1 /FLORIDA 2018 Q3

NON-FATAL OPIOID OVERDOSE SURVEILLANCE

2018 Q3 REPORT

Florida Department of Health –Enhanced State Opioid Overdose Surveillance

FLESOOS.com

2 /FLORIDA 2018 Q3

The purpose of this report is to describe and identify non-fatal (morbidity) geographically-specific and other statistically significant changes in the rate of all drug and opioid-involved overdoses, which occurred in Florida during 2018 Q3 (July—September). Non-fatal overdose data were analyzed by the Florida Department of Health’s Enhanced State Opioid Overdose Surveillance Program, using Florida’s Emergency Medical Services Tracking and Reporting System (EMSTARS) data.

Key Findings in Florida 2018 Q3: • All drug overdose EMS transports peaked on September 8, 2018 at 142 non-fatal overdoses

and non-fatal opioid-involved overdose peaked on September 15, 2018 with 47 EMS transports.

• 2.17% of all 2018 Q3 EMS runs, or 9,454 events, are related to non-fatal all drug overdoses; where 0.72%, or 3,155 events, are related to non-fatal opioid-involved overdose.

• Non-fatal all drug overdose rate decreased 2.69% from 2017 Q3 to 50.6 per 100,000 persons. • Non-fatal opioid-involved overdose rate declined 21.40% from 2017 Q3 to 16.9 per 100,000

persons. • Significant trends between 2016 Q3, 2017 Q3, and 2018 Q3 were not observed for either all

drug or opioid-involved overdoses. • Persons aged 25-34 years were more likely than any other age group to experience either all

drug or opioid-involved non-fatal overdoses. • In descending order, the most substantial number of non-fatal all drug overdose occurred in

Palm Beach, Hillsborough, Miami-Dade, Orange, and Pinellas counties. The highest rates, in descending order, occurred in Alachua, Escambia, Walton, Brevard, and Marion counties.

• In descending order, the most substantial numbers of non-fatal opioid-involved overdoses occurred in Palm Beach, Pinellas, Brevard, Orange, and Hillsborough counties. The highest rates, in descending order, occurred in Brevard, Pinellas, Escambia, Palm Beach, and Manatee counties.

3 /FLORIDA 2018 Q3

Non-fatal Overdose (Morbidity), Florida 2018 Q3 DATA SOURCE Non-fatal overdose counts were derived from Florida’s EMSTARS database, which receives information from EMS agencies that represent 93.60% of the total number of prehospital EMS runs in Florida. CASE DEFINITIONS

All drug overdose

EMSTARS V (1.4) EMSTARS V (3) The primary or secondary impression is “Poisoning/Drug Ingestion”; or, any case where the medication administered is naloxone, and the patient exhibits a positive response, no matter the primary or secondary impression listed.

The primary or secondary impression is any of the following ICD-10 CM “T36 - T50, F11 - F16, F18 - F19” codes.

Opioid-involved overdose

EMSTARS V (1.4) EMSTARS V (3) The medication administered is naloxone and patient exhibits positive response, no matter the primary or secondary impression listed.

The primary or secondary impression of any of the following ICD-10 CM “T40.1 - T40.4, T40.60, T40.69, F11” codes.

OTHER DEFINITIONS OR LIMITATIONS Numeric descrepancy between FL-ESOOS and the Center for Disease Control and Prevention (CDC) may exist due to timing of data pull. CDC data pulled on 01/16/2019. For this report FL-ESOOS data pulled on 02/05/2019. EMS transports indicate the incident-patient record meets the following criteria: 1) are responding to an emergency medical situation (e.g., response to 9-1-1 call) and transported to a hospital; or 2) are responding to an emergency medical situation where the patient was treated and refused transport to the hospital; 3) exclude EMS transfers when a patient is transferred between hospitals or medical care facilities; 4) exclude children 10 years of age or younger. Rates per 100,000 persons were estimated using data from the 2016 U.S. Census Bureau, 2012-2016 American Community Survey 5-Year Estimates. In 2016, the estimated population of Florida ≥ 11 years of age was 18,109,300. Further, the U.S. Census Bureau estimated an annual increase of 1.5% for the Floridian population until 2020. For 2018, we estimated the population of Florida ≥ 11 years of age to be 18,675,035. ICD-10 CM CODE DESCRIPTION Poisoning by: T36-T50 (range includes all drugs), T40.1 (heroin), T40.2 (other opioids), T40.3 (methadone), T40.4 (other synthetic narcotics), T40.60 (unspecified narcotics), T40.69 (other narcotics), F11 (opioid related), F12 (cannabis related), F13 (sedative, hypnotic, or anxiolytic related), F14 (cocaine related), F15 (other stimulant related), F16 (hallucinogen related), F18 (inhalant related), and F19 (other psychoactive substance related).

