Likang Xu's research while affiliated with Centers for Disease Control and Prevention and other places

Publications (53)

Article
Purpose: Suicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to...
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Importance: Direct costs of substance use disorders (SUDs) in the United States are incurred primarily among the working-age population. Quantifying the medical cost of SUDs in the employer-sponsored insurance (ESI) population can improve understanding of how SUDs are affecting workplaces and inform decision-making on the value of prevention strat...
Article
Introduction Expanding access to medications for opioid use disorder is a cornerstone to addressing the opioid overdose epidemic. However, recent research suggests that the distribution of medications for opioid use disorder has been inequitable. This study analyzes the racial‒ethnic disparities in the receipt of medications for opioid use disorder...
Article
Introduction This study compares rural and urban differences in the rates of nonfatal self-harm in the U.S. in 2018. Methods Nationwide Emergency Department Sample and Census data were analyzed to calculate the RR of emergency department visits for self-harm between rural and urban residents. The analyses were conducted in 2021. Results Among a w...
Article
Study objective A better understanding of differences in traumatic brain injury incidence by geography may help inform resource needs for local communities. This paper presents estimates on traumatic brain injury–related hospitalizations and deaths by urban and rural county of residence. Methods To estimate the incidence of traumatic brain injury–...
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Importance: A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment. Objective: To estimate...
Article
Background: Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, TBIs substantially contribute to health care costs, which vary by severity. This is important to consider given the variability in recovery time by severity. Research design: This study quantifies the annual incremental health care costs...
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Importance Although opioids can be effective medications in certain situations, they are associated with harms, including opioid use disorder and overdose. Studies have revealed unexplained prescribing variation and prescribing mismatched with patient-reported pain for many indications. Objective To summarize opioid prescribing frequency, dosages,...
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Objective To estimate the average lost work productivity due to non-fatal injuries in the USA comprehensively by injury type. Methods The attributable average number and value of lost work days in the year following non-fatal emergency department (ED)–treated injuries were estimated by injury mechanism (eg, fall) and body region (eg, head and neck...
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Objective To estimate the average medical care cost of fatal and non-fatal injuries in the USA comprehensively by injury type. Methods The attributable cost of injuries was estimated by mechanism (eg, fall), intent (eg, unintentional), body region (eg, head and neck) and nature of injury (eg, fracture) among patients injured from 1 October 2014 to...
Article
Traumatic brain injury (TBI) affects the lives of millions of Americans each year (1). To describe the trends in TBI-related deaths among different racial/ethnic groups and by sex, CDC analyzed death data from the National Vital Statistics System (NVSS) over an 18-year period (2000-2017). Injuries were also categorized by intent, and unintentional...
Article
Introduction: Despite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emot...
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Objective: To classify and compare US nationwide opioid-related hospital inpatient discharges over time by discharge type: 1) opioid use disorder (OUD) diagnosis without opioid overdose, detoxification, or rehabilitation services, 2) opioid overdose, 3) OUD diagnosis or opioid overdose with detoxification services, and 4) OUD diagnosis or opioid o...
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Introduction: U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose. Methods: In 2018, survey-weighted analysis of hospital stays in the 2016 Healthcare Cost and Utilization Project Nation...
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Introduction: This study describes characteristics of nonfatal self-inflicted injuries and incidence of repeat self-inflicted injuries among a large convenience sample of youth (aged 10-24 years) with Medicaid or commercial insurance. Methods: In 2018, Truven Health MarketScan medical claims data were used to identify youth with a self-inflicted...
Article
Objective. : The increased use of opioids to treat chronic pain in the past 20 years has led to a drastic increase in opioid prescribing in the United States. The Centers for Disease Control and Prevention's (CDC's) Guideline for Prescribing Opioids for Chronic Pain recommends the use of nonopioid therapy as the preferred treatment for chronic pai...
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Background Non-fatal self-inflicted (SI) injuries may be underidentified in administrative medical data sources. Objective Compare patients with SI versus undetermined intent (UI) injuries according to patient characteristics, incidence of subsequent SI injury and risk factors for subsequent SI injury. Methods Truven Health MarketScan was used to...
Article
Background: About 2.8 million TBI-related emergency department visits, hospitalizations and deaths occurred in 2013 in the United States. Post-traumatic epilepsy (PTE) can be a disabling, life-long outcome of TBI. Objectives: The purpose of this study is to address the probability of developing PTE within 9 years after TBI, the risk factors asso...
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Background: Understanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for op...
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Objective: To investigate whether the presence of fraternities and sororities was associated with a higher local injury rate among undergraduate-age youth. Methods: In 2016 we compared the rate of 2010-2013 youth (18-24 years) emergency department (ED) visits for injuries in Hospital Service Areas (HSA) with and without fraternities and sororities....
Article
Background: Although head trauma-related deaths, hospitalizations, and emergency department visits are well characterized, few studies describe pediatric patients presenting outside of emergency departments. We compared the epidemiology and extent of healthcare-seeking pediatric (0-17y) patients presenting in outpatient settings with those of pati...
