Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey

February 23, 2017
Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Questions for Tainya C. Clarke, Ph.D., M.P.H., Health Statistician and Lead Author on the “Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey.”

Q: What health measures does this report look at?

TC: The measures covered in this report are lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure–time physical activity, current cigarette smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma. Three of these measures (lack of health insurance coverage, leisure-time physical activity, and current cigarette smoking) are directly related to Healthy People 2020 Leading Health Indicators.


Q: How do you collect your data for these surveys?

TC: The data is collected by household interview surveys that are fielded continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in respondents’ homes. Health and socio-demographic information is collected on each member of all families residing within a sampled household. Within each family, additional information is collected from one randomly selected adult (the “sample adult”) aged 18 years or older and one randomly selected child (the “sample child”) aged 17 years or younger. NHIS data is collected at one point in time so we cannot determine causation. Data presented in this report are quarterly data and are preliminary.


Q: What are some of the findings that you would highlight in this early release report?

TC: Here are some findings from the early release report:

• The percentage of persons of all ages who had a usual place to go for medical care decreased, from 87.9% in 2003 to 85.4% in 2010, and then increased to 88.3% in January–September 2016.

• The percentage of persons who failed to obtain needed medical care due to cost increased, from 4.3% in 1999 to 6.9% in 2009 and 2010, and then decreased to 4.4% in January–September 2016.

• The percentage of adults aged 65 and over who had ever received a pneumococcal vaccination increased from 63.5% in 2015 to 67.3% in January–September 2016.

• The prevalence of obesity among U.S. adults aged 20 and over increased, from 19.4% in 1997 to 30.6% in January–September 2016.

• In the third quarter of 2016, 52.8% of U.S. adults aged 18 and over met the 2008 federal physical activity guidelines for aerobic activity (based on leisure-time activity). This was higher than the third quarter of 2015 estimate of 49.5%.

• The prevalence of current cigarette smoking among U.S. adults declined, from 24.7% in 1997 to 15.3% in 2015 and remained low through the third quarter of 2016 (15.9%).
• During January–September 2016, men were more likely to have had at least 1 heavy alcohol drinking day (31.6%) in the past year compared with women (18.6%).

• The prevalence of diagnosed diabetes among adults aged 18 and over increased, from 5.1% in 1997 to 9.2% in 2010, and has since remained stable through January–September 2016.


Q: What do the findings in this report tell us about the health of the country overall?

TC: Since 2010, the percentage of uninsured persons has decreased by almost 50% (16.0% vs 8.8%) and the percentage of persons who failed to obtain needed medical care due to cost has also shown a significant decline during the same time period (6.9% to 4.4%). These two indicators demonstrate increased access to healthcare from 2010 to September 2016.


Q: Are there any trends in this report that Americans should be concerned about?

TC: Although in the 3rd quarter of 2016, 52.8% of U.S. adults met the 2008 federal physical activity guidelines for aerobic activity; obesity is an epidemic that has seen a steady increase since 1997 and now affects just under one third (30.6%) of U.S. adults.


Trends and Variations in Reproduction and Instrinsic Rates: United States, 1990-2014

February 22, 2017

Questions for Brady E. Hamilton, Ph.D., Demographer, Statistician, and Lead Author on “Trends and Variations in Reproduction and Intrinsic Rates: United States, 1990-2014

Q: Why did you conduct this study?

BH: We produced this report because we wanted to provide an updated analysis of fertility patterns in the United States. This report provides current detailed information on the fertility patterns for the United States, as measured by reproduction and intrinsic rates, which have not been available since the release of an earlier report more than a decade ago (https://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_17.pdf). The new report focuses on the recent trends in these rates and also presents, for the first time, reproduction and intrinsic rates for the three largest population groups — non-Hispanic white, non-Hispanic black, and Hispanic.


Q: What is the difference between reproduction rates and intrinsic rates, and what can they tell us about population growth and change in the United States?