4 /FLORIDA 2018 Q3

• 9,454 total non-fatal all drug overdose occurrences were counted for 2018 Q3, 110 less than 2017 Q3. Likewise, 3,155 non-fatal opioid-involved overdoses were observed, 793 less than 2017 Q3.

• 2.17% of all 2018 Q3 EMS runs are related to all non-fatal drug overdoses, a significant difference from 2.38% of all 2017 Q3 EMS runs.

• 0.72% of all 2018 Q3 EMS runs are related to non-fatal opioid-involved overdoses, a significant difference from 0.98% of all 2017 Q2 EMS runs.

2017 Q32018 Q32017 Q32018 Q3

Non-fatal Overdose by Year and Drug Type, Florida 2018 Q3

Note: Opioid may include prescription or illicit opioids. Categories are not mutually exclusive.

No.

of E

MS

Tran

spor

ts

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

11000

All Drugs Opioid

9,5649,454

2017 Q32018 Q3

3,9483,155

2017 Q32018 Q3

5 /FLORIDA 2018 Q3

• All drug overdose EMS transports peaked on September 8, 2018 at 142 non-fatal overdoses and non-fatal opioid-involved overdose peaked on September 15, 2018 with 47 EMS transports.

01Jul 09Jul 17Jul 25Jul 02Aug 10Aug 18Aug 26Aug 03Sep 11Sep 19Sep 27Sep2018

25

50

75

100

125EM

S Tr

ansp

ort C

ount

Opioid-InvolvedAll-Drug

Florida Non-fatal Overdose Count Through Time, 2018 Q3

Note: Opioid may include prescription or illicit opioids. Categories are not mutally exclusive.

6 /FLORIDA 2018 Q3

• The estimated 2018 Q3 non-fatal all drug overdose rate is 50.6 per 100,000 persons. An 2.69% rate decrease from 2017 Q3.

• Non-fatal opioid-involved 2018 Q3 overdose rate is estimated at 16.9 per 100,000 persons. A 21.40% decline in rate from 2017 Q3.

2017 Q32018 Q32017 Q32018 Q3

Non-fatal Overdose Rate by Drug Type and Year, Florida 2018 Q3

Note: Opioid may include prescription or illicit opioids. Categories are not mutually exclusive.

EMS

Tran

spor

ts/1

00,0

00 P

op.

0

10

20

30

40

50

60

All Drugs Opioid

52.050.6

2017 Q32018 Q3

21.516.9

2017 Q32018 Q3

7 /FLORIDA 2018 Q3

• Between 2016 Q3, 2017 Q3, and 2018 Q3, significant trends were not observed for all non-fatal drug or opioid-involved overdose rate.

55.752.0

50.6

18.9

21.5

16.9

2016 Q3 2017 Q3 2018 Q3

20

30

40

50EM

S Tr

ansp

orts

/100

,000

Pop

.

OpioidAll Drugs

Florida Non-fatal Overdose Rate Trends by Drug Type and Year Quarter

Note: Opioid may include prescription or illicit opioids. Categories are not mutually exclusive.

8 /FLORIDA 2018 Q3

• Persons aged 25-34 years were at the highest risk than any other age group for all non-fatal drug overdose and opioid-involved overdose.

All DrugsOpioidAll DrugsOpioidAll DrugsOpioidAll DrugsOpioidAll DrugsOpioidAll DrugsOpioidAll DrugsOpioidAll DrugsOpioidAll DrugsOpioid

Non-fatal Overdose Rate by Age and Drug Type, Florida 2018 Q3

Note: Opioid may include prescription or illicit opioids. Categories are not mutually exclusive.

