PODCAST: Latest Edition of Health, United States

March 5, 2021




HOST:  This week marked the release of “Health, United States,” a compilation of data on a wide range of topics, from birth to death – and everything in-between – including: health care, disease prevalence, and other risk factors facing the population.  “Health, United States” is unique because it features not only data from NCHS, but also from sources outside of NCHS, including other federal health agencies. In compliance with the Public Health Service Act, the report is ultimately submitted from the Secretary of Health and Human Services, to Congress and the President.  This latest report is the 43rd edition, and to put that into further perspective, the very first edition of “Health, United States” was published in 1976, when Gerald Ford was president.  That report looked much different from the current edition.  For example, the first report did not contain any data on HIV/AIDS – because the disease was still unknown at the time.  Through the years, the content in the report has evolved to meet emerging public health needs.

Joining us today is Dr. Renee Gindi, who leads the NCHS team that produces the report.

HOST: Turning to this latest edition that came out this week, what are some of the significant highlights in this report?

RENEE GINDI: For the most part, I’ve been talking about three different narratives or stories that line up throughout the chart book.  The first is on leading causes of death and trends in those leading causes of death.  The second is thinking about continuing disparities by race and Hispanic origin.  And the third one is changes in health insurance and access.  The two leading causes of death are heart disease and cancer, and together they accounted for 44% of deaths.  When we look at the trends in mortality due to cancer and heart disease, we find that for the most part between 2008 and 2018 the death rates for cancer had a pretty stable drop.  But that wasn’t the case for heart disease.  We found that when we looked between 2008 and 2018 that while there was a decline certainly over that entire period, actually the rate of that decline was lower between 2011 and 2018.  It just means that while the rate of deaths due to heart disease was falling, it didn’t fall quite as quickly in the second part of that decade.  One of the things that we’re able to do with Health U.S. is t pull together multiple data sources to help understand the topic, so the next thing we did is we also follow this up with a look at trends in heart disease among adults age 18 and older as well as trends in reported history of cancer.  And we saw results that seem to correspond pretty well with those changes in the mortality rate.  For heart disease, we saw a decrease in prevalence between 2008 and 2018 among men and women age 65 and older, and then also among women aged 45 to 64. Results for the reported history of cancer were a little bit more mixed, where when we looked at the reported history of cancer over that time period we did see decreases in the percentage of women age 18 to 44 who reported history of cancer but increases among women aged 65 and over. So when we are able to look not only at mortality and also prevalence of heart disease and cancer, we can also look at prevention.  And so the Health U.S. team also focused on cancer screening trends, this year looking 1st at the use of colorectal cancer testing among adults age 50 to 75.  One of the things we saw we looked at this particular set of trends broken down by race and Hispanic origin and while we certainly saw increases in the percentage of adults who had reported having colorectal cancer testing between 2008 and 2018 in all of the racial in Hispanic origin groups that we studied, we still saw differences by racial and Hispanic origin group by 2018.  We had a little bit of a similar story with the use of mammogram in the past two years.  So while we didn’t see any increases or decreases in the percentage of women who reported having a mammogram in the past two years, by 2018 we still saw some differences by race and Hispanic origin.  So picking up on those differences in race and Hispanic origin, we were able to explore those kinds of differences and disparities across the chart book and across the figures.

HOST:  I want to sort of zero in on the topic of vital statistics, because during the pandemic what we’ve now seen is data coming out very rapidly to meet the needs of the pandemic.  How do you see Health U.S. in the future utilizing vital statistics now that there’s been this surge in speed of data release?

RENEE GINDI:  I think that’s a really great question and I think that can be a really broad question, thinking about the statistical community in general.  There’s a real tension between the desire to get out the most accurate, triple-checked final data, but also the need to get actionable evidence out to the public and the public health community as quickly as possible.  And I think Health U.S. is a good example of that issue.  Partially because we have a compendium of so many different data sources, we have a real tension in our annual report of having all of the data line up so that we’ve got all the same data leading to the same most current point versus getting the report out before we need to update it with new data. I think that you’ve really identified, both with vital statistics and with the National Health Interview Survey Early Release program, some real challenges for us as we figure out how to – and whether to – incorporate these earlier sources of data into what has traditionally been a report that focuses on the final sources.

