Justifying the need for a recovery related surveillance system: Exploratory focused interviews.

Background and Aims: No recovery related surveillance system exists but given the evidence of effectiveness and growing supply, a house- and resident- level recovery house (RH) surveillance system could be beneficial for data collection on recovery support service (RSS) engagement, and retention; for improved standardization of RH programs and services; and for identification of outcomes associated with long-term recovery. Methods: This study aimed to explore current data collection practices at the resident- and house- level through qualitative focus interviews of RH representatives. The 13 RH interviews were scheduled with 16 RH representative respondents. Results: The most frequently collected resident data was at entry (92%) and departure (85%) and included demographics (n = 5), substance use history (n = 6), treatment and recovery history (n = 5), legal and correctional history (n = 6) and mental health information (n = 7). Recovery support data was collected by 85% of houses. Post-stay data was only collected by four RHs (31%). Conclusion: These results indicate that there is a lack of standardized systematic collection, analysis, and reporting of recovery related data in the RH field. A recovery related surveillance system has the potential to fill this gap and inform and improve standard of resident care to support long-term recovery from substance use disorder.

Interrupted time series analysis of drug overdose fatalities in service-related industries versus non-service-related industries during the COVID-19 pandemic, 2018-2021.

BACKGROUND: Variation among industries in the association between COVID-19-related closing or reopening orders and drug overdose deaths is unknown. The objectives of this study were to compare drug overdose decedent demographics, annual drug overdose fatality rates and monthly drug overdose fatality rates by specific industry within the service-related industry sector, and to perform an interrupted time series analysis comparing weekly drug overdose mortality counts in service-related and non-service-related industries, examining the COVID-19 pre-pandemic and pandemic phases by Kentucky closing and reopening orders. METHODS: Kentucky drug overdose death certificate and toxicology testing data for years 2018-2021 were analysed using Χ2 and interrupted time series methods. RESULTS: Before the pandemic, annual drug overdose fatality rates in service-related industries were higher than in non-service-related industries. However, these trends reversed during the pandemic. Both service-related and non-service-related industry groups experienced increased fatal drug overdoses at change points associated with the gubernatorial business closure orders, although the magnitude of the increase differed between the two groups. Young, female and black workers in service-related industries had higher frequencies of drug overdose deaths compared with decedents in the non-service-related industries. CONCLUSION: Spikes in drug overdose mortality in both service-related and non-service-related industries during the pandemic highlight the need to consider and include industries and occupations, as well as worker populations vulnerable to infectious diseases, as integral stakeholder groups when developing and implementing drug overdose prevention interventions, and implementing infectious disease surveillance systems.

Identification of work-related injury emergency department visits using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

INTRODUCTION: Emergency department (ED) visit discharge data are a less explored population-based data source used to identify work-related injuries. When using discharge data, work-relatedness is often determined by the expected payer of workers' compensation (WC). In October 2015, healthcare discharge data coding systems transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). ICD-10-CM's structure offers potential new work-related codes to enhance work-related injury surveillance. This study identified work-related ED visits using relevant ICD-10-CM work-related injury codes. Cases identified using this method were compared with those identified using the WC expected payer approach. METHODS: State ED visit discharge data (2016-2019) were analysed using the CDC's discharge data surveillance definition. Injuries were identified using a diagnosis code or an external cause-of-injury code in any field. Injuries were assessed by mechanism and expected payer. Literature searches and manual review of ICD-10-CM codes were conducted to identify possible work-related injury codes. Descriptive statistics were performed and assessed by expected payer. RESULTS: WC was billed for 87 361 injury ED visits from 2016 to 2019. Falls were the most frequent injury mechanism. The 246 ICD-10-CM work-related codes identified 36% more work-related ED injury visits than using WC as the expected payer alone. CONCLUSION: This study identified potential ICD-10-CM codes to expand occupational injury surveillance using discharge data beyond the traditional WC expected payer approach. Further studies are needed to validate the work-related injury codes and support the development of a work-related injury surveillance case definition.

ICD-10-CM-Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study.

OBJECTIVES: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. METHODS: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). RESULTS: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. CONCLUSIONS: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.

Motor vehicle towing: An analysis of injuries in a high-risk yet understudied industry.

