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April 11th, 2014 posted by Paul Rega, MD, FACEP April 11, 2014 @ 12:13 am

CDC: Births to teens aged 15–17 years have declined but still account for approximately one quarter of births to teens aged 15–19 years.

Key Points
  • Although the birth rate of teens aged 15–17 years declined 63% during the period 1991–2012, about one in four teen births occurred to younger teens (those aged 15–17 years) in 2012.
  • About one in four females teens aged 15–17 years have ever had sex. Among those who have, about eight in 10 had not received any formal sex education before the first time they had sex.
  • About nine in 10 sexually active younger teens used some form of contraception the last time they had sex. However, only 1% used one of the two most effective reversible methods (i.e., intrauterine devices or implants).
  • Strategies to delay sexual initiation and increase the use of the most effective birth control methods include implementing evidence-based youth programs, helping parents talk to their teens about sex and contraception, and making sure that a sexually active younger teen can access reproductive health-care services.

CDC:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6314a4.htm?s_cid=mm6314a4_e

FIGURE 1. Birth rates for teens aged 15–17 years, by age — United States, 1991–2012

The figure shows birth rates for teens aged 15-17 years, by age, in the United States during 1991-2012. The rate of births per 1,000 teens aged 15-17 years declined 63%, from 38.6 in 1991 to 14.1 in 2012. From 1991 to 2012, the rate of births per 1,000 teens declined from 17.9 to 5.4 for those aged 15 years, 36.9 to 12.9 for those aged 16 years, and 60.6 to 23.7 for those aged 17 years.

Source: CDC’s National Center for Health Statistics. National Vital Statistics System data.

Alternate Text: The figure above shows birth rates for teens aged 15-17 years, by age, in the United States during 1991-2012. The rate of births per 1,000 teens aged 15-17 years declined 63%, from 38.6 in 1991 to 14.1 in 2012. From 1991 to 2012, the rate of births per 1,000 teens declined from 17.9 to 5.4 for those aged 15 years, 36.9 to 12.9 for those aged 16 years, and 60.6 to 23.7 for those aged 17 years.

FIGURE 2. Birth rates for teens aged 15–17 years, by reporting area — United States, 2012*

The figure shows birth rates for teens aged 15-17 years, by reporting area, in the United States during 2012. In 2012, the birth rate per 1,000 teens aged 15-17 years varied by race/ethnicity, with the highest rates among Hispanics (25.5), followed by non-Hispanic blacks (21.9), American Indians/Alaska Natives (17.0), non-Hispanic whites (8.4), and Asians/Pacific Islanders (4.1). The rate of births to teens aged 15-17 years also varied widely by state, with the highest rate in the District of Columbia (29.0 per 1,000 teens aged 15-17 years) and the lowest rate in New Hampshire (6.2).

Source: CDC’s National Center for Health Statistics. National Vital Statistics System data.

* The rates in reporting areas shaded medium blue are within 1 standard deviation (SD) of the mean. Rates in reporting areas shaded dark blue are >1 SD above the mean. Rates in reporting areas shaded light blue are >1 SD below the mean.

Alternate Text: The figure above shows birth rates for teens aged 15-17 years, by reporting area, in the United States during 2012. In 2012, the birth rate per 1,000 teens aged 15-17 years varied by race/ethnicity, with the highest rates among Hispanics (25.5), followed by non-Hispanic blacks (21.9), American Indians/Alaska Natives (17.0), non-Hispanic whites (8.4), and Asians/Pacific Islanders (4.1). The rate of births to teens aged 15-17 years also varied widely by state, with the highest rate in the District of Columbia (29.0 per 1,000 teens aged 15-17 years) and the lowest rate in New Hampshire (6.2).

FIGURE 3. Number of teen births* that were to teens aged 15–17 years compared with teens aged 18–19 years — United States, 1991–2012

The figure shows the number of teen births that were to teens aged 15-17 years compared with teens aged 18-19 years in the United States during 1991-2012. In 2012, among 305,388 births to teens aged 15-19 years, 86,423 (28.3%) were births to teens aged 15-17 years. The percentage of births to teens aged 15-19 years that were to teens aged 15-17 years declined significantly during the observation period, from 36% in 1991 to 28% in 2012, representing a 22% decrease.

Source: CDC’s National Center for Health Statistics. National Vital Statistics System data.

