QuickStats: Percentage of Adults Aged 18 or Older with Diagnosed Diabetes by Urbanization Level and Age Group

May 7, 2021

mm7018a4-fIn 2019, the percentage of adults aged 18 years or older with diagnosed diabetes was higher among those living in nonmetropolitan areas (12.4%) than among those living in metropolitan areas (8.9%).

Percentages of adults with diagnosed diabetes were higher in nonmetropolitan than metropolitan areas for those aged 18–44 years (3.5% versus 2.3%) and 45–64 years (15.2% versus 11.6%).

Among adults aged 65 years or older, the difference by urbanization level (21.9% in nonmetropolitan areas versus 19.8% in metropolitan areas) did not reach statistical significance.

The prevalence of diagnosed diabetes increased with age in both nonmetropolitan and metropolitan areas.

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

https://www.cdc.gov/mmwr/volumes/70/wr/mm7018a4.htm


PODCAST: Effects of the Pandemic on Births in New York City

May 7, 2021

STATCAST, MAY 2021: DISCUSSION WITH ELIZABETH GREGORY, CHIEF, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

podcast-iconHOST:  Elizabeth Gregory is a health scientist with the CDC’s National Center for Health Statistics.  Elizabeth has authored a new study examining the effects of the pandemic on births in New York City, one of the hardest-hit areas by COVID-19.  The study looked at changes in the percentage of births to women who are residents of New York City but who gave birth outside the city.  The data covered the period between 2018-2019 and 2019-2020.

HOST:  So this is a different study than what we usually get from NCHS.  Can you explain why you chose this topic?

ELIZABETH GREGORY:  Sure.  Early on during the height of the pandemic in New York City in 2020 there were a lot of news stories about residents leaving the city and busy hospitals with a brief ban on support persons during labor and delivery at some hospitals.  So we decided to take a look at what are these things resulted in women going out of the city to give birth.

HOST: Now a lot of people are anxiously awaiting new data from 2021 to see if there were any major changes in fertility due to the pandemic, but your report is showing really that the pandemic did impact births in New York, at least from a health care utilization, from a delivery perspective, is that correct?

ELIZABETH GREGORY:  So we found that from 2019 to 2020 the percentage of New York City residents giving birth outside the city increased overall for all months from March through November, peaking in April and May.  And the timing of these increases in these out-of-city births correspond with the height of the early pandemic in New York City.

HOST:  is there any indication that these patterns were also true for other cities that were hard hit that in the early stages of the pandemic?

ELIZABETH GREGORY:   We didn’t look at any other cities – but this would be something that would be really interesting to look at.

HOST:  Is there any indication whether these New York City residents were just going across the state line and into New Jersey or Connecticut to have their babies or were they actually traveling further than that? Do you have any information on that?

ELIZABETH GREGORY:   So this is also another thing that be really interesting to look at but for this report we didn’t specifically look at where the out-of-city births were occurring.

HOST:  NCHS of course is also releasing their annual births report on Wednesday and there will be state data and also data for New York City available soon.  Now what happens data-wise in the situation your study focuses on – so for example if a New York City woman goes to New Jersey to give birth does that count as a New Jersey birth or is it still a New York birth?

ELIZABETH GREGORY:  So birth certificates are filed in the state where the birth occurred but are usually looked at by the mother’s state of residence for NCHS reports.  So in this report, a birth to a mother that lived in New York City occurring outside of the city will be considered a birth to a New York City resident.  And in this report it would just be classified as an out-of-city birth.

HOST:   Did we see a surge in births in these neighboring states like New Jersey or Connecticut for 2020?

ELIZABETH GREGORY:  So we didn’t specifically look at where the out-of-city births were occurring but maybe that’s something that could be looked at in the future.

HOST:  So what are some of the conclusions that you’ve drawn from this research?