Article
Objectives: Policies that increase household income, such as the earned income tax credit (EITC), have shown reductions on risk factors for child maltreatment (ie, poverty, maternal stress, depression), but evidence is lacking on whether the EITC actually reduces child maltreatment. We examined whether states' EITCs are associated with state rates...
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Problem/condition: Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizati...
Article
Purpose: This is a descriptive study. It determined the annual, national incidence of head injuries (TBI) to adults and children in motor-vehicle crashes. It evaluated NASS-CDS (National Automotive Sampling System-Crashworthiness Data System) for exposure and incidence of various head injuries in towaway crashes. It evaluated three health databases...
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Objectives: To describe the frequencies and rates of mild traumatic brain injury (mTBI) emergency department (ED) visits, analyze the trend across the years, and compare sociodemographic characteristics of visits by mTBI type (ie, mTBI as the only injury, or present along with other injuries). Design: Population-based descriptive study using dat...
Article
Objective: Guidelines suggest that Traumatic Brain Injury (TBI) related hospitalizations are best treated at Level I or II trauma centers because of continuous neurosurgical care in these settings. This population-based study examines TBI hospitalization treatment paths by age groups. Methods: Trauma center utilization and transfers by age group...
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Paediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California's 2004 pai...
Article
Purpose: When providers recognize that patients are abusing prescription drugs, review of the drugs they are prescribed and attempts to treat the substance use disorder are warranted. However, little is known about whether prescribing patterns change following such a diagnosis. Methods: We used national longitudinal health claims data from the M...
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Importance: It is important to understand the magnitude and distribution of the economic burden of prescription opioid overdose, abuse, and dependence to inform clinical practice, research, and other decision makers. Decision makers choosing approaches to address this epidemic need cost information to evaluate the cost effectiveness of their choic...
Article
Introduction With the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern. Methods We analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age...
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US hospital discharge datasets typically report facility charges (ie, room and board), excluding professional fees (ie, attending physicians' charges). We aimed to estimate professional fee ratios (PFR) by year and clinical diagnosis for use in cost analyses based on hospital discharge data. The subjects consisted of a retrospective cohort of Truve...
Article
To describe similarities and differences in the number of civilian traumatic brain injury (TBI)-related hospitalizations and emergency department visits between national databases that capture US hospital data. TBI-related hospitalizations included in the National Hospital Discharge Survey (NHDS) and Healthcare Cost and Utilization Project Nationwi...
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We estimated the frequency and direct medical cost from the provider perspective of U.S. hospital visits for pediatric abusive head trauma (AHT). We identified treat-and-release hospital emergency department (ED) visits and admissions for AHT among patients aged 0-4 years in the Nationwide Emergency Department Sample and Nationwide Inpatient Sample...
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Background: Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States. Methods: CDC analyzed data on emergency department (ED) visits resulting from...
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Objectives: Health consequences of shaken baby syndrome, or pediatric abusive head trauma (AHT), can be severe and long-lasting. We aimed to estimate the multiyear medical cost attributable to AHT. Methods: Using Truven Health MarketScan data, 2003-2011, we identified children 0 to 4 years old with commercial or Medicaid insurance and AHT diagno...
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Background Pediatric traumatic brain injury (TBI) is an important public health problem and little is known about site of care and outcomes of children with severe TBI. Across the country, most injured children are treated in adult trauma centers (ATCs). Recent literature suggests that ATCs with added qualifications in pediatrics (ATC-AQs) can have...
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Objectives We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. Methods We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone surv...
Conference Paper
Background: In persons with traumatic brain injury (TBI), the presence of either non-TBI co-occurring injuries or comorbidities may increase hospitalization lengths of stay or complicate recovery. Co-occurring injuries and comorbidities among persons hospitalized with TBI have not been described at a national level in the US. Methods: Data from the...
Article
Objective: Abusive head trauma (AHT) is a leading cause of severe injury in maltreated children in the United States. There is little research from nationally representative datasets available to characterize young children who had AHT compared to non-abusive head trauma (NAHT). Methods: Using the recent CDC AHT case definition, we performed a r...
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OBJECTIVES: We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. METHODS: We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone sur...
Article
Patients with severe traumatic brain injury (TBI), head Abbreviated Injury Scale (AIS) score of 3 or greater, who are indirectly transported from the scene of injury to a nontrauma center can experience delays to definitive neurosurgical management. Transport to a hospital with appropriate initial emergency department treatment and rapid admission...
Article
Traumatic Brain Injury (TBI) is a public health problem in the United States. In 2009, approximately 3.5 million patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N=300,667) or were treated and released from emergency departments (EDs; N=2,077,350), outpatient departments (ODs; N=83,857), and offic...
Article
Objective An International Classification of Diseases code-based case definition for non-fatal abusive head trauma (AHT) in children <5 years of age was developed in March 2008 by an expert panel convened at the Centers for Disease Control and Prevention (CDC). This study presents an application of the CDC recommended operational case definition of...