* Teen births are defined as births to teens aged 15-19 years.

Alternate Text: The figure above shows the number of teen births that were to teens aged 15-17 years compared with teens aged 18-19 years in the United States during 1991-2012. In 2012, among 305,388 births to teens aged 15-19 years, 86,423 (28.3%) were births to teens aged 15-17 years. The percentage of births to teens aged 15-19 years that were to teens aged 15-17 years declined significantly during the observation period, from 36% in 1991 to 28% in 2012, representing a 22% decrease.

FIGURE 4. Percentage of never-married females aged 15–17 years who reported receipt of formal sex education and spoke with their parents about sex, by topic discussed — United States, 2006–2010

The figure shows the percentage of never-married females aged 15-17 years who reported receipt of formal sex education and spoke with their parents about sex, by topic discussed, in the United States during 2006-2010. The vast majority of females aged 15-17 years received formal sex education on either birth control or how to say no to sex: 90.9%; fewer (61.3%) received information on both topics.

* Among teens who reported ever having vaginal sex.

Alternate Text: The figure above shows the percentage of never-married females aged 15-17 years who reported receipt of formal sex education and spoke with their parents about sex, by topic discussed, in the United States during 2006-2010. The vast majority of females aged 15-17 years received formal sex education on either birth control or how to say no to sex: 90.9%; fewer (61.3%) received information on both topics.



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April 10th, 2014 posted by Paul Rega, MD, FACEP April 10, 2014 @ 12:20 pm

Will law enforcement officers across NYS carry Narcan?

Public Health / World Health Organization

NY Times

Proposal Would Provide New York Police With Kits to Combat Overdoses

By J. DAVID GOODMAN

“With deaths from heroin and opioid prescription pills soaring, Attorney General Eric T. Schneiderman on Thursday is expected to announce a push to have law enforcement officers across the state carry a drug that is effectively an antidote to overdose.

The program, to be funded primarily from $5 million in criminal and civil seizures from drug dealers, would help provide a kit with the drug, naloxone, and the training to use it to every state and local officer in New York, the attorney general’s office said…..”



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April 9th, 2014 posted by Paul Rega, MD, FACEP April 9, 2014 @ 5:15 am

Oh, oh!!! “…Princess Cruises spokeswoman…..says about 37 passengers on the Crown Princess reported being sick while the ship was in San Francisco on Monday….”

Public Health / World Health Organization

http://www.huffingtonpost.com/2014/04/08/california-cruise-norovirus-princess_n_5113952.html



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April 7th, 2014 posted by Paul Rega, MD, FACEP April 7, 2014 @ 11:19 am

Calls to Poison Centers for Exposures to Electronic Cigarettes

Public Health / World Health Organization

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm?s_cid=mm6313a4_w

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014

Weekly

April 4, 2014 / 63(13);292-293

Kevin Chatham-Stephens, MD1, Royal Law, MPH2, Ethel Taylor, DVM2, Paul Melstrom, PhD3, Rebecca Bunnell, ScD3, Baoguang Wang, MD4, Benjamin Apelberg, PhD4, Joshua G. Schier, MD2

Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA) (1).* In many states, there are no restrictions on the sale of e-cigarettes to minors. Although e-cigarette use is increasing among U.S. adolescents and adults (2,3), its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity (4). To assess the frequency of exposures to e-cigarettes and characterize the reported adverse health effects associated with e-cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e-cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e-cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e-cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.

An e-cigarette exposure call was defined as a call regarding an exposure to the e-cigarette device itself or to the nicotine liquid, which typically is contained in a cartridge that the user inserts into the e-cigarette. A cigarette exposure call was defined as a call regarding an exposure to tobacco cigarettes, but not cigarette butts. Calls involving multiple substance exposures (e.g., cigarettes and ethanol) were excluded. E-cigarette exposure calls were compared with cigarette exposure calls by proportion of calls from health-care facilities (versus residential and other non–health-care facilities), demographic characteristics, exposure routes, and report of adverse health effect. Statistical significance of differences (p<0.05) was assessed using chi-square tests.

During the study period, PCs reported 2,405 e-cigarette and 16,248 cigarette exposure calls from across the United States, the District of Columbia, and U.S. territories. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014 (Figure). Cigarette exposure calls ranged from 301 to 512 calls per month and were more frequent in summer months, a pattern also observed with total call volume to PCs involving all exposures (5).

