Substance Abuse Epidemiology Profile Report - About This Report
How to Use this ReportThis report presents commonly used indicators of substance abuse in New Mexico. These indicators include outcome measures (e.g., alcohol-related death) reported in the Consequences section, mental health indicators associated with substance abuse (e.g., depression) in the Mental Health section, and consumption measures (e.g., self-reported substance use behavior from statewide surveys) reported in the Consumption section. The presentation of each major indicator includes a text description of the major data findings; a detailed table with results by gender, age-group, and race/ethnicity; a table detailing county results by race/ethnicity; a bar chart and a map with rates for each New Mexico county; and, additional charts illustrating other pertinent findings. There are also appendices that provide population denominators used in the calculation of death rates, substance abuse and mental health indicators from the National Survey on Drug Use and Health (NSDUH), and the International Classification of Diseases, Clinical Modification, 9th (ICD-9-CM) and 10th (ICD-10-CM) Edition codes used to produce indicators based on hospital data.
A combined five-year period is used when presenting death, emergency department visits, and hospital discharges. Combining counts over multiple years is necessary because in many of New Mexico's counties, there may be very few events (deaths, emergency department visits, or hospital discharges) due to a given cause in any given year. Combining counts over multiple years allows the calculation of rates that are more stable and, therefore, more meaningful than those calculated based on very few cases. In this report, death, emergency department, and hospitalization rates were calculated and reported for 2012-2016, the most current available five-year period.
Use of this Report: The Problem StatementsThis report presents considerable detail in the form of numbers, proportions, rates, and other statistical summaries, many of these can be found in tables and charts. This information is synthesized in Problem Statements, which provide a brief narrative overview of the data and detailed statistics. These Problem Statements are designed to help explain and frame the epidemiological data presented in each section of the report.
Use of this Report: Tables and ChartsEach of the outcome indicators is presented with at least two tables. Table 1 for each indicator presents the number of events (deaths, emergency department visits, hospital discharges, or number of persons engaging in or experiencing a risk behavior) and their respective rates (or the weighted behavior prevalence rates) by sex, age-group (or grade, in the case of Youth Risk and Resiliency Survey [YRRS] data), and race/ethnicity. In sections that report on causes of death, these tables include the number of deaths, on the left side of the table, and age-adjusted death rates per 100,000 population, on the right side of the table. In sections that report on emergency department visits or hospital discharges, these tables include the number of emergency department visits or hospital discharges, on the left side, and age-adjusted rates per 100,000 population, on the right side. For BRFSS-based indicators, these tables include an estimate of the number of persons engaging in or experiencing the risk behavior, on the left side, and the prevalence rate of the behavior in the population, on the right side. For the aggregated indicators, the number of people was estimated by multiplying the percentage of persons engaging in or experiencing the risk behavior by the population estimate for the corresponding group. In sections that report specifically on youth risk behaviors, Table 1 includes only prevalence rates. These tables are very useful in determining the most important risk groups at the statewide level. Table 2 for each indicator presents results for each NM county by race/ethnicity. Again, the number of events are presented on the left side of the table and the age-adjusted rates on the right side of the table. These tables are useful in determining which counties have the most severe substance use issues, and which racial/ethnic groups are at the highest risk within each county. Youth data are presented by county only.
Discussion of each indicator also includes a county bar chart that graphically presents age-adjusted death rates (or weighted behavior prevalence rates) for each NM county, in descending order. Adjacent to each county name, on the left side of the chart, the number of events occurring (or the estimated number of persons engaging in or experiencing the behavior) in the county and the percent of NM events occurring (or the weighted percent of New Mexicans engaging in or experiencing the behavior) in each county are presented. Counties with the highest rates are easily identified at the top of the chart, while counties with low rates are at the bottom. The state rate is depicted with a darker colored bar and, for most indicators, the most recent available US rate is also included, depicted with a cross-hatched bar, making it easy to compare the county rate to the state and national rate in each instance.
