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.

Evaluating the cause-of-death information needed for estimating the burden of injury mortality: United States, 2019.

Objectives-This study evaluated the quality of the causeof-death information on death certificates for injury deaths, by determining the percentage of deaths for which the underlying cause was a nonspecific injury mechanism.

Urban-rural Differences in Unintentional Injury Death Rates Among Children Aged 0-17 Years: United States, 2018-2019.

Unintentional injuries are the leading cause of death among children aged 0-17 years (1). In 2018-2019, 14% of children in the United States aged 0-17 years resided in rural areas but accounted 24% of all childhood injury deaths (1). Urban-rural differences in injury mortality have been associated with a variety of factors, including differences in types of activities, use of safety equipment, practice of safety-related behaviors, built environments, and access to care (2-9). This report presents rates of unintentional injury death among children aged 0-17 for 2018-2019, highlighting the differences in rates by mechanism of injury and urban-rural status.

A Revised ICD-10-CM Surveillance Case Definition for Injury-related Emergency Department Visits.

Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition.

Unintentional Drowning Deaths Among Children Aged 0-17 Years: United States, 1999-2019.

Drowning deaths are the second leading cause of unintentional injury deaths for children aged 0-17 years and the leading cause for those aged 1-4 (1). Previous studies using national data have shown that unintentional drowning deaths can differ by sex, age, race and ethnicity, and urban-rural category (2,3). This report uses the latest mortality data from the National Vital Statistics System (NVSS) to present national trends in unintentional drowning death rates from 1999 through 2019 for children aged 0-17.

Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants.

Deaths from drug overdose continue to contribute to the public health burden in the United States (1). The increase in the rate of drug overdose deaths involving cocaine and psychostimulants has been well-documented in recent years (1-4). This NCHS Data Brief provides additional information on drug overdose deaths involving cocaine and other psychostimulants (drugs such as methamphetamine, amphetamine, and methylphenidate) by examining the concurrent involvement of opioids. Trends from 2009 through 2019 and differences by census region in 2019 are presented.

Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019.

Drug overdose death rates continue to rise in the United States (1-3), with significant urban-rural differences in rates by sex, age, and types of drugs involved (4). This report uses the most recent mortality data from the National Vital Statistics System (NVSS) to examine urban-rural differences in drug overdose death rates for all drugs and by selected types of opioids and stimula.

Suicide Mortality in the United States, 1999-2019.

In 2019, suicide was the 10th leading cause of death for all ages in the United States (1). As the second leading cause of death for ages 10-34 and the fourth leading cause for ages 35-54, suicide is a major contributor to premature mortality (2). Recent reports have documented a steady increase in suicide rates over the past two decades (3-6). This Data Brief uses final mortality data from the National Vital Statistics System to update trends in suicide rates from 1999 through 2019 and to describe differences by sex, age group, and means of suicide.

Drug Overdose Deaths in the United States, 1999-2020.

Deaths from drug overdose continue to contribute to overall mortality and the lowering of life expectancy in the United States (1-4). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, showing rates by demographic group and by specific types of drugs involved (such as opioids or stimulants), with a focus on changes from 2019 to 2020.

Rates of Alcohol-induced Deaths Among Adults Aged 25 and Over in Urban and Rural Areas: United States, 2000-2018.

Excessive alcohol consumption is a well-known risk factor for mortality and has been causally linked to many diseases, conditions and injuries, including alcohol-attributable cancer, liver cirrhosis, and alcohol poisonings (1). Alcohol-induced deaths, or deaths from dependent and nondependent use of alcohol, as well as accidental poisoning by alcohol (2), have been increasing in the United States since 1999 with differences by sex, age, urban-rural classification, and other demographic characteristics (3,4). This Data Brief focuses on alcohol-induced deaths among adults aged 25 and over, which account for more than 99% of the alcohol-induced deaths in the United States. The report presents trends from 2000 through 2018 by sex and urbanization level of county of residence.

Increase in Drug Overdose Deaths Involving Cocaine: United States, 2009-2018.

Deaths from drug overdose continue to contribute to mortality in the United States. The rate of drug overdose deaths involving cocaine has increased in recent years (1-3). This Data Brief provides additional information on drug overdose deaths involving cocaine by examining trends in rates by sex, age group, race and Hispanic origin, and by concurrent involvement of opioids from 2009 through 2018. Rates by urbanicity and census region in 2018 are also examined.

National Hospital Care Survey Demonstration Projects: Opioid-involved Emergency Department Visits, Hospitalizations, and Deaths.

Objective-This report demonstrates the utility of linking the restricted-use 2014 National Hospital Care Survey (NHCS), 2014-2015 National Death Index (NDI), and 2014-2015 Drug-Involved Mortality (DIM) data to study opioid-involved emergency department (ED) visits, hospitalizations, and mortality within 1 year post-discharge. Example research questions and unweighted results are presented. Results are not nationally representative. Methods-Patient records from the 2014 NHCS with sufficient identifying information were linked to the 2014-2015 NDI and DIM data. Visits were considered opioid-involved if they had International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 304.00-304.02, 304.70-304.72, 305.50-305.52, 760.72, 965.00-965.02, 965.09, 970.1, or E850.0-E850.2 in any diagnosis or external cause of injury code field. Opioid-involved drug overdose deaths were deaths with an International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death code of X40-44, X60-64, X85, or Y10-Y14 and a multiple cause code of T40.0-T40.4 or T40.6. Results-In the 2014 NHCS, there were 15,495 patients with an opioid-involved ED-only visit and 24,059 patients with an opioid-involved hospitalization. Of the 20,962 patients with an opioid-involved hospitalization eligible to be linked to NDI, 1,805 died (9%) within 1 year of discharge. Of these deaths, 341 (19%) resulted from a drug overdose. Of drug overdose deaths, 243 (71%) involved an opioid, where 12% died within 30 days post-discharge, 19% within 31-90 days, and 69% within 91-365 days. Opioids most frequently mentioned included heroin (46%), fentanyl (20%), oxycodone (13%), methadone (12%), and morphine (12%). These categories are not mutually exclusive because a death may involve more than one drug. For approximately 22% of patients who died of an opioid-involved drug overdose in 2014, their last ED-only visit or hospitalization was opioid-involved. Conclusion-While the NHCS data are not nationally representative, these unlinked and linked National Center for Health Statistics data allow for exploratory analyses of ED visits, hospitalizations, and associated mortality outcomes.

