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Objectives: To understand trends in health care use among people living with HIV/AIDS (PLWHA), this study compared trends in hospitalization rates, comorbidities, and hospital death rates of hospitalized PLWHA with the overall hospitalized population in Illinois during 2008-2014. Methods: This study identified principal hospitalizations (the principal discharge diagnosis coded with an HIV-related billing code) and secondary HIV hospitalizations (a non-principal discharge diagnosis coded with an HIV-related billing code) from 2008-2014 Illinois hospital discharge data. Hospitalization rates among PLWHA were calculated using prevalence data from the Illinois Electronic HIV/AIDS Registry; US Census population estimates were used to calculate overall Illinois hospitalization rates. Joinpoint regression analysis was used to assess trends overall and among demographic subgroups. Comorbidities and discharge status for all hospitalizations were identified. Results: In 2014, the hospitalization rate was 2.2 times higher among PLWHA than among the overall Illinois hospitalized population. From 2008 to 2014, principal HIV hospitalization rates per 1000 PLWHA decreased by 48% (from 71 to 37) and secondary HIV hospitalization rates declined by 26% (from 296 to 218). The decline in the principal HIV hospitalization rate was steepest from 2008 to 2011 (annual percentage change = –16.0%; P = .003). Mood disorders, substance-related diagnoses, and schizophrenia accounted for 18% to 22% of principal hospitalizations among PLWHA compared with 7% to 8% of overall Illinois hospitalizations. Hepatitis as a comorbidity was more common among hospitalized PLWHA (18%-22%) than among the overall Illinois hospitalized population (1.4%-1.5%). Hospitalized PLWHA were 3 times more likely than the overall Illinois hospitalized population to die while hospitalized. Conclusions: HIV hospitalizations are largely preventable with appropriate treatment and adherence. Additional efforts to improve retention in HIV care that address comorbidities of PLWHA are needed.

Vaping use has rapidly increased. In this final report from the Wisconsin and Illinois departments of public health, a severe respiratory illness in otherwise healthy young people is described. Of the 98 case patients identified in this investigation, 95% were hospitalized, 26% were intubated, and 2 persons died.

Background Injury is a leading cause of preventable morbidity and mortality in the USA. Ongoing surveillance is needed to understand changing injury patterns to effectively target prevention efforts. Launched jointly in 2000 by the Consumer Product Safety Commission (CPSC) and the Centers for Disease Control and Prevention (CDC), the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) provides national-level estimates of US emergency department visits for nonfatal injuries. A scoping review of peer-reviewed articles was conducted to characterize how NEISS-AIP data have been used for injury surveillance in the USA. Main Body This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three bibliographic databases (PubMed, Scopus, and Google Scholar) were systematically searched for English language peer-reviewed articles that used NEISS-AIP data as the primary data source during 2001–2021. Key article characteristics from included articles were abstracted to generate descriptive summary statistics to understand the use and limitations of NEISS-AIP for injury surveillance. Database queries returned 6944 citations; 594 citations were manually reviewed, and 167 non-duplicate journal articles were identified. An average of 8.0 articles (range: 1–14) were published annually during 2001–2021. Articles appeared in 72 different journals representing a diverse audience with the majority of articles written by CDC authors. Starting in 2013, a higher proportion of articles were published by non-CDC authors. The largest number of articles examined injury among all age groups ( n  = 71); however, the pediatric population was the specific age group of greatest interest ( n  = 48), followed by older adults ( n  = 23). Falls ( n  = 20) and motor-vehicle-related injuries ( n  = 10) were the most studied injury mechanisms. The most commonly identified limitation identified by authors of reviewed articles was that NEISS-AIP only produces national estimates and therefore, cannot be used for state- or county-level injury surveillance ( n  = 38). Conclusions NEISS-AIP has contributed to nonfatal injury surveillance in the USA. CDC and CPSC continue to work together to expand and enhance NEISS-AIP data collection. Researchers are encouraged to continue using this publicly available dataset for injury surveillance.

