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Pediatric drug overdose mortality: contextual and policy effects for children under 12 years

Abstract

Background

We determine trends in fatal pediatric drug overdose from 1999 to 2018 and describe the influence of contextual factors and policies on such overdoses.

Methods

Combining restricted CDC mortality files with data from other sources, we conducted between-county multilevel models to examine associations of demographic and socioeconomic characteristics with pediatric overdose mortality and a fixed-effects analysis to identify how changes in contexts and policies over time shaped county-level fatal pediatric overdoses per 100,000 children under 12 years.

Results

Pediatric overdose deaths rose from 0.08/100,000 children in 1999 to a peak of 0.19/100,000 children in 2016, with opioids accounting for an increasing proportion of deaths. Spatial patterns of pediatric overdose deaths are heterogenous. Socioeconomic characteristics are not associated with between-county differences in pediatric overdose mortality. Greater state expenditures on public welfare (B = −0.099; CI: [−0.193, −0.005]) and hospitals (B = −0.222; CI: [−.437, −.007]) were associated with lower pediatric overdose mortality. In years when a Good Samaritan law was in effect, the county-level pediatric overdose rate was lower (B = −0.095; CI: [−0.177, −0.013]).

Conclusions

Pediatric overdose mortality increased since 1999, peaking in 2016. Good Samaritan laws and investment in hospitals and public welfare may temper pediatric overdoses. Multi-faceted approaches using policy and individual intervention is necessary to reduce pediatric overdose mortality.

Impact

  • Pediatric fatalities from psychoactive substances have risen within the U.S. since 1999.

  • Higher levels of state spending on public welfare and hospitals are significantly associated with lower pediatric overdose mortality rates.

  • The implementation of Good Samaritan laws is significantly associated with lower pediatric overdose mortality rates.

  • We identified no county-level sociodemographic factors associated with pediatric overdose mortality.

  • The findings indicate that a multi-faceted approach to the reduction of pediatric overdose is necessary.

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Fig. 1: Pediatric overdose mortality rate and percentage involving opioids
Fig. 2: Coded cause of overdose deaths by age, 1999-2018
Fig. 3: Pediatric drug overdose rate averaged over annual rates 1999 to 2018 by state

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Acknowledgements

All phases of this study were supported by The National Institute on Drug Abuse (NIDA), grant #R21DA046447.

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Authors

Contributions

B.C.K. and M.V. conceptualized and designed the study, acquired grant funding, conducted data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. L.C.F. conducted data coding and analysis and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mike Vuolo.

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The authors declare no competing interests.

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Appendices

Appendix A. Descriptive statistics (pooled over counties and year, N = 50,079)

  Average/% (SD)
County-level overdose rate
  All pediatric psychoactive substance overdoses 0.14 (2.46)
State-level policies
  Prescription drug monitoring program 68.62%
  Good Samaritan law for drug overdoses 9.55%
  Naloxone possession—no criminal liability 1.60%
  Medical marijuana 15.42%
  Pain management clinic law 11.16%
State-level per capita expenditures ($)
  Education 1.71 (0.42)
  Public welfare 1.24 (0.42)
  Hospitals 0.17 (0.12)
  Health 0.15 (0.08)
County-level demographics
  Unemployment rate 4.19 (1.81)
  Median household income 41,761 (11,461)
  Percent living in poverty 11.40 (5.65)
  Percent with Bachelor’s degree 13.36 (6.63)
  Percent foreign-born 4.09 (5.33)
  Percent female-headed households 6.39 (2.45)
  Percent Black 9.25 (14.35)
  Percent Hispanic 7.81 (12.86)
  Large central metro 2.14%
  Large fringe metro 11.70%
  Medium metro 11.82%
  Small metro 11.41%
  Micropolitan 20.45%
  Noncore 42.48%

Appendix B. Descriptive information on all psychoactive substances involved in pediatric overdoses, 1999–2018

Substance (ICD-10 code) N (%) % of single substance % of combination
Prescription opioid (T40.2) 427 (37.9%) 82.2% 17.8%
Methadone (T40.3) 247 (21.9%) 91.1% 8.9%
Synthetic opioid (T40.4) 128 (11.4%) 78.1% 21.9%
Psychostimulants (T43.6) 95 (8.4%) 86.3% 13.7%
Cocaine (T40.5) 77 (6.8%) 75.3% 24.7%
Antidepressants (T43.0, T43.2) 75 (6.7%) 69.3% 30.7%
Benzodiazepines (T42.4) 56 (5.0%) 26.8% 73.2%
Unidentified narcotic (T40.6) 50 (4.4%) 64.0% 36.0%
Other sedatives (T42.6, T42.7, T42.8) 39 (3.5%) 66.7% 33.3%
Antipsychotics (T43.3, T43.5) 38 (3.4%) 60.5% 39.5%
Heroin (T40.1) 23 (2.0%) 39.1% 60.9%
Barbiturates (T42.3) 12 (1.1%) 75.0% 25.0%

Note: Percentage of deaths do not add to 100 because multiple psychoactive substances can be involved in a single death. There is no overlap for substances classified within different categories.

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Kelly, B.C., Vuolo, M. & Frizzell, L.C. Pediatric drug overdose mortality: contextual and policy effects for children under 12 years. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01567-7

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