OBJECTIVES: National fatality rates for commercial tow truck operators exceed those of other first responders who also perform traffic incident management services. The objectives of the current study are to (1) characterize causal factors associated with injuries among commercial tow truck operators engaged in roadside assistance through analysis of coded and free text data obtained from U.S. Occupational Safety and Health Administration (OSHA) investigation files, and (2) utilize supplemental data sources to analyze environmental factors for injuries in which commercial tow truck operators were struck by roadway traffic. METHODS: Searches of OSHA's online IMIS database were performed to identify investigations of incidents in which tow truck operators were injured while performing roadside assistance duties. Freedom of Information Act (FOIA) requests were submitted to obtain full investigation files for each case. Coded and narrative text analyses were performed to identify causal themes across the identified cases. RESULTS: One-hundred and six cases of tow truck operators being killed or severely injured were identified in IMIS; 41 FOIA requests for related investigation documents were fulfilled. Two major event type themes were identified which accounted for 9 in 10 of the cases identified. These were (1) 'struck-by' incidents, which were primarily injuries resulting from contact with roadway traffic, rolling vehicles and equipment or other non-motorized objects; and (2) 'caught-in or -between' incidents, which were primarily injuries resulting from being pinned beneath and between vehicles and being caught in moving parts. CONCLUSIONS: The towing industry should provide initial and refresher safety training on vehicle loading and unloading, defensive techniques when exposed to traffic on roadways, and proper wheel chocking and braking procedures. States should include tow trucks as a first responder vehicle type in their "Move Over" laws and implement public awareness campaigns to protect all first responders, including tow truck operators.

Enhancing timeliness of drug overdose mortality surveillance: A machine learning approach.

BACKGROUND: Timely data is key to effective public health responses to epidemics. Drug overdose deaths are identified in surveillance systems through ICD-10 codes present on death certificates. ICD-10 coding takes time, but free-text information is available on death certificates prior to ICD-10 coding. The objective of this study was to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance. METHODS: Using 2017-2018 Kentucky death certificate data, free-text fields were tokenized and features were created from these tokens using natural language processing (NLP). Word, bigram, and trigram features were created as well as features indicating the part-of-speech of each word. These features were then used to train machine learning classifiers on 2017 data. The resulting models were tested on 2018 Kentucky data and compared to a simple rule-based classification approach. Documented code for this method is available for reuse and extensions: https://github.com/pjward5656/dcnlp. RESULTS: The top scoring machine learning model achieved 0.96 positive predictive value (PPV) and 0.98 sensitivity for an F-score of 0.97 in identification of fatal drug overdoses on test data. This machine learning model achieved significantly higher performance for sensitivity (p<0.001) than the rule-based approach. Additional feature engineering may improve the model's prediction. This model can be deployed on death certificates as soon as the free-text is available, eliminating the time needed to code the death certificates. CONCLUSION: Machine learning using natural language processing is a relatively new approach in the context of surveillance of health conditions. This method presents an accessible application of machine learning that improves the timeliness of drug overdose mortality surveillance. As such, it can be employed to inform public health responses to the drug overdose epidemic in near-real time as opposed to several weeks following events.

Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose.

PURPOSE OF REVIEW: Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality. RECENT FINDINGS: Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality. SUMMARY: The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation's overdose crisis continues to evolve.

Impact of a Drug Overdose Decedent Toxicology Testing Legislative Mandate on Informing Coroner Death Investigation and Certification Practices.

OBJECTIVE: To (a) determine the impact of Kentucky's (KY's) mandate requiring postmortem toxicology testing of coroner cases; (b) identify the influence of coroner experience and training, jurisdiction size, budget, and location on postmortem testing requests; (c) identify facilitators/barriers for postmortem toxicology testing requests and listing the specific drugs involved in drug-poisoning deaths on death certificates. METHODS: A modified Dillman approach was used to deliver the survey to KY's elected coroners between April and May 2016. Responses stratified by identified influence factors were compared using χ2 tests and Fisher exact tests. RESULTS: Fifty-eight percent of coroners reported that drug overdose investigations had changed since the mandate was enacted. Statistically significant differences in responses were found when stratified. Sixty-three percent of coroners reported always using testing results to complete death certificates. CONCLUSIONS: Uptake of the mandate for postmortem toxicology testing of all decedents is not yet complete. POLICY IMPLICATION: Without uptake of the mandate, surveillance efforts may result in undercounting of drug overdose deaths and the involvement of specific drugs. Mandates for enhanced training and modification of funding structure for medico-legal death investigations could facilitate uptake.

Association between commercial vehicle driver at-fault crashes involving sleepiness/fatigue and proximity to rest areas and truck stops.

