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Introduction Homelessness can result in poor health. The number of families with children living in NYC homeless shelters increased 55% from 2008 to 2014. Half of children living in shelter in 2014 were younger than 6 years old. We compared demographics and health outcomes of mothers and infants residing in NYC homeless shelters to those residing in public housing in this cross-sectional study. Methods Addresses of NYC Department of Homeless Services shelters and NYC Housing Authority (NYCHA) developments were matched to NYC Department of Health birth certificate data for the years 2008-2013. Sociodemographic and health characteristics of newborns residing in shelters were compared to newborns in NYCHA housing using Chi square tests. Results Mothers residing in shelters were younger, more likely to be black and less likely to be Hispanic, more likely to have been born outside NYC and reside in the Bronx. Babies born to mothers living in shelter were more likely to have low birth weight (< 2500 g), be born preterm (< 37 gestational weeks), require assisted ventilation immediately following delivery, have a NICU admission, and use Medicaid. They were less likely to breastfeed within 5 days of delivery and be discharged to their residence. Discussion Homeless mothers and infants had poorer health outcomes compared with those living in public housing. Understanding the health disparities of homeless infants can provide guidance for developing future policies and research initiatives, which may be used to inform the development of new policies to improve health outcomes of homeless infants and their mothers., Author(s): Kathleen H. Reilly [sup.1] , Regina Zimmerman [sup.1] , Mary Huynh [sup.2] , Joseph Kennedy [sup.2] , Katharine H. McVeigh [sup.3] Author Affiliations: (Aff1) 0000 0001 0320 6731, grid.238477.d, [...]

A homeless mortality surveillance system identifies emerging trends in the health of the homeless population and provides this information to key stakeholders in a timely and ongoing manner to effect evidence-based, programmatic change. We describe the first 5 years of the New York City homeless mortality surveillance system and, for the first time in peer-reviewed literature, illustrate the impact of key elements of sustained surveillance (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual homeless decedents) on the programs of New York City's Department of Homeless Services. These key elements had a positive impact on the department's programs that target sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons. [ABSTRACT FROM AUTHOR]

Objectives: Nearly 20 percent of New York City's (NYC) accidental deaths are related to motor vehicles crashes (MVCs). Detailed International Classification of Disease (ICD-10; World Health Organization [WHO] 2007) cause-of-death coding of MVC-related fatalities improves surveillance and resulting identification of prevention strategies. We investigated ICD-10 codes in these fatalities and the potential to make them more specific. Methods: We defined 'nonspecific' MVC ICD-10 codes as all globally unspecific codes (V870-V878, V892) and any codes with nonspecific components regarding vehicle involved, decedent position in vehicle, or MVC setting. We calculated nonspecific-code frequency for 1999-2008 MVC deaths. We reviewed a random 10 percent sample of 2007-2008 MVC deaths (N = 61) and medical examiner (ME) records of all nonspecific death certificates (N = 52), including police accident reports ('full PAR') and summaries prepared by onsite police officers ('brief PAR') to determine whether MEs had sufficient information available but did not include that information at death certification. Results: Among 1999-2008 NYC MVC deaths, 82.9 percent had nonspecific ICD-10 cause-of-death codes. Similarly, of the 61 recent randomly sampled MVC deaths, 52 (85.2%) had nonspecific codes. Of 52 nonspecific death certificates from the random sample, 38 (73.1%) death certificates had adequate information available on full or brief PAR to be more specific at the time of death certification. Consistent with MEs' reports of high reliance on the brief PAR, most nonspecific death certificates (76.9%) lacked adequate information in the brief PAR to be more specific. Conclusion: Specific ICD-10 codes for MVC deaths depends on the level of detail provided by the ME in the 'How Injury Occurred' and 'If Transportation Injury Specify' death certificates sections. We have worked to ensure that key information is available to MEs in the brief PAR and educated MEs on the importance of this information to reduce the frequency of nonspecific codes and enhance injury prevention research. [ABSTRACT FROM AUTHOR]

We calculated proportions and trends in contributing causes of death among persons with AIDS (PWA) and a history of injection drug use (IDU) in New York City and compared the proportions with those among PWA with a transmission risk of high-risk heterosexual sex (HRH) and men who have sex with men (MSM). We included all 10,575 injection drug user, HRH, and MSM residents aged 13++ years with AIDS reported by September 30, 2006, who died from 1999 through 2004. Accidental drug overdose was the most frequent contributing cause of death among IDUs (20.5%%). Overdose prevention initiatives may greatly and immediately reduce deaths among PWA. [ABSTRACT FROM AUTHOR]

The New York City Department of Health and Mental Hygiene and the Columbia University Mailman School of Public Health's National Center for Disaster Preparedness undertook a collaborative project to establish a model academic health department. The goals were to increase student participation at the health department, increase faculty participation in health department activities, and facilitate health department faculty appointments at the school. As a result, 17 students were placed in full-time summer research projects designed by health department staff specifically for the project, 154 health department staff attended a series of six lectures presented by faculty, and five health department professionals applied for academic appointments at the school. The benefits of the efforts toward establishing an academic health department extend to all areas of public health practice, including those of preparedness. [ABSTRACT FROM AUTHOR]