Article
To describe factors associated with inpatient mortality in a field hospital established following the 2010 Haiti earthquake. Data were abstracted from medical records of patients admitted to the University of Miami Global Institute/Project Medishare hospital. Decedents were compared to survivors in terms of age, sex, length of stay, admission ward,...
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Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Approximately 53,000 persons die from TBI-related injuries annually. During 1989-1998, TBI-related death rates decreased 11.4%, from 21.9 to 19.4 per 100,000 population. This report describes the epidemiology and annual rates of TBI-related deaths during 1...

Citations

... In contrast, compared with high rates of methadone treatment, buprenorphine was considerably underutilized in this cohort of predominantly non-Hispanic Black women, and racial/ethnic disparities in buprenorphine access have been observed in prior studies [25][26][27]. Disproportionately low buprenorphine use compared with methadone use has been shown in other studies, with one study reporting 27% past-year treatment with methadone versus fewer than 5% reporting buprenorphine among persons who inject drugs [28,29]. This may be because buprenorphine was only approved for OUD treatment in 2002. ...
... Remaining pathologies identified on CT or clinically diagnosed were subarachnoid hemorrhage, intracerebral hematoma (ICH), brain edema, concussion, diffuse axonal injury (DAI), and intraventricular hemorrhage. These had incidences of 17, 10,9,8,4, and 1, respectively. ...
... 5,6 Furthermore, the societal impacts of SUDs are substantial, with annual SUD-related health care costs exceeding $13 billion, and annual total costs estimated to exceed $700 billion in the USA. 7,8 Given the wide range of negative outcomes related to SUDs, access to and engagement in effective treatment is critical. ...
... While patients are generally not expected to die or incur severe disability after mild TBI (2% and 1-2% at 6 months post-injury, respectively), recent data suggest that 56% have not recovered to their functional baseline and 29% are unable to resume their prior level of employment [6,7]. Consequently, losses of livelihood and productivity for patients, their families, and society after TBI are immense [8][9][10]. ...
... Parous women reported slightly more severe back pain compared to women who had not given birth (NRS 7 [5][6][7][8] vs 6 [5][6][7] out of 10, p = 0.002, Fig. 2). Race (p < 0.001), ethnicity (p = 0.004), and family income were individually associated with back pain severity. ...
... 1 They can result in substantial delays in returning to work after injury, time off work and productivity loss. [2][3][4] For example, among working-age adults, only 67% of adults had made a return to work (RTW) 12 months after being admitted to hospital in England following an unintentional injury. 2 Productivity loss resulting from decreased on-the-job productivity or employee absence 5 6 has substantial societal, 5 employer 3 and individual 4 costs. A recent systematic review of the socioeconomic impact of orthopaedic trauma found most studies report productivity loss in relation to absenteeism, reduced hours of work or financial losses after injury. ...
... Aggregated medical costs (e.g., combined intents by mechanism or combined mechanisms by place of death) from reference sources were assigned when specific estimates by intent or mechanism were not available. The average medical cost among 2019 injury deaths was approximately $15,400 † † ; however, many injury deaths had lower costs because the deaths occurred outside a health care setting (2). The cost of injury mortality includes value of statistical life, a monetary estimate of the collective value that persons place on mortality risk reduction as derived in research studies through revealed preferences (e.g., observed wage differences for dangerous occupations) or stated preferences from surveys of persons' willingness to pay for mortality risk reduction (3). ...
... Traumatic brain injuries (TBI) are a significant public health issue in both developed and developing countries (1)(2)(3)(4)(5)(6)(7)(8)(9) accounting for about 41% of overall Years of Life Lost (YLL) (10), with an estimated annual incidence of TBI globally about 27 to 69 million (11,12). A surveillance study of TBIrelated deaths in the US indicated that TBI remains the chief cause of death and disability in young people (13). Another study (14) found an increasing incidence rate of TBIs among people aged 65 years and older in high-income countries as a result of an unintentional fall. ...
... Stroke is not the only example. Other examples with similar trends include dementia incidence by racial and ethnic group, 45 migraine incidence by household income, 46 and increased traumatic brain injury prevalence in populations of Indigenous people, 47 people who are homeless, 48 and people who are incarcerated. 49 Harmful alcohol use is another example of a major driver of neurological health inequalities powered by commercial determinants of health (alongside tobacco and diet), heavily patterned by socioeconomic status across both high-income countries and LMICs, 50 the effects of alcohol on neurological health include traumatic brain injury, alcohol-related brain damage (eg, Wernicke-Korsakoff syndrome), and foetal alcohol syndrome disorders (which are more frequent in Indigenous people, people who are incarcerated, and children in care). ...
... Almost 500,000 Americans died from an opioid-related overdose between 1999 and 2019 [1]. Although rates of opioid-related U.S. hospital discharges including detoxification services decreased from 31.6 to 27.4 per 100,000 in the general population between 1993 and 2016 [2], among individuals who received treatments for opioid use disorder (OUD) in the prior 12 months, the use of inpatient addiction treatment increased from 38% to 52% from 2004 to 2013 [3]. Rarely an inpatient detoxification admission results in a complete navigation of the inpatient treatment system [4]. ...