Major Adverse Health Outcomes Research Articles

Lives saved by public health restrictions over the Victorian COVID-19 Delta variant epidemic wave, Aug-Nov 2021

BackgroundPrior to mid-2021, Australia’s approach to COVID-19 was to eliminate community transmission. However, between August-November 2021, the state of Victoria, Australia, experienced an outbreak of the Delta variant that continued to grow despite extensive lockdowns and public health measures in place. While these public health restrictions were ultimately unable to stop community transmission, they likely had a major impact reducing transmission and adverse health outcomes relative to voluntary risk-mitigation only (e.g., in response to rising cases and deaths, some people may avoid crowded settings, hospitality, retail, social occasions, or indoor settings). This study aims to estimate the impact of the August-November 2021 enforced public health restrictions in Victoria, compared to voluntary risk-mitigation only. MethodsAn agent-based model was calibrated to Victorian epidemiological, health and behavioural data from 1 August to 30 November 2021, as well as policies that were implemented over that period. Two counter-factual scenarios were run for the same period with (a) no restrictions in place; or (b) voluntary risk-mitigation only, based on behaviour measured over the December-January Omicron BA.1 epidemic wave when restrictions were not in place. ResultsOver August-November 2021, the baseline model scenario resulted in 97,000 (91,000−102,000) diagnoses, 9100 (8500−9700) hospital admissions, and 480 (430−530) deaths. Without any restrictions in place, there were 3,228,000 (3,200,000−3,253,000) diagnoses, 375,100 (370,200−380,900) hospital admissions, and 16,700 (16,000−17,500) deaths. With voluntary risk-mitigation equal to those observed during the Omicron BA.1 epidemic wave, there were 1,507,000 (1,469,000−1,549,000) diagnoses, 130,300 (124,500−136,000) hospital admissions, and 5500 (5000−6100) deaths. ConclusionPublic health restrictions implemented in Victoria over August-November 2021 are likely to have averted more than 120,000 hospitalizations and 5000 deaths relative to voluntary risk-mitigation only. During a COVID-19 epidemic wave voluntary behaviour change can reduce transmission substantially, but not to the same extent as enforced restrictions.

A tale of two generations: Case study of intergenerational living in residential aged care

BackgroundSocial isolation and loneliness are associated with major adverse health outcomes and increased mortality. Intergenerational programs provide an opportunity to consider quality interactions that may reduce social isolation and loneliness, supporting older people to build strong and meaningful relationships. Minimal research has been conducted in the Australian context pertaining to intergenerational living involving university students. AimsTo explore an intergenerational residential model of university students residing with older people in a residential aged care facility and examine the impact on social isolation and engagement. MethodUsing a case study design, this study explored the experience of a university student, Residential Aged Care Facility (RACF) residents and staff who participated in an intergenerational living trial at a regional Aged Care facility in Queensland, Australia. FindingsParticipants indicated that the experience was positive and found the relationships meaningful. For frail older adults the trial provided companionship and reduced isolation. The student gained a deeper understanding of and respect for the older generation; with staff observing an improvement in social interactions between the two. DiscussionThe student was noted to be a catalyst for a cultural shift which resulted into more social interactions among residents in the RACF. The intergenerational program was seen as an opportunity for personal growth for the student, with confidence and independence being one the key areas for development. ConclusionThe study reveals that intergenerational living has the potential to be a positive influence on residents, staff, and students, and should be trialled beyond the setting.

