The Epidemiology of Substance Use Disorders in American Indians and - - PowerPoint PPT Presentation

▶
the epidemiology of substance use disorders in american
SMART_READER_LITE
LIVE PREVIEW

The Epidemiology of Substance Use Disorders in American Indians and - - PowerPoint PPT Presentation

Nov 02, 2023 482 likes •773 views

The Epidemiology of Substance Use Disorders in American Indians and Alaska Natives Heidi Lovejoy, MSc Substance Use Epidemiologist Northwest Portland Area Indian Health Board (NPAIHB) Yellowhawk Tribal Health Center March 5 th 2019 National

slide-1
SLIDE 1

The Epidemiology of Substance Use Disorders in American Indians and Alaska Natives

Heidi Lovejoy, MSc

Substance Use Epidemiologist Northwest Portland Area Indian Health Board (NPAIHB) Yellowhawk Tribal Health Center March 5th 2019

slide-2
SLIDE 2

Northwest Portland Area Indian Health Board

National Drug Overdose Deaths: Trend Since 1999

5 10 15 20 25 Deaths Per 100,000 Year

Age Adjusted Rates per CDC Wonder Data

21.7 .7 13.1 .1 10.1 .1 6.1 .1

slide-3
SLIDE 3

Northwest Portland Area Indian Health Board

National Drug Overdose Deaths: Trend Since 1999

5 10 15 20 25 Deaths Per 100,000 Year

Age Adjusted Rates per CDC Wonder Data

21.7 .7 13.1 .1 10.1 .1 6.1 .1

3.6x Increase

National Public Health Emergency Declared in 2017

slide-4
SLIDE 4

Northwest Portland Area Indian Health Board

National Drug Overdose Deaths: By Race

Age Adjusted Rates per CDC Wonder Data

5 10 15 20 25 30

Deaths Per 100,000

Year White (Non-Hispanic) National Average American Indian/ Alaska Native

21.7 .7 27.5 .5 16.2 .2

slide-5
SLIDE 5

How Does the Northwest Compare?

Northwest Portland Area Indian Health Board

slide-6
SLIDE 6

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: Trend Since 1999

National Age Adjusted Rates per CDC Wonder Data, Washington Age Adjusted Rates per Washington State Death Certificates

5 10 15 20 25

Deaths Per 100,000

Year Washington State National Average

15.4 .4 21.7 .7

slide-7
SLIDE 7

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: By Race

Age Adjusted Rates per Washington State Death Certificates

10 20 30 40 50

Deaths Per 100,000

Year Washington State

15.4 .4

American Indian/ Alaska Native White (Non-Hispanic)

15.3 .3 43.1 .1

slide-8
SLIDE 8

10 20 30 40 50

Deaths Per 100,000

Year

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: WA AI/AN vs National

Age Adjusted Rates per Washington State Death Certificates, National per CDC WONDER

Washington State American Indian/ Alaska Native

43.1 .1

National Average Considered a Public Health Emergency

21.7 .7

2x

national rate

slide-9
SLIDE 9

What Drugs are Involved?

Northwest Portland Area Indian Health Board

slide-10
SLIDE 10

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: What Drugs are Involved?

Age Adjusted Rates per Washington State Death Certificates, 3-Year Rolling Averages

10 20 30 40 50

Deaths Per 100,000 Year

31.5 .5 15.3 .3 44.6 .6 10.2 .2

AI/AN, All OD AI/AN, Opioid OD White, All OD White, Opioid OD

70%

Opioids

slide-11
SLIDE 11

Northwest Portland Area Indian Health Board

Washington State Opioid Overdose Deaths: Which Opioids?

Age Adjusted Rates per Washington State Death Certificates, 3-Year Rolling Averages

Prescription Opioid Multiple Opioids Heroin Methadone 5 10 15 20 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Deaths per 100,000 Year

8.7 .7 7.6 .6 14.4 .4 1.8 .8

American Indian/Alaskan Native

Morphine Codeine Hydrocodone Oxycodone Methadone Etc

slide-12
SLIDE 12

Northwest Portland Area Indian Health Board

Washington State Opioid Overdose Deaths: Which Opioids? AI/AN vs White

Age Adjusted Rates per Washington State Death Certificates, 3-Year Rolling Averages

5 10 15 20

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Deaths per 100,000 Year American Indian/Alaska Native White (Non-Hispanic)

Prescription Multiple Heroin Methadone Prescription Multiple Heroin Methadone

slide-13
SLIDE 13

Northwest Portland Area Indian Health Board

Washington State Overdose Deaths: Other Drugs?

Age Adjusted Rates per Washington State Death Certificates, 3-Year Rolling Averages

5 10 15 20 2001 2003 2005 2007 2009 2011 2013 2015 Deaths per 100,000 Year Methamphetamine & Psychostimulants Cocaine Remove Opioids

3.4 .4 15.5 .5

American Indian/Alaskan Native No Opioid Involved in Death 5 10 15 20 2001 2003 2005 2007 2009 2011 2013 2015 Methamphetamine & Psychostimulants Cocaine

0.7 .7 6.6 .6

American Indian/Alaskan Native

slide-14
SLIDE 14

Northwest Portland Area Indian Health Board

Washington State Opioid Overdose Deaths: By Sex and Race

44.6% 55.4% 41.2% 58.8%

0% 10% 20% 30% 40% 50% 60% 70%

AI/AN Female AI/AN Male White Female White Male Percent

Percent of Deaths per Washington State Death Certificates, 1999-2016

slide-15
SLIDE 15

5 10 15 20 25 30 Rate (per 100,000) Year

Northwest Portland Area Indian Health Board

Washington State Opioid Overdose Deaths: By Sex and Race Over Time

Age Adjusted Rates per Washington State Death Certificates, 3-Year Rolling Averages 1999-2016

