methadone deaths, 1999-2005, finding from the national ...death using narrative text entered into...

Methadone deaths, 1999Methadone deaths, 1999--2005 2005 Findings from the Findings from the

National Vital Statistics SystemNational Vital Statistics System

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

Margaret Warner PhDLois A Fingerhut MA

Li-Hui Chen MPH PhDOffice of Analysis and Epidemiology

Nashville, November 2008

Presentation OverviewPresentation Overview

National methadone poisoning National methadone poisoning mortality in perspectivemortality in perspectiveData sourceData sourceMethadoneMethadone--related poisoning deathsrelated poisoning deaths–– TrendsTrends–– Demographic characteristics Demographic characteristics –– Regional variationRegional variationNext steps for national surveillanceNext steps for national surveillance

Trends in leading mechanisms of Trends in leading mechanisms of injury death: 1968injury death: 1968--20052005

0

10,000

20,000

30,000

40,000

50,000

60,000

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

num

ber o

f dea

ths

MVT

Firearms

Poisoning

ICD-8 ICD-9 ICD-10

Poisoning deaths mentioning Poisoning deaths mentioning methadone, cocaine, heroin, 1999methadone, cocaine, heroin, 1999--20052005

0

1000

2000

3000

4000

5000

6000

7000

Methadone Cocaine Heroin

Num

ber o

f dea

ths

1999 2000 2001 2002 2003 2004 2005

Source: NCHS, data from the National Vital Statistics System

Where do the data come from?Where do the data come from?

Death certificates, which:Death certificates, which:Form the basis for the national mortality Form the basis for the national mortality statistics statistics Describe the chain of events leading to the Describe the chain of events leading to the death using narrative text entered into the death using narrative text entered into the causecause--ofof--death section of the death certificatedeath section of the death certificateCode causes of death using the Code causes of death using the International International Classification of Diseases, Tenth RevisionClassification of Diseases, Tenth Revision(ICD(ICD--10)10)

43. DESCRIBE HOW INJURY OCCURRED43. DESCRIBE HOW INJURY OCCURRED

39. TIME OF INJURY39. TIME OF INJURY

42. LOCATION OF INJURY: State: 42. LOCATION OF INJURY: State: City or Town:City or Town:Street & Number: Street & Number: Apartment No. Apartment No. Zip Code:Zip Code:

34. 34. WERE AUTOPSY FINDINGS AVAILABLE WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE THE CAUSE OF DEATH?TO COMPLETE THE CAUSE OF DEATH?

Yes NoYes No

41. INJURY AT WORK?41. INJURY AT WORK?

Yes NoYes No

40. PLACE OF INJURY (e.g., Decedent’s home, construction 40. PLACE OF INJURY (e.g., Decedent’s home, construction site, restaurant, wooded area)site, restaurant, wooded area)

38. DATE OF INJURY38. DATE OF INJURY(Mo/Day/(Mo/Day/Yr)(SpellYr)(Spell Month)Month)

29. MANNER OF DEATH29. MANNER OF DEATHNatural Pending Natural Pending Accident InvestigationAccident InvestigationSuicide Could not beSuicide Could not beHomicide DeterminedHomicide Determined

36. IF FEMALE:36. IF FEMALE:Not pregnant within past yearNot pregnant within past yearPregnant at time of deathPregnant at time of deathNot pregnant but pregnant within 42 days of deathNot pregnant but pregnant within 42 days of deathNot pregnant but pregnant 43 days to 1 year before deathNot pregnant but pregnant 43 days to 1 year before deathUnknown if pregnant within the past yearUnknown if pregnant within the past year

35. DID TOBACCO USE 35. DID TOBACCO USE CONTRIBUTE TO DEATH?CONTRIBUTE TO DEATH?

Yes ProbablyYes ProbablyNo UnknownNo Unknown

CAUSE OF DEATH (See instructions and examples)CAUSE OF DEATH (See instructions and examples)

44. IF TRANSPORTATION INJURY, SPECIFY44. IF TRANSPORTATION INJURY, SPECIFYDriver/OperatorDriver/OperatorPassengerPassengerPedestrianPedestrianOther (Specify)Other (Specify)

33. WAS AN AUTOPSY PERFORMED?33. WAS AN AUTOPSY PERFORMED?Yes NoYes No

PART II. Enter otherPART II. Enter other significant conditions contributing to deathsignificant conditions contributing to death but not resulting in the underlying cause but not resulting in the underlying cause given in Part I.given in Part I.