Background The disease burden due to heat-stress illness (HSI), which can result in significant morbidity and mortality, is expected to increase as the climate continues to warm. In the United States (U.S.) much of what is known about HSI epidemiology is from analyses of urban heat waves. There is limited research addressing whether HSI hospitalization risk varies between urban and rural areas, nor is much known about additional diagnoses of patients hospitalized for HSI. Methods Hospitalizations in Illinois for HSI (ICD-9-CM codes 992.x or E900) in the months of May through September from 1987 to 2014 ( n  = 8667) were examined. Age-adjusted mean monthly hospitalization rates were calculated for each county using U.S. Census population data. Counties were categorized into five urban-rural strata using Rural Urban Continuum Codes (RUCC) (RUCC1, most urbanized to RUCC5, thinly populated). Average maximum monthly temperature (°C) was calculated for each county using daily data. Multi-level linear regression models were used, with county as the fixed effect and temperature as random effect, to model monthly hospitalization rates, adjusting for the percent of county population below the poverty line, percent of population that is Non-Hispanic Black, and percent of the population that is Hispanic. All analyses were stratified by county RUCC. Additional diagnoses of patients hospitalized for HSI and charges for hospitalization were summarized. Results Highest rates of HSI hospitalizations were seen in the most rural, thinly populated stratum (mean annual summer hospitalization rate of 1.16 hospitalizations per 100,000 population in the thinly populated strata vs. 0.45 per 100,000 in the metropolitan urban strata). A one-degree Celsius increase in maximum monthly average temperature was associated with a 0.34 increase in HSI hospitalization rate per 100,000 population in the thinly populated counties compared with 0.02 per 100,000 in highly urbanized counties. The most common additional diagnoses of patients hospitalized with HSI were dehydration, electrolyte abnormalities, and acute renal disorders. Total and mean hospital charges for HSI cases were $167.7 million and $20,500 (in 2014 US dollars). Conclusion Elevated temperatures appear to have different impacts on HSI hospitalization rates as function of urbanization. The most rural and the most urbanized counties of Illinois had the largest increases in monthly hospitalization rates for HSI per unit increase in the average monthly maximum temperature. This suggests that vulnerability of communities to heat is complex and strategies to reduce HSI may need to be tailored to the degree of urbanization of a county.

The relationship of serum vitamin E, beta-carotene, vitamin C, and selenium to asthma was investigated among 7,505 youth (4-16 years old) in the Third National Health and Nutrition Examination Survey. Logistic regression models adjusted for potentially confounding variables, which generally had no effect on the coefficients for the antioxidants. Serum vitamin E had little or no association with asthma. In separate models, a SD increase in beta-carotene (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.7, 1.0), vitamin C (OR, 0.8; 95% CI, 0.7, 0.9), and selenium (OR, 0.9; 95% CI, 0.7, 1.1) was associated with a 10-20% reduction in asthma prevalence. Serum cotinine was used to identify youth with no cigarette smoke exposure and passive exposure (7%): Active smokers were too few to be studied further. The selenium-asthma association was stronger in youth who were smoke exposed (p = 0.075). A SD increase in selenium was associated with a 50% reduction in asthma prevalence (OR, 0.5; 95% CI, 0.2, 1.4) in youth with passive smoke exposure compared with a 10% reduction in youth with no smoke exposure. The findings support an association of antioxidants with prevalent asthma, which for some antioxidants is stronger among children exposed to cigarette smoke.

Use of tobacco products in any form is unsafe, and nearly all tobacco product use begins during adolescence. CDC and the Food and Drug Administration (FDA) analyzed data from the 2024 National Youth Tobacco Survey to determine tobacco product use among U.S. middle school (grades 6-8) and high school (grades 9-12) students. In 2024, current (previous 30-day) use of any tobacco product was reported by 10.1% of high school students (representing 1.58 million students) and 5.4% of middle school students (representing 640,000 students). Among all students, e-cigarettes were the most commonly reported tobacco product currently used (5.9%), followed by nicotine pouches (1.8%), cigarettes (1.4%), cigars (1.2%), smokeless tobacco (1.2%), other oral nicotine products (1.2%), heated tobacco products (0.8%), hookahs (0.7%), and pipe tobacco (0.5%). During 2023-2024, among all students, the estimated number who reported current use of any tobacco product decreased from 2.80 to 2.25 million students; e-cigarette use decreased (from 2.13 to 1.63 million students); and hookah use decreased (from 290,000 to 190,000 students). Among high school students, current use of any tobacco product decreased from 12.6% to 10.1% of students, and e-cigarette use decreased from 10.0% to 7.8%. Among middle school students, no statistically significant changes occurred. Evidence-based strategies can help prevent initiation and promote cessation of tobacco product use among U.S. youths.

