Buprenorphine utilization among all Washington State residents' based upon prescription monitoring program data - Characteristics associated with two measures of retention and patterns of care over time.

BACKGROUND: Opioid use disorder is a serious health condition for which buprenorphine is proven effective, yet providers substantially underutilize buprenorphine. We present two approaches to measuring treatment duration, factors associated with retention, and patterns of care. METHODS: The study determined incident buprenorphine prescribing for all Washingtonians utilizing prescription monitoring program data from 2012 to 2019. The study calculated episode of care and cumulative time in care. Generalized linear models estimated associations among the length of the first episode of care and cumulative time in care with sex, age, and rurality. Cox proportional hazards models estimated the time to discontinuing buprenorphine for the first four episodes of care and time to discontinuing the last episode of care. RESULTS: Mean and median duration of the first episode were 320 and 84 days, respectively, and for cumulative time in care 308 and 195 days. A minority of peoples' first episodes exceeded 180 days (37%). Being female and older were significantly associated with longer first episodes and cumulative time in care. Survival analyses indicated that the proportion of those still in care at 6, 12, and 24 months into their first episode of care declined for those with more than one episode of care; conversely the study found much smaller differences in retention for the last episode of care, indicating that many people were eventually able to be retained in care for longer periods of time. CONCLUSION: Episodes of care and cumulative time on buprenorphine were both short compared to minimum quality recommendations of 180 days. Median cumulative time in care was double that of the first episode, highlighting that many people engage in subsequent episodes of substantial length. Episode of care and cumulative care analyses should inform states, payers, health care systems and providers in measuring and setting treatment duration goals.

Volatile substance misuse deaths in Washington State, 2003-2012.

BACKGROUND: Volatile substance misuse (VSM - also known as huffing or sniffing) causes some deaths, but because there are no specific cause-of-death codes for VSM, these deaths are rarely tabulated. OBJECTIVES: Count and describe VSM deaths occurring in Washington State during 2003-2012. METHODS: We used the textual cause-of-death information on death certificates to count VSM-associated deaths that occurred in Washington State during 2003-2012. We extracted records that contained words suggesting either a method of inhalation or a substance commonly used for VSM, and reviewed those records to identify deaths on which the inhalation of a volatile substance was mentioned. We conducted a descriptive analysis of those deaths. RESULTS: Fifty-six deaths involving VSM occurred in Washington State during 2003-2012. VSM deaths occurred primarily among adults age 20 and over (91%), males (88%), and whites (93%). Twelve different chemicals were associated with deaths, but 1 of them, difluoroethane, was named on 30 death certificates (54%), and its involvement increased during the study period. Gas duster products were named as the source of difluoroethane for 12 deaths; no source was named for the other 18 difluoroethane deaths. CONCLUSIONS: Most VSM deaths occurred among white male adults, and gas duster products containing difluoroethane were the primary source of inhalants. Approaches to deter VSM, such as the addition of bitterants to gas dusters, should be explored.

Crash fatality and vehicle incompatibility in collisions between cars and light trucks or vans.

BACKGROUND: In crashes between a car and a light truck or van (LTV), car occupants are more likely to be killed than LTV occupants. The extent this is due to the greater harm imposed by LTVs on cars or the greater protection they offer their own occupants is not known. METHODS: We conducted a case-control study of collisions between two passenger vehicles in the USA during 1990-2008. Cases were all decedents in fatal crashes (N=157,684); one control was selected from each crash in a national probability sample of crashes (N=379,458). RESULTS: Adjusted for the type of vehicle they were riding in and other confounders, occupants of vehicles colliding with any type of LTVs (categorised as compact sport utility vehicles (SUV), full-size SUVs, minivans, full-size vans, compact pickups and full-size pickups) were at higher risk of death compared with occupants colliding with cars. Adjusted for the type of vehicle they crashed with and other confounders, occupants of LTVs in a collision with any vehicle were at lower risk of death compared with car occupants. Compared with a crash between two cars, the overall RR of death in a crash between any of the other 27 different combinations of vehicle types was 1.0 or greater, except for crashes between two full-size pickups, where the RR of death was 0.9. CONCLUSIONS: Although LTVs protect their own occupants better than cars do, LTVs are associated with an excess total risk of death in crashes with cars or other LTVs.

