Medical examiner response to the drug overdose epidemic in King County Washington: “Real-time” surveillance,data science,and applied forensic epidemiology

As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with “real-time” fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.     

Trends in the proportion of married women of reproductive age in Spain, 1887–1991

Using the Princeton nuptiality index I_m, we analyzed historical developments in the proportion of married women of reproductive age in Spain. We show the internal diversity in nuptiality patterns and offer an explanatory statistical model based on panel data analysis to identify the main variables influencing these changes over more than a century (1887–1991). We found that Spain has been the developed country with the greatest contrasts in its provincial nuptiality patterns (measured by I_m), although this diversity has lessened over the course of time. We also found that some socioeconomic variables (the gross domestic product per capita and the percentage of population living in cities) do not have a linear relationship with female nuptiality but rather have a U shape or an inverted U shape. This may partly account for some of the controversy that has raged on this topic over the past few decades on an international level.