Faculty Bibliography

Study Objectives: New York City (NYC) recently expanded its bicycle routes by demarcating bike lanes with paint and constructing 30 miles of protected paths that physically separate automobile traffic from bicyclists to address increases in bicyclist fatalities. Our objective was to determine whether bike lanes and protected paths result in safety benefits for bicyclists in NYC. We hypothesized that bike lanes would be associated with reduced injury severity among bicyclists colliding with motor vehicles and that protected paths would be associated with an even greater safety benefit. Methods: We performed a secondary analysis of bicyclist injury data collected from December 2008 to August 2014 at a Level 1 Trauma Center in NYC. We evaluated the association of protected paths and bike lanes on injury severity while controlling for potential confounders including patient demographics, scene-related and environmental information, helmet use, traffic law compliance, street characteristics, and injury mechanism. Data were obtained from patient interviews and medical records. Injury severity score (ISS) was categorized according to National Trauma Data Bank (NT

PURPOSE: Prescription drug overdose (PDO) deaths are a critical public health problem in the United States. This study aims to assess the association between emergency department (ED) utilization patterns in a cohort of ED patients and the risk of subsequent unintentional PDO mortality. METHODS: Using data from the New York Statewide Planning and Research Cooperative System for 2006-2010, a nested case-control design was used to examine the relationship between ED utilization patterns in New York State residents of age 18-64 years and subsequent PDO death. RESULTS: The study sample consisted of 2732 case patients who died of PDO and 2732 control ED patients who were selected through incidence density sampling. With adjustment for demographic characteristics, and diagnoses of pain, substance abuse, and psychiatric disorders, the estimated odds ratios of PDO death relative to one ED visit or less in the previous year were 4.90 (95% confidence interval [CI]: 4.50-5.34) for those with two ED visits, 16.61 (95% CI: 14.72-18.75) for those with three ED visits, and 48.24 (95% CI: 43.23-53.83) for those with four ED visits or more. CONCLUSIONS: Frequency of ED visits is strongly associated with the risk of subsequent PDO death. Intervention programs targeting frequent ED users are warranted to reduce PDO mortality.

BACKGROUND: This study quantifies the spatiotemporal risk of pedestrian and bicyclist injury in New York City at the census tract level over a recent 10-year period, identifies areas of increased risk, and evaluates the role of socioeconomic and traffic-related variables in injury risk. METHODS: Crash data on 140,835 pedestrian and bicyclist injuries in 1908 census tracts from 2001 to 2010 were obtained from the New York City Department of Transportation. We analyzed injury counts within census tracts with Bayesian hierarchical spatial models using integrated nested Laplace approximations. The model included variables for social fragmentation, median household income, and average vehicle speed and traffic density, as well as a spatially unstructured random effect term, a spatially structured conditional autoregression term, a first-order random walk-correlated time variable, and an interaction term for time and place. Incidence density ratios, credible intervals, and probability exceedances were calculated and mapped. RESULTS: The yearly rate of crashes involving injuries to "pedestrians" (including bicyclists) decreased 16.2% over the study period, from 23.7 per 10,000 population to 16.2 per 10,000. The temporal term in the spatiotemporal model indicated that much of the decrease over the study period occurred during the first 4 years of the study period. Despite an overall decrease, the model identified census tracts that were at persistently high risk of pedestrian injury throughout the study period, as well as areas that experienced sporadic annual increases in risk. Aggregate social, economic, and traffic-related measures were associated with pedestrian injury risk at the ecologic level. Every 1-unit increase in a standardized social fragmentation index was associated with a 19% increase in pedestrian injury risk (incidence density ratio = 1.19 [95% credible interval = 1.16 - 1.23]), and every 1 standardized unit increase in traffic density was associated with a 20% increase in pedestrian injury risk (1.20 [1.15 - 1.26]). Each 10-mile-per-hour increase in average traffic speed in a census tract was associated with a 24% decrease in pedestrian injury risk (0.76 [0.69 - 0.83]). CONCLUSIONS: The risk of a pedestrian or bicyclist being struck by a motor vehicle in New York City decreased from 2001 to 2004 and held fairly steady thereafter. Some census tracts in the city did not benefit from overall reductions or experienced sporadic years of increased risk compared with the city as a whole. Injury risk at the census tract level was associated with social, economic, and traffic-related factors.

BACKGROUND:Abuse of prescription drugs, particularly opioid analgesics, has become a major source of injury mortality and morbidity in the United States. To prevent the diversion and misuse of controlled substances, many states have implemented prescription drug monitoring programs (PDMPs). This study assessed the impact of state PDMPs on drug overdose mortality. METHODS:We analyzed demographic and drug overdose mortality data for state-quarters with and without PDMPs in 50 states and the District of Columbia during 1999-2008, and estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of drug overdose mortality associated with the implementation of state PDMPs through multivariable negative bionomial regression modeling. RESULTS:During the study period, annual national death rates from drug overdose increased by 96%, from 5.7 deaths per 100,000 population in 1999 to 11.2 in 2008. The impact of PDMPs on drug overdose mortality varied greatly across states, ranging from a 35% decrease in Michigan (aRR = 0.65; 95% CI = 0.54-0.77) to a more than 3-fold increase in Nevada (aRR = 3.37; 95% CI = 2.48-4.59). Overall, implementation of PDMPs was associated with an 11% increase in drug overdose mortality (aRR = 1.11; 95% CI = 1.02-1.21). CONCLUSIONS:Implementation of PDMPs did not reduce drug overdose mortality in most states through 2008. Program enhancement that facilitates the access and use of prescription drug monitoring data systems by healthcare practitioners is needed.