Given the increase in pedal cyclist fatalities despite the decline in VMT in 2020, emergency department (ED) visits for nonfatal pedal cyclist injuries in 2019 and 2020 were compared. The monthly proportions of injury-related ED visits accounted for by pedal cyclist injuries in 2020 and 2019 were compared using pairwise t-tests in SAS-callable SUDAAN (version 11.0.3; RTI International); comparison of the changes in monthly proportions by age group and sex was assessed using logistic regression. Estimated monthly number of emergency department visits for total and pedal cyclist–related nonfatal injuries and monthly percentage of visits due to pedal cyclist injuries, by age group and sex — National Electronic Injury Surveillance System–All Injury Program, United States, 2019–2020Return to your place in the text Characteristic/Yr Pedal cyclist–related injury ED visits Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Age group, yrs, % (95% CI) 2019 <18 0.5 (0.3–0.8) 0.8 (0.3–1.2) 1.3 (0.9–1.8) 2.1 (1.7–2.5) 2.8 (2.3–3.3) 3.7 (3.2–4.2) 3.1 (2.5–3.6) 3.9 (3.0–4.8) 2.8 (2.2–3.3) 1.6 (1.2–1.9) 1.0 (0.7–1.4) 0.8 (0.4–1.3) ≥18 0.7 (0.3–1.1) 0.7 (0.4–1.0) 0.8 (0.4–1.1) 1.0 (0.6–1.3) 1.0 (0.8–1.3) 1.1 (1.0–1.3) 1.4 (1.1–1.6) 1.3 (1.1–1.5) 1.3 (1.0–1.5) 1.1 (0.8–1.4) 0.8 (0.5–1.0) 0.7 (0.4–0.9) 18–49 0.7 (0.3–1.0) 0.5 (0.3–0.7) 0.7 (0.4–0.9) 1.1 (0.7–1.4) 1.0 (0.7–1.2) 1.2 (1.0–1.4) 1.4 (1.1–1.7) 1.4 (1.1–1.6) 1.5 (1.1–1.8) 1.1 (0.8–1.4) 0.7 (0.5–0.9) 0.6 (0.4–0.9) ≥50 —* 0.9 (0.4–1.4) — 0.8 (0.4–1.3) 1.1 (0.8–1.4) 1.0 (0.8–1.3) 1.3 (1.1–1.6) 1.2 (0.8–1.6) 1.0 (0.7–1.3) 1.0 (0.7–1.4) 0.9 (0.5–1.3) 0.7 (0.3–1.1) 2020 <18 0.7 (0.4–1.0) 1.2† (0.8–1.7) 2.2† (1.7–2.7) 6.0† (4.8–7.2) 5.7† (4.8–6.6) 5.4† (4.4–6.5) 5.3† (4.6–6.1) 5.1† (4.1–6.1) 3.9† (2.9–4.9) 2.4† (1.9–2.8) 1.8† (1.3–2.2) 1.1 (0.7–1.5) ≥18 0.8 (0.4–1.2) 0.8 (0.4–1.1) 1.1† (0.6–1.7) 1.5† (0.9–2.0) 1.7† (1.2–2.2) 1.5† (1.2–1.8) 1.4 (1.1–1.7) 1.5† (1.3–1.7) 1.4 (1.2–1.6) 1.2 (0.9–1.5) 0.9 (0.6–1.2) 0.7 (0.4–1.1) 18–49 0.8 (0.4–1.1) 0.7 (0.4–1.0) 0.9† (0.6–1.3) 1.2 (0.8–1.7) 1.5† (1.1–2.0) 1.4 (1.1–1.7) 1.5 (1.1–1.8) 1.6 (1.2–1.9) 1.4 (1.2–1.6) 1.3 (0.9–1.6) 0.8 (0.5–1.0) 0.7 (0.4–0.9) ≥50 — 0.9 (0.4–1.4) — 1.7† (0.9–2.6) 1.9 (1.0–2.8) 1.6† (1.2–2.0) 1.4 (1.0–1.7) 1.4 (1.1–1.7) 1.3 (1.0–1.7) 1.2 (0.8–1.5) 1.1 (0.6–1.5) — Sex, % (95% CI) 2019 Female 0.4 (0.2–0.6) — 0.4 (0.2–0.7) 0.7 (0.4–1.0) 0.8 (0.6–1.0) 1.0 (0.8–1.2) 0.9 (0.7–1.1) 0.8 (0.7–1.0) 0.8 (0.6–1.1) 0.6 (0.4–0.9) 0.3 (0.2–0.5) 0.3 (0.2–0.5) Male 0.9 (0.5–1.4) 0.9 (0.5–1.2) 1.2 (0.8–1.7) 1.6 (1.3–1.9) 2.0 (1.7–2.3) 2.2 (1.9–2.4) 2.3 (2.0–2.6) 2.6 (2.2–2.9) 2.2 (1.8–2.5) 1.6 (1.4–1.9) 1.3 (0.9–1.6) 1.0 (0.6–1.5) 2020 Female 0.5 (0.2–0.8) 0.5 (0.2–0.7) 0.9† (0.5–1.3) 1.7† (1.1–2.3) 1.7† (1.2–2.2) 1.5† (1.3–1.7) 1.4† (1.1–1.6) 1.4† (1.1–1.7) 1.1 (0.8–1.3) 0.7 (0.5–1.0) 0.5 (0.3–0.8) — Male 1.0 (0.5–1.5) 1.2† (0.7–1.7) 1.6† (1.1–2.2) 2.5† (2.0–3.0) 2.8† (2.2–3.3) 2.6† (2.1–3.0) 2.6 (2.2–3.0) 2.6 (2.3–3.0) 2.4 (2.1–2.7) 1.9 (1.6–2.3) 1.4 (1.0–1.9) 1.0 (0.7–1.4) Total, % (95% CI) 2019 0.7 (0.3–1.0) 0.7 (0.4–1.0) 0.9 (0.5–1.2) 1.2 (0.9–1.5) 1.4 (1.2–1.6) 1.6 (1.4–1.8) 1.7 (1.4–1.9) 1.8 (1.6–2.0) 1.6 (1.3–1.9) 1.2 (1.0–1.4) 0.8 (0.6–1.1) 0.7 (0.4–1.0) 2020 0.8 (0.4–1.2) 0.9 (0.5–1.2) 1.3† (0.8–1.8) 2.2† (1.7–2.6) 2.3† (1.9–2.7) 2.1† (1.8–2.4) 2.1† (1.8–2.4) 2.1† (1.9–2.4) 1.8 (1.6–2.1) 1.4 (1.1–1.7) 1.0† (0.7–1.3) 0.8 (0.5–1.1) ED visits, no. 2019 Pedal cyclist ED visits 13,954 12,984 19,228 25,958 33,993 38,565 42,655 44,668 38,422 26,965 17,165 14,348 Injury-related ED visits 2,067,565 1,879,084 2,196,156 2,180,453 2,386,593 2,352,969 2,543,118 2,479,241 2,425,673 2,289,238 2,046,299 2,063,942 2020 Pedal cyclist ED visits 16,613 17,471 22,592 27,920 42,471 43,696 44,090 45,058 36,447 27,932 18,683 13,658 Injury-related ED visits 2,134,526 2,038,440 1,729,883 1,288,572 1,839,591 2,062,185 2,138,277 2,142,528 1,999,441 1,987,562 1,814,376 1,711,755 Abbreviation: ED = emergency department. * Dashes indicate estimate suppressed because coefficient of variation >30%. † Difference in the pairwise comparison of the monthly percentage in 2020 compared with 2019 is statistically significant at p<0.05. Moreland A, Herlihy C, Tynan MA, et al.; CDC Public Health Law Program; CDC COVID-19 Response Team, Mitigation Policy Analysis Unit.

Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings. Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden.

During 2010-2019, U.S. correctional authorities held 1.4-1.6 million persons in state and federal prisons annually, and 10.3-12.9 million persons were admitted to local jails each year (1,2). Incarcerated persons experience a disproportionate burden of negative health outcomes, including unintentional and violence-related injuries (3,4). No national studies on injury-related emergency department (ED) visits by incarcerated persons have been conducted, but a previous study demonstrated a high rate of such visits among a Seattle, Washington jail population (5). To examine nonfatal injury-related ED visits among incarcerated adults, CDC analyzed 2010-2019 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) data. During 2010-2019, an estimated 733,547 ED visits by incarcerated adults occurred in the United States. The proportion of ED visits resulting from assault* and self-harm among incarcerated adults was five times as high as those among nonincarcerated adults. Among incarcerated adults, men and adult persons aged <65 years had the highest proportion of assault-related ED visits. Falls accounted for the most ED visits among incarcerated adults aged ≥65 years. A higher proportion of ED visits by incarcerated women than incarcerated men were for overdose or poisoning. These findings suggest that injuries among incarcerated adults differ from those among nonincarcerated adults and might require development and implementation of age- and sex-specific prevention strategies for this population.