HOST:  So now that we’ve transitioned to a more web-based electronic environment in terms of publishing, how is Health U.S. adapted to those changes?

RENEE GINDI:  We have been a product since 1975, and we’ve been keeping up with the times since then.  We started sending our trend tables out on floppy disk in 1990, and we had our first publication on the World Wide Web in Y2K.  So we have a really long tradition of trying to make sure that we provide high quality data in a timely way to the broadest possible audience.  In service of that, in the past few years we’ve actually introduced something called the “Data Finder” page which has become the most popular way to access the Health U.S. tables and figures.  Using the Data Finder, people can search for different kinds of health topics or choose from different population or geographic subgroups that they’re interested in.  They can download individual printable PDF tables for reference.  Or they can download an Excel table to be able to get more data years, more statistical information, or to work with the data themselves.  Our future really, I think, brings that same commitment to timeliness, quality, and utility.  We’re trying to phase in improved access.  So we want more people to be able to access our data more quickly.  We want to bring in topical web pages to allow people to search for topics that they are interested in.  And we want to have more timely trend table updates, to be able to update those data tables, those trend tables, in a way that’s a little bit closer to when those data become available.  We really want to focus our analysis on those cornerstone detailed trend tables, and one of the things that will help us do is to report on more trends in a broader variety of topics, rather than the smaller selection that we’ve needed to focus on when we are working on the chart books.  And we want to really also look towards a more streamlined annual summary, and that will allow us to report on this year’s-worth of updates across the topical pages in a slightly smaller format to make it more accessible to our policymaker audience.

(Music bridge)

HOST:  Our thanks to Dr. Renee Gindi for joining us on this edition of “Statcast.”

HOST:  The National Household Pulse Survey, which tracks mental health and health care access issues during the pandemic, released its latest data last week, covering the period February 3 thru the 15th.   Nearly 2 out of 5 adults reported anxiety or depression-like symptoms in the previous week.  This 39% figure was the lowest number reported since October.  Nearly a quarter of adults with anxiety or depression-related symptoms over the past four weeks did not get needed mental health care during this time.  Over a third of adults delayed or did not get necessary medical care in the past four weeks due to the pandemic.

Today, NCHS also released the latest quarterly provisional data on infant mortality in the United States.  The infant mortality rate remained stable during the first quarter of 2020, at nearly 5.6 infant deaths per 1,000 live births.  The rate has remained quite stable over the past several years.

QuickStats: Percentage of Adults in Fair or Poor Health, by Age Group and Race and Ethnicity

March 5, 2021

In 2019, the percentage of adults in fair or poor health increased by age (7.8% for those aged 18–39 years, 17.2% for those 40–64 years, and 25.1% for those ≥65 years) and for each racial/ethnic group shown.

Hispanic and non-Hispanic Black adults were most likely to be in fair or poor health in each age group.

Among persons aged 18–39 and 40–64 years, non-Hispanic Asian adults were least likely to be in fair or poor health.

Among persons aged ≥65 years, non-Hispanic Asian and non-Hispanic White adults were least likely to be in fair or poor health.

Hispanic and non-Hispanic Black adults aged ≥65 years had the highest percentages of fair or poor health (40.3% and 35.5%, respectively), and non-Hispanic Asian adults aged 18–39 years had the lowest percentage of fair or poor health (4.1%).

Source: National Center for Health Statistics, National Health Interview Survey, 2019 data. https://www.cdc.gov/nchs/nhis.htm

NCHS Releases Latest Health, United States Report and Hosting Upcoming Webinar

March 2, 2021

The latest Health, United States report for the President and Congress has been released by CDC’s National Center for Health Statistics today.  The Health, United States series features national trends in health status and determinants, health care utilization, health care resources, and health care expenditures and payers from a variety of data sources, and provides relevant data to policymakers and public health professionals to inform evidence-based decisions.

NCHS will be hosting a webinar on Thursday, March 4, 2021, which will feature key findings from the report, as well as a review of tools for using the data in health disparities research and an update for viewers on program modernization efforts.

PODCAST: Suicide Trends in the U.S. and Weekly NCHS Updates

February 26, 2021



HOST:  Last week NCHS released the latest trend report on suicide rates in the nation.  Joining us today is Holly Hedegaard, the lead author of this new report.