AI/AN Male White Male AI/AN Female White Female

19.6 .6 9.2 .2 25.0 .0 6.0 .0

slide-16
SLIDE 16

Northwest Portland Area Indian Health Board

Washington State Opioid Overdose Deaths: By Age and Sex

Age Adjusted Rates per Washington State Death Certificates, 1999-2016

0.7 24.9 48.8 71.0 44.8 19.4 4.9 35.5 52.9 77.8 61.5 27.3

10 20 30 40 50 60 70 80 90 0-19 20-29 30-39 40-49 50-59 60+ Rate (per 100,000) Age Group American Indian/Alaska Native Male Female

slide-17
SLIDE 17

Northwest Portland Area Indian Health Board

Washington State Opioid Overdose Deaths: By Race, Age, and Sex

Age Adjusted Rates per Washington State Death Certificates, 1999-2016

AI/AN Male AI/AN Female

0.7 24.9 48.8 71.0 44.8 19.4 4.9 35.5 52.9 77.8 61.5 27.3 0.9 8.4 15.4 24.2 22.9 7.5 1.6 19.7 24.9 34.4 27.8 8.0

10 20 30 40 50 60 70 80 90 0-19 20-29 30-39 40-49 50-59 60+ Deaths per 100,000 Age Group White Female White Male

slide-18
SLIDE 18
  • Racial misclassification
  • Many AI/AN are not classified as AI/AN in state data systems

= underrepresentation of burden on AI/AN

  • Limited access to behavioral health/treatment data
  • Hard to know prevalence of SUD or treatment for SUD
  • Difficulty obtaining tribe-level data
  • Can only provide regional data
  • Inconsistency in overdose cause of death reporting
  • What drug(s) actually involved?

Northwest Portland Area Indian Health Board

Opioid and Overdose Epidemiology Data Challenges

slide-19
SLIDE 19

Northwest Portland Area Indian Health Board

Racial Misclassification: What we do about it

Process:

  • 1. Obtain state data, like death certificates
  • 2. Link data with the National Tribal Registry
  • 3. Check if AI/AN is indicated one database but not

the other

  • 4. Correct racial classification
  • 5. Do our own statistics with the corrected data

 We fix race in the data

Death certificates National Tribal Registry

NTR

AI/AN AI/AN AI/AN White

?

AI/AN White AI/AN

slide-20
SLIDE 20

10 20 30 40 50 Deaths per 100,000

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: Race Corrected vs Race Un-Corrected

AI/AN Race Corrected AI/AN Race Un-Corrected Up to 20% underrepresentation in AI/AN overdose death rate No difference in rates White (non-Hispanic) Race Corrected and Un-Corrected

slide-21
SLIDE 21

43.1 35.6 31.9

10 20 30 40 50 Deaths per 100,000

2016 AI/AN Drug Overdose Death Rate in Washington

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: by Reporting Agency

AI/AN

  • ONLY-

Not Race- Corrected Race- Corrected NPAIHB Reporting Agency WA DOH CDC

slide-22
SLIDE 22

43.1 35.6 31.9

10 20 30 40 50 Deaths per 100,000

2016 AI/AN Drug Overdose Death Rate in Washington

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: by Reporting Agency

AI/AN

  • ONLY-

Not Race- Corrected Race- Corrected NPAIHB WA DOH Reporting Agency State data reports 20% lower CDC

slide-23
SLIDE 23

43.1 35.6 31.9

10 20 30 40 50 Deaths per 100,000

2016 AI/AN Drug Overdose Death Rate in Washington

Northwest Portland Area Indian Health Board

Washington State Drug Overdose Deaths: by Reporting Agency

AI/AN

  • ONLY-

Not Race- Corrected Race- Corrected NPAIHB WA DOH CDC Reporting Agency National data reports 30% lower

slide-24
SLIDE 24

Northwest Portland Area Indian Health Board

National Drug Overdose Deaths: By Race

Age Adjusted Rates per CDC Wonder Data

5 10 15 20 25 30

Deaths Per 100,000

Year White (Non-Hispanic) National Average American Indian/ Alaska Native

21.7 .7 27.5 .5 16.2 .2

?

AI/AN rates may be higher nationally?

slide-25
SLIDE 25
  • Deaths from drug overdoses are increasing
  • Most overdose deaths involve opioids
  • People aged 40-49 have the most overdose deaths
  • Nationally, AI/AN have a lower overdose death rate than whites
  • In Washington, AI/AN have the highest overdose death rate (3x whites)
  • National and state statistics may significantly underestimate AI/AN statistics

Northwest Portland Area Indian Health Board

Take Away Messages

slide-26
SLIDE 26

Heidi Lovejoy, MSc

Substance Use Epidemiologist Northwest Portland Area Indian Health Board HLovejoy@NPAIHB.org

Northwest Portland Area Indian Health Board

Thank You!

Questions?

slide-27
SLIDE 27

Northwest Portland Area Indian Health Board

Why use rates?

Scenario: Group A: 1,000 people 50 people die of a disease in both groups. Group B: 100 people Group A: 50/1,000 = 5% died. Not good. To compare across groups with different sized populations Group B: 50/100 = 50% died. Really bad!! Same number of deaths. This is why we use rates – to compare across populations