Using emergency department (ED) syndromic surveillance to measure injection-drug use as an indicator for hepatitis C risk

Transcription

1 Massachusetts Department of Public Health Bureau of Infectious Disease and Laboratory Sciences Using emergency department (ED) syndromic surveillance to measure injection-drug use as an indicator for hepatitis C risk Mark Bova, MPH Office of Integrated Surveillance and Informatics Services Bureau of Infectious Disease and Laboratory Sciences Massachusetts Department of Public Health

2 Objectives To use ED syndromic surveillance data to estimate an at-risk population for hepatitis C virus (HCV) infection To compare demographic and geographic characteristics in the at-risk population

3 Background In 2015, there were nearly 9,000 confirmed/probable HCV cases reported to MDPH 1 >50% of cases were under 40 years of age Injection drug use (IDU), and in particular heroin/fentanyl use is on the rise in MA 350% increase in opioid-related deaths since 2000, most associated with heroin and fentanyl 2 1 MDPH Hepatitis C Virus Infection Surveillance Report, MDPH Chapter 55 Data Brief: An assessment of opioid-related deaths in Massachusetts,

4 Background (cont d) IDU represents a major risk factor for acute HCV infection, especially for younger age groups Ascertainment of risk factors is difficult to determine after diagnosis ED syndromic surveillance can be used to monitor health trends Rich, timely, public health data source

5 MDPH ED Syndromic Surveillance Began accepting data in December 2014 in line with Meaningful Use standards As of December 2016, receiving data from 55 MA EDs (~85% of statewide ED visits) Connectivity between hospitals and the NSSP is managed by the Mass HIway Data transmitted from EDs includes a free text chief complaint, diagnosis codes and basic demographic information

6 Methods Developed an IDU syndrome to monitor IDU related visits to MA emergency departments to be used as a proxy for HCV risk Compared demographic and geographic distribution of IDU-related ED visits to confirmed/probable HCV cases, with focus on those <40 years of age

7 IDU ED Syndrome Definition Uses combination of chief complaint, triage notes, and discharge diagnoses Visits must contain at least one use term, one drug term, and no negation terms (drug and use terms include likely misspellings) Definition Use terms abscess, L03, cellulitis, inject, overdose, over dose, overose, addiction, injection drug use, PWID, person who injects drugs, person who inject drug, detox, IVDU, intravenous drug use, intra venous drug use, drug treatment, abuse, needle, syringe, hypodermic, OD, IDU Drug terms Negation terms drug, opioid, opoid, opiat, oxyco, oxyi, percoc, vicod, fentan, narcan, naloxo, hydrocod, codeine, codene, morphin, oxymor, dilaud, hydromor, tramad, analgesic, analgsc, opium, methadone, metadone, narcotic, heroin, herion, dope, speed ball, speedball, bupren, suboxone, subutex, cocaine denies substance inhalation, denies any substance inhalation, denies drug, denies any drug

8 Results 23,296 IDU ED visits captured by MDPH syndromic surveillance system in ,810 confirmed/probable HCV cases reported to MDPH s infectious disease surveillance system, MAVEN, in As of July 2017, subject to change

9 Mean age and proportion of visits/cases <40 years of age, IDU ED visits vs. MAVEN HCV cases Group Mean age (sd) Percent of visits/cases <40 years of age Syndromic Surveillance IDU Visits (n=23,296) 37.8 (15.0) 61.9% MAVEN confirmed/probable HCV cases (n=7,810) Group 40.1 (14.8) 58.2% Proportion of total visits/cases by gender and <40 years of age, IDU ED visits vs. MAVEN HCV cases Percent female gender Percent male gender Percent other/missing gender Syndromic Surveillance IDU Visits (n=14,429) MAVEN confirmed/probable 37.9% 62.0% 0.0% 37.2% 59.7% 3.1%

10 Percent of total Percent of total Percent of total Syndromic Surveillance IDU ED visits/confirmed MAVEN HCV Cases ages 40 and below by ethnicity (left) and race (right) African-American American Indian/Alaska Native Asian Syndromic Surveillance IDU Visits Native Hawaiian/Pacific Islander White MAVEN HCV Cases Other Race *Missing values removed from both groups to limit the effect of missing data 0 Hispanic Not Hispanic Syndromic Surveillance IDU Visits MAVEN HCV Cases

11 N=14,429

12 N=4,545

13 Summary Developed an injection-drug use syndrome to estimate population at-risk for acute HCV infection Patients using the ED and captured by the syndromic IDU definition are younger than cases reported with HCV IDU ED patients (<40 years) more likely to be male and white/non-hispanic Race/ethnicity data are much more complete in syndromic dataset Some geographic overlap between both groups (SE MA, Berkshire County) Some areas (Hampshire County) are very different

14 Limitations of ED Syndromic Surveillance Certain geographical areas are not well represented Data are highly variable, including between and within hospitals, and also over time ED visits do not represent individuals/cases Absolute numbers should be treated with caution More useful for observing trends over time and for situational awareness

15 Conclusions Differences in geographic distribution may indicate areas where access to HCV testing is limited, and this is worth further exploration Syndromic surveillance might be used to estimate at-risk population for HCV First step towards elimination May be used to target prevention and testing services May reduce the number of new cases of HCV IDU ED visits may skew slightly younger than new HCV cases due to: Shifting risk groups Time gap between infection and diagnosis

16 Conclusions (continued) Missing race/ethnicity data are a major challenge for the MDPH Hepatitis Program Syndromic data allow us to understand the racial and ethnic profile of those being seen in the ED for IDU May allow us to find where there are gaps in HCV testing among different racial and ethnic groups

17 Questions? Special thanks to: Rosa Ergas Shauna Onofrey Dan Church Sue Soliva Tej Mishra Stefanie Albert Gillian Haney Monina Klevens Contact: Mark Bova, MPH