E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls, increasing from 0.3% in September 2010 to 41.7% in February 2014. A greater proportion of e-cigarette exposure calls came from health-care facilities than cigarette exposure calls (12.8% versus 5.9%) (p<0.001). Cigarette exposures were primarily among persons aged 0–5 years (94.9%), whereas e-cigarette exposures were mostly among persons aged 0–5 years (51.1%) and >20 years (42.0%). E-cigarette exposures were more likely to be reported as inhalations (16.8% versus 2.0%), eye exposures (8.5% versus 0.1%), and skin exposures (5.9% versus 0.1%), and less likely to be reported as ingestions (68.9% versus 97.8%) compared with cigarette exposures (p<0.001).

Among the 9,839 exposure calls with information about the severity of adverse health effects, e-cigarette exposure calls were more likely to report an adverse health effect after exposure than cigarette exposure calls (57.8% versus 36.0%) (p<0.001). The most common adverse health effects in e-cigarette exposure calls were vomiting, nausea, and eye irritation. One suicide death from intravenous injection of nicotine liquid was reported to PCs.

Calls about exposures to e-cigarettes, which were first marketed in the United States in 2007, now account for 41.7% of combined monthly e-cigarette and cigarette exposure calls to PCs. The proportion of calls from health-care facilities, age distribution, exposure routes, and report of adverse health effects differed significantly between the two types of cigarette.

This analysis might have underestimated the total number of e-cigarette and cigarette exposures for several reasons. Calls involving e-cigarettes or cigarettes and another exposure were excluded, and the code indicating a case of e-cigarette exposure might have been underused initially. In addition, health-care providers, including emergency department providers, and the public might not have reported all e-cigarette or cigarette exposures to PCs. Given the rapid increase in e-cigarette-related exposures, of which 51.1% were among young children, developing strategies to monitor and prevent future poisonings is critical. Health-care providers; the public health community; e-cigarette manufacturers, distributors, sellers, and marketers; and the public should be aware that e-cigarettes have the potential to cause acute adverse health effects and represent an emerging public health concern.

References

  1. Food and Drug Administration. News and events—electronic cigarettes (e-cigarettes). Silver Spring, Maryland: US Department of Health and Human Services, Food and Drug Administration; 2014. Available at http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htmExternal Web Site Icon.
  2. CDC. Notes from the field: electronic cigarette use among middle and high school students—United States, 2011–2012. MMWR 2013;62:729–30.
  3. King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever-use of electronic cigarettes among U.S. adults, 2010–2011. Nicotine Tob Res 2013;15:1623–7.
  4. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health: the rise of the “e-cigarette.” Am J Public Health 2010;100:2340–2.
  5. Mowry JB, Spyker DA, Cantilena LR Jr, Bailey JE, Ford M. 2012 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th annual report. Clin Toxicol (Phila) 2013;51:949–1229.

* Currently, e-cigarettes and their components, such as the nicotine they contain, that are intended for therapeutic purposes (e.g., for smoking cessation) are drug/device combination products. When they are marketed for therapeutic purposes they are regulated by the FDA’s Center for Drug Evaluation and Research. FDA’s Center for Tobacco Products currently regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. FDA has stated its intention to issue a proposed rule extending FDA’s tobacco product authorities beyond these products to include other products like e-cigarettes not intended for therapeutic purposes.

FIGURE. Number of calls to poison centers for cigarette or e-cigarette exposures, by month — United States, September 2010–February 2014The figure above shows the number of calls to poison centers for cigarette or e-cigarette exposures, by month, in the United States during September 2010–February 2014. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014.

 

Alternate Text: The figure above shows the number of calls to poison centers for cigarette or e-cigarette exposures, by month, in the United States during September 2010–February 2014. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014.



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April 7th, 2014 posted by Paul Rega, MD, FACEP @ 11:16 am

April is STD Awareness Month

Public Health / World Health Organization

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a6.htm?s_cid=mm6313a6_w

Announcement: STD Awareness Month — April 2014

 Weekly

April 4, 2014 / 63(13);296-296

April is STD Awareness Month, an annual event calling attention to the impact of sexually transmitted diseases (STDs) in the United States. This month-long observance provides individuals, doctors, and community-based organizations the perfect opportunity to address ways to prevent some of nearly 20 million new cases of STDs that occur in the United States each year (1), costing the U.S. health-care system nearly $16 billion in direct medical costs (2) and placing a significant human and economic burden on the nation.