BH: The reproduction and intrinsic rates are important to understanding population growth and change in the United States and are useful additions to the annual birth and fertility rates (such as the crude birth rate and general fertility rate) published by NCHS. Unlike the annual birth and fertility rates which measure the fertility of women in a given year, the reproduction rates summarize the number of births expected for a (hypothetical) group of 1,000 women over their lifetime given their particular fertility and mortality rates. The reproduction rates can measure, for example, whether the number of births is at “replacement,” that is, the level at which a given group of women can exactly replace themselves. For example, the net reproduction rate in 2014 was 897 which means that given their fertility and mortality rates in 2014, we would expect to see 897 daughters born per 1,000 of these women, which is below replacement level (1,000 daughters). The reproduction rates can be used to compare populations over time or among different groups. The intrinsic rates summarize the birth, death, and rate of change of a population, which would be expected to prevail given particular fertility and mortality rates. These rates measure the change of a population, either growth or decline, and can be used to compare populations over time or among different groups. For example, the intrinsic rate of natural increase in 2014 was -3.7, which means that given the fertility and mortality rates in 2014, the population for the United States was declining. This measure excludes migration.


Q: Was there a result in your study’s analysis of reproduction and intrinsic rates in the United States that you hadn’t expected and that really surprised you?

BH: The pervasive and large declines in the rates among the race and Hispanic origin groups was quite striking. For the three largest groups — non-Hispanic white, non-Hispanic black, and Hispanic– the total fertility, gross reproduction, and net reproduction rates declined by at least 7% from 2006 through 2014. The Intrinsic rate of natural increase declined by at least 78% from 2006 through 2014 for the three groups.


Q: What differences, if any, did you see among race and ethnic groups?

BH: While the total fertility, gross reproduction, and net reproduction rates and intrinsic rate of natural increase declined for the three race and Hispanic origin groups, there were differences among the groups in the rate of decline and among the rates themselves. In general, the reproduction rates declined the least for non-Hispanic white women and the most for Hispanic women from 2006 through 2014. Similarly, in 2014, the reproduction rates were lowest for non-Hispanic white women and highest for Hispanic women. The intrinsic rates of natural increase differed, too, with the rate being negative for both the non-Hispanic white and non-Hispanic black population groups in 2014, but positive for the Hispanic population group.


Q: What is the take home message of this report?

BH: The take home message from the report is that reproduction rates and intrinsic rate of natural increase have declined overall from 1990 through 2014 and for the three largest race and Hispanic origin groups from 2006 through 2014. However, differences in the reproductive and intrinsic rates for the groups exist.


QuickStats: Percentage of Total Daily Kilocalories Consumed from Sugar-Sweetened Beverages Among Children and Adults, by Sex and Income Level

February 21, 2017

During 2011–2014, on average, 7.3% of boys’ and 7.2% of girls’ total daily calories were obtained from Sugar Sweetened Beverages (SSB) compared with 6.9% for men and 6.1% for women.

For men, women, and girls, the percentage of total daily kilocalories from SSBs declined as income level increased.

For boys, the percentage of total daily kilocalories was lower for those in the highest income group than in the other income groups. Compared with women, a larger proportion of men’s total daily kilocalorie intake came from SSBs.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6606a8.htm


Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013

February 17, 2017

Questions for Esther Hing, Survey Statistician and Lead Author on “Characteristics of Primary Care Physicians in Patient-Centered Medical Home Practices: United States, 2013

Q: Can you define what a patient-centered medical home (PCMH) practice is?

EH: One of several PCMH definitions is that PCMHs provide care that is: comprehensive care provided by a team of providers, patient-centered care, coordinated care, has accessible services, and care focused on quality and safety.


Q: Why did you decide to do a report on PCMH practices?

EH: Although the PCMH has been advocated by the “primary care community” for more than a decade, there are no national estimates that describe characteristics of this model of care delivery. “Primary care community” includes primary care physicians as well as other primary care providers and associated professional societies. The report, based on questions funded by the Assistant Secretary for Planning and Evaluation (ASPE), will inform policy makers of the prevalence of certified PCMH practices in the United States, as well as care attributes of these practices (compared with non-PCMH practices).

Estimates not only serve as benchmark estimates for this model of primary care, but adds to the knowledge base about this type of practice. Payers and the federal government have increasingly funded PCMH demonstrations, and certain payers and states have also increased funding to practitioners in PCMH practices.


Q: Is the first time NCHS has published a report on this topic?

EH: Yes, this is the first year that the PCMH questions have been reported.


Q: What did your report find on primary care physicians in PCMH practices?

EH: The report found that primary care physicians in PCMH practices tended to be in larger practices, and located in urban areas. These findings may be attributed to infrastructure requirements needed for PCMH care delivery. It may also reflect that in 2013, the Centers for Medicare and Medicaid Service (CMS) demonstrations and payment policy supporting chronic care was not yet implemented or was in early stages of development.


