States with highest population-based death rates - what's going on out west? Posts from 2009

[Nika]

Re: States with highest population-based death rates - what's going on out west?

I wonder if there are any sequences from South Dakota, New Mexico, Wyoming, Arizona, Alaska, Utah, or Nevada indicating D225G? Doesn't it seem odd that South Dakota has double to triple the death rate of most other states?

Deaths per million residents

South Dakota 26.1
New Mexico 20.2
Wyoming 18.8
Arizona 17.8
Alaska 16.0
Utah 14.3
Nevada 13.8
Montana 12.4
California 11.6
Puerto Rico 11.4
Colorado 11.1
Rhode Island 10.5
Washington 10.5

Fog of War?

You have likely seen the odd story about MEs are catching H1N1 deaths in postmortem.

Perhaps MEs and docs in these sleepy areas have the luxury of doing a more exact job of IDing H1N1 in the living and then in the dead. (Am guessing its more the first than the last unless there is data to support that)

Whereas the intense crush of inner city hospitals, the sheer mass of cases of all sorts of disease conditions makes for a statistical skew as you see above.

(as well as many many uninsured who may not even go to the hosp and then are not caught in postmortems)

Just throwing these confounding factors into the conversation.

[Laidback Al]

Re: States with highest population-based death rates - what's going on out west?

Fog of War?

You have likely seen the odd story about MEs are catching H1N1 deaths in postmortem.

Perhaps MEs and docs in these sleepy areas have the luxury of doing a more exact job of IDing H1N1 in the living and then in the dead. (Am guessing its more the first than the last unless there is data to support that)

Whereas the intense crush of inner city hospitals, the sheer mass of cases of all sorts of disease conditions makes for a statistical skew as you see above.

(as well as many many uninsured who may not even go to the hosp and then are not caught in postmortems)

Just throwing these confounding factors into the conversation.

There may be some truth in Nika's observations. Public health official in the western USA may be doing a better job communicating with local doctors and hospitals to get accurate H1N1 death counts. As noted in the map below some of these states have a lower death rate per 100,000 individuals than other parts of the country. Whether these overall lower rates allow better identification of cause of death is open to debate.



map source: http://www.statehealthfacts.org/comp...p?cat=2&ind=58

[Shannon Bennett]

Re: States with highest population-based death rates - what's going on out west?

Probably coincidental but, the top 5 states also may have the highest percent of Native Americans.

[Laidback Al]

Re: States with highest population-based death rates - what's going on out west?

Probably coincidental but, the top 5 states also may have the highest percent of Native Americans.

Yes, but my cursory review of the demographics of deaths in these states does not indicate a high percentage of Native American deaths. Perhaps JimO or someone else tabulating the deaths can comment.

[JimO]

Re: States with highest population-based death rates - what's going on out west?

Yes, but my cursory review of the demographics of deaths in these states does not indicate a high percentage of Native American deaths. Perhaps JimO or someone else tabulating the deaths can comment.

I don't have much information on ethnicity. I will try to look into this in the coming week. The next couple of days will be very busy because most public health offices were closed Thursday and Friday and very little media coverage has been seen since Wednesday. After the dust settles, I should have time to look into this for states where the information is available.

[Missouriwatcher]

Re: States with highest population-based death rates - what's going on out west?

According to CDC, "Native Americans or AK Native" (children) represent 1% of population and at the time they did info on deaths, they represented 1% of total pediatric deaths.

When they looked at case reports for "American Indians or AK Native", between April 19-June 16, they represented 3.5%.

From this report (April 14-Sept30), it appears Hispanics and Blacks have disproportional death rates.

http://www.cdc.gov/Vaccines/recs/acip/downloads/mtg-slides-oct09/12-2-flu-vac.pdf

[JimO]

Re: States with highest population-based death rates - what's going on out west?

According to CDC, "Native Americans or AK Native" (children) represent 1% of population and at the time they did info on deaths, they represented 1% of total pediatric deaths.