Although most sexually transmitted infections will not cause serious harm, some can lead to major health problems, such as infertility. Infection with a sexually transmitted pathogen can also make a person more susceptible to infection with the human immunodeficiency virus (HIV).

Behaviors such as not using condoms, having multiple sex partners, having anonymous sex partners, or having sex while under the influence of drugs or alcohol increase the risk for infection with a sexually transmitted pathogen. Lifestyle changes that reduce risk, regular STD screening, and prompt disease treatment are the most effective tools available to protect one’s health and prevent the spread of all STDs, including HIV.

During the month of April, CDC encourages clinicians to think about changes they might make to raise STD awareness among their patients and within their community. Learning resources for clinicians, patients, and community members about STDs are available from CDC at http://www.cdc.gov/std.

References

  1. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among U.S. women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013;40:187–93.
  2. Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis 2013;40:197–201.


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April 4th, 2014 posted by Paul Rega, MD, FACEP April 4, 2014 @ 4:42 am

The hand-held device, called Evzio, delivers a single dose of naloxone, to reverse the effects of a narcotic OD, and will be used on those who have stopped breathing or lost consciousness

Public Health / World Health Organization

“I’m worried that there will be a false sense of security” among drug users, said James Rathmell, chief of the division of pain medicine at Massachusetts General Hospital. “Like, ‘O.K., I’ve got a naloxone pen, we can party all we want, no one is going to die.’ ”



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March 24th, 2014 posted by Paul Rega, MD, FACEP March 24, 2014 @ 3:30 am

World TB Day — March 24, 2014

Public Health / World Health Organization

CDC

 MMWR Weekly

March 21, 2014 / 63(11);229-229

Each year, World TB Day is observed on March 24. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB). World TB Day provides an opportunity to raise awareness about TB-related problems and solutions and to support worldwide TB control efforts. For 2014, CDC selected the theme “Find TB. Treat TB. Working together to eliminate TB.” Health officials in local and state TB programs are encouraged to reach out to their communities to raise awareness about TB and partner with others who are caring for those most at risk for TB. Everyone has a role in ensuring that one day TB will be eliminated.

In 2013, a total of 9,588 new TB cases were reported in the United States, for a rate of 3.0 cases per 100,000 (1). Although the number of TB cases continues to decline, challenges remain that slow progress toward the goal of TB elimination in the United States. TB still persists at greater incidence rates in specific populations. Foreign-born persons and racial/ethnic minorities continue to be affected disproportionately.

CDC is committed to a world free of TB. Initiatives to improve awareness, testing, and treatment of latent TB infection and TB disease among high-risk groups are critical to reaching the goal of TB elimination in the United States. Additional information about World TB Day and CDC’s TB elimination activities is available at http://www.cdc.gov/tb/events/worldtbday.

Reference

  1. CDC. Trends in tuberculosis—United States, 2013. MMWR 2014;63:229–33.


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March 20th, 2014 posted by Paul Rega, MD, FACEP March 20, 2014 @ 3:08 am

FDA approves Impavido to treat tropical disease leishmaniasis

Public Health / World Health Organization

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm389671.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery

FDA NEWS RELEASE

For Immediate Release: March 19, 2014 Media Inquiries: Stephanie Yao, 301-796-0394, stephanie.yao@fda.hhs.gov Consumer Inquiries: 888-INFO-FDA

FDA approves Impavido to treat tropical disease leishmaniasis

The U.S. Food and Drug Administration today approved Impavido (miltefosine) to treat a tropical disease called leishmaniasis.

Leishmaniasis is a disease caused by Leishmania, a parasite which is transmitted to humans through sand fly bites. The disease occurs primarily in people who live in the tropics and subtropics. Most U.S. patients acquire leishmaniasis overseas.

Impavido is an oral medicine approved to treat the three main types of leishmaniasis: visceral leishmaniasis (affects internal organs), cutaneous leishmaniasis (affects the skin) and mucosal leishmaniasis (affects the nose and throat). It is intended for patients 12 years of age and older. Impavido is the first FDA-approved drug to treat cutaneous or mucosal leishmaniasis.

“Today’s approval demonstrates the FDA’s commitment to making available therapeutic options to treat tropical diseases,” said Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research.

