Identifying Areas with Disproportionate Local Health Department Services Relative to Opioid Overdose, HIV and Hepatitis C Diagnosis Rates: A Study of Rural Illinois

Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings.Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden

Two decades of nonfatal injury data: a scoping review of the National Electronic Injury Surveillance System-All Injury Program, 2001–2021

Abstract Background Injury is a leading cause of preventable morbidity and mortality in the USA. Ongoing surveillance is needed to understand changing injury patterns to effectively target prevention efforts. Launched jointly in 2000 by the Consumer Product Safety Commission (CPSC) and the Centers for Disease Control and Prevention (CDC), the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) provides national-level estimates of US emergency department visits for nonfatal injuries. A scoping review of peer-reviewed articles was conducted to characterize how NEISS-AIP data have been used for injury surveillance in the USA. Main Body This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three bibliographic databases (PubMed, Scopus, and Google Scholar) were systematically searched for English language peer-reviewed articles that used NEISS-AIP data as the primary data source during 2001–2021. Key article characteristics from included articles were abstracted to generate descriptive summary statistics to understand the use and limitations of NEISS-AIP for injury surveillance. Database queries returned 6944 citations; 594 citations were manually reviewed, and 167 non-duplicate journal articles were identified. An average of 8.0 articles (range: 1–14) were published annually during 2001–2021. Articles appeared in 72 different journals representing a diverse audience with the majority of articles written by CDC authors. Starting in 2013, a higher proportion of articles were published by non-CDC authors. The largest number of articles examined injury among all age groups (n = 71); however, the pediatric population was the specific age group of greatest interest (n = 48), followed by older adults (n = 23). Falls (n = 20) and motor-vehicle-related injuries (n = 10) were the most studied injury mechanisms. The most commonly identified limitation identified by authors of reviewed articles was that NEISS-AIP only produces national estimates and therefore, cannot be used for state- or county-level injury surveillance (n = 38). Conclusions NEISS-AIP has contributed to nonfatal injury surveillance in the USA. CDC and CPSC continue to work together to expand and enhance NEISS-AIP data collection. Researchers are encouraged to continue using this publicly available dataset for injury surveillance

Hospitalizations for heat-stress illness varies between rural and urban areas: an analysis of Illinois data, 1987–2014

Abstract Background The disease burden due to heat-stress illness (HSI), which can result in significant morbidity and mortality, is expected to increase as the climate continues to warm. In the United States (U.S.) much of what is known about HSI epidemiology is from analyses of urban heat waves. There is limited research addressing whether HSI hospitalization risk varies between urban and rural areas, nor is much known about additional diagnoses of patients hospitalized for HSI. Methods Hospitalizations in Illinois for HSI (ICD-9-CM codes 992.x or E900) in the months of May through September from 1987 to 2014 (n = 8667) were examined. Age-adjusted mean monthly hospitalization rates were calculated for each county using U.S. Census population data. Counties were categorized into five urban-rural strata using Rural Urban Continuum Codes (RUCC) (RUCC1, most urbanized to RUCC5, thinly populated). Average maximum monthly temperature (°C) was calculated for each county using daily data. Multi-level linear regression models were used, with county as the fixed effect and temperature as random effect, to model monthly hospitalization rates, adjusting for the percent of county population below the poverty line, percent of population that is Non-Hispanic Black, and percent of the population that is Hispanic. All analyses were stratified by county RUCC. Additional diagnoses of patients hospitalized for HSI and charges for hospitalization were summarized. Results Highest rates of HSI hospitalizations were seen in the most rural, thinly populated stratum (mean annual summer hospitalization rate of 1.16 hospitalizations per 100,000 population in the thinly populated strata vs. 0.45 per 100,000 in the metropolitan urban strata). A one-degree Celsius increase in maximum monthly average temperature was associated with a 0.34 increase in HSI hospitalization rate per 100,000 population in the thinly populated counties compared with 0.02 per 100,000 in highly urbanized counties. The most common additional diagnoses of patients hospitalized with HSI were dehydration, electrolyte abnormalities, and acute renal disorders. Total and mean hospital charges for HSI cases were $167.7 million and$20,500 (in 2014 US dollars). Conclusion Elevated temperatures appear to have different impacts on HSI hospitalization rates as function of urbanization. The most rural and the most urbanized counties of Illinois had the largest increases in monthly hospitalization rates for HSI per unit increase in the average monthly maximum temperature. This suggests that vulnerability of communities to heat is complex and strategies to reduce HSI may need to be tailored to the degree of urbanization of a county

Identifying Areas with Disproportionate Local Health Department Services Relative to Opioid Overdose, HIV and Hepatitis C Diagnosis Rates: A Study of Rural Illinois

Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings. Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden