Magnitude and Trends in Cocaine, Other Psychostimulant, and Benzodiazepine-related Poisoning Deaths Massachusetts Residents, 2000-2009 Holly Hackman, MD, MPH Jeanne Hathaway, MD, MPH Massachusetts Department of Public Health
Background Increase in all poisoning deaths in U.S. and MA Past 2-3 decades Largely due to unintentional drug poisoning Heightened surveillance of poisoning i events and expanded prevention initiatives/partnerships Most focusing on opioids Need for routine surveillance of poisoning events associated with other agents of abuse/misuse Single agent or co-occurrence with other agents Useful for prevention and evaluation efforts
Data Sources and Timeframe Massachusetts Data MA Death File Registry of Vital Records and Statistics, MA Dept. of Public Health. 2000-20092009 MA Inpatient Hospital and Emergency Department Discharge Databases, MA Division of Health Care Finance and Policy. FY2003-20102010 U.S. Data National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS)
ICD-10 10-based Definitions Acute Poisoning Death: X40-X49, X60-X69, X85-X90, Y10-Y19, Y35.2, U01(.6-.7) or F10.0 in underlying cause of death field Associated with: Opioid: T40.0-T40.4 0 4 and T40.6* Cocaine: T40.5 Benzodiazepine: T42.4 Psychostimulants with abuse potential (excluding cocaine): T43.6 Ethyl and Unspecified Alcohol: T51.0, T51.9 or F10.00 *Substantial proportion of opioid-related deaths in MA receive this code.
US and MA Age-Adjusted Adjusted All Poisoning Death Rates, 2000-2009 2009 16.0 per 100,000 0 Age Adju usted Rate persons s 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 U.S. Massachusetts 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Sources: Registry of Vital Records and Statistics, MA Department of Public Health; Centers for Disease Control and Prevention; NCIPC, CDC, WISQARS (Accessed 4/19/2012).
MA Poisoning Death Rates by Intent, 2000-2009 2009 16.0 14.0 000 Crude Ra ate per 100, 12.0 10.0 8.0 6.0 4.0 20 2.0 0.0 suicide unintentional+undetermined intent 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Source: Registry of Vital Records and Statistics, MDPH
Poisoning Deaths Associated with Selected Agents/Class of Agents, MA Residents 2000-2009 2009 Age-Ad djusted Rate per 100,00 0 12 10 8 6 4 2 0 N=363 Opioid Cocaine Benzodiazepines Alcohol Other Psychostimulants N=627 N=171 N= 163 Benzo, N =17 Benzo, N = 104 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Source: Registry of Vital Records and Statistics, MA Department of Public Health Categories are not mutually exclusive.
Poisoning Deaths Associated with Opioids by Selected Age Subgroups, MA Residents 2000-20092009 25.0 100,000 persons Rate per 20.0 15.0 10.00 5.0 15-24 25-34 35-44 45-54 55-64 0.0 2000 2001 2002 2003 2004Year 2005 2006 2007 2008 2009 Source: Registry of Vital Records and Statistics, MA Department of Public Health
Sex: Poisonings Associated with Opioids by Select Demographics and Intent, MA Residents 2000-20092009 Male rate remained stable or decreased since 2006 M:F rate ratio 2.4:1 in 2009 Race/ethnicity: White, NH rates > Black, NH > Hispanic in 2009 Since 2006: Hispanic rates have consistently declined White, NH rates relatively stable Intent: 96% unintentional or undetermined intent
Poisonings Associated with Cocaine by Select Demographics and Intent, MA Residents 2000-20092009 Age: Slight aging of peak rates over the decade (45-54 in 2008, 2009 vs. 35-44 earlier in decade) Lowest rates in 2009 were among 15-24 year olds Rates among 55-64 year olds higher in latter part of decade compared with earlier Sex: M > F rate ratio 3.3:1 in 2009 Race/ethnicity: it Highest rates in Black, NH throughout decade; all race/ethnic rates declining in latter part of decade Intent: 98% unintentional or undetermined intent
Poisonings Associated with Benzodiazapines by Select Demographics and Intent, MA Residents 2000-20092009 Age: Sex: Increased death rates in all age grps (greatest % changes in 25-34, 45-54, 54, 55-64 yr olds) Highest ave. annual rate (2007-2009) in 45-54 yr olds M:F rate ratio 1.8:1 in 2009 Race/ethnicity: Increase in death rates is overwhelmingly among White, NH residents Intent: 81% unintentional or undetermined intent
Co-Occurrences of Select Agents among Poisoning Deaths, MA Residents 2000-2009 2009 90.0 80.0 70.0 Perc cent of Total 60.00 50.0 40.0 30.0 20.0 10.0 0.0 % of cocaine among opioid % of opioid among cocaine % of benzo among opioid % of opioid id among benzo 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year
Emergency Department Discharges Associated with Mention of Nonfatal Opioid, Benzodiazepine, Cocaine and Other Psychostimulant Poisoning, MA Residents, FY2003-20102010 Number of ED Encou unters with Mention 3500 3000 2500 2000 1500 1000 500 0 2584 1445 Opioid Benzo Psychostimulant Cocaine 2345 1773 2003 2004 2005 2006 2007 2008 2009 2010 Year Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and Policy *Categories are not mutually exclusive.
Inpatient Hospital Discharges Associated with Mention of Nonfatal Opioid, Benzodiazepine, Cocaine and Other Psychostimulant Poisoning, MA Residents, FY2003-20102010 Numb ber of Hosp pitalization with Mention n1800 1600 1400 1200 1000 800 600 400 200 0 1205 961 Opioid Benzo Psychostimulant Cocaine 1712 1401 2003 2004 2005 2006 2007 2008 2009 2010 Year Source: MA Inpatient Hospital Discharge Database, MA Division of Health Care Finance and Policy *Categories are not mutually exclusive.
Limitations Secondary data sources Possible changes in ascertainment (toxicology testing) Changes in death certificate completion practices over time
Conclusion/Discussion ICD coded death data may be useful to identify emerging trends in poisoning deaths from agents beyond opioids Enhanced surveillance may be necessary to validate and interpret findings Overall trends may vary substantially across demographic groups Examining trends in co-occurrences occurrences of agents may help in directing and evaluating prevention efforts
Contact t Info: Holly Hackman holly.hackman@state.ma.us hackman@state Jeanne Hathaway jeanne.hathaway@state.ma.us t t