Crash fatality risk and unibody versus body-on-frame structure in SUVs.

BACKGROUND: In crashes between cars and SUVs, car occupants are more likely to be killed than if they crashed with another car. An increasing proportion of SUVs are built with unibody, rather than truck-like body-on-frame construction. Unibody SUVs are generally lighter, less stiff, and less likely to roll over than body-on-frame SUVs, but whether unibody structure affects risk of death in crashes is unknown. OBJECTIVE: To determine whether unibody SUVs differ from body-on-frame SUVs in the danger they pose to occupants of other vehicles and in the self-protection they offer to their own occupants. METHODS: Case-control study of crashes between one compact SUV and one other passenger vehicle in the US during 1995-2008, in which the SUV was model year 1996-2006. Cases were all decedents in fatal crashes, one control was selected from each non-fatal crash. FINDINGS: Occupants of passenger vehicles that crashed with compact unibody SUVs were at 18% lower risk of death compared to those that crashed with compact body-on-frame SUVs (adjusted odds ratio 0.82 (95% confidence interval 0.73-0.94)). Occupants of compact unibody SUVs were also at lower risk of death compared to occupants of body-on-frame SUVs (0.86 (0.72-1.02)). CONCLUSIONS: In two-vehicle collisions involving compact SUVs, unibody structure was associated with lower risk of death both in occupants of other vehicles in the crash, and in SUVs' own occupants.

Using textual cause-of-death data to study drug poisoning deaths.

Death certificate data are often used to study the epidemiology of poisoning deaths, but the International Classification of Diseases (ICD) codes used to tabulate death data do not convey all of the available information about the drugs and other substances named on death certificates. In the United States and some other countries, the SuperMICAR computer system is used to assign ICD codes to deaths. The SuperMICAR system also stores a verbatim record of the text entered for the cause of death. We used the SuperMICAR text entries to study the 7,817 poisoning deaths that occurred among Washington State residents between 2003 and 2010. We tabulated the drugs named on death certificates and computed age-adjusted and age-specific death rates for the top-named drugs and for prescription and illicit drugs. Methadone was named on 2,149 death certificates and was the most frequently named substance, followed by alcohol, opiate, cocaine, oxycodone, and methamphetamine. For both men and women and at all ages, prescription drugs were involved in more deaths than were illicit drugs. Among the 25 drugs named most frequently, only 4 have unique ICD codes; the other 21 can be identified only by using the SuperMICAR data.

Will the light truck bumper height-matching standard reduce deaths in cars?

BACKGROUND: In a collision between a car and a sport utility vehicle (SUV) or pickup truck, car occupants are more likely to be killed than if they crashed with another car. Some of the excess risk may be due to the propensity of SUVs and pickups with high bumpers to override the lower bumpers in cars. To reduce this incompatibility, particularly in head-on collisions, in 2003 automobile manufacturers voluntarily established a bumper height-matching standard for pickups and SUVs. OBJECTIVE: To assess whether height-matching bumpers in pickups and SUVs were associated with the risk of death in either car occupants or pickup and SUV occupants. METHODS: Case-control study of collisions between one car and one SUV or pickup in the US during 2000-2008, in which the SUV or pickup was model year 2000-2006. Cases were all decedents in fatal crashes; one control was selected from each crash in a national probability sample of crashes. FINDINGS: Occupants of cars that crashed with SUVs or pickups with height-matching bumpers may be at slightly reduced risk of death compared to those that crashed with other SUVs or pickups (adjusted odds ratio: 0.83 (95% confidence interval 0.61-1.13)). There was no evidence of a reduction in risk in head-on crashes (1.09 (0.66-1.79)). In crashes in which the SUV or pickup struck the car on the side, height-matched bumpers were associated with a reduced risk of death (0.68 (0.48-0.97)). Occupants of SUVs and pickups with height-matching bumpers may also be at slightly reduced risk of death (0.91 (0.64-1.28)). CONCLUSIONS: Height-matching bumpers were associated with a reduced risk of death among car occupants in crashes in which SUVs or pickups struck cars in the side, but there was little evidence of an effect in head-on crashes. The new bumper height-matching standard may not achieve its primary goal of reducing deaths in head-on crashes, but may modestly reduce overall deaths in crashes between cars and SUVs or pickups because of unanticipated benefits to car occupants in side crashes, and a possible beneficial effect to SUV and pickup occupants.