Drug Overdose Deaths in the United States, 1999-2018.

Deaths from drug overdose continue to contribute to mortality in the United States (1-5). This report uses the most recent data from the National Vital Statistics System (NVSS) to update trends in drug overdose deaths for all drugs and for specific drugs and drug types, and to identify changes in rates by state from 2017 to 2018.

Increase in Suicide Mortality in the United States, 1999-2018.

Suicide is the 10th leading cause of death for all ages in the United States (1). Suicide is a major contributor to premature mortality as it ranks as the second leading cause of death for ages 10-34 and the fourth leading cause for ages 35-54 (1). Despite national goals to lower the suicide rate (2), several recent reports have documented a steady increase in suicide rates in recent years (3-6). This data brief uses final mortality data from the National Vital Statistics System (NVSS) to update trends in suicide rates from 1999 through 2018 and to describe differences by sex, age group, and urbanicity of county of residence.

Drug Overdose Deaths in the United States, 1999-2019.

Deaths from drug overdose continue to be a public health burden in the United States (1-5). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, including information on trends from 1999 through 2019 by sex and age group, and by specific types of drugs involved (i.e., opioids and stimulants).

The 2020 International Classification of Diseases, 10th Revision, Clinical Modification Injury Diagnosis Framework for Categorizing Injuries by Body Region and Nature of Injury.

Background-Injury diagnosis frameworks, or matrices, based on the International Classification of Diseases (ICD) provide standardized categories for reporting injuries by body region and nature of injury. In 2016, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed injury diagnosis matrix for use with data coded using the ICD, 10th Revision, Clinical Modification (ICD-10-CM). At the time the proposed matrix was developed, ICD-10-CM coded data were not available to evaluate the performance of the proposed matrix. As data became available, NCHS and NCIPC received recommendations from clinicians and researchers to improve the consistency and clinical applicability of categorization of codes within the matrix. This report describes the modifications made to the 2016 proposed ICD-10-CM injury diagnosis matrix and presents the final 2020 ICD-10-CM injury diagnosis matrix. Methods-Comments on the 2016 proposed matrix were received from several federal agencies, military health centers, state health departments, researchers, and others. Additionally, subject matter experts from NCHS, NCIPC, the Council of State and Territorial Epidemiologists, and others reviewed code descriptions, coding guidelines, updates to the ICD-10-CM code set, and other materials to identify possible needed changes to the 2016 proposed ICD-10-CM injury diagnosis matrix. Results-Consideration of issues raised by clinicians and researchers and from the internal review resulted in relocation of approximately 3% of the 9,000 codes in the 2016 proposed ICD-10-CM injury diagnosis matrix. These relocations generally involved changes to the assigned nature-of-injury category. Additionally, approximately 200 new injury diagnosis codes not available at the time the 2016 proposed matrix was developed were added to create the final 2020 matrix. Conclusions-The 2020 final ICD-10-CM injury diagnosis matrix provides standard categories for reporting injuries by body region and nature of injury. Use of this tool promotes consistency for comparisons across populations and over time.

An Updated International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Surveillance Case Definition for Injury Hospitalizations.

The National Center for Health Statistics (NCHS) and National Center for Injury Prevention and Control (NCIPC) have routinely collaborated with injury epidemiology partners to develop standard injury surveillance case definitions based on the International Classification of Diseases (ICD). With the transition in October 2015 to the use of the ICD, 10th Revision, Clinical Modification (ICD-10-CM) for reporting medical information in administrative claims data, NCHS and NCIPC proposed an ICD-10-CM surveillance case definition for injury hospitalizations. At the time, ICD-10-CM coded data were not readily available, and the proposed surveillance definition could not be tested using real data. As ICD-10-CM coded data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists, injury epidemiologists from state and local health departments, and the Agency for Healthcare Research and Quality to test the proposed definition. This report summarizes the findings from the testing process and describes how the findings were used to update the proposed case definition. In the updated ICD-10-CM surveillance case definition, injury hospitalizations are identified as hospitalization records with a principal diagnosis of select ICD-10-CM S, T, O, and M codes. The codes must indicate an initial encounter for active treatment of an injury or be missing encounter type information. The selection criteria exclude hospitalization records with an injury as a secondary or subsequent diagnosis (not the principal diagnosis) or that have an external cause-of-injury code but do not have an injury code as the principal diagnosis. The updated ICD-10-CM surveillance case definition for injury hospitalizations provides standardized selection criteria for monitoring differences in hospitalization rates among populations and over time.

Urban-rural Differences in Drug Overdose Death Rates, by Sex, Age, and Type of Drugs Involved, 2017.

Drug overdose deaths remain a significant public health concern in the United States (1-3). This report uses the most recent data from the National Vital Statistics System (NVSS) to examine urban-rural differences in drug overdose death rates by sex, age group, and the type of drugs involved.