Association of Hormonal Contraceptive Use With Adverse Health Outcomes

Meta-analyses have reported conflicting data on the safety of hormonal contraception, but the quality of evidence for the associations between hormonal contraceptive use and adverse health outcomes has not been quantified in aggregate. To grade the evidence from meta-analyses of randomized clinical trials (RCTs) and cohort studies that assessed the associations between hormonal contraceptive use and adverse health outcomes among women. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched from database inception to August 2020. Search terms included hormonal contraception, contraceptive agents, progesterone, desogestrel, norethindrone, megestrol, algestone, norprogesterones, and levonorgestrel combined with terms such as systematic review or meta-analysis. The methodological quality of each meta-analysis was graded using the Assessment of Multiple Systematic Reviews, version 2, which rated quality as critically low, low, moderate, or high. The Grading of Recommendation, Assessment, Development and Evaluations approach was used to assess the certainty of evidence in meta-analyses of RCTs, with evidence graded as very low, low, moderate, or high. Evidence of associations from meta-analyses of cohort studies was ranked according to established criteria as nonsignificant, weak, suggestive, highly suggestive, or convincing. A total of 2996 records were screened; of those, 310 full-text articles were assessed for eligibility, and 58 articles (13 meta-analyses of RCTs and 45 meta-analyses of cohort studies) were selected for evidence synthesis. Sixty associations were described in meta-analyses of RCTs, and 96 associations were described in meta-analyses of cohort studies. Among meta-analyses of RCTs, 14 of the 60 associations were nominally statistically significant (P ≤ .05); no associations between hormonal contraceptive use and adverse outcomes were supported by high-quality evidence. The association between the use of a levonorgestrel-releasing intrauterine system and reductions in endometrial polyps associated with tamoxifen use (odds ratio [OR], 0.22; 95% CI, 0.13-0.38) was graded as having high-quality evidence, and this evidence ranking was retained in the subgroup analysis. Among meta-analyses of cohort studies, 40 of the 96 associations were nominally statistically significant; however, no associations between hormonal contraceptive use and adverse outcomes were supported by convincing evidence in the primary and subgroup analyses. The risk of venous thromboembolism among those using vs not using oral contraception (OR, 2.42; 95% CI, 1.76-3.32) was initially supported by highly suggestive evidence, but this evidence was downgraded to weak in the sensitivity analysis. The results of this umbrella review supported preexisting understandings of the risks and benefits associated with hormonal contraceptive use. Overall, the associations between hormonal contraceptive use and cardiovascular risk, cancer risk, and other major adverse health outcomes were not supported by high-quality evidence.

Ishii test for screening sarcopenia: performance in community-dwelling older adults.

Sarcopenia is associated with an increased likelihood of major adverse health outcomes. Therefore, screening and early and timely identification of sarcopenia are essential. EWGSOP2 (European Working Group on Sarcopenia in Older People2) suggests Ishii screening test for formal-case findings. We aimed to define the diagnostic value of the Ishii screening test, which estimates the probability of sarcopenia using an equation-derived score based on three variables (age, grip strength, and calf circumference) in Turkish older adults. Older adults aged > = 60 who applied to a geriatric outpatient clinic were included in the study. The recommendation of the EWGSOP2 for the definition of sarcopenia was followed. The probability of sarcopenia was estimated by using a score chart of Ishii. Performance of Ishii screening test was analyzed by using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver-operating characteristic (ROC) analysis was performed to determine the area under the curve (AUC). We included 1635 patients with the mean age of 74.7 ± 7.0. The prevalence of probable sarcopenia was 11.9%. The prevalence of confirmed sarcopenia according to height2 was 0.7%. The prevalence of severe sarcopenia was 0.3% in total. Against diagnoses of probable sarcopenia, confirmed sarcopenia, and severe sarcopenia, the sensitivity values of the Ishii screening test were 84%, 100%, and 100%; the specificity values were 86.1%, 83.9%, and 84.6%, respectively. PPV values were 44.9%, 4.2%, 2.1%; NPV were 97.6%, 100%, 100%, and the AUC values were 0.933, 0.961, and 0.959, respectively. Our results suggest that the Ishii screening test is a successful screening and maybe a candidate diagnostic test for sarcopenia.