INTRODUCTION: There is ongoing concern at the national level about the availability of adequate commercial vehicle rest areas and truck stops for commercial vehicle drivers to rest or to wait for a delivery window. METHODS: A retrospective case-control study was conducted to determine the association between the occurrence of sleepiness/fatigue-related (cases) vs. all other human factor-related commercial vehicle driver at-fault crashes (controls) and proximity to rest areas, weigh stations with rest havens, and truck stops. RESULTS: Commercial vehicle driver at-fault crashes involving sleepiness/fatigue were more likely to occur on roadways where the nearest rest areas/weigh stations with rest havens/truck stops were located 20 miles or more from the commercial vehicle crash site (Odds Ratio [OR]=2.32; Confidence Interval [CI] 1.615, 3.335] for 20-39.9 miles vs. <20 miles; and OR=6.788 [CI 2.112, 21.812] for 40+ miles) compared to commercial vehicle at-fault driver crashes with human factors other than sleepiness/fatigue cited in crash reports. Commercial vehicle driver at-fault crashes involving sleepiness/fatigue also were more likely to occur on parkways compared to interstates (adjusted OR=3.747 [CI 2.83, 4.95]), during nighttime hours (adjusted OR=6.199 [CI 4.733, 8.119]), and on dry pavement (adjusted OR 1.909, [CI 1.373, 2.655]). CONCLUSIONS: The use of statewide crash data analysis coupled with ArcGIS mapping capabilities provided the opportunity to both statistically determine and to visualize the association between rest area/weigh station with rest haven/truck stop distance and the occurrence of commercial vehicle driver at-fault crashes involving sleepiness/fatigue. Implementation and evaluation of commercial vehicle employer policies and interventions such as the use of commercial vehicle driver fatigue alert systems may help to reduce fatigue and sleepiness in commercial vehicle drivers. These results can be used by state and local highway transportation officials to inform and increase truck parking availability, especially on parkways.

Interrupted time series design to evaluate the effect of the ICD-9-CM to ICD-10-CM coding transition on injury hospitalization trends.

BACKGROUND: Implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) in the U.S. on October 1, 2015 was a significant policy change with the potential to affect established injury morbidity trends. This study used data from a single state to demonstrate 1) the use of a statistical method to estimate the effect of this coding transition on injury hospitalization trends, and 2) interpretation of significant changes in injury trends in the context of the structural and conceptual differences between ICD-9-CM and ICD-10-CM, the new ICD-10-CM-specific coding guidelines, and proposed ICD-10-CM-based framework for reporting of injuries by intent and mechanism. Segmented regression analysis was used for statistical modeling of interrupted time series monthly data to evaluate the effect of the transition to ICD-10-CM on Kentucky hospitalizations' external-cause-of-injury completeness (percentage of records with principal injury diagnoses supplemented with external-cause-of-injury codes), as well as injury hospitalization trends by intent or mechanism, January 2012-December 2017. RESULTS: The segmented regression analysis showed an immediate significant drop in external-cause-of-injury completeness during the transition month, but returned to its pre-transition levels in November 2015. There was a significant immediate change in the percentage of injury hospitalizations coded for unintentional (3.34%) and undetermined intent (- 3.39%). There were immediate significant changes in the level of injury hospitalization rates due to poisoning, suffocation, struck by/against, other transportation, unspecified mechanism, and other specified not elsewhere classifiable mechanism. Significant change in slope after the transition (without immediate level change) was identified for assault, firearm, cut/pierce, and motor vehicle traffic injury rates. The observed trend changes reflected structural and conceptual features of ICD-10-CM coding (e.g., poisoning and suffocations are now captured via diagnosis codes only), new coding guidelines (e.g., requiring coding of injury intent as "accidental" if it is unknown or unspecified), and CDC proposed external-cause-of-injury code groupings by injury intent and mechanism. Researchers can replicate this methodology assessing trends in injuries or other ICD-10-CM-coded conditions using administrative billing data sets. CONCLUSIONS: The CDC 's Proposed Framework for Presenting Injury Data Using ICD-10-CM External Cause of Injury Codes provided a logical transition from the ICD-9-CM-based matrix on injury hospitalization trends by intent and mechanism. Our findings are intended to raise awareness that changes in the ICD-10-CM coding system must be understood to assure accurate interpretation of injury trends.

Prevalence of gabapentin in drug overdose postmortem toxicology testing results.

