Injury Epidemiology最新文献

Background: Overdose mortality increased substantially during the COVID-19 pandemic, but it is unclear to what extent the COVID-19 mortality had contributed to this increase at the neighborhood level.

Methods: This was an ecological study based on New York City United Hospital Fund (NYC UHF) neighborhood-level data from 2019 to 2021, split into two time-windows: pre-COVID (2019) and during-COVID (2020 and 2021). Linear regression models were used to estimate the effect of cumulative COVID-19 mortality on the increase in drug overdose mortality from the pre-COVD to during-COVID periods at the neighborhood level, with and without adjusting for neighborhood characteristics.

Results: Drug overdose mortality rate increased from 21.3 to 33.4 deaths per 100,000 person-years across NYC UHF neighborhoods from pre-COVID to during-COVID. For each additional COVID-19 death per 1,000 person-years at the neighborhood level, the increase in drug overdose mortality rose 2.4 (95% CI: 1.7, 3.3) times. Furthermore, neighborhoods with a higher percentage of Hispanic residents, a higher percentage of single-person households, and a higher percentage of residents with health insurance experienced significantly larger increases in drug overdose mortality. In contrast, neighborhoods with a higher percentage of residents aged 75 and older had a smaller increase in drug overdose mortality.

Conclusions: NYC neighborhoods with higher cumulative COVID-19 mortality experienced a greater increase in drug overdose mortality during the first two years of the COVID-19 pandemic.

Background: Firearm injuries are the leading cause of death for U.S. adolescents. Given the prevalence of firearm ownership in the U.S., particularly among parental figures in homes with children and teens, and the relationship between firearm access and injury outcomes, it is vital to shed light on potential parental motivations for keeping firearms in their homes. The purpose of this analysis was to examine whether exposure to community violence is associated with parental firearm ownership.

Methods: Data from the Firearm Safety Among Children and Teens Consortium's National Survey (6/24/2020-7/24/2020) was examined. The survey sample comprised parents/caregivers of high-school-age teens (age 14-18). The survey examined various measures, including firearm ownership, storage, community violence exposure, and sociodemographic characteristics. Stepwise logistic regression was used to examine the association between community violence exposure and parental firearm ownership.

Results: The study included 2,924 participants, with 45.1% identifying as male, 12.9% identifying as Hispanic, and 25.3% identifying as non-White. Among these participants, 43.1% reported firearm ownership, and 49.9% reported exposure to community violence. Regression models demonstrate that community violence exposure is associated with an increased likelihood of firearm ownership among parents/caregivers of high-school age teens (OR = 1.08, p < 0.05). Other significant predictors of firearm ownership among parents/caregivers included parent/caregiver age (OR = 0.99, p < 0.01), marital status (OR = 1.29, p < 0.05), and educational attainment (OR = 0.60, p < 0.001).

Conclusions: The findings supported the hypothesis that community violence exposure was associated with an increased likelihood of parental firearm ownership, even after adjusting for potential confounders. These findings contribute to the existing literature by shedding light on the possible contributing factors for firearm ownership among parents/caregivers of teens. Public health interventions focused on raising awareness about the risks of firearm access in households with youths, providing counseling on locked storage practices, and offering resources for accessing secure firearm storage options, such as rapid access storage, may contribute to reducing firearm access among youth. Additionally, community-based initiatives focused on violence prevention and addressing the root causes of community violence can help create safer environments, thereby reducing the perceived need for accessible firearms in the home by parents and caregivers.

Background: Suicide-related presentations to pediatric emergency departments (PED) have increased in recent years. PED providers have the opportunity to reduce suicide risk by counseling on restricting access to lethal means. Supplementing lethal means counseling (LMC) with safety device distribution is effective in improving home safety practices. Data on PED-based LMC in high-risk patient populations is limited. The objective of this study was to determine if caregivers of children presenting to PED for mental health evaluation were more likely to secure all household firearms if given cable-style gun locks in addition to LMC.

Methods: In this randomized controlled trial, caregivers completed a survey regarding storage practices of firearms and medication in the home. Participants were randomized to receive LMC (control) or LMC plus 2 cable-style gun locks (intervention). Follow-up survey was distributed 1 month after encounter. Primary outcome was proportion of households reporting all household firearms secured at follow-up. Secondary outcomes included: removal of lethal means from the home, purchase of additional safety devices, use of PED-provided locks (intervention only), and acceptability of PED-based LMC.