Due to (or as a consequeDue to (or as a consequence of):nce of):

d.d.


c.c.


b.b.Sequentially list conditions, Sequentially list conditions, if any, leading to the cause if any, leading to the cause listed on line a. Enter the listed on line a. Enter the UNDERLYING CAUSEUNDERLYING CAUSE (disease (disease or injury that initiated the events or injury that initiated the events resulting in death) resulting in death) LASTLAST

a.a.IMMEDIATE CAUSEIMMEDIATE CAUSE (Final (Final disease or condition resulting in death)disease or condition resulting in death)

Approximate Approximate interval: interval: Onset to deathOnset to death32. PART I. Enter the 32. PART I. Enter the chain of chain of events events -- -- diseases, injuries, or complications diseases, injuries, or complications -- -- that directly caused the death. DO NOT enter that directly caused the death. DO NOT enter

terminal events such as cardiac arrest, respiratory arrest, or vterminal events such as cardiac arrest, respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT entricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lineABBREVIATE. Enter only one cause on a line. Add additional lines if necessary.s if necessary.

To B

e C

ompl

eted

By:

ME

DIC

AL

CE

RTI

FIER

Other contributing conditions

Causes of death

How injury occurred

Poisoning deaths with and without Poisoning deaths with and without mention of methadone: 1999mention of methadone: 1999--20052005

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

1999 2000 2001 2002 2003 2004 2005

Num

ber o

f poi

soni

ng d

eath

s

Methadone mentioned

No mention of methadone

4%

14%


Percent distribution of all methadone Percent distribution of all methadone deaths by cause and intent: 2005deaths by cause and intent: 2005


Unintentional poisoning

80%

Suicide poisoning5%

Undetermined intent poisoning

11%

Other injury deaths

1%

Noninjury deaths3%

Methadone deaths by underlying Methadone deaths by underlying cause and intent: 1999cause and intent: 1999--20052005

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

1999 2000 2001 2002 2003 2004 2005

Num

ber o

f dea

ths

Unintentional

Undetermined intent

All methadone deaths

Suicide


AgeAge--specific methadone death specific methadone death rates: 1999rates: 1999--20052005

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1999 2000 2001 2002 2003 2004 2005

Dea

ths

per 1

00,0

00 p

opul

atio

n

55-64

15-24

25-34

35-44

45-54


Methadone poisoning deaths Methadone poisoning deaths by age, 2005by age, 2005

0

200

400

600

800

1000

1200

1400

Under 15 15-24 25-34 35-44 45-54 55-64 65 andover

Num

ber o

f dea

ths


Age in years

Methadone poisoning death ratesMethadone poisoning death ratesby age and sex: 2004by age and sex: 2004--20052005


0

1

2

3

4

5

6

7

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54Age

Dea

ths

per 1

00,0

00 p

opul

atio

n

Male

Female

* Figure does not meet standards of reliability or precision

Methadone poisoning deaths, 2005Methadone poisoning deaths, 2005

Place of poisoningPlace of poisoning70 % At home70 % At home

5 % Trade/service areas (including hotels)5 % Trade/service areas (including hotels)23 % Unspecified place23 % Unspecified place

Place of deathPlace of death58 % At home58 % At home15 % Outpatient or emergency department15 % Outpatient or emergency department

5 % Other medical (e.g. inpatient, nursing home)5 % Other medical (e.g. inpatient, nursing home)5 % Dead on arrival5 % Dead on arrival

Next steps for us:Next steps for us:Getting more information from the Getting more information from the

death certificatedeath certificate

Currently, we use ICDCurrently, we use ICD--10 coded data 10 coded data from death certificatefrom death certificate

Developing methods to use literal text Developing methods to use literal text from death certificatefrom death certificate

Narcotic substances mentioned in Narcotic substances mentioned in poisoning deaths: 1999poisoning deaths: 1999--20052005

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Heroin Methadone Cocaine Other opioids Other syntheticnarcotics

Other narcotics

Num

ber o

f dea

ths

1999 2000 2001 2002 2003 2004 2005


What are the specific narcotics mentioned?Morphine, oxycodone,

fentanyl, others ??

Non-specific ICD-10 codesSpecific ICD-10 codes

Published findings Published findings can be found on thecan be found on the

National Center for Health Statistics National Center for Health Statistics website underwebsite underHealth EHealth E--statsstats

Increases in Increases in Poisoning and MethadonePoisoning and Methadone--Related Deaths: Related Deaths:

United States, 1999United States, 1999--20052005by Lois A. Fingerhut, M.Aby Lois A. Fingerhut, M.A

Thank youThank you

Margaret WarnerMargaret [email protected]@cdc.gov

For more information on injury data and resources from NCHS, see:

www.cdc.gov/nchs/injury.htm.

methadone deaths, 1999-2005, finding from the national ...death using narrative text entered into...

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