The FDA granted Impavido fast track designation, priority review, and orphan product designation. These designations were granted because the drug demonstrated the potential to fill an unmet medical need in a serious disease or condition, the potential to be a significant improvement in safety or effectiveness in the treatment of a serious disease or condition, and is intended to treat a rare disease, respectively. With this approval, Impavido’s manufacturer, Paladin Therapeutics, is awarded a Tropical Disease Priority Review Voucher under a provision included in the Food and Drug Administration Amendments Act of 2007 that aims to encourage development of new drugs and biological products for the prevention and treatment of certain tropical diseases.

Impavido’s safety and efficacy were evaluated in four clinical trials. A total of 547 patients received Impavido and 183 patients received either a comparator drug or a placebo. Results from these trials demonstrated that Impavido is safe and effective in treating visceral, cutaneous and mucosal leishmaniasis.

The labeling for Impavido includes a boxed warning to alert patients and health care professionals that the drug can cause fetal harm and therefore should not be given to pregnant women. Health care professionals should advise women to use effective contraception during and for five months after Impavido therapy.

The most common side effects identified in clinical trials were nausea, vomiting, diarrhea, headache, decreased appetite, dizziness, abdominal pain, itching, drowsiness and elevated levels of liver enzymes (transaminases) and creatinine.

Paladin Therapeutics is based in Montreal, Canada.

For more information:

FDA Approved Drugs: Questions and Answers

FDA: Drug Innovation

CDC: Leishmaniasis

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

###



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March 17th, 2014 posted by Paul Rega, MD, FACEP March 17, 2014 @ 4:27 am

Driving, drugs, and death

Public Health / World Health Organization

http://thenationshealth.aphapublications.org/content/44/2/E9.full

Online-only: Deadly vehicle crashes involving drugs climbing, study says

  1. Natalie McGill

Fatal driving crashes involving drugs are on the rise in the U.S., according to a recent study.

Published online Jan. 29 in the American Journal of Epidemiology, the study found that the presence of drugs other than alcohol, such as marijuana, in a driver’s system after a deadly crash                  increased from 16.6 percent to 28.3 percent from 1999 to 2010.

The study is important because motor vehicle crashes are a major source of morbidity and mortality and a leading cause of                  death for children and young adults, said study co-author Guohua Li, DrPH, MD, professor of epidemiology and director of the                  Center for Injury Epidemiology and Prevention at the Columbia University Mailman School of Public Health. Li, an APHA member,                  said 50 percent of fatal crashes involve drivers under the influence of alcohol, other drugs or both.

“Given that consumption of prescription drugs, primarily opioid analgesics, has been steadily rising, we expected to see an                  increase in nonalcohol drugs detected in driver fatalities, but were stunned by the magnitude of the increase — the prevalence                  of marijuana and narcotics tripled during the study period,” Li told The Nation’s Health. “If the trend continues, nonalcohol drugs will overtake alcohol around 2020 to be the most commonly detected substance in                  traffic fatalities.”

The study looked at more than 23,500 drivers between 1999 and 2010 in California, Hawaii, Illinois, New Hampshire, Rhode Island                  and West Virginia. Researchers targeted the states because they routinely test drivers for drug use following crashes.

Most of the increase in drugs detected in drivers’ systems was from marijuana and opioids. The prevalence of opioids, such                  as oxycodone and codeine, increased from 1.8 percent in 1999 to 5.4 percent in 2010, the study said. For marijuana, the increase                  was 4.2 percent to 12.2 percent in the same period. The presence of alcohol held steady at 39 percent from 1999 to 2010.

Li suggested public health interventions such DUI check points, in which law enforcement stop motorists they suspect are driving                  while impaired. In the wake of some states decriminalizing marijuana use, the public should be informed of the drug’s effects                  on driving safety, Li said.

“The epidemic of drug overdose has claimed over 250,000 lives in the U.S. in the past decade,” Li said. “Every sector of the                  society, particularly the public health community, needs to step up efforts to control this quiet but deadly epidemic. A nationwide                  prescription drug monitoring program would be a good first step. A national dialogue about the war on drugs and the marijuana                  legalization movement is much needed.”

For more information, visit http://aje.oxfordjournals.org/content/early/2014/01/27/aje.kwt327.full.