Results: Two hundred participants were enrolled and randomized. Comparable portions of study groups completed follow-up surveys. Control and intervention arms had similar proportions of households reporting all firearms secured at baseline (89.9% vs. 82.2%, p = 0.209) and follow-up (97.1% vs. 98.5%, p = 0.96), respectively. Other safety behaviors such as removal of firearms (17.6% vs. 11.8%, p = 0.732), removal of medication (19.1% vs. 13.2%, p = 0.361), and purchase of additional safety devices (66.2% vs. 61.8%, p = 0.721) were also alike between the two groups. Both groups held favorable views of PED-based counseling. Within the intervention group, 70% reported use of provided locks. Preference for a different style of securement device was the most cited reason among those not using PED-provided locks.

Conclusions: PED-based LMC is a favorably-viewed, effective tool for improving home safety practices in families of high-risk children. Provision of cable-style gun locks did not improve rate of firearm securement compared LMC alone-likely due to high baseline rates of firearm securement and preference for different style of lock among non-utilizers.

Clinical trial registration: ID: NCT05568901 .

Clinicaltrials: gov. https://clinicaltrials.gov/ . Retrospectively registered October 6, 2022. First participant enrollment: June 28, 2021.

Objective: To date, systematic reviews of frostbite injuries predominantly focus on the treatment of frostbite, which narrows the scope of prevention and disregards the impact of frostbite-related predisposing factors. Comprehensively synthesizing relevant evidence to understand the psychosocial and personal predisposing factors to frostbite injury and related amputation would provide new insight into frostbite injury prevention. This review investigated the psychosocial and personal predisposing factors of frostbite injury and associated amputation.

Methods: Databases, including Embase, PubMed, and PsycINFO, were systematically searched for relevant studies. Two independent reviewers performed the screening, data extraction, and quality assessment. Inclusion criteria were studies that reported cold injury, predisposing factors for frostbite injury or related amputations, and assessed the relationship between a predisposing factor and the frostbite injury or amputation outcome based on a descriptive or inferential test.

Results: Thirty-six (36) studies met the inclusion criteria; 29 reported on both frostbite injury and amputations, and seven reported on only frostbite injury. Six psychosocial predisposing factors were observed in 28 out of the 36 studies reviewed, which included people experiencing homelessness, low socioeconomic status, alcohol intoxication/abuse, smoking, psychiatric disorders, and substance use. Personal predisposing factors identified included inadequate/improper winter clothing, delay in seeking medical care, and lack of knowledge of how to deal with the cold.

Conclusions: While it is crucial to allocate additional resources and research toward improving the treatment of individuals affected by frostbite injuries and associated limb loss, it is equally important to direct efforts toward addressing the psychosocial and personal predisposing factors that predispose individuals to these injuries and amputations.

Background: Approximately 15% of pediatric firearm injuries are unintentional. While demographic characteristics of unintentional firearm injuries have been described, the relationship between injury characteristics and mortality is not well understood. In this study, we identified injury characteristics associated with fatality among unintentional firearm injuries in adolescents.

Methods: We conducted a retrospective (May 2022-May 2023) cross-sectional study of unintentional firearm injuries among adolescents 12-17 years old using the Gun Violence Archive. Variables included victim age and sex, shooter age and sex, injury location, injury circumstance, number of firearms, type of firearm, firearm owner, census region, and shooter relationship to the victim. Logistic regression was used to identify variables associated with fatality.

Results: Of 319 unintentional incidents, 212 (66.5%) were non-fatal and 107 (34.5%) were fatal. Of all shootings, 176 (55.2%) occurred in a residence. A shooter was identified in 256 (80.3%) cases; 43.0% of these were a peer of the victim. The adjusted odds of fatality were higher when a peer was the shooter (aOR 5.38, 95% CI 2.57, 11.80) compared to self-inflicted injury and when the shooting took place in the victim's residence (aOR 2.87, 95% CI 1.07, 7.88) or another residence (aOR 3.03, 95% CI 1.45, 6.67) versus a public location (Fig. 1).