BACKGROUND: The goal of this study was to establish and compare baseline data on the prevalence of gabapentin identified through postmortem toxicology testing among drug overdose decedents in several geographically diverse states/jurisdictions with differing levels of drug overdose fatality burdens in 2015. METHODS: Death certificates and postmortem toxicology result reports from five U.S. jurisdictions were used to identify residents who died from drug overdoses in year 2015 and to calculate prevalence rates of gabapentin in postmortem toxicology by jurisdiction. RESULTS: On average, 22% of all drug overdose decedents in our study tested positive for gabapentin. The percentage of gabapentin-positive overdose deaths varied significantly among jurisdictions: 4% in Northeast Tennessee, 7% in Maricopa County, 15% in West Virginia, 20% in North Carolina, and 41% in Kentucky (p < 0.0001). Among the drug overdose decedents who tested positive for opioids (including heroin), 26% also tested positive for gabapentin, with significant variation among states/jurisdictions (p < 0.0001). There was a significant difference in the gender distribution among drug overdose decedents who tested positive for gabapentin (46% male) vs. those who tested negative for gabapentin (65% male) (p < 0.0001). In Kentucky, gabapentin was listed as a contributing drug on the death certificate in 40% of the overdose deaths with gabapentin-positive toxicology; in North Carolina this percentage was 57%. CONCLUSIONS: Routine gabapentin postmortem testing and linking of death certificate, medical examiner, coroner, toxicology, and prescription history data will provide more reliable information on the extent of gabapentin misuse, diversion, and implications for clinical care.

Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices.

BACKGROUND: According to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population. OBJECTIVE: The elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS). METHODS: DOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths. RESULTS: DOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013-2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids. CONCLUSIONS: A comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.

Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance.

BACKGROUND: The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS: The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. RESULTS: Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. CONCLUSIONS: The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Narrative and quantitative analyses of workers' compensation-covered injuries in short-haul vs. long-haul trucking.

Trucking remains one of the most dangerous industries in the U.S. Study aims were to (1) identify differences in worker injury types; (2) describer typical injury scenarios; and (3) recommend injury control measures, in short-haul vs. long-haul trucking. Narrative text analyses of Kentucky short-haul and long-haul trucking workers' compensation first reports of injury were performed. A higher percentage of lifting and cranking injuries were identified in short-haul trucking compared with long-haul trucking that had a higher percentage of securing/opening/closing/adjusting injuries that involved tarping, trailer door handling, and cab slippage. In contrast, a higher proportion of short-haul trucking injury scenarios involved roadway departures and rear-end collisions. Study findings can be used to inform intrastate vs. interstate trucking injury prevention control strategies such as an enhanced driver safety training and safe freight handling in short-haul trucking, and tarping, trailer safety, and cab safety in long-haul trucking.

Healthcare Industry Injuries by Patient Contact Status in Kentucky, 2012-2014.

OBJECTIVES: The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to characterize healthcare industry injuries by patient contact status, identify the occupations associated with healthcare injuries by patient contact status, and determine healthcare injury rates by occupation to gain a better understanding of healthcare industry-compensated injuries and better target safety practices and programs in the healthcare industry. METHODS: Kentucky healthcare industry workers' compensation first reports of injuries from calendar years 2012-2014 were categorized into injuries involved in direct patient contact versus injuries without direct patient contact using narrative text analysis. Injury numbers and rates were calculated for a number of data variables. RESULTS: Healthcare injuries without direct patient contact (55% of all first reports of injuries) occurred more frequently among older workers (45 years old and older [51%]), in "other" occupations such as housekeeping and maintenance (28%), and as a result of falls/slips/trips (39%) and sprains/tears (38%). In contrast, a higher percentage of healthcare injuries involving direct patient contact occurred among workers younger than 35 years (48%), in healthcare support occupations (50%), and resulting from sprains/tears (66%) and lifting/handling (52%), compared with those without direct patient contact. CONCLUSIONS: Findings from this study can better target the need for new and/or additional specific workplace safety training, especially in the healthcare support and nursing occupations with and without patient contact.

Newborn Congenital Malformations Associated With Prenatal Exposure to Drugs in Kentucky, 2009-2013.