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March 17th, 2014 posted by Paul Rega, MD, FACEP @ 4:25 am

CDC: Excessive alcohol consumption, the fourth leading preventable cause of death in the United States, resulted in approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) annually during 2006–2010 and cost an estimated $223.5 billion in 2006

Public Health / World Health Organization

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6310a2.htm?s_cid=mm6310a2_e

Alcohol-Attributable Deaths and Years of Potential Life Lost — 11 States, 2006–2010

 Weekly

March 14, 2014 / 63(10);213-216

Katherine Gonzales, MPH1, Jim Roeber, MSPH2, Dafna Kanny, PhD3, Annie Tran, MPH4, Cathy Saiki, MS5, Hal Johnson, MPH6, Kristin Yeoman, MD7, Tom Safranek, MD8, Kathleen Creppage, MPH9, Alicia Lepp10, Tracy Miller, MPH10, Nato Tarkhashvili, MD11, Kristine E. Lynch, PhD12, Joanna R. Watson, DPhil13, Danielle Henderson, MPH14, Megan Christenson, MS, MPH15, Sarah Dee Geiger, PhD16 (Author affiliations at end of text)

What is already known on this topic?

The health consequences of excessive alcohol use vary across geographically diverse states and include substantial disparities in alcohol-related outcomes by sex and race/ethnicity.

What is added by this report?

Adjusted to the 2000 U.S. standard population, in a convenience sample of 11 states, the median alcohol-attributable death (AAD) rate was 28.5 per 100,000, and the median years of potential life lost (YPLL) was 823 per 100,000 during 2006–2010. The majority of AAD (median 70%) and YPLL (median = 82%) were among working-age adults (aged 20–64 years).

What are the implications for public health practice?

Routine monitoring of alcohol-attributable health outcomes, including deaths and YPLL, in states could support the planning and implementation of evidence-based prevention strategies recommended by the Community Preventive Services Task Force to reduce excessive drinking and related harms. Such strategies include increasing the price of alcohol, limiting alcohol outlet density, and holding alcohol retailers liable for harms related to the sale of alcoholic beverages to minors and intoxicated patrons (dram shop liability).

Excessive alcohol consumption, the fourth leading preventable cause of death in the United States (1), resulted in approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) annually during 2006–2010 and cost an estimated $223.5 billion in 2006 (2). To estimate state-specific average annual rates of alcohol-attributable deaths (AAD) and YPLL caused by excessive alcohol use, 11 states analyzed 2006–2010 data (the most recent data available) using the CDC Alcohol-Related Disease Impact (ARDI) application. The age-adjusted median AAD rate was 28.5 per 100,000 population (range = 50.9 per 100,000 in New Mexico to 22.4 per 100,000 in Utah). The median YPLL rate was 823 per 100,000 (range = 1,534 YPLL per 100,000 for New Mexico to 634 per 100,000 in Utah). The majority of AAD (median = 70%) and YPLL (median = 82%) were among working-age (20–64 years) adults. Routine monitoring of alcohol-attributable health outcomes, including deaths and YPLL, in states could support the planning and implementation of evidence-based prevention strategies recommended by the Community Preventive Services Task Force to reduce excessive drinking and related harms. Such strategies include increasing the price of alcohol, limiting alcohol outlet density, and holding alcohol retailers liable for harms related to the sale of alcoholic beverages to minors and intoxicated patrons (dram shop liability) (3).