Purpose: Long-term follow-up of newborn screening for conditions such as sickle cell disease can be conducted using linkages to population-based data. We sought to estimate childhood sickle cell disease mortality and risk factors among a statewide birth cohort with sickle cell disease identified through newborn screening., Methods: Children with sickle cell disease identified by newborn screening and born to New York residents in 2000-2008 were matched to birth and death certificates. Mortality rates were calculated (using numbers of deaths and observed person-years at risk) and compared with mortality rates for all New York children by maternal race/ethnicity. Stratified analyses were conducted to examine associations between selected factors and mortality., Results: Among 1,911 infants with sickle cell disease matched to birth certificates, 21 deaths were identified. All-cause mortality following diagnosis was 3.8 per 1,000 person-years in the first 2 years of life and 1.0 per 1,000 person-years at ages 2-9 years. The mortality rate was significantly lower among children of foreign-born mothers and was significantly higher among preterm infants with low birth weight. The mortality rates were not significantly higher for infants after 28 days with sickle cell disease than for all New York births, but they were 2.7-8.4 times higher for children 1 through 9 years old with homozygous sickle cell disease than for those of all non-Hispanic black or Hispanic children born to New York residents., Conclusion: Estimated mortality risk in children with homozygous sickle cell disease remains elevated even after adjustment for maternal race/ethnicity. These results provide evidence regarding the current burden of child mortality among children with sickle cell disease despite newborn screening.Genet Med 17 6, 452-459.

Purpose: Sickle cell disease is estimated to occur in 1:300-400 African-American births, with higher rates among immigrants from Africa and the Caribbean, and is less common among Hispanic births. This study determined sickle cell disease incidence among New York State newborns stratified by maternal race/ethnicity and nativity., Methods: Newborns with confirmed sickle cell disease born to New York State residents were identified by the New York State newborn screening program for the years 2000-2008 and matched to birth records to obtain birth and maternal information. Annual incidence rates were computed and bivariate analyses were conducted to examine associations with maternal race/ethnicity and nativity., Results: From 2000 to 2008, 1,911 New York State newborns were diagnosed with sickle cell disease and matched to the birth certificate files. One in every 1,146 live births was diagnosed with sickle cell disease. Newborns of non-Hispanic black mothers accounted for 86% of sickle cell disease cases whereas newborns of Hispanic mothers accounted for 12% of cases. The estimated incidence was 1:230 live births for non-Hispanic black mothers, 1:2,320 births for Hispanic mothers, and 1:41,647 births for non-Hispanic white mothers. Newborns of foreign-born non-Hispanic black mothers had a twofold higher incidence of sickle cell disease than those born to US-born non-Hispanic black mothers (P < 0.001)., Conclusion: This study provides the first US estimates of sickle cell disease incidence by maternal nativity. Women born outside the United States account for the majority of children with sickle cell disease born in New York State. Such findings identify at-risk populations and inform outreach activities that promote ongoing, high-quality medical management to affected children.

Introduction: New York City has one of the highest reported death rates from coronary heart disease in the United States. We sought to measure the accuracy of this rate by examining death certificates., Methods: We conducted a cross-sectional validation study by using a random sample of death certificates that recorded in-hospital deaths in New York City from January through June 2003, stratified by neighborhoods with low, medium, and high coronary heart disease death rates. We abstracted data from hospital records, and an independent, blinded medical team reviewed these data to validate cause of death. We computed a comparability ratio (coronary heart disease deaths recorded on death certificates divided by validated coronary heart disease deaths) to quantify agreement between death certificate determination and clinical judgment., Results: Of 491 sampled death certificates for in-hospital deaths, medical charts were abstracted and reviewed by the expert panel for 444 (90%). The comparability ratio for coronary heart disease deaths among decedents aged 35 to 74 years was 1.51, indicating that death certificates overestimated coronary heart disease deaths in this age group by 51%. The comparability ratio increased with age to 1.94 for decedents aged 75 to 84 years and to 2.37 for decedents aged 85 years or older., Conclusion: Coronary heart disease appears to be substantially overreported as a cause of death in New York City among in-hospital deaths.

The Genetic Analysis Workshop 14 simulated dataset was designed 1) To test the ability to find genes related to a complex disease (such as alcoholism). Such a disease may be given a variety of definitions by different investigators, have associated endophenotypes that are common in the general population, and is likely to be not one disease but a heterogeneous collection of clinically similar, but genetically distinct, entities. 2) To observe the effect on genetic analysis and gene discovery of a complex set of gene x gene interactions. 3) To allow comparison of microsatellite vs. large-scale single-nucleotide polymorphism (SNP) data. 4) To allow testing of association to identify the disease gene and the effect of moderate marker x marker linkage disequilibrium. 5) To observe the effect of different ascertainment/disease definition schemes on the analysis. Data was distributed in two forms. Data distributed to participants contained about 1,000 SNPs and 400 microsatellite markers. Internet-obtainable data consisted of a finer 10,000 SNP map, which also contained data on controls. While disease characteristics and parameters were constant, four "studies" used varying ascertainment schemes based on differing beliefs about disease characteristics. One of the studies contained multiplex two- and three-generation pedigrees with at least four affected members. The simulated disease was a psychiatric condition with many associated behaviors (endophenotypes), almost all of which were genetic in origin. The underlying disease model contained four major genes and two modifier genes. The four major genes interacted with each other to produce three different phenotypes, which were themselves heterogeneous. The population parameters were calibrated so that the major genes could be discovered by linkage analysis in most datasets. The association evidence was more difficult to calibrate but was designed to find statistically significant association in 50% of datasets. We also simulated some marker x marker linkage disequilibrium around some of the genes and also in areas without disease genes. We tried two different methods to simulate the linkage disequilibrium.