Community Injury Research

Association between Type of Residence and Clinical Signs of Neglect in Older Adults. Friedman L, Avila S, Friedman D, Meltzer W. Gerontology.

In this study, we use the Clinical Signs of Neglect Scale (CSNS), an aggregate measure of clinical signs of neglect, to evaluate the association of residence type and health outcomes. While there are numerous studies that have demonstrated that measures of lower quality of care and associated adverse health effects are more prevalent in for-profit nursing homes compared to not-for-profit facilities, these studies ignore home care and exclusively focus on individual clinical signs which may obscure the true effect size since these clinical signs rarely occur in isolation. Our findings show that patients receiving care in for-profit institutions, were diagnosed with substantially more clinical signs of neglect than patients residing in not-for-profit facilities and low functioning community dwelling patients.

Using clinical signs of neglect to identify elder neglect cases. Friedman LS, Avila S, Liu E, Dixon K, Patch O, Partida R, Zielke H, Giloth B, Friedman D, Moorman L, Meltzer W. J Elder Abuse Neglect.

Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual’s residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals.

Physical Abuse of the Elderly: Victim Characteristics and Determinants of Revictimization.  Friedman LS, Avila S, Rizvi T, Partida R, and Friedman D.  J Am Ger Soc.

This study assessed history of revictimization for elder mistreatment based on hospital admission histories, Adult Protective Services records, and self-report. More than half of the  cases suffering physical abuse had documented histories of revictimization. Risk factors for revictimization included individuals who were female, widowed, diagnosed with dementia, and returning to the home where the perpetrator lived or visited were substantially more likely to be revictimized. Revictimized individuals were more likely to be assaulted through unarmed force by a proximal relative, in particular a husband, boyfriend, child, or child-in-law. Based on hospital records, only 57% of community-dwelling cases had their abuse reported to Adult Protective Services or the police, and only 26.6% had Adult Protective Services investigations on record.

A Description of Cases of Severe Physical Abuse in the Elderly and 1-Year Mortality. Friedman LS, Avila S, Tanouye K, Joseph K.  J Elder Abuse Negl.

We conducted a case-control study to evaluate severe physical abuse of the elderly treated in two Chicago area Level I trauma centers. This report details whether physicians are adequately reporting cases of abuse to Adult Protective Services (APS), and assesses 1 year. The failure to report two-thirds of the cases and the substantially higher risk of death during the first year after hospitalization indicates the need for improved identification, reporting, and intervention. It is important that clinicians understand the complexity of elder abuse in order to better identify suspected victims and report these cases to professionals in APS.

Description of Opioid Related Hospital Deaths that Do Not Have a Subsequent Autopsy.  Abasilim C, Holloway-Beth A, and Friedman LS. Epidemiology.

Since the current U.S. surveillance system relies on death records to monitor the most severe outcome of opioid-use disorders, we need to ensure that opioid-involved deaths are captured as fully as possible on death certificates and provide detailed information about those that die and the specific drugs contributing to their deaths. The current study linked hospital data with medical examiner data to determine how many opioid-involved deaths that occur in a hospital setting do not have an autopsy. We found that only 19.5% of opioid deaths in a hospital setting had an autopsy performed.

Disparities in Opioid-involved Overdoses among Middle-aged Black Men and Women. Friedman LS, Karch L, Abasilim C, and Holloway-Beth A.

In Cook County Illinois, we observed stark disparities in opioid-involved overdoses among middle-aged Black men and women relative to other age groups and ethnicities of the same age.  Most alarming is that the trends are continuing to rise and data indicates a similar pattern may be unfolding nationwide.

Trends in Non-Fatal and Fatal Opioid Overdoses During the First Two Years of COVID-19 Pandemic. Abasilim C, Friedman LS, Karch L and Holloway-Beth A.

In Cook County Illinois, we observed increase in fatal opioid overdose rates and decline in rates for both admissions and ED visits across strict pandemic mitigation phases. Our findings underscore the importance of multiple sources of surveillance for public health planning and to better characterize opioid-involved overdoses.

Opioid Epidemic in Cook County Illinois. Friedman LS, Nguyen N, and Holloway-Beth A.

The report analyzed four health data systems to characterize the opioid epidemic among residents covered under the Cook County Department of Public Health jurisdiction. The datasets utilized for this analysis included data from the Illinois Poison Center, hospital outpatient emergency department (ED) visits that do not result in a hospital admission, hospital inpatient admissions, and the Cook County Medical Examiner’s Office. No single dataset fully characterizes the problem of the opioid epidemic in Cook County, and individual characteristics and types of opioids differ in each dataset. However, the aggregate of information gathered across all the datasets provides the most comprehensive picture. This report focuses on cases of acute intoxication-overdose from January 2016 through June 15, 2020.

Harm Reduction Strategies to Address the Opioid Epidemic in Suburban Cook County. Friedman LS.

Report conducted in partnership with the Cook County Department of Public Health. The report presents the state of scientific knowledge regarding different harm reduction strategies that can be used to mitigate the harm from the ongoing opioid epidemic. The pragmatic harm reduction model takes into account that individuals with substance use disorders move along the recovery continuum in both directions — allowing for relapse– which is in direct opposition to traditional zero-tolerance models. The role of public health practitioners is to meet individuals “where they are” instead of ineffectively forcing individuals with SUDs and those assisting these individuals to adhere to a singular and unidirectional intervention path.

Surveillance of Civilians Injured by Law Enforcement

In the U.S. during a given year, an estimated 1 million civilians experience police threat of or use of force resulting in a conservative estimate of 85,000 non-fatal injuries requiring hospital treatment and 600-1000 deaths. Both Black/African-Americans and Hispanics/Latinos are twice as likely to experience threat of or use of force during police initiated contact (Bureau of Justice Statistics). Based on CDC data, Black African-Americans are more than twice as likely to be killed and almost 5-times more likely to suffer an injury requiring medical care at a hospital compared to white non-Hispanics.