EMS

Tran

spor

ts/1

00,0

00 P

op.

0

10

20

30

40

50

60

70

80

90

100

11-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

9.80.2

All DrugsOpioid

56.312.6

All DrugsOpioid

97.537.2

All DrugsOpioid

79.529.1

All DrugsOpioid

45.113.1

All DrugsOpioid

39.112.8

All DrugsOpioid

20.08.3

All DrugsOpioid

17.46.7

All DrugsOpioid

22.08.4

All DrugsOpioid

9 /FLORIDA 2018 Q3

5.87 7.389.80

68.4 61.356.3

11099.1 97.5

74.0 74.079.5

57.353.1

45.143.338.6 39.1

20.2 20.720.0

17.4 19.0 17.4

23.920.7 22.0

2016 Q3 2017 Q3 2018 Q3

0

20

40

60

80

100EM

S Tr

ansp

orts

/100

,000

Pop

.

85+75-8465-7455-6445-5435-4425-3415-2411-14

Florida Non-fatal All Drug Overdose Rate Trends by Age Group and Year Quarter

Note: Opioid may include prescription or illicit opioids.

10 /FLORIDA 2018 Q3

• Between 2016 Q3, 2017 Q3, and 2018 Q3, significant trends were not observed for any non-fatal drug or opioid-involved overdose for all age groups.

0.5 0.5 0.2

19.817.7

12.6

39.5

47.1

37.2

23.3

32.829.1

16.5

20.2

13.115.914.8

12.89.09.6 8.38.5

9.9

6.7

17.312.4

8.4

2016 Q3 2017 Q3 2018 Q3

0

10

20

30

40

50EM

S Tr

ansp

orts

/100

,000

Pop

.

85+75-8465-7455-6445-5435-4425-3415-2411-14

Florida Non-fatal Opioid-Involved Overdose Rate Trends by Age Group and YearQuarter

Note: Opioid may include prescription or illicit opioids.

11 /FLORIDA 2018 Q3

• Males aged 25-34 years experienced non-fatal all-cause drug overdose more frequently and at a higher rate than females of the same age category, in 2018 Q3.

• Overall in 2018 Q3, males, particularly younger men, were transported for all cause non-fatal drug overdose at a higher rate than females.

MaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale

Non-fatal All Drug Overdose by Sex and Age, Florida 2018 Q3

Note: All Ages: 11-years and older

EMS

Tran

spor

ts/1

00,0

00 P

op.

0

10

20

30

40

50

60

70

80

90

100

110

120

130

11-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ All Ages

4.715.1

MaleFemale

59.653.0

MaleFemale

121.373.0

MaleFemale

97.761.6

MaleFemale

51.638.8

MaleFemale

47.131.9

MaleFemale

23.117.3

MaleFemale

16.318.1

MaleFemale

20.722.8

MaleFemale

60.341.4

MaleFemale

12 /FLORIDA 2018 Q3

• Between 2016 Q3, 2017 Q3, and 2018 Q3, all non-fatal drug overdose significant trends were not observed for either males or females among all age groups.

Non-fatal All Drug Overdose Rate Trends by Age and Sex, Florida 2018 Q3

85+75-8465-7455-6445-5435-4425-3415-2411-14

3.4

5.44.7

72.466.5

59.6

143

125 121

90.996.4 97.7

71.4 64.6

51.652.947.6

47.1

21.9 23.9 23.114.6

17.8 16.3

19.117.8 20.7

Male

8.4 9.415.1

64.1 55.6

53.0

75.6 72.5 73.0

57.3

52.1

61.6

43.7 41.9 38.834.7

30.4 31.9

18.6 17.817.319.7

19.9 18.1

26.722.2 22.8

Female

2016 Q3 2017 Q3 2018 Q32016 Q3 2017 Q3 2018 Q3

0

25

50

75

100

125

150EM

S Tr

ansp

orts

/100

,000

Pop

.

13 /FLORIDA 2018 Q3

• Males aged 25-34 years experienced non-fatal opioid-involved overdose more frequently and at a higher rate than females of the same age category, in 2018 Q3.

• Overall in 2018 Q3, males, particularly younger men, were transported for non-fatal opioid-involved overdose at a higher rate than females.

MaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale

Non-fatal Opioid-Involved Overdose by Sex and Age, Florida 2018 Q3

Note: All Ages: 11-years and olderNote: Opioid may include prescription or illicit opioids.

EMS

Tran

spor

ts/1

00,0

00 P

op.

0

10

20

30

40

50

11-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ All Ages

0.00.4

MaleFemale

14.111.1

MaleFemale

45.428.7

MaleFemale

37.620.8

MaleFemale

15.710.5

MaleFemale

14.811.1

MaleFemale

9.86.9

MaleFemale

7.06.4

MaleFemale

5.410.2

MaleFemale

20.613.4

MaleFemale

14 /FLORIDA 2018 Q3

• Between 2016 Q3, 2017 Q3, and 2018 Q3, non-fatal opioid-involved overdose significant trends were not observed for either males or females among all age groups.

Note: Opioid may include prescription or illicit opioids.

Non-fatal Opioid-Involved Overdose Rate Trends by Age and Sex, Florida 2018Q3

85+75-8465-7455-6445-5435-4425-3415-2411-14

0.2 0.80.0

23.720.3

14.1

54.861.1

45.4

31.0

44.4

37.6

20.0

26.0

15.717.8

18.2 14.88.9 11.5 9.87.0

8.1 7.0

15.312.4

5.4

Male

0.9 0.2 0.4

15.7 15.011.1

23.8

32.728.7

15.8

21.3 20.8

13.0

14.7

10.5

14.2

11.8 11.18.9 7.8 6.9

9.7 11.4

6.4

18.2

12.410.2

Female

2016 Q3 2017 Q3 2018 Q32016 Q3 2017 Q3 2018 Q3

0

20

40

60EM

S Tr

ansp

orts

/100

,000

Pop

.

15 /FLORIDA 2018 Q3

Florida County M

ap of Non-fatal A

ll Drug O

verdose Estimates, 2018 Q

3

*Rates not calculated or observations unavailable

Drug overdose/100,000 Pop.

*N/A

0.1-1010.1-25

25.1-3535.1-65

65.1-8080.1+

ALACHUA

BAKER

BAY

BRADFORD

BREVARD

BROW

ARD

CALHOUN

CHARLOTTE

CITRUS

CLAY

COLLIER

COLUM

BIA

DE SOTO

DIXIE

DUVAL

ESCAMBIA

FLAGLER

FRANKLIN

GADSDEN

GILCHRIST

GLADES

GULF

HAMILTO

N

HARDEE

HENDRY

HERNANDO

HIGHLANDS

HILLSBORO

UGH

HOLM

ES

INDIAN RIVER

JACKSON

JEFFERSON

LAFAYETTE

LAKE

LEE

LEON

LEVY

LIBERTY

MADISO

N

MANATEE

MARIO

N

MARTIN

MIAM

I-DADE

MO

NROE

NASSAU

OKALO

OSA

OKEECHO

BEE

ORANG

EOSCEO

LA

PALM BEACH

PASCO

PINELLAS

POLK

PUTNAM

ST JOHNS

ST LUCIE

SANTA ROSA

SARASOTA

SEMINO

LE

SUMTER

SUWANNEE

TAYLOR

UNION

VOLUSIA

WAKULLA

WALTO

NW

ASHINGTO

N

16 /FLORIDA 2018 Q3

Florida County M

ap of Non-fatal O

pioid-Involved Overdose Estim

ates, 2018 Q3

*Rates not calculated or observations unavailable

Opioid overdose/100,000 Pop.

