Tracking Trends in the Opioid Epidemic in North Carolina : Early Results from the Opioid Action Plan Metrics.

BACKGROUND Deaths from unintentional opioid overdose have increased markedly over the last decade in North Carolina. In 2017 the state created a North Carolina Opioid Action Plan, which laid out a multisectoral response to the crisis that included the medical community, law enforcement, emergency medical services, and treatment professionals. It also created a website providing county-level data associated with the crisis. Using this publicly available data, we examine trends and associations between opioid-related mortality and strategies to reduce opioid prescriptions, reduce fatality of overdose, and improve treatment and recovery.METHOD We examine yearly trends from 2010-2017 for statewide unintentional opioid-related death rates, prescription of opioid pills, buprenorphine prescription rates, naloxone administrations, and number of Certified Peer Support Specialists. We compare recent opioid-related death rates for 2015-2017 with an earlier period (2010-2012) at the county level, and examine the association between death rates and rates of the supply, treatment, and recovery metrics.RESULTS Trends for all metrics increased from 2010-2017, although the number of opioid pills per capita has declined since 2015. Between 2010 and 2017, 84 of the state's 100 counties experienced an increase in opioid-related mortality. County-level mortality was positively associated with opioid prescription rate (r = +0.12, P = 0.24) and with naloxone administrations (r = +0.20, P = 0.05). Prescription of buprenorphine was associated with a reduction in opioid mortality (r = -0.27, P = 0.01). The effect of Certified Peer Support Specialists was not discernable.LIMITATIONS Data are available for only eight years and aggregated at the county level. Mortality data are based on death certificates using ICD-10 codes from the North Carolina State Center for Health Statistics, Vital Statistics, which may not capture all opioid-related fatalities. Drug-related deaths may involve multiple non-opioid substances; in addition, determining the intent of the deceased individual may be difficult (suicide versus unintentional). Naloxone administration data only includes data from emergency medical services, not community-administered naloxone, because that data was only available for 2013 and later and is based only on self-reports.CONCLUSIONS The potential efficacy of buprenorphine is promising and should be further explored. All interventions should be monitored.

Increased Mortality and Health Risk Behaviors of Midlife White North Carolinians: A Marked Contrast to Nonwhites.

BACKGROUND Death rates for white, middle-aged Americans are increasing after decades of steady decline. In this paper, mortality and health behavior trends are examined for midlife North Carolinians.METHODS Mortality rates were calculated for midlife whites from 2000 to 2013 for the state as a whole and in counties grouped by level of economic distress. Trend lines were used to estimate future death rates, and comparisons were made to rates for nonwhites. Current and past health risk behaviors were also analyzed.RESULTS The all-cause mortality rate for midlife whites in North Carolina was higher than the 2000 base in 11 of 13 years; white midlife mortality increased by 5.9%. In contrast, nonwhite mortality decreased by 30.6%. By 2020, midlife mortality for whites is predicted to increase by 9.1%; for nonwhites, there is a predicted decrease of 47.2%. Midlife white mortality increased most in economically distressed counties. Major contributors were suicide and liver disease. Risk factors that increased were drinking, obesity, and lack of health insurance.LIMITATIONS Mortality and risk factor data could not be analayzed by ethnicity. Deaths due to drug and alcohol poisoning were not included.CONCLUSIONS The statewide mortality rate for midlife whites in North Carolina is increasing and is in marked contrast to the decreasing rate for nonwhites. The racial disparity in this metric is likely to be eliminated by 2020, perhaps even reversed. Midlife white mortality increased most dramatically in the state's poorest counties. Policymakers should consider links between economic issues and health behaviors involved in midlife mortality and why they may affect whites and nonwhites differently.

Oral Health in North Carolina: Relationship With General Health and Behavioral Risk Factors.

BACKGROUND: Oral health is an integral part of general health, and loss of teeth may affect both physical and mental health. We examined how an individual's perception of his or her general health is related to oral care and loss of teeth, as well as how socioeconomic and behavioral factors are related to loss of teeth and oral care. METHODS: Logistic regression was used to analyze data from the North Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey to investigate how oral health relates to general health. We examined the effects of loss of teeth and recency of dental clinic visits on perceived general health; we also examined the effects of demographic characteristics and health-related behavioral risk factors on oral health. RESULTS: Adults who had lost 6 or more teeth were more likely to report poor or fair general health, especially among those who were younger than 65 years (adjusted odds ratio = 3.59) compared to those who were 65 years or older (adjusted odds ratio = 1.87). Those who had not visited a dentist within the past year, those who had less education, those with lower incomes, and smokers were more likely to have lost 6 or more teeth. LIMITATIONS: BRFSS is a large-scale survey that collects self-reported data using random telephone methods; during the years included in this analysis, the sample included only households with landline phones that answered the survey. The measure of general health is subjective. As the BRFSS survey is a cross-sectional survey, causal relationships cannot be established. CONCLUSIONS: Loss of teeth and poor oral care are significant predictors of poor general health, indicating that oral health and oral care are integral parts of general health. Loss of teeth and oral care are affected by demographic factors such as educational attainment, income, and health-related risk factors.

Premature mortality in North Carolina: progress, regress, and disparities by county and race, 2000-2010.