Conclusions: Unintentional firearm injuries were more likely fatal when a peer was the shooter and when the shooting occurred at a residence. This amplifies the importance of safe home firearm storage and exploring other evidence-based approaches to decreasing youth access to firearms.

Background: The U.S.-Mexico "border wall" between El Paso, Texas and Ciudad Juárez, Mexico was raised and extended beginning in 2018 in accordance with Presidential Executive Order 13,767. We hypothesized that these changes resulted in increased incidence and severity of injuries of individuals attempting to cross the border wall in the El Paso region.

Methods: A retrospective cohort review was conducted of University Medical Center of El Paso Trauma Registry charts from 2001 to 2022. Year of injury, gender, age, Injury Severity Score, hospital length-of-stay, ICU length-of-stay, ventilator days, and survival were analyzed by Chi-square analysis with Fisher's exact test for categorical variables and Independent Samples T-test for continuous variables. An independent samples Mann Whitney U Test was used to compare border wall fall injuries before and after 2018.

Results: Of the 842 patients reviewed, 69 patients presented before 2018 and 773 presented from 2018 to 2022. Statistically significant differences were identified in the mean Injury Severity Score which increased from 6.3 (SD ± 3.8) to 8.3 (SD ± 5.5, p < .001) and the mean hospital length-of-stay which increased from 6.7 days (SD ± 5.5) to 9.5 days (SD ± 8.0, p < .005).

Conclusion: The incidence, severity, and hospital length-of-stay related to injuries crossing the U.S.-Mexico border have increased with changes in height of the border wall since 2018. Additional resources should be allocated to Emergency Departments and Trauma Centers along the Southwest Border to serve this unique patient population. Additional consideration should be given to the cost of the border wall.

Background: Gabapentin and pregabalin were originally introduced as anticonvulsant medications but are now also prescribed on- and off-label for multiple medical disorders, especially for pain management. The national opioid crisis has led to increased use of non-opioid pain medications, including gabapentinoids, which has been associated with changing patterns of adverse events associated with these medications. This study investigated the characteristics and trends of gabapentin and pregabalin exposures reported to US poison centers from 2012 to 2022.

Methods: National Poison Data System data involving gabapentin and pregabalin exposures for 2012 to 2022 were analyzed.

Results: There were 124,161 exposures involving gabapentin and pregabalin as the primary substance reported to US poison centers during the study period. Most exposures involved gabapentin (85.9%), females (59.4%), single-substance exposures (62.9%), or occurred at a residence (97.2%). Suspected suicides accounted for 45.2% of exposures. Most exposures were associated with a minor effect (27.4%) or no effect (34.0%), while 22.1% experienced a serious medical outcome, including 96 fatalities. The rate of gabapentin and pregabalin exposures per one million US population increased by 236.1% from 22.7 in 2012 to 76.5 in 2019 (P < 0.001), followed by a non-significant decrease to 68.5 in 2022 (P = 0.068).

Conclusions: The rate of gabapentin and pregabalin exposures reported to US poison centers increased by more than 230% from 2012 to 2019 before plateauing from 2019 to 2022. The observed rate trend was driven primarily by gabapentin exposures and by cases associated with suspected suicide. Although most exposures were associated with a minor or no effect, 22% of individuals experienced a serious medical outcome, including 96 fatalities. These findings contribute to the discussion of rescheduling gabapentin as a federally controlled substance, which is the current status of pregabalin. Prevention of suicide associated with gabapentin and pregabalin merits special attention.

Background: Firearm violence is a significant public health issue. However, it is unclear if there is an association between the Social Vulnerability Index (SVI) and the intent of both fatal and nonfatal firearm injuries, and if these associations are modified by community race and ethnic composition. This study examines the association between community-level social vulnerability and firearm injury incidence in North Carolina (NC) using 2021-2022 emergency medical services (EMS) data. Additionally, it investigates how these associations vary by the intent of injury (assault, self-inflicted, and unintentional), and whether they are modified by community racial/ethnic composition.

Methods: This cross-sectional study utilized NC EMS data, capturing firearm incidents from January 1, 2021, to December 31, 2022. The SVI from the Centers for Disease Control and Prevention (CDC) was used to assess community-level vulnerability. The SVI's racial/ethnic minority status component was removed for stratification analysis. Firearm injury rates were calculated per 100,000 population, and negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) for different SVI levels and intents of firearm injuries.

