in the proposed definitions are presented and caveats for use of the proposed definitions are described.

Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later.

BACKGROUND: We conducted a comprehensive analysis of the epidemiology of trauma deaths in our urban county during a one-year period a decade ago. In the interim we have implemented a statewide trauma system, initiated a number of injury-prevention programs, and have had a major public effort to reduce drug traffic and related gangs. Consequently, we have reassessed the regional trauma mortality to ascertain the impact of these measures and to search for new injury patterns. METHODS: Trauma deaths occurring within our urban county from January 1 through December 31, 2002 were reviewed for mechanism, demographics, and cause of fatal injury; cases were identified using death certificates from the Colorado Department of Public Health. We compared these data to the trauma fatalities occurring during 1992. RESULTS: During the 2002 study period, there were 420 injury-related deaths. Most of the patients were men (296 patients, 70%), with a mean age of 47.3 years (median age, 42 years). The three predominant mechanisms of fatal injury were transport-related (180 patients, 43%), intentional (99 patients, 24%), and falls (86 patients, 20%). Comparison between 1992 and 2002 showed significant increases in the percentage of transport-related and fall-related deaths, and a significant reduction in intentional fatal injuries. There was also a shift in the percentage of deaths occurring in the first 24 h to delayed times. The death rate per capita in Denver County declined from 0.081 in 1992 to 0.060 in 2002. CONCLUSIONS: Along with a decrease in the per capita death rate, the major mechanisms of patient's deaths changed substantively over the decade 1992-2002; there was a shift from intentional injuries to transport-related deaths as the predominant etiology of trauma related deaths. Recognition of such injury patterns will direct future injury-prevention efforts and coordination of citywide trauma care.