Finally, maps showing rates by county have been included for each indicator. The counties have been categorized and shaded according the county rates. Map shading categories have been chosen to identify counties that have rates lower than the state rate, counties that have rates somewhat higher than the state rate, and counties that have rates substantially higher than the state rate. The latter category (corresponding to the darkest-shaded counties) represent rates that are higher than the state rate by a selected amount. For maps based either on death or hospital-related event rates, this amount corresponds to rates that are 50% or higher than the state rate; for those based on behavioral data (BRFSS or YRRS), this amount corresponds to rates that are 25% higher than the state rate.
Use of this Report: Rates and NumbersBoth rates and the numbers of events are presented in the tables and charts of this report. While the rates are very important for indicating the degree of an issue in a given county or population group, they only provide part of the picture needed for comparing the burden of a problem from one county or group to another. The number of events also needs to be considered when making planning decisions. For instance, Rio Arriba County has an alcohol-related death rate (144.1 per 100,000 population), more than twice that of Bernalillo County (55.7 per 100,000). However, the number of alcohol-related deaths in Bernalillo County (2006) is over six times the number in Rio Arriba County (290). While problems are more severe in Rio Arriba County (reflected in higher rates), Bernalillo County bears a larger proportion of the statewide burden (30.9% of all alcohol-related deaths in the state compared to 4.5% for Rio Arriba County). When prioritizing the distribution of resources and selecting interventions, it is important to look at both the total number of deaths and the death rate. Because of its extremely high rate of alcohol-related deaths, interventions that address this problem are very important in Rio Arriba County. At the same time, Bernalillo County is also very important when locating interventions because it bears much of the statewide burden of alcohol-related deaths.
Use of this Report: Why are some rates missing from the tables?For survey-based measures of risk behaviors (i.e., BRFSS and YRRS), rates based on fewer than 50 respondents for a given table cell have been removed from this report. While prevalence estimates can be calculated based on very small numbers of respondents, estimates based on fewer than 50 respondents can be unstable and are often misleading. Such estimates are of questionable value for planning purposes and have been excluded from this report.
Morbidity and mortality numbers and rates are not reported when the number of events are three or less for a denominator (population) of less than twenty, in accordance with the NMDOH small numbers rule ( https://ibis.health.state.nm.us/view/docs/Standards/NMSmallNumbersRule2006.pdf).
Although not suppressed, mortality and morbidity rates calculated with less than ten events (numerator) should be considered unstable. When rates are calculated using small numbers of events, rates can vary widely, from one reporting to the next, for reasons different from actual changes in the frequency of occurrence of the events measured.
Specifically, for indicators using Emergency Department Data (EDD) or Hospital Inpatient Discharge Data (HIDD), missing rates correspond to events for which data on race-ethnicity, sex, or county of residence were missing. Although these events are included in the total count of events for NM, rates cannot be calculated and are, therefore, not reported. Footnotes on the corresponding tables for these indicators will refer to the number of events missing. EDD and HIDD indicators have been produced by searching for specific diagnostic codes on these datasets. For EDD, all diagnosis fields have been used. Thus, the inclusion of the word 'Related' in the name of the indicator. For HIDD, only the main diagnosis was used. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes used are listed on Appendix 4.
Other Data ResourcesThe data presented here come from various sources. Other valuable publications have been written utilizing these data sources. The New Mexico Substance Abuse Epidemiology Profile should be seen as complementary to these other publications, and program planners will want to refer to these other documents for additional information. These publications include:
- Other reports produced by the Substance Abuse Epidemiology Program (SAEP), Injury and Behavioral Epidemiology Bureau (IBEB), Epidemiology and Response Division (ERD), New Mexico Department of Health (NMDOH). Available online at: http://nmhealth.org/about/erd/ibeb/sap/.