Results: During the study period, we identified 7,250 EMS encounters at non-healthcare locations related to firearm injuries, encompassing 2,648 NC census tracts. Assault was the leading cause of firearm injuries (n = 3,799), followed by self-inflicted (n = 1,498), and unintentional injuries (n = 722). High-SVI communities had significantly higher rates of firearm injuries compared to low-SVI communities, particularly for assault-related injuries. When the minority status component was excluded from SVI, racial/ethnic minority status emerged as a significant modifier, with higher rates of firearm injuries being observed in communities with larger racial/ethnic minority populations.

Conclusion: Community-level social vulnerability is significantly associated with firearm injury incidence, with the effect being more pronounced in racial/ethnic minority communities. These findings underscore the need for targeted public health interventions that address underlying social determinants of health (e.g., access to education) to reduce firearm violence. Future research should further explore the intersection of social vulnerability and racial/ethnic composition to develop effective prevention strategies.

Background: Cannabis use has been causally linked to violent behaviors in experimental and case studies, but its association with homicide victimization has not been rigorously assessed through epidemiologic research.

Methods: We performed a case-control analysis using two national data systems. Cases were homicide victims from the National Violent Death Reporting System (NVDRS), and controls were participants from the National Survey on Drug Use and Health (NSDUH). While the NVDRS contained toxicological testing data on cannabis use, the NSDUH only collected self-reported data, and thus the potential misclassification in the self-reported data needed to be corrected. We took a data fusion approach by concatenating the NSDUH with a third data system, the National Roadside Survey of Alcohol and Drug Use by Drivers (NRS), which collected toxicological testing and self-reported data on cannabis use for drivers. The data fusion approach provided multiple imputations (MIs) of toxicological testing results on cannabis use for the participants in the NSDUH, which were then used in the case-control analysis. Bootstrap was used to obtain valid statistical inference.

Results: The analyses revealed that cannabis use was associated with 3.55-fold (95% CI: 2.75-4.35) increased odds of homicide victimization. Alcohol use, being Black, male, aged 21-34 years, and having less than a high school education were also significantly associated with increased odds of homicide victimization.

Conclusions: Cannabis use is a major risk factor for homicide victimization. The data fusion with MI method is useful in integrative data analysis for harmonizing measures between different data sources.

Background: In recent years, the United States (US) has witnessed a rise in political violence. Prior research has found that an individual's social network is associated with their likelihood of engaging in various forms of violence, but research on social networks and political violence in the US context is limited. This study examined associations between social network size and endorsement of political violence in a recent nationally representative survey and explored how the relationship varied by use of social media as a major news source, perceptions of the government as an enemy, and membership in a marginalized or privileged racial or ethnic group.

Methods: This was a nationally representative cross-sectional survey study of adults aged 18 and older in the US, administered from May 13-June 2, 2022. The exposure was social network size, defined by the number of strong social connections. We examined three violence-related outcomes: support for non-political violence, support for political violence, and personal willingness to engage in political violence. We estimated prevalence ratios for associations using survey-weighted Poisson regression with robust standard errors, adjusting for hypothesized confounders and including interaction terms to examine effect measure modification.

Results: The sample included 8,620 respondents. Median age was 48.4 years (95% CI = 47.9-48.8), 51.5% were female (95% CI = 50.4-52.7%), and 62.7% self-identified as non-Hispanic White (95% CI = 61.4-65.9%). In adjusted models, those with zero strong connections were more likely than those with 1-4 strong social connections to consider political violence usually/always justified in general (PR = 2.43, 95% CI = 1.47-4.01). Those with 50 + strong connections were more likely than those with 1-4 strong social connections to consider political violence usually/always justified in at least one situation (PR = 1.19, 95% CI = 1.03-1.37) and were more likely to report being willing to personally use political violence (PR = 1.52, 95% CI = 1.13-2.04). Associations varied somewhat by social media use, perceptions of the government as an enemy, and racialized identity.

Conclusions: Individuals who reported very few and very many strong social connections were more likely than others to support political violence or be personally willing to engage in it in one form or another. Findings point toward potential intervention and prevention opportunities.