METABOLITES ASSOCIATED WITH HIGH VERSUS LOW WALKING ABILITY AMONG COMMUNITY-DWELLING OLDER MEN AND WOMEN

Low walking ability is highly prevalent with advanced age and associated with a higher risk of major adverse health outcomes. Metabolomics may help better characterize differences among older adults with vastly different walking abilities and provide insight into altered metabolic processes underlying age-related declines in physical functioning. Here, we sought to identify metabolites associated with high versus low walking ability using a nested case-control study of 120 community-dwelling adults ages 79-95 (40% men, 10% black) from the Cardiovascular Health Study (CHS) All Stars study. Participants with high versus low walking ability were matched one-to-one on age, gender, race, and fasting time. Using liquid chromatography-mass spectrometry, 569 metabolites were identified in overnight-fasting plasma. High versus low walking ability was defined as the best versus worst tertile of gait speed (≥0.9 versus <0.7 meters/second) and Walking Ability Index scores (7-9 versus 0-1). Ninety-six metabolites were associated with walking ability extremes (p<0.05, false discovery rate<30%), where 24% were triacylglycerols. Triacylglycerols containing mostly polyunsaturated fatty acids (e.g., omega-3) were higher, whereas those containing mostly saturated/monounsaturated fatty acids were lower among those with high versus low walking ability. Arginine and proline metabolism was a top pathway identified. Body mass index partly explained the association between a subset of metabolites and walking ability extremes. These findings may partly reflect pathways implicating modifiable risk factors including excess dietary lipids and lack of physical activity, which contribute to obesity and cause further alterations in metabolic pathways, potentially leading to age-related declines in walking ability in this cohort.

Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease.

Recent studies have demonstrated that obstructive sleep apnea (OSA) is associated with the development and evolution of nonalcoholic fatty liver disease (NAFLD), independent of obesity or other shared risk factors. Like OSA, NAFLD is a prevalent disorder associated with major adverse health outcomes: Patients with NAFLD may develop cirrhosis, liver failure, and hepatocellular carcinoma. One major finding that has emerged from these studies is that the OSA-NAFLD association is related to the degree of nocturnal hypoxemia in OSA. Animal models have therefore largely focused on intermittent hypoxia, a key manifestation of OSA, to shed light on the mechanisms by which OSA may give rise to the complex metabolic disturbances that are seen in NAFLD. Intermittent hypoxia leads to tissue hypoxia and can result in oxidative stress, mitochondrial dysfunction, inflammation, and overactivation of the sympathetic nervous system, among many other maladaptive effects. In such models, intermittent hypoxia has been shown to cause insulin resistance, dysfunction of key steps in hepatic lipid metabolism, atherosclerosis, and hepatic steatosis and fibrosis, each of which is pertinent to the development and/or progression of NAFLD. However, many intriguing questions remain unanswered: Principally, how aggressively should the clinician screen for NAFLD in patients with OSA, and vice versa? In this review, we attempt to apply the best evidence from animal and human studies to highlight the relationship between these two disorders and to advocate for further trials aimed at defining these relationships more precisely.

Adverse outcomes of long-term use of proton pump inhibitors: a systematic review and meta-analysis

The association between the long-term use of proton pump inhibitors (PPIs) and the risks of various diseases remains controversial. Therefore, the primary objective of this study was to quantify the associations as presented in the literature and to also provide this information to healthcare professionals and patients about their potentially adverse effects. In July 2016, we searched through Medline (PubMed), Embase, and the Cochrane Library from inception using common keywords. We included observational studies that provided risk estimates on the long-term use of PPIs and their adverse effects. Overall, 43 studies were included in the systematic review, of which 28 studies were also included in the random effect meta-analysis. Odds of community-acquired pneumonia, hip fracture, and colorectal cancer were 67% [odds ratio (OR)=1.67; 95% confidence interval (CI): 1.04-2.67], 42% (OR=1.42; 95% CI: 1.33-1.53), and 55% (OR=1.55; 95% CI: 0.88-2.73) higher in patients with long-term PPIs use compared with patients who did not use PPIs. Although the use of PPIs provides short-term health benefits, their prolonged use is associated with minor and also potentially major adverse health outcomes. Hence, we strongly recommend that the prescription of PPIs should be done with caution to improve the medication's efficacy and patients' safety.

Pending Laboratory Test Results at the Time of Discharge: A 3-Year Retrospective Comparison of Paper Versus Electronic Test Ordering in Three Emergency Departments.

