Poisoning by Race, Gender and Intent in Kansasc.ymcdn.com/sites/ by Race, Gender and Intent in...

Poisoning by Race, Gender and Intent in Kansas

Dan DaoFor Safe States/SAVIR 2013 NationalFor Safe States/SAVIR 2013 National

Meeting

“Drug overdose deaths increased forDrug overdose deaths increased for the 11th consecutive year in 2010”

“Opioid analgesics, such as p goxycodone, hydrocodone, and methadone, were involved in about 3 ,of every 4 pharmaceutical overdose deaths”CDC, Opioids drive continued increase in drug overdose deaths , 02/20/2013

ObjectivesObjectives

• Describe poisoning rates by Race Gender andDescribe poisoning rates by Race, Gender and Intent in Kansas

• How the Injury Surveillance Work Group 7• How the Injury Surveillance Work Group 7 (ISW7, Safe States) work on classifying drugs has changed future poisoning analysishas changed future poisoning analysis

Methods

Full Hospital Discharge Dataset

Centers for Disease Control and Prevention (CDC)Injury Indicators Selection Criteria (2010)Injury Indicators Selection Criteria (2010)

CDC f k f E d G iCDC framework for E‐code Groupings(Cause Coding)

Injury Surveillance Workgroup 7 (ISW7)Framework for Drug Type

Primary E‐CODE used to classify drug type

Methods Cont.Methods Cont.

• Hospital Dischargesosp ta sc a ges– These are stays in the hospital that are 24 hours or longer

• Emergency Department visits, those less than 24 hours, were analyzed but not included in this presentation

– Data is provided to us by the Kansas Hospital p y pAssociation

• Non federal, short stay community or general hospitals in Kansas are not required to report their data to KansasKansas are not required to report their data to Kansas Hospital Association, therefore their databases may not include 100 percent of hospital discharges in Kansas

– Data presented in this analysis are from 2005‐2009Data presented in this analysis are from 2005 2009

Methods Cont. (last one)Methods Cont. (last one)• Cutoff

– A count of 25 HD is used as a cutoff for rate calculation. Subgroups with counts below 25 do not have calculated rates.

• Drug Coding– ISW7 defines 19 drug categories. These 19 categories are

grouped into larger categories in this analysis.• Race Coding

– Not all race groups shown due to small counts– Ethnicity is inclusive within each Race group. For example,

White race group contains both Hispanic White and non‐Hi i WhiHispanic White.

– Asian and Non‐Hawaiian Pacific Islander are combined

RaceSex

Intent

Age-Adjusted (AA) Poisoning Related Hospital Discharge (HD) Rates by Gender, KS 2005-2009

Overall KS 95%CI00k

Overall KS 95%CI90

Rat

e pe

r 10

60

rela

ted

HD

30

A Po

ison

ing

0

Female Male

AA

Female Male

Sex

Source: 2005-2009 Kansas Hospital Discharge Database, Kansas Hospital Assocition

Age-Adjusted (AA) Poisoning Related Hospital Discharge (HD) Rates by Intent, KS 2005-2009

00k

40

Rat

e pe

r 10

20rela

ted

HD

20

A Po

ison

ing

0

Suicide Unintentional All Other

AA

Suicide Unintentional All Other

Intent


Age-Adjusted (AA) Poisoning Related Hospital Discharge (HD) Rates by Race, KS 2005-2009

Overall KS 95%CI90

100k

D R

ate

per 1

60

g re

late

d H

D

30

AA P

oiso

ning

0

African-American Asian / NHOPI Native American White

A

African American Asian / NHOPI Native American White

Race


Age-Adjusted (AA) Poisoning Related Hospital Discharge (HD) Rates by Gender and Race, KS 2005-2009

African-American White120

k

90

Rat

e pe

r 100

60

elat

ed H

D R

30

Pois

onin

g re

0

F M F M

AA

F M F M

Sex


Age-Adjusted (AA) Poisoning Related Hospital Discharge (HD) Rates by Gender and Intent, KS 2005-2009

African-American White

50

k

40

Rat

e pe

r 100

20

30

elat

ed H

D R

10

20

Pois

onin

g re

0

Suicide Unintentional Suicide Unintentional

AA

Suicide Unintentional Suicide Unintentional

Intent


Gender Specific Age-Adjusted (AA) Hospital Discharge (HD)Poisoning Rates by Intent and Race, KS 2005-2009

Female Male60

Af

20

40

frican-Amerte

per

100

k

0

20

60

ican

ated

HD

Ra

40 Whit

Pois

onin

g re

la

0

20

e

AA P

Suicide Unintentional


Pink chartUnintentional Poisoning Hospital Discharge (HD) CountsBy Age Group and Race Group, KS 2005-2009Pink chart


nts

75

400ted

HD

Cou

n

50

soni

ng re

lat

25200

entio

nal P

oi

0 0

20 40 60 80 20 40 60 80

Uni

nt

20 40 60 80 20 40 60 80

Age


Unintentional Poisoning Hospital Discharge (HD) CountsBy Age Group, Race Group and Drug Type, KS 2005-2009


ount

s

75

400

late

d H

D C

o

50

200Pois

onin

g re

25200

inte

ntio

nal P

0 0

20 40 60 80 20 40 60 80

Age

Un

Age

Other Opiates opioids Cocaine Antidepressants PSY


Unintentional (UNT) Poisoning Related Hospital Discharge (HD)by Gender and Drug among Kansans 40-70 years old2005 2009

African-American White

2005-2009

30

per 1

00k Antidepressants PSY

CocaineOpiates/Opioids

20

ed H

D R

ate

10soni

ng re

late

0

UN

T Po

is

0

Drug Group


LimitationsLimitations

• Consistency in definitions of “poisoning” hasConsistency in definitions of poisoning has been difficult with so many groups involved.

• Future analysis can include race‐ethnicFuture analysis can include race ethnic combination variable to give clearer measurements (example: Non‐Hispanic White)measurements (example: Non Hispanic White)

• Undercounting could be possible due to only looking at E‐codes to define poisoning, aslooking at E codes to define poisoning, as compared to using any mention of drug type across all diagnosis fields.g

ConclusionsConclusions

• Poisoning related HD rates higher in African‐Americans, g g ,females, and suicide.

• Cocaine poisoning related HD rates in middle age d lt (40 70) i hi h i Af i A iadults (40‐70) is very high in African‐Americans compared to other drug‐race combinations

• Poisoning is a very complex issue that intersects race,Poisoning is a very complex issue that intersects race, intent, sex and age.

• Further subgroup analysis was necessary to pull out a clearer description of the issue.

• Describing drug type adds valuable information to prevention efforts and gives us real focus areasprevention efforts and gives us real focus areas.

Contact Information:

D D MPHDan Dao, [email protected]

Our vision is 'healthy Kansans living in safe and sustainable environments'.

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