When they looked at case reports for "American Indians or AK Native", between April 19-June 16, they represented 3.5%.

From this report (April 14-Sept30), it appears Hispanics and Blacks have disproportional death rates.
http://www.cdc.gov/Vaccines/recs/aci...-2-flu-vac.pdf

Here are the number of deaths in each of the subject states as of August 31st:

South Dakota - 0
New Mexico - 2
Wyoming - 1
Arizona - 20
Alaska - 3
Utah - 18
Nevada - 10
Montana - 1
California - 167
Puerto Rico - 30
Colorado - 1
Rhode Island - 3
Washington - 14

[AlaskaDenise]

Re: States with highest population-based death rates - what's going on out west?

Probably coincidental but, the top 5 states also may have the highest percent of Native Americans.

The latest AK DHSS report (posted under Alaska), said the highest infection rates were in Alaskan natives and Asia/Pacific natives. Both groups here have a lot of obesity, especially the large Samoan population in Anchorage.

.

[AlaskaDenise]

Re: States with highest population-based death rates - what's going on out west?

Obesity rates map is below. Notice it is the opposite of H1N1 death rates.

http://calorielab.com/news/2008/07/02/fattest-states-2008/

.

[AlaskaDenise]

Re: States with highest population-based death rates - what's going on out west?

According to CDC, "Native Americans or AK Native" (children) represent 1% of population and at the time they did info on deaths, they represented 1% of total pediatric deaths.

When they looked at case reports for "American Indians or AK Native", between April 19-June 16, they represented 3.5%.

From this report (April 14-Sept30), it appears Hispanics and Blacks have disproportional death rates.
http://www.cdc.gov/Vaccines/recs/aci...-2-flu-vac.pdf

We need to look at ALL races, and not just compare American natives to caucasian. The US has so many immigrants, many of whom have issues similar to US natives.

In the CDC report above, the highest death rates were in "other" non-white/hispanic races or racially-mixed of non-caucasian/hispanic.

.

[mcphilbrick]

Re: States with highest population-based death rates - what's going on out west?

Living in Kansas, this thread makes me question what is so different about South Dakota when compared to other plains states?

Thus, I started looking at Kansas and several other states neighboring those with high death rates to determine their death rate. I used FluTrackers for the death count and 2008 US Census estimates for the population.

State - deaths - population - deaths/million
Kansas - 21 - 2802134 - 7.5
Nebraska - 7 - 1783432 - 3.9
North Dakota - 2 - 641481 - 3.1
Oklahoma - 38 - 3642361 - 10.4
Idaho - 15 - 1523816 - 9.8
Oregon - 61 - 3790060 - 16.1

After looking at this data in comparison to South Dakota, I have to join JimO in questioning what is going on in South Dakota. Many of their deaths have occurred in the southeast corner of the state (near Iowa) but not all. [see page 6 of weekly summary] South Dakota week 46 Summary

A Texas study indicates that lack on insurance and/or access to health care may be an issue. Latinos hard hit by H1N1

Hispanics accounted for more than half of the 95 swine flu-related deaths in Texas in the first six months of the H1N1 pandemic, an analysis by the state health department found.

Hispanics predominate in the state's southernmost counties, where 28 percent of the H1N1 deaths happened through Oct. 17.

The area “clearly is the hot spot” for the state's H1N1 deaths, said Dr. Joseph McCormick, regional dean of The University of Texas School of Public Health in Brownsville.

Several physical conditions that are more common among Hispanics have been identified by the Centers for Disease Control and Prevention as risk factors for H1N1 becoming fatal. They include pregnancy, diabetes and possibly obesity, McCormick said.

Residents in Rio Grande Valley counties are more likely to lack medical insurance and have less access to health care than the average Texan.

“Viruses don't care whether you're black or white or whether you're Hispanic or not,” said Lovell A. Jones, a health disparities researcher who directs the Center for Research on Minority Health at Houston's M.D. Anderson Cancer Center.

