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Overview of Suicide Related Events Among
Emergency Department Overdose Visits in
West Virginia
Dr. Steven A Koehler, MPH, PhDCDC Foundation
Bureau for Public HealthJuly 23, 2019
Charleston, West Virginia
Background
Suicide Events are Classified as:
➢ Successful SuicideDefined as death caused by self-directed injurious behaviors with the intent to die as a result of the behaviors
➢ Unsuccessful SuicideDefined as actions designed to end one’s life that for a number of reasons failed to result in death
➢ Suicide AttemptDefined as non-fatal, self-directed, potentially injurious behaviors with an intent to die as a result of the behaviors even if the behavior does not result in injury
➢ Suicide IdeationDefined as thinking about, considering, or planning suicide
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Numbers
Suicide in West Virginia: 2017 Data*
➢ 10th Leading Cause of Death➢ 393 Deaths➢ Rate: 21/100,000 WV➢ Rate: 14/100,000 US➢ State Ranking: 8th
Non-Fatal Suicide in West Virginia:
➢ 1:27 Suicide to Suicide Attempts➢ 8700 Suicide Attempts
*CDC-National Center for Health Statistics
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Study
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Suicide-Related Events Among ER OD Visits: 2016-2018
Study Design
➢ Using Essence ED data from 46 hospitals➢ Period: 2016-2018➢ Variables:➢ Age, Sex, Year➢ ICD-10 Codes associated with Suicide or
Intentional Self Harm (Discharge Diagnosis)
➢ CDC-CCDD Category Code:➢ Suicide-Related Events ➢ Disposition
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ICD-10 Codes (Discharge Diagnosis)
ICD-10 Codes Associated with Suicide:
R45.851-Suicide Ideation
T14.91-Attempted Suicide
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ICD-10 Codes
ICD-10 Codes Associated with Drug OD Intentional Self-Harm:
T39.012-Poisoning by aspirin, intentional self-harmT39.1X2-Poisoning by 4-Aminophenol derivatives, intentional self-harmT39.312-Poisoning by propionic acid derivatives, intentional self-harmT39.392-Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm
T40.0X2-Poisoning by opium, intentional self-harmT40.1X2-Poisoning by heroin, intentional self-harmT40.2X2-Poisoning by other opioids, intentional self-harmT40.2X2-Poisoning by other opioids, intentional self-harm Initial EncounterT40.3X2-Poisoning by methadone, intentional self-harmT40.4X2-Poisoning by other synthetic narcotics, intentional self-harmT40.5X2-Poisoning by cocaine, intentional self-harmT40.602-Poisoning by unspecified narcotics, intentional self-harmT40.692-Poisoning by other narcotics, intentional self-harmT40.7X2-Poisoning by cannabis (derivatives), intentional self-harmT40.8X2-Poisoning by lysergide [LSD], intentional self-harmT40.902-Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harmT40.992-Poisoning by other psychodysleptics [hallucinogens], intentional self-harm
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ICD-10 Codes
ICD-10 Codes Associated with Drug OD Intentional Self-Harm:
T42.3X2-Poisoning by barbiturates, intentional self-harmT42.4X2-Poisoning by benzodiazepines, intentional self-harmT42.5X2-Poisoning by mixed antiepileptics, intentional self-harmT42.6X2-Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm
T43.012-Poisoning by tricyclic antidepressants, intentional self-harmT43.022-Poisoning by tetracyclic antidepressants, intentional self-harmT43.202-Poisoning by unspecified antidepressants, intentional self-harmT43.592-Poisoning by other antipsychotics and neuroleptics, intentional self-harmT43.622-Poisoning by amphetamines, intentional self-harm
T44.7X2-Poisoning by beta-adrenoreceptor antagonists, intentional self-harm
T47.1X2-Poisoning by other antacids and anti-gastric-secretion drugs, intentional self-harm
T50.902A-Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter
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ICD-10 Codes converted into CDC-CCDD Categories:
Suicide-Related
All DrugsHeroin ODOpioid ODMarijuanaStimulantsAsthmaPneumoniaChronic Hep AChronic Hep CAFM Broad-PediatricAll Traffic RelatedFirearm Injuries Intimate Partner ViolenceSexual Violence 8
Study Design
0
100000
200000
300000
400000
500000
600000
700000
800000
2016 2017 2018
Total ER Visits
Total ER Visits
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Results: Total ER Visits
ER Visits: All OD and Suicide Related OD
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2016 2017 2018
Total OD Related ED Visits Total Suicide Related ER Visits
12.5% 14.1% 17.4%
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Overall Summary
Variable 2016 2017 2018
Total Suicide Related Events
593 556 663
Male 220 (37%) 194 (35%) 223 (34%)
Female 373 (63%) 362 (65%) 440 (66%)
Median Age 33 28 32
Admitted 48 (8%) 36 (6%) 19 (3%)
Discharged 168 (28%) 118 (21%) 230 (35%)
Transferred 144 (24%) 144 (26%) 215 (32%)
Died 1 (0.2%) 0 3 (0.5%)
Not Recorded 232 (39%) 258 (46%) 196 (30%)11
Minnesota Department of Health
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CDC CategoriesVariable 2016 2017 2018
Suicide Related +Traffic
1 (0.2%) - 1 (0.1%)
Suicide Related +Heroin OD
20 (3.4%) 13 (2.3%) 7 (1.0%)
Suicide Related +Opioid OD
52 (8.8%) 41 (7.4%) 47 (7.1%)
Suicide Related +Marijuana
10 (1.7%) 17 (3.1%) 21 (3.2%)
Suicide Related +Stimulants
1 (0.2%) 2 (0.4%) 6 (0.9%)
Suicide Related +All Drugs
513 (86.5%) 482 (86.7%) 561 (84.6%)
Suicide Related +Drugs + Medical Conditions
12 (2%) 20 (3.6%) 28 (4.2%)
Suicide Related + Violence
2 (0.3%) 2 (0.4%) 2 (0.3%)13
Suicide Related + Heroin OD
0
5
10
15
20
25
Heroin
2016 2017 2018
14
3.4%
2.3%
1.0%
Suicide Related + Opioid OD
0
10
20
30
40
50
60
Opioid
2016 2017 2018
7.1%
15
8.8%
7.4%
Suicide Related + Marijuana
0
5
10
15
20
25
Marijuana
2016 2017 2018
16
1.7%
3.1%
3.2%
Suicide Related + Medical Conditions
0
5
10
15
20
25
30
Medical Condition2016 2017 2018
17
2.0%
3.6%
4.2%AsthmaPneumoniaHep AHep C
Summary
➢Suicide-Related OD Events accounted for 15% of all ER OD Related Visits
➢65% of Suicide-Related OD Events involved Females
➢Among Suicide-Related ER OD Visits:➢ Suicide + Heroin-Decreased➢ Suicide + Opioid-Decreased➢ Suicide + Marijuana-Increased➢ Suicide + Stimulants-Increased ➢ Suicide + Medical Conditions-Increased
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Contact
Steven A. KoehlerCDC Foundation Epidemiologist West Virginia Department of Health and Human ResourcesBureau for Public HealthPhone: 304-356-4375Email: [email protected]
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