BACKGROUND: This study examined trends in premature mortality--defined as years of potential life lost before age 75 years--in North Carolina during the period 2000-2010. METHODS: Premature mortality at the county level was calculated and compared for two 5-year periods (1996-2000 and 2006-2010) for the entire population, among whites, and among nonwhites. This study also examined and compared leading causes of death that contributed to premature mortality among whites and nonwhites in each county and in the state as a whole. RESULTS: Premature mortality in North Carolina was reduced 13.3% for the population as a whole, 26.6% for nonwhites, and 7.2% for whites. However, premature mortality actually increased for the population as a whole in 20 counties, among whites in 35 counties, and among nonwhites in 8 counties. Among whites, chronic obstructive pulmonary disease, suicide, injuries, and motor vehicle crashes each contributed an above-average share of premature mortality. Among nonwhites, stroke, diabetes, homicide, and heart disease each contributed an above-average share of premature mortality. LIMITATIONS: We were unable to calculate reliable rates of premature mortality for Hispanics, Asians, American Indians, and other nonwhite ethnic groups because the numbers at the county level were too small. CONCLUSIONS: Public health professionals should focus attention on counties in which premature mortality is increasing or remaining constant and should address the specific underlying causes of such deaths. In counties in which premature mortality among whites is increasing, community health efforts should focus on prevention of smoking, suicide, and injury. In counties with large nonwhite populations, programs should focus on prevention of stroke, heart disease, diabetes, homicide, and kidney disease.

Beyond the BMI: the search for better guidelines for bariatric surgery.

The application of the BMI of > or =35 as the major prerequisite for access to bariatric surgery is no longer appropriate because the index, now incorporated in the requirements of Medicare, Medicaid and most private carriers, does not reflect the degree or distribution of adiposity, it discriminates unfairly on the basis of gender, race, age, fitness, and body fat composition. Further, with increasing evidence that bariatric surgery can also induce full and durable remission of such comorbidities as type 2 diabetes even in patients with BMIs <30, new guidelines must be pursued.

Disparities in motor vehicle crash fatalities of young drivers in North Carolina.

BACKGROUND: Motor vehicle crashes (MVCs) are the leading cause of death for young people, but rates based on the general population do not account for differences in risk across groups as proportions of people driving vary. We examine disparities in MVC death rates for various demographic groups based on numbers of drivers in each group. METHODS: North Carolina driver license holders 16 through 24 years of age are determined. Fatality rates per population and per licensed driver are calculated and compared by age, gender, race/ethnicity, and region. RESULTS: Proportions of individuals holding a license vary substantially by age, race/ethnicity, and region. Eighty-three percent of young Whites hold licenses compared to 68% of Hispanics, 55% of African Americans, and 52% of Native Americans. Substantial disparities in fatality by race/ethnicity and age exist using a rate per licensed driver. In younger age groups, fatality rates per licensed drivers are much greater than rates per population: 300%, 200%, 50%, and 25% greater for 16, 17, 18, and 19-year-olds, respectively. African Americans have the lowest fatality rate per population, but their rate per driver is equal to that of Whites. The rate for Native Americans is 2.2 times greater than Whites; for Hispanics, 1.5 times greater. Disparities are 20%-60% greater when rates per driver are used. LIMITATIONS: Potential misspecification of race and ethnicity in records, inability to count unlicensed drivers, and exclusion of those with learner's permits may unequally bias rates across subgroups. CONCLUSIONS: Significant disparities are revealed using a rate based on number of drivers. Policy makers and physicians should tailor prevention efforts accordingly.

Beliefs about and responses to childhood ear infections: a study of parents in eastern North Carolina.

Middle ear infection, also known as otitis media (OM), is a major public health problem among American children. Although clinical and epidemiological aspects of OM have been intensely studied, cultural factors that may be contributing to the problem of OM have received less attention. This article presents findings from an ethnographic study exploring beliefs about OM and responses to the illness among parents from eastern North Carolina. In-depth interviews were conducted with a convenience sample of nine mothers in order to learn more about parents' explanatory models of OM, the source of their beliefs, and how they respond to the illness. A survey instrument based on their statements was then constructed and administered to a convenience sample of 79 parents. The survey consisted of belief statements about OM, as well as questions pertaining to sources of beliefs, the home management of the disease, and the effects of the illness on families. A cultural consensus analysis of responses to belief statements indicates that parents shared a common model of OM. Beliefs about risks, symptoms, and causes of OM were similar to the current biomedical model of the illness, but their divergent beliefs about the diagnosis, prognosis and treatment of OM could lead to unnecessary use of health care services. Clinicians, family, and friends were reported to be important sources of information about OM. Parents also reported using similar home management strategies and care seeking behaviors to minimize the impact of the illness on their children and families. While these findings need to be replicated in studies with larger, more representative samples, this study suggest that ethnographic approaches may provide new insights into the cultural dimension of the problem of OM.

The doctor as God's mechanic? Beliefs in the Southeastern United States.

Spiritual practice and beliefs related to healing are described using data from a telephone survey. Questions in the survey address the practice of prayer and spiritual beliefs related to healing. Questions explore belief in miracles, that God acts through religious healers, the importance of God's will in healing, and that God acts through physicians. Questions also ask whether people discuss spiritual concerns with their physician and whether they would want to if seriously ill. We create a composite index to compare religious faith in healing across race, gender, education, income denomination, and health status. Logistic regression predicts types of patients who believe God acts through physicians and those inclined to discuss spiritual concerns when ill. The most important findings are that: 80% of respondents believe God acts through physicians to cure illness, 40% believe God's will is the most important factor in recovery, and spiritual faith in healing is stronger among women. African-Americans, Evangelical Protestants, the poorer, sicker, and less educated. Those who believe that God acts through physicians are more likely to be African-American than White (OR = 1.9) and 55 or older (OR = 3.5). Those who discuss spiritual concerns with a physician are more likely to be female (OR = 1.9) and in poor health (OR = 2.1). Although 69% say they would want to speak to someone about spiritual concerns if seriously ill, only 3% would choose to speak to a physician. We conclude that religious faith in healing is prevalent and strong in the southern United States and that most people believe that God acts through doctors. Knowledge of the phenomena and variation across the population can guide inquiry into the spiritual concerns of patients.