Through our UIC Law Enforcement Epidemiology Project we have developed a statewide surveillance system and release an annual report that summarizes serious injuries suffered by civilians during contact with law enforcement. We also publish in the scientific peer reviewed literature on risk factors associated with civilian injuries and race-ethnic disparities in injury rates.

Full Annual Report

More detailed information can be found at Law Enforcement Epidemiology Project Website.

Public Health Surveillance for the Prevention of Pesticide-Related Illness in Illinois. Kyeremateng-Amoah E, Friedman L, Wahl M, and Forst L. J Occ Environ Med.

By linking multiple public health surveillance data systems we estimated the counts of pesticide related illnesses (PRI) in Illinois. Between 2010-2015, we identified 3867 unique cases of PRI and 6269 asymptomatic pesticide exposures. Out of the 3867 PRI cases, there were 1319 emergency department visits and 321 hospitalizations. We identified 13 deaths and 1640 major or moderate effects from PRI. Over half of ingestion related exposures occurred in children aged 0 to 4 years. Workers’ compensation and Emergency Medical Service data were unusable.  We continue to monitor PRI cases using this established surveillance system and will be releasing a report in the coming year.

Hospital outcomes and economic costs from poisoning cases in Illinois. Krajewski AK and Friedman LS. Clin Toxicol (Phila).

We also compared a broad definition for poisoning used in our analysis with the definitions used by four national health surveys in order to assess the adequacy of various definitions in capturing poisonings for surveillance. In Illinois, 425,491 patients were treated in hospitals for poisoning in one year alone, of whom 222,339 were inpatients. The age-adjusted incidence rate was 3,189 per 100,000 persons, with an average length of stay among inpatients of 5.5 days. The cumulative hospital charges were $7.9 billion.  Nearly all of the cases of poisoning did not involve illicit drugs. The definitions used in national surveys miss 60-90% of poisoning cases. Poisoning is the leading cause of fatal injuries in the U.S., but as this study shows broadening the definition for poisoning may provide a more accurate representation of the direct and indirect effects of poisoning in the US.

The association between U.S. Poison Center assistance and length of stay and hospital charges.  Friedman LS, Krajewski A, Vannoy E, Allegretti A, Wahl M.  Clin Toxicol (Phila).

Among the inpatient cases, when Poison Center staff are contacted to provide assistance in the diagnosis and treatment of persons exposed to poisons, total hospital charges are substantially lowered among the most critical cases. Involvement of Poison Center staff was also associated with significantly shorter hospitalizations.

Analysis of Suspected Suicides Using Poison Center Data.  Liang S and Friedman LS.  Arch Suicide Res.

Although there has been extensive research into the epidemiology and prevention of suicide, there continues to be a paucity of research on non-fatal suicides, in particular persons not treated in hospitals following a suicide attempt. Poison Center data is a great resource for characterizing suicide attempts among those that do not get treated in hospitals.  This study identifies common agents used in suicide attempts.  The analysis also showed significant declines in calls for suspected suicides during periods of holidays and vacations.

Comparison of health outcomes from heat-related injuries by National Weather Service reported heat wave days and non-heat wave days – Illinois, 2013-2019. Abasilim C, Friedman LS. Int J Biometeorol.

It is predicted that heat waves will increase as climate changes. Related public health interventions have expanded over the past decades but are primarily targeted at health outcomes occurring during heat waves. However, heat adaptation is dynamic and adverse outcomes related to heat injuries occur with moderate increases in temperature throughout the summertime.  Despite the higher rate of heat injury on heat wave days, only 12.7% of the 17,662 heat related injuries diagnosed from 2013-2019 occurred during reported heat waves. In addition, the National Weather Service surveillance system monitoring heat related injuries only captured 2.1% of all heat related injuries and 30.6% of heat related deaths. As climate changes and warmer conditions become more common, public health response to moderate increases in temperature during summertime needs to be strengthened as do the surveillance systems used to monitor adverse heat related health events.

Clinical outcomes of temperature related injuries treated in the hospital setting, 2011-2018. Friedman LS, Abasilim C, Fitts R, Wueste M. Environ Res.

Concerns over climate change have prompted substantial interest in temperature related injuries resulting from extreme weather conditions. Climate models predict that as global temperatures increase, the frequency and severity of extreme heat and cold weather events will grow which will likely increase the incidence of temperature related injury. The aim of this study was to analyze the healthcare impacts of temperature related injuries in the state of Illinois in order to serve as a model to guide future public health policy. The crude annual total hospital utilization incidence rate for heat injuries was 23.6 per 100,000 residents compared to 23.2 per 100,000 residents for cold injuries, however, the crude annual inpatient admission incidence rate was more than four-fold higher for cold injuries compared to heat injuries (10.2 vs 2.4 per 100,000). Although hypothermia made up 27.0% of all temperature related injuries, it comprised 94.0% of all deaths. While climate change is increasing the number of extreme heat days, it may also impact cold adaptation resulting in more serious adverse health outcomes when severe cold weather events do occur.  Our analysis indicates that better awareness of both heat and cold injury risks are needed as the climate changes.

Medical Complications Following Heat Related Illness. Abasilim C, Shannon B, and Friedman LS.

Our analysis evaluates the primary medical complications that occur in persons diagnosed with a heat related injury including heat fatigue, syncope, and stroke.  Heat injury is associated with specific cardiovascular, neurologic and respiratory medical complications that occur secondary to the initial heat injury.  The study provides important clinical information for the treatment of patients following heat injury.