The ARDI Custom Data module* was used for this analysis by 11 states (California, Florida, Michigan, Nebraska, New Mexico, North Carolina, North Dakota, South Dakota, Utah, Virginia, and Wisconsin) participating in the Council of State and Territorial Epidemiologists’ Alcohol Subcommittee. ARDI estimates AAD and YPLL resulting from excessive alcohol use by using multiple data sources and methods (4).† ARDI estimates AAD by multiplying the number of age- and sex-specific deaths from 54 alcohol-related conditions by the alcohol-attributable fractions (AAF) for that condition. AAF are used to express the extent to which alcohol consumption contributes to a health outcome. AAF estimate the proportion of deaths from various causes that are directly or indirectly attributable to alcohol consumption. The AAF range from 1.0 for 15 conditions (e.g., alcoholic liver disease and alcoholic polyneuropathy) to as low as 0.01 (e.g., hypertension and hemorrhagic stroke in females). The AAF used in ARDI and for this analysis are provided in the application. YPLL by age, sex, and race/ethnicity were calculated by multiplying age- and sex-specific AAD estimates for each cause by the corresponding life expectancy estimate at the time of death.§ For chronic causes of death (e.g., liver disease), AAD and YPLL were estimated for decedents aged ≥20 years; for acute causes, they were estimated for decedents aged ≥15 years. AAD and YPLL also were estimated for persons aged <15 years who died from motor-vehicle crashes, child maltreatment, or low birth weight. State death certificate data from 2006–2010, the most recent available for participating states, were used to determine the average annual number of alcohol-related deaths for the 54 alcohol-related conditions assessed by the ARDI application and to obtain decedent demographic information. Death records missing data on decedent age, sex, or race/ethnicity were excluded. Prevalence data on alcohol use for 2006–2010 were obtained from state Behavioral Risk Factor Surveillance Systems and used to calculate AAF for most chronic conditions profiled in ARDI. Average annual state rates for AAD and YPLL per 100,000 population for 2006–2010 were calculated by dividing the average annual AAD and YPLL estimates for 2006–2010 by the average annual bridged-race population estimates from the U.S. Census for 2006–2010, and then multiplying by 100,000. The rates were then age-adjusted to the 2000 U.S. population.

During 2006–2010, the median age-adjusted AAD rate was 28.5 per 100,000 (state median AAD = 1,647; rate range = 50.9 deaths per 100,000 in New Mexico to 22.4 per 100,000 in Utah) (Table 1). The median AAD rates increased with age, and the majority of AAD (median 70%) involved working-age (20–64 years) adults. The median AAD rate was highest (60.3 per 100,000) for persons aged ≥65 years and lowest (4.1 per 100,000) for persons aged 0–19 years. The median age-adjusted AAD rate for men (42.4 per 100,000) was more than twice the median age-adjusted AAD rate for women (15.8 per 100,000). AAD rates varied substantially by race and ethnicity; some states (e.g., North Dakota and South Dakota) had very high rates of AAD among American Indians/Alaska Natives (AI/AN), whereas rates in other states (California, Michigan, and Virginia) were highest among blacks (Table 1).

During 2006–2010, the median age-adjusted YPLL rate was 823 per 100,000 population (state median YPLL = 42,756; rate range = 1,534 YPLL per 100,000 in New Mexico to 634 YPLL per 100,000 in Utah) (Table 2). The median YPLL rates were highest among persons aged 35–49 years (state median YPLL = 12,486; median state rate = 1,183 per 100,000) and lowest among persons aged 0–19 years (state median YPLL = 3,285; median state rate = 256 per 100,000).  A median of 82% of all alcohol-attributable YPLL involved working-age adults (range = 85% in New Mexico to 78% in Nebraska). The median YPLL rate for men (1,215 per 100,000) was more than twice the median rate for women (456 per 100,000). YPLL rates were highest for AI/AN, ranging from 4,195 YPLL (South Dakota) to 200 YPLL per 100,000 (Virginia) (Table 2).

Editorial Note

During 2006–2010, excessive alcohol use resulted in a median annual age-adjusted AAD rate of 28.5 per 100,000 population and a median YPLL rate of 823 per 100,000 in the 11 states studied. Approximately two out of three deaths and four out of five YPLL were among working-aged adults, and more than two thirds of AAD and YPLL involved males. Although the majority of AAD involved non-Hispanic whites, the median AAD rate for AI/AN (60.6 per 100,000) was twice as high as the AAD rate for any other racial or ethnic group. These findings are consistent with other published estimates on the distribution of AAD and YPLL by sex (4), disparities by race/ethnicity within states (5), and differences in AI/AN rates among states (6).

The findings in this report highlight the ongoing public health impact of excessive drinking in the United States, as well as the geographic and demographic disparities in AAD and YPLL. Differences in age-adjusted rates of AAD and YPLL among states probably reflect differences in the prevalence of excessive drinking (7), which is affected by various factors, including state and local laws governing the price, availability, and marketing of alcoholic beverages (8). These death rates also might reflect the influence of other factors (e.g., rurality and access to trauma care) that could affect the risk for death from alcohol-attributable conditions (9). The high rates of AAD and YPLL among working-age adults further highlight the impact of excessive alcohol use throughout a person’s lifespan, and were a major contributor to alcohol-attributable productivity losses from premature mortality that, together with lost wages, were responsible for 72% of the estimated $223.5 billion in economic costs in 2006 (2). The AAD and YPLL rates were lower among the 0–19 years age group because this age group had fewer AAD compared with other age groups.