*N/A

0.1-0.30.31-3

3.1-7.57.51-15

15.1-2525.1+

ALACHUA

BAKER

BAY

BRADFORD

BREVARD

BROW

ARD

CALHOUN

CHARLOTTE

CITRUS

CLAY

COLLIER

COLUM

BIA

DE SOTO

DIXIE

DUVAL

ESCAMBIA

FLAGLER

FRANKLIN

GADSDEN

GILCHRIST

GLADES

GULF

HAMILTO

N

HARDEE

HENDRY

HERNANDO

HIGHLANDS

HILLSBORO

UGH

HOLM

ES

INDIAN RIVER

JACKSON

JEFFERSON

LAFAYETTE

LAKE

LEE

LEON

LEVY

LIBERTY

MADISO

N

MANATEE

MARIO

N

MARTIN

MIAM

I-DADE

MO

NROE

NASSAU

OKALO

OSA

OKEECHO

BEE

ORANG

EOSCEO

LA

PALM BEACH

PASCO

PINELLAS

POLK

PUTNAM

ST JOHNS

ST LUCIE

SANTA ROSA

SARASOTA

SEMINO

LE

SUMTER

SUWANNEE

TAYLOR

UNION

VOLUSIA

WAKULLA

WALTO

NW

ASHINGTO

N

17 /FLORIDA 2018 Q3

Florida County A

ll Non-fatal D

rug Overdose C

ounts by ZIP Code, 2018 Q

3

All N

on-fatal Drug O

verdose Count

0-34-7

8-1617-25

26-5556+

18 /FLORIDA 2018 Q3

Florida County N

on-fatal Opioid-Involved O

verdose Counts by ZIP C

ode, 2018 Q3

Non-fatal O

pioid-Involved Drug O

verdose Count

1-23-5

6-1011-25

26+

19 /FLORIDA 2018 Q3

Florida Counties with the Highest Count and Rate of Non-fatal Overdoses—Florida 2018 Q3 ALL DRUG-INVOLVED NON-FATAL OVERDOSE RANK COUNTY (COUNT) RANK COUNTY (RATE PER 100,000) 1 Palm Beach (952) 1 Alachua (190.2) 2 Hillsborough (750) 2 Escambia (112.8) 3 Miami-Dade (702) 3 Walton (108.1) 4 Orange (696) 4 Brevard (105.6) 5 Pinellas (603) 5 Marion (90.3) 6 Broward (599) 6 Manatee (85.9) 7 Brevard (569) 7 Dixie (79.5) 8 Duval (513) 8 Bradford (73.0) 9 Alachua (462) 9 Palm Beach (71.4) 10 Pasco (331) 10 Pasco (70.2) OPIOID-INVOLVED NON-FATAL OVERDOSE RANK COUNTY (COUNT) RANK COUNTY (RATE PER 100,000) 1 Palm Beach (665) 1 Brevard (72.4) 2 Pinellas (597) 2 Pinellas (66.3) 3 Brevard (390) 3 Escambia (53.4) 4 Orange (212) 4 Palm Beach (49.9) 5 Hillsborough (179) 5 Manatee (33.6) 6 Escambia (153) 6 Union (28.7) 7 Broward (139) 7 Okaloosa (28.3) 8 Manatee (117) 8 Nassau (26.9) 9 Duval (111) 9 Walton (26.6) 10 Seminole (54) 10 Dixie (26.5)

20 /FLORIDA 2018 Q3

Non-fatal Drug Overdose (Morbidity), Florida 2018 Q3 RATE PER 100,000 FLORIDIANS ≥11-YEARS. OPIOID-INVOLVED MAY INCLUDE PRESCRIPTION, AND ILLICIT OPIOIDS, CATEGORIES ARE NOT MUTUALLY EXCLUSIVE ALL DRUG OPIOID-INVOLVED No. Rate No. Rate TOTAL Q3 9,454 50.6 3,155 16.9 AGE 11-14 93 9.8 2 0.2 15-24 1,431 56.3 321 12.6 25-34 2,699 97.5 1,029 37.2 35-44 2,021 79.5 740 29.1 45-54 1,282 45.1 371 13.1 55-64 1,101 39.1 360 12.8 65-74 469 20.0 194 8.3 75-84 226 17.4 87 6.7 85+ 126 22.0 48 8.4 ETHNICITY (RACE) HISPANIC 485 N/A 111 N/A WHITE 10 N/A 3 N/A BLACK 4 N/A 1 N/A ASIAN 4 N/A 3 N/A MULTIPLE RACE 1 N/A 0 N/A UNKNOWN RACE 466 N/A 104 N/A UNKNOWN-HISPANIC 8,969 N/A 3,044 N/A