Holly, so what do the latest final numbers tell us?

HOLLY HEDEGAARD:  Well the report that was just released from the National Center for Health Statistics looked at suicide rates over the last 20 years and what we saw was that from 1999 through 2018 there’s been a steady increase in the suicide rate – it increased about 35% over that time period. But what’s interesting is that in 2019 the rate is lower than it was in 2018 and that’s the first significant drop in suicide rates we’ve seen in the past 20 years.  While that’s an encouraging sign, I think it’s important to remember that a single year drop doesn’t necessarily say that’s a meaningful change in the overall trend is just that within a single year we saw a decrease in the suicide rates in 2019 compared to 2018

HOST:  Youth suicide in particular is a major concern.  What do the trends show among young people?

HOLLY HEDEGAARD:  So for young people suicide rates are actually lower than for other age groups – so that’s a good thing that the rates are lower – but what’s concerning is that these are the age groups where we’ve seen quite a bit of an increase in the suicide rates in recent years.  And so for example for girls who are age 10 to 14, their rates have increased about four-fold in the past 20 years, but their rates are still among the lowest of all the age and sex groups.  Rates have also increased for boys and for young men but not to the same extent as for girls.  And so again, for both boys and girls and for age 10 to 14 and ages 15 to 24, the rates are low but they are increasing – and I think that’s the reason of concern about suicide rates in young people.

HOST:  What groups have the highest suicide rates in the country?

HOLLY HEDEGAARD:  This report focuses on rates by sex and by age group, so the report looks at those particular characteristics, and the suicide rates are highest for men age 75 and older and that’s been true for a long period of time so the highest rates among men aged 75 and older.  For females the highest rates are for women ages 45 to 64 so it’s more of the middle-aged female when you look for high suicide rates among females.

HOST:  There aren’t full-year data available yet for 2020, but mental health professionals worry that the stress and isolation from the pandemic will result in a spike in suicide rates.  Do you have any insight at all about 2020 at this point?

HOLLY HEDEGAARD:  As you mentioned, we don’t have any of the final data for 2020 yet so we can’t give a definitive answer but NCHS has been generating from provisional estimates to try to get a sense of what has been happening during 2020.  And NCHS has posted some provisional estimates for the first quarter of 2020 – which it goes through March of 2020 – and as of the beginning of last year the rate, the suicide rate, was slightly higher than the rate during the comparable time period in 2019.  So a slight increase in the first quarter.  NCHS has been developing some additional modeling techniques to look at the trends in a variety of different types of deaths including drug overdose, suicide, and transportation related deaths during the early months of 2020, and based on that modeling technique the predicted weekly numbers of suicide deaths early 2020 were similar to historic levels, and then declined a little bit between March and June, and then again was pretty much no different than historic levels from July through October.  So based on these model estimates, that suggested there hasn’t really been a spike in suicide mortality, at least in the first half of 2020.  But it’s important to recognize that these are modeled estimates – these are not final numbers, they aren’t the final rates – and we’ll continue to be refining and confirming these estimates as NCHS receives more data for the deaths that occurred in 2020.  So as of now, we don’t have anything that looks like there’s been a huge increase in suicide during 2020 but that’s again based on modeled estimates.

HOST:  Your report looks at the different mechanisms used in suicides in the U.S.  What do those numbers tell us?

HOLLY HEDEGAARD:  The means of suicide varies by males compared to females, and for males about little over half of the suicides involve use of a firearm and about 28% involve hanging or suffocation… A much smaller proportion involved poisoning or other means. We’ve seen a slight increase in the rates for firearm-related suicides among men over the past 20 years but where there’s been a rather large increase has been in the rate for suicide by hanging or suffocation.  That rate among men has doubled over the last 20 years.  The picture for women is a little bit different.  From about 2001 through 2015, poisoning was the leading means of suicide among women.  But Interestingly in the last few years, since about 2016, we’ve actually seen a decline in the rate of suicide by poisoning among women and an increase in the rate of suicides that involve firearms or suffocation.  And so in the most recent years, the rates of suicide by firearm and by suffocation are slightly higher than the rate of suicide by poisoning.  The rate of suicide by suffocation among females has actually tripled in the past 20 years.

HOST:  Now by poisoning are you referring to drug overdoses?