Q: Were there any findings that surprised you?

EH: The finding that a substantial percentage of non-PCMH practices have non- physician clinicians and Electronic Health Records suggests that there is untapped potential for a greater number of primary care practices to become PCMHs.

However, the relatively lower participation by solo and small practices as PCMHs suggests the need for assistance or coaching to make this transformation. The ongoing implementation of payment incentives from CMS and elsewhere has encouraged growth of PCMHs. This is a trend that the National Ambulatory Medical Care Survey (NAMCS) can be used to examine for the next few years and beyond.


U.S. Heart Attack Deaths from 2010-2015

February 15, 2017
Year
Deaths
2010
122,071
2011
119,905
2012
117,944
2013
116,793
2014
114,019
2015
114,023
TOTAL
704,755

 Source: http://wonder.cdc.gov

ICD-10: Acute myocardial infarction (I21-I22)

 


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2016

February 14, 2017
Michael Martinez, M.P.H., M.H.S.A., Epidemiologist and Health Statistician

Michael Martinez, M.P.H., M.H.S.A., Epidemiologist and Health Statistician

Questions for Michael Martinez, M.P.H., M.H.S.A., Epidemiologist, Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2016

Q: What do you think is the most significant finding in your new study?

MM: I think the most significant finding in this study is the snapshot view of varied health insurance types. While from January through September 2016, among adults aged 18 to 64, 12.3% were uninsured at the time of interview, 20.3% had public coverage, and 69.0% had private health insurance coverage. Among the 136.0 million adults in this age group with private coverage, 9.3 million–or 4.7%–were covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges during the first 9 months of 2016.


Q: How did health insurance coverage in the United States compare in the first 9 months of 2016 to 2015 and 2010?

MM: We’ve observed a number of changes in health insurance coverage between 2010 and 2015 compared to the first 9 months of 2016. Between 2010 and the first 9 months of 2016, 20.4 million persons of all ages gained coverage. In the first 9 months of 2016, 28.2 million (8.8%) persons of all ages were uninsured at the time of interview, compared with 48.6 million (16.0%) persons in 2010 and 28.6 million (9.1%) persons in 2015. The difference in uninsured estimates between 2015 and the first 9 months of 2016 was not significant.


Q: Where do high-deductible plans through private health insurance fit into 2016 estimates compared to earlier years?

MM: Among private health insurance plans, enrollment in high-deductible health plans has been increasing in recent years. 39.1% of persons under age 65 with private health insurance were enrolled in high-deductible health plans in the first 9 months of 2016. This percentage has increased significantly, from 25.3% in 2010 and from 36.7% in 2015.


Q: What are the trends among race and ethnicity groups in health insurance coverage this year and compared over time?

MM: There’s been quite a bit of change in health insurance coverage among race and ethnicity groups over the years. For example, in the first 9 months of 2016, 24.7% of Hispanic, 15.1% of non-Hispanic black, 8.5% of non-Hispanic white, and 7.8% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview. Significant decreases in the percentage of uninsured adults were observed between 2013 and the first 9 months of 2016 for Hispanic, non-Hispanic black, non-Hispanic white, and non-Hispanic Asian adults. Hispanic adults had the greatest percentage point decrease in the uninsured rate between 2013 (40.6%) and the first 9 months of 2016 (24.7%).


Q: How is health insurance coverage looking this year for our youngest population – children under 18 years of age?

MM: From January through September 2016, among children under 18 years of age, 5.0% were uninsured at the time of interview, 43.4% had public coverage, and 53.5% had private health insurance coverage. Among the 39.3 million children under 18 years of age with private coverage, 1.7 million or 2.3% were covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges during the first 9 months of 2016.


QuickStats: Prevalence of Edentualism in Adults Aged 65 Years or Older, by Age Group and Race/Hispanic Origin

January 31, 2017

During 2011–2014, 17.6% of adults aged 65 years or older were edentulous or had lost all their natural, permanent teeth.

Adults aged 75 years or older (23%) were more likely to be edentulous compared with adults aged 65–74 years (13.9%).

Non-Hispanic black adults aged 65 years or older were more likely to be edentulous (27%) compared with non-Hispanic white (16.2%), non-Hispanic Asian (18.0%), and Hispanic adults (16.4%) aged 65 years or older.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6603a12.htm