ELIZABETH GREGORY:  Well from 2019 to 2020 the percent of New York City residents giving birth outside the city increased overall from March through November, peaking in April and May, with the timing of the increases in these out-of-city births corresponding with the height of the early pandemic in New York City.  And additionally, the overall rise in out-of-city births is largely the result of increases among non-Hispanic white women while increases were less pronounced for births to non-Hispanic black and Hispanic residents.

HOST:   Are you planning any other similar geographic studies based on the 2020 data?

ELIZABETH GREGORY:  We currently have a report in the works that will be looking at whether there were any changes between 2019 and 2020 in the percentage of births by whether the mother was born inside or outside the U.S.  I just wanted to mention that we are also working on another report about home births, just to see whether there was a change in the percentage of home births that were occurring in the U.S. from 2019 to 2020.

HOST:  Elizabeth Gregory’s new study was released on the same day that the full-year 2020 birth statistics for the U.S. were released.  These new data were based on over 99% of birth certificates issued in the U.S. during the year, and were featured in a new report that had a number of noteworthy findings:

The nation’s general fertility rate, which is the number of births per 1,000 women age 15-44, reached another record low in 2020, dropping 4% from 2019.  The total number of births in 2020 also fell 4%, to 3,605,201 – the sixth straight year the number of births declined.

The new report also revealed that births in the U.S. continue to be at below replacement levels, based on another decline in the total fertility rate.  Birth rates declined for females of all age groups except two:  adolescents age 10-14 and women age 45-49.

The birth rate for teenagers age 15–19 declined by 8% in 2020 to 15.3 births per 1,000 women in that age group.  The teen birth rate has declined every year going all the way back to 1991 except for two – 2006 and 2007.  The rates in 2020 declined for both younger teens age 15–17 and older teens age 18–19.

Nearly one-third of all births in 2020 were by cesarean delivery, and over one-fourth of births were low-risk cesarean deliveries.  Also, the preterm birth rate in the U.S. declined in 2020 for the first time since 2014, to just over 10% of all births in 2020.


Latest Pulse Survey on Anxiety and Depression during Pandemic

May 6, 2021

The latest Household Pulse Survey shows 1 out of 3 U.S. adults (32.1%) had symptoms of an anxiety or a depressive disorder in the past week.  This is the lowest percentage since the start of the survey a year ago.  Also, more than half of 18-29 year olds experienced the same symptoms.

More Findings:

  • Almost 10% of U.S. adults say they needed counseling or therapy, but did not get it the past month.  This is a 1.2 percentage decrease from more than a year ago.
  • Almost 1 out of 4 U.S. adults (24%)  delayed or did not get needed medical care in the past month due to the pandemic. This estimate is almost 5 percentage points lower than the estimate from March 17-29, 2021.
  • 25% of U.S. adults had an appointment with a health professional over video or phone in the past month.  
  • 2 out of 5 U.S. adults with a disability (40.5%) had an appointment with a health professional over video or phone in the past month.

To rapidly monitor recent changes in mental health, NCHS partnered with the Census Bureau on an experimental data system called the Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. The data collection period for Phase 1 of the Household Pulse Survey occurred between April 23, 2020 and July 21, 2020. Phase 2 data collection occurred between August 19, 2020 and October 26, 2020. Phase 3 data collection occurred between October 28, 2020 and March 29, 2021. Data collection for Phase 3.1 of the survey began on April 14, 2021 and will continue through July 5, 2021.


Fact or Fiction: The pandemic had a significant impact on fertility in the United States during 2020

May 5, 2021

Source: National Vital Statistics System

https://www.cdc.gov/nchs/data/vsrr/vsrr012-508.pdf


Births: Provisional Data for 2020

May 5, 2021

lady-holding-baby-mask-01The general fertility rate in the U.S. reached another record low in 2020 and the number of births in 2020 fell for the sixth straight year, according to provisional statistics released today by NCHS.