A systematic review of screening questionnaires for childhood lead poisoning.

CONTEXT: The Centers for Disease Control and Prevention encourages the use of risk factor questionnaires to screen children for lead poisoning. A majority of state health departments have formal lead screening guidelines that recommend health care providers use questionnaires. OBJECTIVE: We conducted a systematic review to evaluate the ability of lead screening questionnaires to predict lead poisoning risk among children. METHODS: Articles that reported the evaluation of a predesigned lead screening questionnaire were obtained by searching Medline/PubMed and by examining references of articles obtained through the online search. From each evaluation, we abstracted the number of children that were true positive, false positive, true negative, and false negative, according to the results of the screening questionnaire and the follow-up blood lead test. From these data, we calculated specificity and sensitivity of the questionnaire for each evaluation. RESULTS: Twenty articles met the inclusion criteria: these included 28 separate questionnaire evaluations. Among 17 evaluations of the 1991 Centers for Disease Control and Prevention questionnaire, sensitivity ranged from 0.25 to 0.87, specificity from 0.31 to 0.80, and accuracy (sum of sensitivity and specificity) from 0.74 to 1.39. The pooled mean estimates for this questionnaire were sensitivity 0.61 (95% confidence interval: 0.53-0.68); specificity 0.52 (0.45-0.60); accuracy 1.12 (1.06-1.18). Among 11 evaluations of all other questionnaires, sensitivity ranged from 0.43 to 0.90, specificity from 0.17 to 0.66, and accuracy from 0.94 to 1.27. For these questionnaires, the pooled mean estimates were sensitivity 0.76 (0.68-0.85), specificity 0.41 (0.33-0.49), and accuracy 1.12 (1.06-1.18). CONCLUSIONS: Lead screening questionnaires showed a wide range of sensitivity and specificity and performed little better than chance at predicting lead poisoning risk among children.

Comparison of examination-based and self-reported risk factors for cardiovascular disease, Washington State, 2006-2007.

INTRODUCTION: Obesity, hypertension, and high cholesterol are risk factors for cardiovascular disease, which accounts for approximately 20% of deaths in Washington State. For most states, self-reports from the Behavioral Risk Factor Surveillance System (BRFSS) provide the primary source of information on these risk factors. The objective of this study was to compare prevalence estimates of self-reported obesity, hypertension, and high cholesterol with examination-based measures of obesity, hypertension, and high-risk lipid profiles. METHODS: During 2006-2007, the Washington Adult Health Survey (WAHS) included self-reported and examination-based measures of a random sample of 672 Washington State residents aged 25 years or older. We compared WAHS examination-based measures with self-reported measures from WAHS and the 2007 Washington BRFSS (WA-BRFSS). RESULTS: The estimated prevalence of obesity from WA-BRFSS (27.1%; 95% confidence interval [CI], 26.3%-27.8%) was lower than estimates derived from WAHS physical measurements (39.2%; 95% CI, 33.6%-45.1%) (P < .001). Prevalence estimates of hypertension based on self-reports from WA-BRFSS (28.1%; 95% CI, 27.4%-28.8%) and WAHS (33.4%; 95% CI, 29.4%-37.7%) were similar to the examination-based estimate (29.4%; 95% CI, 25.8%-33.4%). Prevalence estimates of high cholesterol based on self-reports from WA-BRFSS (38.3%; 95% CI, 37.5%-39.2%) and WAHS (41.8%; 95% CI, 35.8%-48.1%) were similar; both were lower than the examination-based WAHS estimate of high-risk lipid profiles (59.2%; 95% CI, 54.2%-64.2%) (P < .001). CONCLUSION: Self-reported heights and weights underestimate the prevalence of obesity. The prevalence of self-reported high cholesterol is significantly lower than the prevalence of high-risk lipid profiles. Periodic examination-based measurement provides perspective on routinely collected self-reports.