- New Mexico Behavioral Risk Factor Surveillance System (BRFSS) reports, produced by the Survey Section, IBEB-ERD-NMDOH Available online at: http://archive.nmhealth.org/erd/healthdata/health_behaviors.shtml
- New Mexico Youth Risk and Resiliency Survey (YRRS) reports, produced by NMDOH, NM Public Education Department, and the UNM Prevention Research Center. Available online at: http://archive.nmhealth.org/ERD/HealthData/yrrs.shtml
- Emergency Department Data (EDD) Annual Reports, produced by the Health Systems Epidemiology program, ERD-NMDOH Available online at: http://nmhealth.org/about/erd/hsep/edd/
- Hospital Inpatient Discharge Data (HIDD) Annual Reports, produced by the Health Systems Epidemiology program, ERD-NMDOH Available online at: http://nmhealth.org/about/erd/hsep/hidd/
Technical Note: Methodological Changes since Previous ReportsWhen comparing this online report to previous published hard copy New Mexico State Epidemiology Profiles, please note that there have been several important methodological changes implemented since the first New Mexico State Epidemiology Profile was published in 2005. These methodological changes and their impact on this report are described in more detail below:
- Changes to the Definition of Alcohol-Related Death
In 2013, the Centers for Disease Control and Prevention (CDC) updated the Alcohol-Related Disease
Impact (ARDI) Alcohol-Attributable Fractions (AAFs), which are central to the estimation of alcohol-related
deaths and alcohol-related death rates in this report (available online at:
https://www.cdc.gov/alcohol/announcement.html ). The
updated AAFs were implemented in the 2015 and subsequent reports. The key difference between the
updated CDC's ARDI AAFs used in the 2015 and subsequent reports and the AAFs used in previous
reports is that the age-specific AAFs for alcohol-attributable motor-vehicle traffic crashes have been
The AAFs are the proportion of a given cause of death that can be attributed to excessive alcohol use. The CDC ARDI AAFs are the standard AAFs recommended for use by the CDC. These AAFs were first reported in Midanik, L., Chaloupka, F., Saitz, R., Toomey, T., Fellows, J., Dufour, M., Landen, M., Brounstein, P., Stahre, M., Brewer, R., Naimi, T., and Miller, J. (2004). Alcohol-attributable deaths and years of potential life lost - United States, 2001. Morbidity and Mortality Weekly Report, 53:866-870). The ARDI AAFs are further described on the CDC website ( http://nccd.cdc.gov/DPH_ARDI/default/Default.aspx).
- Changes to Race/Ethnicity Categories
The original 2005 report in this series used the National Center for Health Statistics (NCHS) standard
race/ethnicity categories for reporting by race/ethnicity. These NCHS standard race/ethnicity categories
break out Hispanic for each race category (e.g., White, Black, etc.); and combine the Hispanic portion of
each race category (e.g., White Hispanic, Black Hispanic, etc.) when reporting the Hispanic category.
The 2010 report implemented new race/ethnicity reporting standards used by NMDOH for all indicators except those based on the YRRS. These NMDOH standard race/ethnicity categories report only the White Hispanic category as Hispanic; and report the Hispanic subset of other race groups (e.g., Black Hispanic) in the corresponding race category (e.g., Black). The 2011 report implemented the NMDOH race/ethnicity reporting categories for all YRRS-based indicators as well.
In 2012, NMDOH adopted a new standard for reporting race/ethinicity. The New Mexico reporting standard uses the estimates by bridged race and Hispanic ethnicity. Presentation of race and ethnicity will be done together in the same table. Race/ethnicity will be viewed as a single social and cultural construct. Persons designated as Hispanic ethnicity, regardless of race, will be categorized as 'Hispanic.' Persons not designated as Hispanic will be categorized by their single race ('Black or African American,' 'American Indian or Alaska native,' 'Asian or Pacific Islander,' 'White,' or 'Other'). For more information, refer to the NMDOH Guidelines for Race/Ethnicity Data at: https://ibis.health.state.nm.us/view/docs/Standards/Race_Guidelines.pdf.
These changes in the race/ethnicity categories make the 2013 and subsequent reports' counts and rates by race/ethnicity comparable to each other but not comparable to the 2005 report.
- Changes to the NSDUH Questionnaire and data collection: In 2015, a number of changes were made to the NSDUH questionnaire and data collection procedures resulting in the establishment of a new baseline for a number of measures. Therefore, estimates for several measures included in prior reports are not available. For details, see Section A of the "2014-2015 NSDUH: Guide to State Tables and Summary of Small Area Estimation Methodology" at: http://www.samhsa.gov/data/.