Pending laboratory test results at discharge can have major adverse health outcomes. The availability of test results at discharge may depend on whether the tests were ordered electronically or by using a paper-based system. The aim of this study was to determine the rate of pending test results at time of discharge from Emergency Departments (ED), and compare the rate for paper-based and electronic orders across three EDs in New South Wales, Australia. This retrospective study described 71,466 ED presentations with 357,476 laboratory tests across three years (2014-2016). Only patients who were treated in ED and eventually discharged from ED were included. Most tests were ordered using the electronic system (97.2%, n=347,469). The rate of pending test results was significantly lower for electronic orders (6.6%, n=22,928) than for paper orders (9.7%, n=966): a difference of 3.1%. Similar differences were observed when analysis was done by year of ED presentation. Moreover, in a subgroup analysis that included the top five high volume tests, four of the five tests had significantly lower rates of pending test results for electronic orders than for paper-based orders. The study highlighted an important benefit of ordering tests via electronic system which can potentially improve patient outcomes.

Prevalence and Associated Factors of Sarcopenia and Frailty in Parkinson’s Disease: A Cross-Sectional Study

Background: Sarcopenia and frailty are found in up to one-third of the general elderly population. Both are associated with major adverse health outcomes such as nursing home placement, disability, decreased quality of life, and death. Data on the frequency of both syndromes in Parkinson’s disease (PD), however, are very limited. Objective: We aimed to screen for sarcopenia and frailty in PD patients and to assess potential associations of both geriatric syndromes with demographic and clinical parameters as well as quality of life. Methods: In this observational, cross-sectional study, we included 104 PD patients from a tertiary center and 330 non-PD controls from a population-based cohort aged > 65 years. All groups were screened for sarcopenia using the SARC-F score and for frailty using the Clinical Frailty Scale of the Canadian Study of Health and Aging (CSHA CFS). Prevalence rates of sarcopenia and frailty were also assessed in 18 PD patients from a population-based cohort aged > 65 years. Moreover, PD patients from the tertiary center were evaluated for motor and non-motor symptoms, quality of life, and dependency. Results: The prevalence of sarcopenia was 55.8% (95% CI: 46.2–64.9%) in PD patients from the tertiary center and 8.2% (5.7–11.7%; p < 0.001) in non-PD controls. Frailty was detected in 35.6% (27.0–45.2%) and 5.2% (3.2–8.1%; p < 0.001). Prevalence rates for sarcopenia and frailty were 33.3% (16.1–56.4%; p = 0.004) and 22.2% (8.5–45.8%; p = 0.017) in the community-based PD sample. Both sarcopenia and frailty were significantly associated with longer disease duration, higher motor impairment, higher Hoehn and Yahr stages, decreased quality of life, higher frequency of falls, a higher non-motor symptom burden, institutionalization, and higher care levels in PD patients from a tertiary center compared to not affected PD patients (all p < 0.05). Conclusions: Both frailty and sarcopenia are more common in PD patients than in the general community and are associated with a more adverse course of the disease. Future studies should look into underlying risk factors for the occurrence of sarcopenia and frailty in PD patients and into adequate management to prevent and mitigate them.

The burden of chronic breathlessness across the population.

Chronic breathlessness is a common and distressing symptom globally. It is associated with major adverse health outcomes. This review provides an overview of new evidence about the prevalence of chronic breathlessness in the population. A literature search was conducted using MEDLINE database including studies on prevalence of chronic breathlessness and its impact on the community published between 2016 and 2018. Identified studies were divided into four themes: breathlessness in relation to sex, BMI, quality of life and age (the elderly). In the general population, breathlessness was twice as common in women as in men related to their smaller absolute lung volumes. Obesity was to be found an independent risk factor for chronic breathlessness. A strong association between chronic breathlessness and poor physical and mental health-related quality of life was found across all adult age groups. Among elderly people, breathlessness predicted activity of daily living decline over 5 years. Interesting large population-based studies published recently have shed light on the association between chronic breathlessness and sex, obesity, quality of life and increasing age.

Absolute lung size and the sex difference in breathlessness in the general population.

BackgroundBreathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes.MethodsCross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spirometry and diffusing capacity (n = 1,013; 49% women). Breathlessness was measured using the modified Medical Research Council (mMRC) scale and analyzed using ordinal logistic regression adjusting for age, pack-years of smoking, body mass index, chronic airway limitation, asthma, chronic bronchitis, depression and anxiety in all models.ResultsBreathlessness was twice as common in women as in men; adjusted odds ratio (OR) 2.20 (95% confidence interval, 1.32−3.66). Lower absolute lung volumes were associated with increased breathlessness prevalence in both men and women. The sex difference in breathlessness was unchanged when adjusting for lung function in %predicted, but disappeared when controlling for absolute values of total lung capacity (OR 1.12; 0.59−2.15), inspiratory capacity (OR 1.26; 0.68−2.35), forced vital capacity (OR 0.84; 0.42−1.66), forced expiratory volume in one second (OR 0.70; 0.36−1.35) or lung diffusing capacity (OR 1.07; 0.58−1.97).ConclusionIn the general population, the markedly higher prevalence of breathlessness in women is related to their smaller absolute lung volumes.

Role of NO/VASP Signaling Pathway against Obesity-Related Inflammation and Insulin Resistance.

Obesity has quickly become a worldwide pandemic, causing major adverse health outcomes such as dyslipidemia, type 2 diabetes mellitus, cardiovascular disease and cancers. Obesity-induced insulin resistance is the key for developing these metabolic disorders, and investigation to understand the molecular mechanisms involved has been vibrant for the past few decades. Of these, low-grade chronic inflammation is suggested as a critical concept in the development of obesity-induced insulin resistance, and the anti-inflammatory effect of nitric oxide (NO) signaling has been reported to be linked to improvement of insulin resistance in multiple organs involved in glucose metabolism. Recently, a body of evidence suggested that vasodilatory-stimulated phosphoprotein (VASP), a downstream mediator of NO signaling plays a crucial role in the anti-inflammatory effect and improvement of peripheral insulin resistance. These preclinical studies suggest that NO/VASP signaling could be an ideal therapeutic target in the treatment of obesity-related metabolic dysfunction. In this review, we introduce studies that investigated the protective role of NO/VASP signaling against obesity-related inflammation and insulin resistance in various tissues.

Status of adolescent pelvic inflammatory disease management in the United States

Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

Glypican-4 is a new comer of adipokines working as insulin sensitizer.

Glypican-4 is a new comer of adipokines working as insulin sensitizer.

Response to first antiepileptic drug trial predicts health outcome in epilepsy

Failure to respond to the initial antiepileptic drug (AED) is a predictor of increased risk of pharmacoresistant epilepsy. Whether response to the first AED also predicts adverse health outcomes is unknown. This longitudinal study compared rates of major adverse health outcomes (loss of driving privileges, unemployment, divorce/separation, injury, emergency room admission, hospitalization, and death) in 33 patients who failed the first AED (cases) and 30 patients who became seizure-free with the first AED (controls). Patient data were obtained by chart review and confirmed through a structured interview with each subject at 5-7 years after starting AED treatment. We also assessed between-group differences in quality of life, depression, and adverse AED effects by using standardized instruments completed by each subject at the end of follow-up. The number of major adverse health outcomes was similarly high during the first year of AED treatment [mean ± standard deviation (SD) 2.64 ± 0.99 for cases and 2.50 ± 1.14 for controls], but thereafter decreased to a greater extent in controls than in cases (p < 0.001). Controls had a higher cumulative probability of experiencing ≥1 year free from major adverse health outcomes compared to cases (p = 0.002). Two cases died during the follow-up, both of sudden unexpected death. Cases had worse quality of life ratings than controls, whereas no significant between-group differences were found for measures of depression and adverse AED effects. In a post hoc analysis limited to cases, patients who became seizure-free with subsequent AED treatments showed for the first 4 years major adverse health outcome rates similar to those recorded in patients with persisting seizures. After 4 years, however, cases who achieved late seizure freedom tended to show a more favorable outcome. Patients with epilepsy failing the initial AED trial are at increased risk of experiencing adverse health outcomes, at least for the first 4 years after diagnosis. Incorporating these findings into clinical decision making may aid in reducing delays in surgical referrals for pharmacoresistant epilepsy.