WHITE 6,482 N/A 2,499 N/A BLACK 1,279 N/A 257 N/A ASIAN 72 N/A 35 N/A MULTIPLE RACE 317 N/A 86 N/A UNKNOWN RACE 819 N/A 167 N/A SEX (AGE) MALE 5,465 60.3 1,867 20.6 11-14 23 4.7 N/A N/A 15-24 775 59.6 183 14.1 25-34 1,697 121.3 636 45.4 35-44 1,230 97.7 473 37.6 45-54 720 51.6 219 15.7 55-64 626 47.1 196 14.8 65-74 252 23.1 107 9.8 75-84 96 16.3 41 7.0 85+ 46 20.7 12 5.4 FEMALE 3,976 41.4 1,284 13.4 11-14 70 15.1 N/A N/A 15-24 656 53.0 138 11.1 25-34 998 73.0 392 28.7 35-44 790 61.6 267 20.8 45-54 562 38.8 152 10.5

21 /FLORIDA 2018 Q3

55-64 474 31.9 164 11.1 65-74 217 17.3 87 6.9 75-84 129 18.1 46 6.4 85+ 80 22.8 36 10.2 COUNTY ALACHUA 462 190.2 28 11.5 BAKER N/A N/A N/A N/A BAY 74 44.5 29 17.4 BRADFORD 18 73.0 N/A N/A BREVARD 569 105.6 390 72.4 BROWARD 599 34.5 139 8.0 CALHOUN N/A N/A N/A N/A CHARLOTTE N/A N/A N/A N/A CITRUS 34 24.9 26 19.0 CLAY 44 23.3 N/A N/A COLLIER 49 14.4 N/A N/A COLUMBIA 15 23.9 N/A N/A DE SOTO 10 30.4 N/A N/A DIXIE 12 79.5 N/A N/A DUVAL 513 61.9 111 13.4 ESCAMBIA 323 112.8 153 53.4 FLAGLER 44 43.2 14 13.8 FRANKLIN N/A N/A N/A N/A GADSDEN 10 24.0 N/A N/A GILCHRIST N/A N/A N/A N/A GLADES N/A N/A N/A N/A GULF N/A N/A N/A N/A HAMILTON N/A N/A N/A N/A HARDEE N/A N/A N/A N/A HENDRY 12 35.0 N/A N/A HERNANDO 44 25.8 18 10.6 HIGHLANDS 47 50.0 13 13.8 HILLSBOROUGH 750 60.6 179 14.5 HOLMES N/A N/A N/A N/A INDIAN RIVER 93 65.2 18 12.6 JACKSON N/A N/A N/A N/A JEFFERSON N/A N/A N/A N/A LAFAYETTE N/A N/A N/A N/A LAKE N/A N/A N/A N/A LEE 222 33.0 N/A N/A LEON 65 24.4 17 6.4 LEVY N/A N/A N/A N/A LIBERTY N/A N/A N/A N/A MADISON N/A N/A N/A N/A MANATEE 299 85.9 117 33.6 MARION 292 90.3 15 4.6 MARTIN 89 59.5 23 15.4 MIAMI-DADE 702 28.3 45 1.8 MONROE 19 25.5 N/A N/A NASSAU 36 48.4 20 26.9 OKALOOSA 119 65.9 51 28.3

22 /FLORIDA 2018 Q3

OKEECHOBEE 19 52.1 N/A N/A ORANGE 696 58.7 212 17.9 OSCEOLA 142 47.2 42 14.0 PALM BEACH 952 71.4 665 49.9 PASCO 331 70.2 N/A N/A PINELLAS 603 66.9 597 66.3 POLK 156 25.8 24 4.0 PUTNAM 14 21.3 N/A N/A ST JOHNS 117 54.3 N/A N/A ST LUCIE 173 61.3 15 5.3 SANTA ROSA N/A N/A N/A N/A SARASOTA 28 7.1 N/A N/A SEMINOLE 100 23.9 54 12.9 SUMTER 69 56.2 N/A N/A SUWANNEE 18 45.0 N/A N/A TAYLOR 10 49.3 N/A N/A UNION N/A N/A N/A N/A VOLUSIA 280 56.8 N/A N/A WAKULLA N/A N/A N/A N/A WALTON 65 108.1 16 26.6 WASHINGTON N/A N/A N/A N/A

N/A: Rates not calculated or not enough observations available