key: cord-0019129-o8xgink3
authors: Slavova, Svetla; Quesinberry, Dana; Hargrove, Sarah; Rock, Peter; Brancato, Candace; Freeman, Patricia R.; Walsh, Sharon L.
title: Trends in Drug Overdose Mortality Rates in Kentucky, 2019-2020
date: 2021-07-13
journal: JAMA Netw Open
DOI: 10.1001/jamanetworkopen.2021.16391
sha: a9dd7fb38e364cc25088c5ed092c2d645f729822
doc_id: 19129
cord_uid: o8xgink3

This cross-sectional study evaluates the changes in drug overdose mortality rates for Kentucky residents between 2019 and 2020.

This study used electronic death certificate records from the Kentucky Office of Vital Statistics, Cabinet for Health and Family Services, supplemented with postmortem toxicology data from the Kentucky Drug Overdose Fatality Surveillance System 1 housed at the Kentucky Injury Prevention and Research Center, bona fide agent for the Kentucky Department for Public Health.

Drug overdose deaths were identified based on electronic death certificate records with an underlying cause-of-death coded with an ICD-10 (International Classification of Diseases, 10th Revision 2 ) code in the range X40-X44 (unintentional drug poisoning), X60-X64 (intentional self-poisoning by drugs/suicide), X85 (homicide poisoning by drugs), or Y10-Y14 (poisoning by drug with undetermined intent). 3 Drug overdose deaths with specific drug involvement: Multiple cause of death ICD-10 codes were used to identify the involvement of the following drugs/drug classes in the drug overdose deaths: T40.1 heroin; T40.0 -T40.4 or T40.6 opioids; T40.5 cocaine; T43.6 psychostimulants with abuse potential (e.g., methamphetamine, amphetamine, 3,4-Methylenedioxymethamphetamine (MDMA), methylphenidate; excluding cocaine). 4 Due to the lack of specific ICD-10 codes, involvement of fentanyl and fentanyl analogs was identified from narrative text analyses of the cause-of-death section on the death certificate, using an approach described by the Council of State and Territorial Epidemiologists 5 and a list of search terms for fentanyl and fentanyl analogs developed by the National Center for Health Statistics (NCHS) 6 . According to the NCHS, the monthly percentage of Kentucky drug overdose death certificates that did not list any specific drugs involved in an overdose death varied from 5.2% to 8.1% in the January 2019 -December 2020 period. 7 In such cases, the presence of any opioids, specific involvement of heroin or fentanyl and fentanyl analogs, cocaine, or other psychostimulants with abuse potential (specifically amphetamine or methamphetamine) was identified from the postmortem toxicology testing report.

The literal text in the cause-of-death section on the death certificates was queried for search terms (including drug names, misspellings, and metabolites) used previously by Hedegaard et al 6 Denominators for crude rates: The denominator for the 2020 statewide rates was based on the U.S. Census Bureau's population estimate of the Kentucky resident population as of July 1, 2020. 8 The denominator for the 2019 statewide rates as well as the denominators for the 2019 and the 2020 groupspecific rates were based on the 2019 bridged-race population estimates from the National Center for Health Statistics 9 because 2020 Kentucky resident population estimates by age group, race/ethnicity, gender, and county of residence were not available at the time the analysis was performed.

Rates, rate ratios, and 95% confidence intervals were modeled with Poisson distribution, using statistical software SAS 9.4 and proc GENMOD. 10 Rates based on small number of deaths should be interpreted

Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention

International classification of diseases, tenth revision: version 2016. World Health Organization

Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants

Drug Overdose Deaths in the United States

Epi tool to analyze overdose death data

Regional Differences in the Drugs Most Frequently Involved in Drug Overdose Deaths: United States

NCHS) Vital Statistis Rapid Release. Table on Improvement of Data Quality, by State and Year

Bridged-Race Resident Population Estimates, United States, State and County, for the years

Usage Note 24188: Modeling rates and estimating rates and rate ratios (with confidence intervals)