Advances in injury epidemiology and prevention are among the landmark achievements in epidemiology and public health in the past century. Despite remarkable success and growth, the field of injury epidemiology did not have its own publication outlet until now. This commentary marks the debut of the new academic journal Injury Epidemiology and introduces the reader to the first batch of peer-reviewed manuscripts accepted for publication in this new journal.

BACKGROUND:Unintentional drug overdose has increased markedly in the past two decades and surpassed motor vehicle crashes as the leading cause of injury mortality in many states. The purpose of this study was to understand the trajectory of the drug overdose epidemic in the United States by applying Farr's Law. Farr's "law of epidemics" and the Bregman-Langmuir back calculation method were applied to United States drug overdose mortality data for the years 1980 through 2011 to project the annual death rates from drug overdose from 2012 through 2035. FINDINGS/RESULTS:From 1980-2011, annual drug overdose mortality increased from 2.7 to 13.2 deaths per 100,000 population. The projected drug overdose mortality would peak in 2016-2017 at 16.1 deaths per 100,000 population and then decline progressively until reaching 1.9 deaths per 100,000 population in 2035. CONCLUSION/CONCLUSIONS:The projected data based on Farr's Law suggests that drug overdose mortality in the United States will decline in the coming years and return to the 1980 baseline level approximately by the year 2034.

BACKGROUND:In 2005, the US Congress allocated $612 million for a national Safe Routes to School (SRTS) program to encourage walking and bicycling to schools. We evaluated the effectiveness of a SRTS in controlling pedestrian injuries among school-age children. METHODS:Bayesian changepoint analysis was applied to model the quarterly counts of pedestrian injuries among 5- to 19-year old children in New York City between 2001 and 2010 during school-travel hours in census tracts with and without SRTS. Overdispersed Poisson model was used to estimate difference-in-differences in injury risk between census tracts with and without SRTS following the changepoint. RESULTS:In SRTS-intervention census tracts, a change point in the quarterly counts of injuries was identified in the second quarter of 2008, which was consistent with the timing of the implementation of SRTS interventions. In census tracts with SRTS interventions, the estimated quarterly rates of pedestrian injury per 10,000 population among school-age children during school-travel hours were 3.47 (95% Credible Interval [CrI] 2.67, 4.39) prior to the changepoint, and 0.74 (95% CrI 0.30, 1.50) after the changepoint. There was no change in the average number of quarterly injuries in non-SRTS census tracts. Overdispersed Poisson modeling revealed that SRTS implementation was associated with a 44% reduction (95% Confidence Interval [CI] 87% decrease to 130% increase) in school-age pedestrian injury risk during school-travel hours. CONCLUSIONS:Bayesian changepoint analysis of quarterly counts of school-age pedestrian injuries successfully identified the timing of SRTS intervention in New York City. Implementation of the SRTS program in New York City appears to be effective in reducing school-age pedestrian injuries during school-travel hours.

INTRODUCTION: Epidemiologic studies examining the association between anesthetic exposure and neurodevelopmental outcomes have primarily focused on exposures occurring under 3 years of age. In this study, we assess outcomes associated with initial anesthetic exposure occurring between 3 and 10 years of age. METHODS: We used data from the Western Australian Pregnancy Cohort (Raine) Study to examine the risk of cognitive deficit at age 10 in children with initial anesthetic exposure between 3 and 5 years and between 5 and 10 years of age compared with children unexposed at those ages. The cohort included 2868 children born from 1989 to 1992 evaluated using a range of neuropsychological tests. A modified multivariable Poisson regression model was used to determine the adjusted association of initial anesthetic exposure in each age group with outcomes. RESULTS: Exposed and unexposed children were found to have similar neuropsychological test results except for the McCarron Assessment of Neuromuscular Development (MAND) motor function scores. Even after adjusting for demographic and comorbidity differences, children exposed to anesthesia had a higher risk of motor deficit after initial exposure between ages 3 and 5 years (adjusted risk ratio, 2.32; 95% confidence interval, 1.42-3.79) and between 5 and 10 years (adjusted risk ratio, 2.33; 95% confidence interval, 1.21-4.48) compared with unexposed children. CONCLUSIONS: Initial exposure to anesthesia after age 3 had no measurable effects on language or cognitive function. Decreased motor function was found in children initially exposed after age 3 even after accounting for comorbid illness and injury history. These results suggest that there may be distinct windows of vulnerability for different neurodevelopmental domains in children.

OBJECTIVE: We evaluated the cost-effectiveness of a package of roadway modifications in New York City funded under the Safe Routes to School (SRTS) program. METHODS: We used a Markov model to estimate long-term impacts of SRTS on injury reduction and the associated savings in medical costs, lifelong disability, and death. Model inputs included societal costs (in 2013 US dollars) and observed spatiotemporal changes in injury rates associated with New York City's implementation of SRTS relative to control intersections. Structural changes to roadways were assumed to last 50 years before further investment is required. Therefore, costs were discounted over 50 consecutive cohorts of modified roadway users under SRTS. RESULTS: SRTS was associated with an overall net societal benefit of $230 million and 2055 quality-adjusted life years gained in New York City. CONCLUSIONS: SRTS reduces injuries and saves money over the long run.