Associations of self-reported periodontal disease with metabolic syndrome and number of self-reported chronic conditions.

INTRODUCTION: Increasing evidence supports associations between periodontal disease and various chronic conditions. Possible explanations include chronic inflammatory processes, shared pathogens, and shared risk factors, such as smoking and psychosocial stress. The objective of this study was to assess associations of periodontal disease with metabolic syndrome and number of chronic diseases. METHODS: As part of the Washington Adult Health Survey, a household-based cross-sectional study conducted during 2006-2007 among adults aged 25 years or older in Washington State, we collected questionnaire data, blood samples, and anthropometric measures. We used these data to assess associations of periodontal disease with metabolic syndrome and the number of self-reported chronic diseases, controlling for age, sex, annual household income, smoking, and psychosocial stress. We used both complete case and multiple imputation Poisson regression analyses. RESULTS: In the adjusted complete case analysis, 1.4 times as many chronic conditions were found among people with severe compared with no periodontal disease, and people with severe periodontal disease were 1.5 times more likely to have metabolic syndrome than people with no periodontal disease. Arthritis and liver disease were individually associated with severe periodontal disease. Results of the multiple imputation analyses were similar. CONCLUSION: These results suggest that people with severe periodontal disease are likely to have more chronic diseases and are more likely to have metabolic syndrome compared with people without periodontal disease. Research about the effectiveness of periodontal treatment to help prevent or control chronic diseases is needed.

Low proportion of male births and low birth weight of sons of flour mill worker fathers.

BACKGROUND: The Washington State Department of Health has collected and coded parental occupation information on birth certificates since 1980. We used these data to search for possible effects of parental occupational exposures on birth outcomes. METHODS: We tabulated sex ratio, birth weight, and proportions of multiple births, still births, and malformations by mothers' and fathers' occupations. RESULTS: There were 59 births (22 boys and 37 girls) where the father's occupation was specified as flour mill worker. The sex ratio of 0.373 (95% confidence interval [CI]: 0.261-0.500) was lower than the mean sex ratio of 0.512. The mean birth weight for flour mill workers' boy babies was 3,180 g (95% CI: 2,971-3,389), compared to an overall mean of 3,511 g for all boy babies. The mean birth weight of flour mill workers' girl babies was 3,602 (95% CI: 3,380-3,824), compared to an overall mean of 3,389 for all girl babies. CONCLUSION: The low prevalence of male infants born to fathers of flour mill workers in Washington State suggests that fumigants that they are exposed to are causing testicular dysfunction. The very low birth weight seen in the male infants of flour mill fathers is unprecedented and may be another genotoxic endpoint.

A computer system for coding occupation.

BACKGROUND: Occupation information is widely used in epidemiologic studies and is collected on most death certificates and many birth certificates in the United States. Coding the massive amount of occupation information collected has been a challenge. METHODS: A simple word-matching computer program to code occupation entries from vital records was developed. The accuracy of the program was evaluated by comparing its output to codes assigned by human coders. RESULTS: In routine use in the Washington State Department of Health (DOH), the computer system codes 96-97% of the occupation entries on birth and death records. It assigned the correct code on 89% (95% confidence interval (87%, 91%)) of the records it coded. CONCLUSIONS: The occupation-coding program is both efficient and accurate and can simplify the process of coding occupation entries from vital records. The system is adaptable and can be modified to use occupation classifications other than the one used by DOH.