HOLLY HEDEGAARD:  No, poisoning is actually a broader terminology that includes drug poisoning, but it also includes other types of poisons like carbon monoxide or chemicals or a variety of other things that sometimes people ingest or take. But they aren’t drugs there are used for other purposes.

HOST:  So your data then show that drug overdoses are really not a significant method used in suicides?

HOLLY HEDEGAARD:  It’s different – again, as I mentioned – for men or for women.  For men, only about 5% of suicide actually involve a drug overdose.  For women, it’s about 27% of their suicides involve a drug overdose.  So they’re not the, drug overdoses are not the leading means of suicide for either men or women.  For both men and women, rates of firearm-related suicide or suicide by hanging and suffocation are higher than the rates of suicide by drug overdose.

HOST:  This report doesn’t look at geographical differences but what areas of the country are having a tougher time with this problem?

HOLLY HEDEGAARD:  So the higher suicide rates are found in the Rocky Mountain states such as Wyoming, Montana, New Mexico, Colorado, Utah, as well as Alaska.  So these are states that have historically been high and they continue to remain high.  In the most current years or recent years, we’ve seen increase in the rates in some of the other states in the Midwest and in the New England states, up in Maine and Vermont and New Hampshire.  They aren’t the highest rates but they are increasing, so it’s important to sort of recognize that there are states in addition to the Rocky Mountain stage that also are seeing higher suicide rates.

HOST:   The National Health Interview Survey issued two new reports, on Tuesday and Wednesday of this week.  On Tuesday, NCHS teamed with the VA on a report that examined multiple chronic conditions among veterans and non-veterans.  Based on data from the 2015-2018 NHIS, the study authors found that about one-half of male veterans and over one-third of female veterans had two or more chronic conditions, compared with less than one-fourth of male nonveterans and less than one-fifth of female nonveterans.  Hypertension and arthritis were the most prevalent chronic conditions among all veterans age 25 and over.  Diabetes was also prevalent among male veterans ages 25 to 64 and asthma was also prevalent among female veterans in this age group.  Cancer was also prevalent among all veterans age 65 and older.

On Wednesday, NCHS released another study looking at health care utilization among those afflicted with inflammatory bowel disease, or IBD.  The study used NHIS data and found that adults with IBD were more likely than those without IBD to have visited any doctor or mental health provider in the past year, and were also more likely to have been prescribed medication or to have received acute care services such as ER visits, overnight hospital stays, or surgeries.

On Thursday, NCHS released a third study – on dietary supplement use among American adults age 20 and over.  The report used data from the 2017-2018 National Health and Nutrition Examination Survey, and found that over half of adults used a dietary supplement in the past month – nearly two-thirds /3 of women and just over half of men.  Eight out of ten women age 60 and over used dietary supplements, and older Americans are more likely to use more than one dietary supplement.   The most common dietary supplement used was multivitamin-mineral supplements.  Vitamin D and omega-3 fatty acid supplements were also commonly used.

Finally, today NCHS is releasing the latest quarterly provisional data on birth rates in the United States, through the third quarter of 2020, showing that fertility rates in the country continued to drop compared to the same point in 2019.  Teen birth rates and pre-term rates also declined in Quarter 3 of 2020 compared with Quarter 3 of 2019, while cesarean delivery rates increased over this period.


QuickStats: Motor-Vehicle–Traffic Death Rates Among Persons Aged 15–24 Years and ≥25 Years — United States, 2000–2019

February 26, 2021

From 2000 to 2006, rates of death caused by motor-vehicle–traffic injuries among persons aged 15–24 years and ≥25 years did not change significantly.

From 2006 to 2010, motor-vehicle–traffic death rates per 100,000 population declined among those aged 15–24 years, from 25.1 (2006) to 16.1 (2010), and among those aged ≥25 years, from 15.9 (2006) to 12.5 (2010).

Throughout most of the period, motor-vehicle–traffic death rates were higher among persons aged 15–24 years; however, motor-vehicle–traffic death rates began to converge in more recent years, and by 2019, the difference in the rate among those aged 15–24 years (13.7) and those aged ≥25 years (13.6) was not statistically significant.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 2000–2019. https://www.cdc.gov/nchs/nvss/deaths.htm


Dietary Supplement Use Among Adults: United States, 2017–2018

February 25, 2021

NCHS releases a new report that describes recent prevalence estimates for dietary supplement use among U.S. adults, the distribution of the number of dietary supplements used, and the most common types of dietary supplements used.

