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The Contribution of Local Public Health to Heroin Surveillance in Orange County, Florida

Posted By Ben Klekamp, Toni Hudson, and Sarah Matthews, Friday, March 25, 2016
Updated: Tuesday, March 22, 2016

From left to right, Sarah Matthews, Ben Klekamp, and Toni Hudson

 

To better inform community decisions in the fight against heroin addiction, the Florida Department of Health in Orange County used multiple data sources to conducted heroin-related morbidity and mortality surveillance from 2010 to present.

Data from the Orange County Medical Examiner’s Office and Florida Department of Health was used to conduct a descriptive analysis on Orange County deaths where heroin was listed as the cause of death or heroin was in the blood stream at the time of death (Figure 1). To identify areas for potential interventions, addresses where heroin-related deaths occurred were analyzed using spatial cluster analysis (i.e., kernel density) in ArcGIS (Figure 2).

 

Figure 1. Epidemic Curve of Heroin-related Deaths in Orange County, Florida 2010-2014.

 

Figure 2. Cluster Analysis of Heroin-related Deaths in Orange County, Florida 2010-2014.

 
Two data sources were used in heroin-related morbidity surveillance. The Florida Agency for Health Care Administration (ACHA) is the regulatory authority for Florida’s health facilities, which includes capturing health data from these facilities. AHCA data was queried utilizing heroin specific international classification of disease (ICD) codes in Orange County hospitals. This analysis provided information on the heroin-related hospital burden including hospital specific information, insurance status, and demographic information of identified patients. Zip Codes of patients utilizing hospitals for heroin-related healthcare needs were mapped to better understand the geographic burden of heroin morbidity in Orange County (Figure 3).
 

Figure 3. Agency for Health Care Administration Data: Rate and Frequency of Heroin-related Morbidity by Zip Code, Orange County, Florida 2010-2014.

 
Due to the delay in data availability in both the Medical Examiner and AHCA datasets, the Department’s syndromic surveillance system ESSENCE-FL (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) was utilized to understand current demographic and geographic trends related to heroin morbidity (Figure 4). ESSENCE-FL is the Florida Department in Health’s syndromic surveillance system and captures data on hospital emergency department visits, poison control consultations, Merlin reportable diseases, and vital statistics death records. All hospital emergency departments in Orange County send daily updates to ESSENCE-FL on chief complaints and discharge diagnoses. A query for heroin (and common misspellings) was developed and compared to the AHCA data to understand if the developed ESSENCE-FL data query was comparable to the AHCA data.
 

Figure 4. ESSENCE-FL Data: Rate and Frequency of Heroin-related Morbidity by Zip Code, Orange County, Florida 2010-2014.

 
Overlay of the three data sources used in this surveillance highlights the data trend agreement between data sources and relative timeliness of data availability of each source (Figure 5). While ESSENCE-FL data may misclassify and overestimate the true burden of heroin-related morbidity in a community compared to the AHCA data trends, the rapid availability of the data may prove useful in understanding a population health problem until more accurate datasets (e.g., medical examiner) become available for analysis.
 

Figure 5. Heroin-related Morbidity and Mortality, Orange County Florida 2010-2016


The Department presented the surveillance findings to the public and community leaders as part of the Orange County Mayor’s Heroin Taskforce on February 29, 2016. The full presentation and an Orange County Heroin factsheet, in addition to other Orange County authored publications, can be viewed on the Epidemiology Program Publications webpage. The Epidemiology Program will continue to support and track the health related outcomes of community efforts to combat the heroin epidemic through ongoing surveillance.

Questions and comments on the Florida Department of Health in Orange County Epidemiology Program heroin-related morbidity and mortality surveillance can be directed to Ben Klekamp at ben.klekamp@flhealth.gov or Toni Hudson at tonimarie.hudson@flhealth.gov.

Ben Klekamp, MSPH, CPH, is an epidemiologist and Project SHINE I-TIPP fellow, Toni Hudson, MSPH, CIC, is an epidemiologist, and Sarah Matthews, MPH, is the epidemiology program manager for the Florida Department of Health in Orange County. To learn more about substance abuse surveillance, visit the Substance Abuse Subcommittee. Informatics-Training in Place Program (I-TIPP) fellowships enable current health department staff to develop capacity in their roles—learn more and apply by April 1, 2016 at http://www.shinefellows.org/.

 

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