The economic cost of adverse health effects from wildfire-smoke exposure: a review

The economic costs of adverse health effects associated with exposure to wildfire smoke should be given serious consideration in determining the optimal wildfire management policy. Unfortunately, the literature in this research area is thin. In an effort to better understand the nature of these economic costs, we review and synthesise the relevant literature in three areas: studies that estimated the health-related economic costs of wildfire-smoke exposure; epidemiology studies related to the health risk of wildfire smoke; and general economic studies that estimated the monetary value of preventing the specific adverse health outcomes. Based on the findings from this literature review, we identify the need for a better understanding of the effect of wildfire smoke on major and minor adverse health outcomes. It would also be useful to know more about averting behaviours among residents exposed to smoke during a wildfire event. Finally, we suggest investigating the unique health effects of wildfire smoke compared with conventional air pollution to determine whether it is appropriate to extrapolate from previously estimated conventional pollution dose–response functions.

World Kidney Day 2009

World Kidney Day is an occasion to mark growing concerns over the impact of kidney disease on global public health. Although the distribution of causes of kidney disease and access to dialysis and transplantation may vary among regions of the world, arguably, one point is universal. An expanding proportion of people in every nation in the world are affected by chronic kidney disease (CKD). In the United States, the most recent data suggest that 27 million individuals have CKD, representing nearly one in every seven adults and a 30% increase over the past decade.1 Population sampling studies from around the globe now indicate similar prevalence rates, usually ranging between 10 and 13%. Because the prevalence of CKD rises dramatically with age and is also associated with obesity and diabetes, kidney disease will be a public health concern for the foreseeable future. Kidney disease is linked with major adverse health outcomes, including premature cardiovascular disease, with a graded increase in risk as kidney function is lost.2,3 This is now clear from epidemiologic studies, community-based studies, and reanalysis of clinical trials of patients with kidney disease. The rising rate in the number of patients who do reach end-stage kidney disease and are treated with dialysis or renal transplantation also continues to be of concern. There is significant risk that the growing economic burden will render treatment costs unsustainable even in resource-rich environments. An overall decline in physical performance and cognitive function is also linked to kidney disease, markedly affecting quality of life. As a global community, we need to ask ourselves whether we have in place the strategy to address fully the universal health problems arising from kidney disease, given the biologic and culture heterogeneity of populations, diverse environments, and varying capabilities of health care delivery systems around …

Area-level socioeconomic status in relation to outcomes in γ-hydroxybutyrate intoxication

Background. Area-level socioeconomic status (SES) may play an important role in drug abuse patterns, including related health outcomes. This may be particularly relevant for γ-hydroxybutyrate (GHB), which is prototypical of “party” drug abuse. Methods. We retrospectively reviewed GHB-related cases reported to the California Poison Control System (CPCS; January 1, 1999 through June 30, 2007). We limited analysis to CPCS calls containing a residential zip code (ZC). The CPCS data were extracted for key case characteristics, including the residential ZC. We linked cases to corresponding 2000 U.S. Census data for area-level measures of SES and demographics. We used multiple logistic regression analysis to test the associations between area-level SES and GHB case severity, taking into account area-level demographics and individual-level GHB high-risk behaviors. Results. We analyzed 210 cases. Taking into account area-level demographics (age and racial mix; urbanicity) and GHB-related high-risk behaviors (use of GHB congeners; GHB-dependence; co-ingestion of other agents), we associated higher area-level SES with greater GHB case severity. There was 40% increased likelihood of major GHB adverse health outcomes for every $100,000 incremental increase in median home values (OR 1.41; 95% CI 1.1–1.8). For median annual household income (per $10,000), the association was similar (OR 1.39; 95% CI 1.0–1.9). Conclusion. Higher area-level SES is associated with greater GHB-related case severity. This study may serve as a model using a geographic information system (GIS) approach to study the population-based correlates of drugs of abuse reported through poison control surveillance.