Trends in dietary supplement use from 2007–2008 through 2017–2018 are also reported.


  • Among U.S. adults aged 20 and over, 57.6% used any dietary supplement in the past 30 days, and use was higher among women (63.8%) than men (50.8%).
  • Dietary supplement use increased with age, overall and in both sexes, and was highest among women aged 60 and over (80.2%).
  • The use of two, three, and four or more dietary supplements increased with age, while the percentage of adults not using any dietary supplement decreased with age.
  • The most common types of dietary supplements used by all age groups were multivitamin-mineral supplements, followed by vitamin D and omega-3 fatty acid supplements.
  • From 2007–2008 through 2017–2018, the prevalence of dietary supplement use increased in all age groups among U.S. adults.

Health Care Utilization Among U.S. Adults With Inflammatory Bowel Disease, 2015–2016

February 24, 2021

NCHS releases new report that measures health care utilization among adults with inflammatory bowel disease (IBD) and compare with adults without IBD.


  • Compared with adults without IBD, adults with IBD were more likely to have visited any doctor or mental health provider in the past 12 months.
  • IBD was also associated with higher prevalence of being prescribed medication, and having received
    acute care services, such as emergency room visits, overnight hospitalizations, or surgeries.
  • Differences by IBD status were greatest for visiting a specialist and home visits in the past 12 months.

Multiple Chronic Conditions Among Veterans and Nonveterans: United States, 2015–2018

February 23, 2021

A new NCHS report describes the prevalence of multiple (two or more) chronic conditions (MCC) among veterans and nonveterans and examines whether differences by veteran status may be explained by differences in sociodemographic composition, smoking behavior, and weight status based on body mass index.

Key Findings:

  • Among adults aged 25 and over, age-adjusted prevalence of MCC was higher among veterans compared with nonveterans for both men and women (22.2% compared with 17.0% for men aged 25–64, 66.9% compared with 61.9% for men aged 65 and over, 25.4% compared with 19.6% among women aged 25–64, and 74.1% compared with 61.8% among women aged 65 and over).
  • Following stratification by age and adjustment for selected sociodemographic characteristics, the prevalence of MCC remained higher among veterans compared with nonveterans for both men and
  • After further adjustment for smoking status and weight status, differences in the prevalence of MCC by veteran status were reduced

QuickStats: Death Rates Attributed to Excessive Cold or Hypothermia† Among Persons Aged15 Years or older, by Urban-Rural Status and Age Group

February 19, 2021

In 2019, among persons aged 15 years or older, death rates attributed to excessive cold or hypothermia were higher in rural areas than in urban areas across every age group.

Crude rates were lowest among those aged 15–34 years at 0.2 and 0.5 per 100,000 population in urban and rural areas, respectively.

Rates increased with age, with the highest rates among those aged 85 years or older at 4.6 in urban areas and 8.6 in rural areas. Differences between urban and rural rates also increased with age.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data 2019. https://wonder.cdc.gov/mcd-icd10.html


PODCAST: Decline in Life Expectancy

February 19, 2021



HOST:  NCHS for the first time is releasing provisional, mid-year 2020 estimates on life expectancy in the United States.  With the arrival of COVID-19 as one of the major causes of death in 2020, NCHS has been releasing mortality and other data related to the pandemic in record time.  This new release of data documents that life expectancy at birth for the U.S. population dropped a full year in the first half of 2020 alone.  This one-year drop in life expectancy, from 78.8 years in 2019 to 77.8 years in mid-year 2020, is the largest drop in life expectancy since 1943, during World War II.

Joining us today is the lead author of this new study, Elizabeth Arias, with NCHS’s Division of Vital Statistics.

HOST:  So this is the first time NCHS has released a mid-year estimate on life expectancy.  How were you able to do this for the first time?

ELIZABETH ARIAS:  We were able to produce provisional life expectancy estimates for the first half of 2020 because of steady improvements to the timeliness and quality of death records over the past few years.  We will be updating the half year provisional life expectancy estimates with estimates based on deaths for the entire year with the goal of publishing them by May or June of 2021.  And then we will also publish life expectancy estimates for 2020 based on final mortality data as part of the U.S. annual life tables.