Childhood lead poisoning in Washington state: A statewide survey.

Although childhood lead poisoning is an important health issue in the United States, it is not distributed evenly across the country. To estimate the prevalence of childhood lead poisoning in Washington State, the authors conducted a birth certificate follow-back survey of 1- to 2-year-old children. Interviewers visited participating families at their homes to conduct blood lead tests with a portable testing device. The estimated prevalence of lead poisoning for all 1- to 2-year-old children in the state was 0.9% (95% confidence interval [CI]: 0.3-2.7); for Hispanic children in central Washington, it was 3.7% (95% CI: 1.3-10.2), and their risk of lead poisoning was significantly higher than that of all other children in the state (relative risk [RR] = 5.8, 95% CI: 1.3-24.9). Lead poisoning prevalence in Washington State children is lower than the US average and is highest among Hispanic children in central Washington.

Driver's licenses as a source of data on height and weight.

We investigated the feasibility of using driver's license records to obtain height and weight data of individuals. First, we linked Washington State driver's license records (DOL) to the state birth files to assess how well driver's licenses can be linked to a public health database. We were able to match 78.4% of mothers and 71.7% of fathers on birth records to driver's license records. Then we assessed the accuracy of DOL height and weight data by comparing them to heights and weights measured on control women enrolled in a cancer etiology study (CES). There is a close relation between CES and DOL heights, but not a close relation between weights. Our results suggest that driver's license files are a good source of information for women's heights, but are not as good for women's weights.

Socioeconomic and demographic disparities in treatment for carcinomas of the colon and rectum.

BACKGROUND: The current study examined the relationship between socioeconomic and demographic factors and type of treatment for carcinomas of the colon and rectum. The National Institutes of Health and the National Cancer Institute recommend surgery followed by adjuvant chemo- and/or radiotherapy for Stage III colon and Stages II and III rectal carcinomas. METHODS: The authors linked Washington State's cancer registry and hospital discharge records and U.S. census data to assess socioeconomic and demographic factors related to treatment, controlling for clinical factors. RESULTS: Compared to colon carcinoma patients under age 65 years, patients aged 75-84 years and 85 years or older were at higher risk for a treatment plan of surgery without adjuvant therapy (adjusted odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.3-4.7; OR = 14.1, CI = 6.3-31.4, respectively). Risk of no adjuvant therapy was more than doubled for patients in zip codes in the lowest quartile of per capita income compared to the top three quartiles (OR = 2.3, CI = 1.5-3.4) and for those with Medicare compared to private insurance (OR = 2.2, CI = 1.3-3.8). Older patients with rectal carcinoma were also at higher risk of a treatment plan that did not include adjuvant therapy. CONCLUSIONS: The current findings suggest disparities in the provision of recommended medical procedures related to socioeconomic and demographic factors.

Freeway speed limits and traffic fatalities in Washington State.

BACKGROUND: In 1987 individual states in the USA were allowed to raise speed limits on rural freeways from 55 to 65 mph. Analyses of the impact of the increased speed limits on highway safety have produced conflicting results. OBJECTIVE: To determine if the 1987 speed limit increase on Washington State's rural freeways affected the incidence of fatal crashes or all crashes on rural freeways, or affected average vehicle speeds or speed variance. DESIGN: An ecological study of crashes and vehicle speeds on Washington State freeways from 1974 through 1994. RESULTS: The incidence of fatal crashes more than doubled after 1987, compared with what would have been expected if there had been no speed limit increase, rate ratio 2.1 (95% confidence interval (CI), 1.6-2.7). This resulted in an excess of 26.4 deaths per year on rural freeways in Washington State. The total crash rate did not change substantially, rate ratio 1.1 (95% CI, 1.0-1.3). Average vehicle speed increased by 5.5 mph. Speed variance was not affected by the speed limit increase. CONCLUSIONS: The speed limit increase was associated with a higher fatal crash rate and more deaths on freeways in Washington State.