Latinos, who represent 37 percent of the state's population, comprised 52 percent of H1N1 deaths — even with 17 percent of victims having an unknown race or ethnicity — so their actual share may be even higher. Hispanics also accounted for nearly two-thirds of intensive care unit admissions for swine flu

[kiwibird]

Re: States with highest population-based death rates - what's going on out west?

Are people who have no medical insurance more likely to take over the counter pharmaceuticals like cepacol? which has benzocaine?

Benzocaine also is a well-known cause of methemoglobinemia.

http://en.wikipedia.org/wiki/Benzocaine

Benzocaine Lozenges

Generic Name: Benzocaine (BEN-zoe-kane)
Brand Name: Examples include Cepacol Maximum Strength and Laryngesic

http://www.drugs.com/cdi/benzocaine-lozenges.html

Benzocaine Sprays - Increased Risk of Methemoglobinemia

February 15, 2006

The FDA released a public health advisory reminding healthcare professionals of adverse effects such as methemoglobinemia associated with benzocaine sprays. The VA is no longer administering benzocaine topical throat sprays before minor surgical procedures or intubation due to increased risk of methemoglobinemia. This potentially fatal adverse reaction may be caused by using too much benzocaine or using the product for a longer duration than recommended. The FDA is not planning to remove the drug from the market because when used properly it can greatly benefit patients and the risk of methemoglobinemia is low. More details are available at the following links

http://healthcare.utah.edu/pharmacy/alerts/147.htm

[kiwibird]

Re: States with highest population-based death rates - what's going on out west?

Did anyone know they used bezocaine as a topical anaesthetic for ECMO patients ( and intubation)? Is this true?

[Missouriwatcher]

Re: States with highest population-based death rates - what's going on out west?

I would disagree re: "The majority of deaths are in SE corner" (post #26) I would say the majority of the deaths occurred in the southern half of the state. http://doh.sd.gov/Flu/PDF/Week46.pdf

Although SD State University is located near the SE corner (Brookings}, they have only reported a small number of cases in comparison to the rest of the country's campuses. http://www.acha.org/ILI_LatestWeek.cfm#chart_state

[Flufreak]

Re: States with highest population-based death rates - what's going on out west?

http://www.cdc.gov/h1n1flu/in_the_news.htm

009 H1N1 and Seasonal Influenza Infections and Invasive Pneumococcal Disease
November 24, 2009 6:00 PM ET

Some of CDC's Active Bacterial Core surveillance (ABCs) sites have seen an increase in serious cases of pneumococcal disease coincident with increases in influenza-associated hospitalizations. CDC has been working with state and local public health officials in Colorado for example concerning its ABCs site in the Denver Metro area to collect additional data on pneumococcal disease cases.

There is good evidence that 2009 H1N1 influenza may be responsible for this increase in invasive pneumococcal disease (IPD) cases in the Denver Metro area. (5-year average number of cases in October, ~20; total number in October 2009, 58).

The increase in IPD cases in the Denver Metro area is primarily among younger adults with 36 out of 58 (62%) cases occurred among 20-59 year olds. In a typical non-pandemic year, most IPD cases occur among persons 65 years of age and older.

What occurred in Denver is likely an indicator of what is happening in other parts of the country. Data shown below is preliminary and subject to change upon further investigation.

For more information on preventing pneumococcal infections secondary to seasonal and 2009 H1N1 influenza: http://www.cdc.gov/h1n1flu/vaccinati...eumococcal.htm.

end of snip--

When the data becomes available (or someone finds it), a correlation may be found between the high death rates observed and the rates of bacterial co-infection (pneumonia) with pneumococcus, MRSA, and/or Strep A, all 3 of which are the most commonly seen with this new virus so far ( per associates at John Hopkins and elsewhere).

(Also, you may wish update your lists to include Oregon as it looks to have quite probably the highest death rate on west coast, still waiting for today's update.)