HOST:  Given the surge in COVID-19 deaths around the holidays, should we expect that the full-year life expectancy estimate for 2020 will be a much larger drop?

ELIZABETH ARIAS:  Well if the number of excess deaths occurring in the months of July through December are greater than the number of excess deaths that occurred in the months January through June, then the full year life expectancy estimates may be lower.  Excess deaths are typically defined as the difference between the observed number of deaths in specific time periods and expected number of deaths in the same time period.

HOST:  How does this drop in life expectancy compare with the declines in life expectancy during the 1918 flu pandemic?

ELIZABETH ARIAS:  The decline in life expectancy that we saw for 2020 is the highest decline that we have seen, not since the pandemic, but since the second world war when life expectancy declined 2.9 years between 1942 and 1943.

HOST: In general, men have shorter life expectancy than women.  Does this mid-year 2020 analysis show reflect the same disparity?

ELIZABETH ARIAS:  Yes it does.  The disparity in life expectancy between men and women in fact increased in 2020 to 5.4 years from 5.1 years in 2019.

HOST:  The new data shows bigger declines in life expectancy among minority populations.  Could you discuss that?

ELIZABETH ARIAS:  The COVID-19 pandemic has disproportionately affected minority populations, including African Americans, Hispanics, and Native Americans.  The significantly larger declines in life expectancy in the African American population, which was 2.7 years, and in the Hispanic population, which was 1.9 years, reflect the racial and ethnic disparities in the effects of the pandemic.  The decline in life expectancy for the African American population was 3.4 times greater than the decline for the non-Hispanic white population.  And the decline in life expectancy for the Hispanic population was 2.4 times greater than the decline for the non-Hispanic white population.

HOST:  Past studies have shown that the Hispanic population has longer life expectancy than other groups.  But it appears the pandemic has cut into that advantage significantly?

ELIZABETH ARIAS:  Yes it has.  For over 30 years, studies have consistently shown the Hispanic population has lower mortality than the non-Hispanic white population.  Since we began estimating life expectancy by Hispanic origin with data year 2006, this Hispanic mortality advantage relative to the non-Hispanic white population increased from 2.1 year to 3.0 years between 2006 and 2019.  As a result of the pandemic, the Hispanic life expectancy advantage declined 37% between 2019 and 2020 to an advantage of just 1. 9 years.

HOST:  Will you at some point have life expectancy estimates for Asians or other populations?

ELIZABETH ARIAS:  Yes – we are currently working to expand the U.S. life table program to include life tables for the Asian and Native American populations.  Problems with data quality has been the main reason we have not produced official U.S. life tables for these groups in the past.  However, through a combination of improvement in data quality and the development of methods to address the data quality problems, we will be able to publish life tables for these populations very soon.

HOST:  What about geographic differences in life expectancy during the pandemic?  Any insight on that?

ELIZABETH ARIAS:  Well, we did not produce life expectancy estimates by geography, including state or County estimates, so we cannot speak directly to geographic differences in life expectancy during the pandemic.  We can speculate though that the national life expectancy estimates we produced for the first half of 2020 may underestimate life expectancy due to the over-representation of mortality in urban areas, where the pandemic was more prevalent during the first half of 2020 and where groups who experienced the worst effects are concentrated, such as the Hispanic and African American populations.

HOST: We’ve also seen very substantial increases in drug overdose deaths in the first part of 2020.  Could that also be driving this decline in life expectancy?

ELIZABETH ARIAS:  The life expectancy estimates for the first half of 2020 were estimated based on the total number of deaths that occurred during that period. The difference in life expectancy between the first half of 2020 and 2019 is due to the increase in the number of excess deaths during the former period. So excess deaths during that period may include deaths from causes other than COVID-19, such as drug overdose deaths.

HOST: Thanks to Elizabeth Arias for joining us to discuss her new study on the drop in life expectancy during the 2020 pandemic.

Today, NCHS is also releasing an updated trend report on suicide in the U.S., covering two decades from 1999 to 2019.  The report shows that the suicide rate in the U.S. declined in 2019 for the first time since 2005.  Holly Hedegaard, the author of the study, will be joining us on next week’s edition of “Statcast” to discuss.