The findings in this report are subject to at least seven limitations. First, ARDI exclusively uses the underlying cause of death and does not consider contributing causes that might be alcohol-related. Second, ARDI does not include AAD estimates for several causes (e.g., tuberculosis) for which excessive alcohol use is believed to be an important risk factor. Third, the alcohol data used to calculate AAF estimates were based on self-reports and might underestimate the actual prevalence of excessive alcohol use (10). Fourth, state estimates calculated in this study might be different than those available in the ARDI application. Fifth, national AAF data were used, even though studies suggest that there are important state differences in AAF for some causes of alcohol-attributable deaths. Sixth, AAD and YPLL rates could not be calculated for some age and race/ethnicity categories because of the small number of AAD in some of these groups. Finally, some AI/AN might have been misclassified by race on death certificates, which could have resulted in an underestimate of the number of AI/AN deaths and YPLL in states (6).

The Community Preventive Services Task Force has recommended several population-level, evidence-based strategies to reduce excessive drinking and related harms, including increasing the price of alcohol, limiting alcohol outlet density, and holding alcohol retailers liable for harms related to the sale of alcoholic beverages to minors and intoxicated patrons (dram shop liability) (3). Routine monitoring of alcohol-attributable health outcomes, including deaths and YPLL, in states could support the planning and implementation of evidence-based prevention strategies to reduce excessive drinking and related harms.

1Michigan Department of Community Health; 2New Mexico Department of Health; 3Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 4Council of State and Territorial Epidemiologists (CSTE); 5California Department of Public Health; 6Florida Department of Children and Families; 7CDC EIS Officer (Nebraska Department of Health and Human Services); 8Nebraska Department of Health and Human Services; 9CDC/CSTE Applied Epidemiology Fellow (North Carolina Division of Public Health); 10North Dakota Department of Health; 11CDC Career Epidemiology Field Officer, Office of Public Health Preparedness and Response (South Dakota Department of Health); 12CDC/CSTE Applied Epidemiology Fellow (Utah Department of Health); 13CDC EIS Officer (Utah Department of Health); 14Virginia Department of Health; 15CDC/CSTE Applied Epidemiology Fellow (Wisconsin Division of Public Health); 16Wisconsin Division of Public Health (Corresponding author: Katherine Gonzales, gonzalesk2@michigan.gov, 517-335-5027)

References

  1. Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA 2004;291:1238–45.
  2. Bouchery EE, Harwood H, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the U.S., 2006. Am J Prev Med 2011;41:516–24.
  3. Community Preventive Services Task Force. Preventing excessive alcohol consumption. In: The guide to community preventive services. New York, NY: Oxford University Press; 2005. Available at http://www.thecommunityguide.org/alcohol/index.htmlExternal Web Site Icon.
  4. CDC. Alcohol-attributable deaths and years of potential life lost—United States, 2001. MMWR 2004;53:866–70.
  5. Sutocky JW, Shultz JM, Kizer KW. Alcohol-related mortality in California, 1980 to 1989. Am J Public Health 1993;83:817–23.
  6. CDC. Alcohol-attributable deaths and years of potential life lost among American Indians and Alaska Natives—United States, 2001–2005. MMWR 2008;57:938–41.
  7. CDC. Binge drinking—United States, 2011. MMWR 2013;62(Suppl 3):77–80.
  8. Naimi TS, Blanchette J, Nelson TF, et al. A new scale of the U.S. alcohol policy environment and its relationship to binge drinking. Am J Prev Med 2014;46:10–6.
  9. Branas CC, MacKenzie EJ, Williams JC, et al. Access to trauma centers in the United States. JAMA 2005;293:2626–33.
  10. Stockwell T, Donath S, Cooper-Stanbury M, et al. Under-reporting of alcohol consumption in household surveys: a comparison of quantity-frequency, graduate-frequency and recent recall. Addiction 2004;99:1024–33.

* Available at http://apps.nccd.cdc.gov/ardi.

† Additional information available at http://apps.nccd.cdc.gov/dach_ardi/info/methods.aspx.

§ Available at http://www.cdc.gov/nchs/products/life_tables.htm#life for 2006–2009, and at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf Adobe PDF file for 2010.

 



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