The provisional data are featured in a new report, “Births: Provisional Data for 2020,” which is based on over 99% of birth certificates issued during the year. The report reveals that the number of births in 2020 was 3,605,201, down 4% from 2019. The general fertility rate in 2020 was 55.8 births per 1,000 women ages 15–44, also down 4% from 2019.

Other findings in the report:

  • The total fertility rate (TFR) was 1,637.5 births per 1,000 women in 2020, down 4% from 2019 and another record low for the nation. The TFR in 2020 means the U.S. continues to be at “below replacement levels.”
  • Birth rates were unchanged for adolescents ages 10-14 and women ages 45-49, but declined for all other age groups.
  • The birth rate for teenagers ages 15–19 declined by 8% in 2020 to 15.3 births per 1,000 females. The teen birth rate has declined every year except for two (2006 and 2007) going back to 1991. The rates declined in 2020 for both younger (ages 15–17) and older (ages 18–19) teenagers.
  • The cesarean delivery rate increased to 31.8% in 2020, and the low-risk cesarean delivery rate increased to 25.9%.
  • The preterm birth rate declined for the first time since 2014, to 10.09% in 2020.

NYC-medium_croppedNCHS also released a second report today that examined changes in the proportion of births to New York City residents outside the city for 2018-2019 and 2019-2020.

Other findings in the report:

  • From 2019 to 2020, the percentage of births to New York City residents that occurred outside of the City increased for all months from March through November, ranging from +15% for September to +70% for April.
  • Out-of-city births peaked in April (10.2%) and May (10.3%) at more than one and onehalf times the 2019 levels (6.0% and 6.2%, respectively).
  • Among non-Hispanic white women, the percentage of out-of-city births was nearly 2.5 times higher in 2020 than in 2019 in April (15.6% versus 6.6%) and May (15.8% versus 6.5%).
  • The percentage of out-of-city births among non-Hispanic black and Hispanic residents increased in only two months in 2020.

QuickStats: Percentage of Adults Aged 18 Years or Older with Arthritis, by Sex and Age Group — National Health Interview Survey, United States, 2019

April 30, 2021

mm7017a7-F

In 2019, among adults aged 18 years or older, prevalence of arthritis (including rheumatoid arthritis, gout, lupus, and fibromyalgia) increased with age among both men and women.

For men, prevalence increased from 5.8% among those aged 18–44 years to 22.3% among those aged 45–64 years, 40.1% among those aged 65–74 years, and 44.7% among those aged 75 years or older.

For women, prevalence increased from 6.6% among those aged 18–44 years to 29.3% among those aged 45–64 years, 48.6% among those aged 65–74 years, and 57.8% among those aged 75 years or older.

Women were more likely to have arthritis than were men overall (24.3% versus 18.3%) and in all age groups except 18–44 years, where the difference did not reach statistical significance.

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

https://www.cdc.gov/mmwr/volumes/70/wr/mm7017a7.htm


PODCAST: Healthy People Initiative, Part Four

April 30, 2021

STATCAST, APRIL 2021: DISCUSSION WITH DAVID HUANG, CHIEF, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

podcast-iconHOST:  David Huang is the chief of the health promotion statistics branch at NCHS, and serves as the center’s primary statistical advisor on the Healthy People initiative. Healthy People for decades now has been identifying science-based objectives with targets to monitor progress and motivate and focus action aimed at improving the health of the nation.  David joined us to discuss the history of the program, what is going on presently, and what the future directions are.

HOST:  So we can expect more products coming in the future – in the days, weeks, months ahead – from “Healthy People 2020.”  What about any differences between “Healthy People 2030” and “2020” – what are some of the more distinctive differences?

