Factors associated with incomplete toxicology reporting in drug overdose deaths, 2010–2016

Tote, Katherine; Bradley, Heather; Martin, Erika G.; Yucel, Recai; Rosenberg, Eli S.

doi:10.1016/j.annepidem.2019.08.006

Cited by 21 publications

(11 citation statements)

References 11 publications

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“…Past studies have shown that women and white non-Hispanics, 19 , 21 , 29 those dying from suicide, 16 residents of nonurban lower income counties, 21 , 29 and people in specific age groups 16 , 19 , 21 , 29 are more likely to be coded as “T50.9: unspecified drug overdose” on death records. Some studies have also identified lower general autopsy rates among white non-Hispanics, older individuals, 30 – 32 and individuals having chronic diseases, 32 but these studies were not specific to opioid-involved deaths.…”

Section: Discussionmentioning

confidence: 99%

“…4 Furthermore, prior studies demonstrate that the completeness of documenting multiple causes of death on death certificates, particularly identifying the drugs involved in a death, is lower among coroners compared to medical examiners or pathologists and varies across jurisdictions. 14,16,21,22 Given the large proportion of deaths that do not have an autopsy and the varying resources across jurisdictions responsible for completing death certificates, it is possible that a large number of opioid-involved deaths are missed entirely by death certificates.…”

Section: Introductionmentioning

confidence: 99%

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Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy

2022

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Background: Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine potential undercount of opioid-involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount. Methods: A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid-involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose. Results: Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR = 3.7: 2.1, 6.5), hospitalized for 4+ days (aOR = 2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR = 4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR = 0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR = 0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6% to 15%. Conclusions: Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20%-40% undercount reported elsewhere. See video abstract at, http://links.lww.com/EDE/B990.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy

2022

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“…In addition, postmortem toxicology testing requirements and practices vary by state, county, and individual medical examiner or coroner. Fatalities involving substance use in OGE and throughout the US in all industries may be underreported because of nonstandardized toxicology testing procedures, disparities in death investigations resources, and less frequent toxicology testing among coroners compared with medical examiners 72,73 . Pharmacokinetics, the movement of the substances in the body, was not investigated because of the lack of temporal information.…”

Section: Limitationsmentioning

confidence: 99%

“…Fatalities involving substance use in OGE and throughout the US in all industries may be underreported because of nonstandardized toxicology testing procedures, disparities in death investigations resources, and less frequent toxicology testing among coroners compared with medical examiners. 72,73 Pharmacokinetics, the movement of the substances in the body, was not investigated because of the lack of temporal information. In addition, because the FOG database only collects data on fatalities, we are unable to study substance use behaviors or related nonfatal outcomes in the OGE industry.…”

Section: Limitationsmentioning

confidence: 99%

Fatalities Involving Substance Use Among US Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014–2019)

Ramirez-Cardenas

Wingate

Pompei

et al. 2023

J Occup Environ Med

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Objective: Characteristics of oil and gas extraction (OGE) work, including long hours, shiftwork, fatigue, physically demanding work, and job insecurity are risk factors for substance use among workers. Limited information exists examining worker fatalities involving substance use among OGE workers. Methods: The National Institute for Occupational Safety and Health's Fatalities in Oil and Gas Extraction database was screened for fatalities involving substance use from 2014 through 2019. Results: Twenty-six worker deaths were identified as involving substance use. Methamphetamine or amphetamine was the most common substances (61.5%) identified. Other contributing factors were lack of seatbelt use (85.7%), working in high temperatures (19.2%), and workers' first day with the company (11.5%). Conclusions: Employer recommendations to mitigate substance use-related risks in OGE workers include training, medical screening, drug testing, and workplace supported recovery programs.

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“…7 Compared with counties with coroners, counties with medical examiners tend to have a lower rate of unspecified drug information on death certificates and, thus, tend to have higher-quality and more consistently documented data. 8 We initiated this analysis out of concern that issues that may arise from varying death investigation and reporting systems across states may be magnified in states that have a decentralized county-based system, which may cause investigation and certification of drug overdose deaths to become both geographically and demographically inconsistent. 9 Requirements for coroners and medical examiners vary by state legislation.…”

mentioning

confidence: 99%

Need for Improved Timeliness of Reporting on Drug Overdose Fatalities: The HEALing Communities Study

Gelberg¹,

Chase

Lindstrom

et al. 2023

Public Health Rep

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Objective: Timely data on drug overdose deaths can help identify community needs, evaluate the effectiveness of interventions, and allocate resources. We identified variations in death investigation and reporting systems within and between states that affect the timeliness and accuracy of death certificate information. Methods: The HEALing Communities Study (HCS) is a community-engaged, data-driven approach to combating the opioid crisis in 67 communities in 4 states: Kentucky, Massachusetts, New York, and Ohio. HCS conducted a survey of coroners and medical examiners to understand variability in drug overdose death data. We compared survey results in Massachusetts, New York, and Ohio with national data to investigate the completeness of provisional death counts by type of death investigation system. Results: Communities in each HCS state had different ways of collecting and reporting mortality data. Completion of death certificates for drug overdoses ranged from <2 weeks in 23% (7 of 31) of those surveyed to more than 3 months in 10% (3 of 31) of those surveyed. Variabilities in the timeliness of reporting drug overdose deaths were not associated with type of coroner or medical examiner office in each state, urban versus rural setting, or specificity of drug information on the death certificate. Conclusion: Having specific drug information on the death certificate may increase death certificate quality, comparability, and accuracy. We recommend the following: (1) all coroners and medical examiners should be trained on conducting death investigations, interpreting toxicology reports, and completing death certificates; (2) 1 office in each state should oversee all coroners and medical examiners to increase data consistency; and (3) communities should identify and address barriers to timely death certification.

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Factors associated with incomplete toxicology reporting in drug overdose deaths, 2010–2016

Cited by 21 publications

References 11 publications

Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy

Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy

Fatalities Involving Substance Use Among US Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014–2019)

Need for Improved Timeliness of Reporting on Drug Overdose Fatalities: The HEALing Communities Study

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