Dataset Information

Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009.

ABSTRACT: Drug poisoning mortality has increased substantially in the U.S. over the past 3 decades. Previous studies have described state-level variation and urban-rural differences in drug-poisoning deaths, but variation at the county level has largely not been explored in part because crude county-level death rates are often highly unstable.The goal of the study was to use small-area estimation techniques to produce stable county-level estimates of age-adjusted death rates (AADR) associated with drug poisoning for the U.S., 1999-2009, in order to examine geographic and temporal variation.Population-based observational study using data on 304,087 drug-poisoning deaths in the U.S. from the 1999-2009 National Vital Statistics Multiple Cause of Death Files (analyzed in 2012). Because of the zero-inflated and right-skewed distribution of drug-poisoning death rates, a two-stage modeling procedure was used in which the first stage modeled the probability of observing a death for a given county and year, and the second stage modeled the log-transformed drug-poisoning death rate given that a death occurred. Empirical Bayes estimates of county-level drug-poisoning death rates were mapped to explore temporal and geographic variation.Only 3% of counties had drug-poisoning AADRs greater than ten per 100,000 per year in 1999-2000, compared to 54% in 2008-2009. Drug-poisoning AADRs grew by 394% in rural areas compared to 279% for large central metropolitan counties, but the highest drug-poisoning AADRs were observed in central metropolitan areas from 1999 to 2009.There was substantial geographic variation in drug-poisoning mortality across the U.S.

SUBMITTER: Rossen LM

PROVIDER: S-EPMC4659504 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009.

Rossen Lauren M LM Khan Diba D Warner Margaret M

American journal of preventive medicine 20131201 6

<h4>Background</h4>Drug poisoning mortality has increased substantially in the U.S. over the past 3 decades. Previous studies have described state-level variation and urban-rural differences in drug-poisoning deaths, but variation at the county level has largely not been explored in part because crude county-level death rates are often highly unstable.<h4>Purpose</h4>The goal of the study was to use small-area estimation techniques to produce stable county-level estimates of age-adjusted death r ...[more]

PMID: 24237925

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Project description:IntroductionWe examined trends in seven mutually exclusive tobacco product use patterns (T-PUPs) in nationally representative samples of U.S. youth over time and age.MethodsWe used time varying effect modeling on National Youth Tobacco Surveys, 1999-2014 (N = 38662, 9-17 years, M = 15.02). Regression coefficients were estimated as a non-parametric function of time. T-PUPs were cigarette only, non-cigarette combustible only, noncombustible only, non-cigarette combustible and noncombustible dual, cigarette and noncombustible dual, cigarette and non-cigarette combustible dual, and POLY (i.e. cigarettes, non-cigarette combustibles, and noncombustibles) use.ResultsAmong youth tobacco users, cigarette only use was the predominant T-PUP from 1999 to 2010. After 2010 and 2013, non-cigarette combustible only (AOR 1.38, CI = 1.02-1.87) and noncombustible only (AOR 1.57, CI = 1.00-2.45) use became more prevalent than cigarette only use. In 2011, dual and POLY T-PUPs were on the rise although not significantly different from cigarette only use. Cigarette only use was the predominant T-PUP among 11- to 17-year-old tobacco users. Non-cigarette combustible only (AOR 0.14, CI = 0.10-0.19), noncombustible only (AOR 0.01, CI = 0.008-0.02), non-cigarette combustible and noncombustible (AOR 0.01, CI = 0.01-0.03), cigarette and noncombustible (AOR 0.02, CI = 0.01-0.04), cigarette and non-cigarette combustible (AOR 0.32, CI = 0.24-0.43), and POLY (AOR 0.02, CI = 0.01-0.04) use were less prevalent than cigarette only use at age 17.ConclusionsNon-cigarette, dual, and POLY T-PUPs are rising among youth tobacco users. Screening for all tobacco use and delivering treatment during pediatrician visits should be standard clinical practice.ImplicationsTracking trends in tobacco product use patterns (T-PUPs) over time and age is necessary to achieve Healthy People 2020 goal of reducing tobacco use among youth. Trends over time show a rise of non-cigarette T-PUPs especially noncombustible products but cigarette only use remains the most prevalent among 11- to 17-year-old tobacco users. The recent extension of FDA's regulatory jurisdiction over all tobacco products (e.g. e-cigarettes, hookah) is a step toward comprehensive tobacco control especially among youth. Public health practitioners should extend prevention and cessation efforts among youth to T-PUPs beyond exclusive cigarette smoking.

Project description:BackgroundDocumenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning.MethodsWe conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018.ResultsDiabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007-2010 period and the 2015-2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non-high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007-2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015-2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011-2014 to 2015-2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015-2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure-lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control.ConclusionsAfter more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off. (Funded by the National Heart, Lung, and Blood Institute.).

Dataset Information

Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009.

Publications

Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009.

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