OBJECTIVES: This study examined associations between prenatal drug exposures and congenital organ system malformation diagnoses in newborns (at birth) and infants (hospitalizations after birth up to 30 days of age) in Kentucky. METHODS: Data were obtained from Kentucky inpatient hospitalization records for newborns and for infants from 2009 to 2013. Prenatal drug exposures and congenital anomalies were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes for prenatal drug exposures (760.70-760.79; 304; 779.5) and congenital anomalies (740-759). Descriptive analyses and logistic regression were performed. RESULTS: Neonatal abstinence syndrome was the most frequent prenatal drug exposure-related diagnosis in newborns (1%). Cardiac and circulatory malformation diagnoses were significantly elevated in newborns prenatally exposed to drugs compared with cardiac and circulatory malformation diagnoses in newborns with no prenatal drug exposures (P < 0.0001); genital and urinary anomalies also were significantly elevated among newborns with prenatal drug exposures (P < 0.05). Newborns and infants diagnosed as having congenital malformations who were prenatally exposed to drugs had significantly extended hospitalization stays and higher total hospitalization charges compared with newborns and infants diagnosed as having congenital malformations who were not prenatally exposed to drugs (P < 0.0001). CONCLUSIONS: Further research is needed to identify specific risk factors (eg, drug classes, tobacco) and toxicities (eg, intake amount, frequency of intake, drug metabolism) associated with congenital malformation diagnoses following prenatal exposure to drugs.

Patterns of pneumoconiosis mortality in Kentucky: Analysis of death certificate data.

BACKGROUND: Mortality rates associated with total pneumoconiosis, including coal worker's pneumoconiosis (CWP), have remained elevated. METHODS: 2003-2013 pneumoconiosis mortality data obtained from National Center for Health Statistics and 2011-2013 Kentucky death certificates were analyzed. RESULTS: Total pneumoconiosis mortality rates showed significant linear decreases in West Virginia, Pennsylvania, Kentucky, and the U.S. from 2003 to 2013; Pennsylvania and Kentucky had comparable rates in 2003 but while Pennsylvania rates significantly decreased ∼3.0 deaths/million annually, Kentucky rates decreased only 0.5/million annually. Kentucky and Pennsylvania CWP fatality rates were also comparable in 2003 but while Pennsylvania rates decreased 82% over the study period, Kentucky rates decreased only 26%. Kentucky pneumoconiosis deaths primarily occurred in white Appalachian males in-hospital. Diseases leading to pneumoconiosis death were largely respiratory and cardiovascular, with autopsies rarely performed. CONCLUSIONS: Coal worker environmental exposure protection should be enhanced and pneumoconiosis surveillance improvements, including enhanced management of comorbid conditions like COPD, should be considered.

Work-related concussion surveillance.

BACKGROUND: The goal of this study was to use multiple state-based data sources (emergency department [ED] visits, hospital discharge [HD] data, and workers' compensation [WC] data) to estimate the 2011 work-related concussion injury rate in Kentucky. METHODS: Deterministic data linkages between the 2011 WC data and ED/HD data were performed. Annual crude rates of work-related concussions per 100,000 employed civilians age 16 years or older were reported. RESULTS: Using the three data sources, the 2011 work-related concussion crude rate was 31.8/100,000, higher for men (38.8/100,000) than for women (24.1/100,000). The use of WC data alone resulted in an estimated rate of only 11.7/100,000. ED data utilization alone resulted in a rate of 21.7/100,000. CONCLUSION: This study's primary recommendation is to use WC, ED, and HD data on a routine basis as part of multiple data source surveillance for work-related concussion injuries.

Drug overdose surveillance using hospital discharge data.

OBJECTIVES: We compared three methods for identifying drug overdose cases in inpatient hospital discharge data on their ability to classify drug overdoses by intent and drug type(s) involved. METHODS: We compared three International Classification of Diseases, Ninth Revision, Clinical Modification code-based case definitions using Kentucky hospital discharge data for 2000-2011. The first definition (Definition 1) was based on the external-cause-of-injury (E-code) matrix. The other two definitions were based on the Injury Surveillance Workgroup on Poisoning (ISW7) consensus recommendations for national and state poisoning surveillance using the principal diagnosis or first E-code (Definition 2) or any diagnosis/E-code (Definition 3). RESULTS: Definition 3 identified almost 50% more drug overdose cases than did Definition 1. The increase was largely due to cases with a first-listed E-code describing a drug overdose but a principal diagnosis that was different from drug overdose (e.g., mental disorders, or respiratory or circulatory system failure). Regardless of the definition, more than 53% of the hospitalizations were self-inflicted drug overdoses; benzodiazepines were involved in about 30% of the hospitalizations. The 2011 age-adjusted drug overdose hospitalization rate in Kentucky was 146/100,000 population using Definition 3 and 107/100,000 population using Definition 1. CONCLUSION: The ISW7 drug overdose definition using any drug poisoning diagnosis/E-code (Definition 3) is potentially the highest sensitivity definition for counting drug overdose hospitalizations, including by intent and drug type(s) involved. As the states enact policies and plan for adequate treatment resources, standardized drug overdose definitions are critical for accurate reporting, trend analysis, policy evaluation, and state-to-state comparison.