DAVID HUANG:  I think the main difference is that there was really a concerted effort by the Department and its stakeholders to reduce the size of “Healthy People.” “2020” was becoming very large and in some ways unwieldy, and it was felt that the initiative had grown too large to be really useful for its stakeholders.  So as part of these efforts, we went through a process over the past several years where we reduced the size of the initiative itself.  We went from about 1100 objectives with data in “2020” to 355 for “2030.”  In addition to that, there was also an effort to maintain a better balance and structure across the initiative.  So during the development of “2030,” after all of the objectives went through the approval process with the interagency steering committee – the federal interagency work group -there was actually another group that reviewed the objectives, the slate of objectives as a whole, and looked for balance.  And there were actually some objectives that were removed, I think one or two that were added, and that was something that was not part of the “2020” process in terms of looking at the balance of objectives as a whole.  As I mentioned earlier, we made sure that the objectives themselves were aligned with the latest science and that included aligning with the latest recommendations, the latest evidence, and also the latest issues that are important in the field of public health, specifically disease prevention and health promotion.

HOST:  Any other future directions that you like to talk about as far as the Healthy People program?

DAVID HUANG: Well of course we’re wrapping up “Healthy People 2020” with the release of a couple of more components that will comprise the rest of the “Healthy People 2020 Final Review.”  As part of that work, we’re also working on a Statistical Note on the elimination of health disparities, specifically among racial and ethnic groups, as well as a more formal archive site for both “Healthy People 2020” and “Data 2020,” which is the Healthy People 2020 database.  Now for “Healthy People 2030,” of course there is a lot to do over the next decade.  And we’re working on a variety of interactive tools, infographics, and products, working with our federal partners including ODPHP.  And this will start with the launch of our database, “Data 2030,” later this year.  Of note also, our webinars that are related to the leading health indicators and overall health and well-being measures.  And finally I’ll note that we are working on a “Healthy People 2030” disparities tool in collaboration with the HHS Office of Minority Health and ODPHP.

HOST:  One question that comes to mind – for “Healthy People 2030” are there any specific objectives dealing with the pandemic?

DAVID HUANG:  So we don’t have anything that is necessarily directly related to COVID, but certainly as many listeners will be aware there are many risk factors and diseases that are tied to COVID-19, and there’s actually a customized list that the Department has created that has all of the “Healthy People 2030” objectives directly related to COVID and this list is actually available to the public from the “Healthy People 2030” website.

HOST:  Anything else at all that we haven’t covered here that you like to mention?

DAVID HUANG:   Sure.  I actually wanted to mention that in terms of the new decade the branch is actually looking forward to expanding outreach and dissemination efforts throughout the decade, and this is actually possible because we do have a more focused and parsimonious set of objectives in Healthy People 2030.

HOST:  Very good – well, thank you David for joining us.

DAVID HUANG:  You’re welcome.

MUSIC BRIDGE:

HOST:  Our thanks to David Huang for joining us on this edition of “Statcast.”

HOST:  This week NCHS released a new report examining the prevalence of underlying chronic conditions among U.S. adults in the years leading into the pandemic. The analysis helps us understand how many people were at high risk for severe COVID-19 illness going into the pandemic.  Seven risk factors were examined: obesity – in particular severe obesity, diabetes, chronic obstructive pulmonary disease or COPD, serious heart conditions including heart failure, coronary artery disease, and cardiomyopathies, chronic kidney disease or CKD, and smoking.  The data come from the 2015-2018 National Health and Nutrition Examination Survey, and showed that 3/4 of all adults in the U.S. had at least one of these chronic conditions or risk factors that put them at high risk for severe COVID-19 illness, and over 86% of non-Hispanic black adults had one or more of these conditions.


Race and Hispanic-origin Disparities in Underlying Medical Conditions Associated With Severe COVID-19 Illness: U.S. Adults, 2015–2018

April 28, 2021

Figure_02192021A new NCHS report calculates the prevalence of selected conditions by race and Hispanic origin among U.S. adults (aged 20 and over) during 2015–2018.

Data were used from the National Health and Nutrition Examination Survey. Conditions included asthma, chronic obstructive pulmonary disease, and heart disease based on self-report; and obesity, severe obesity, diabetes, chronic kidney disease, smoking, and hypertension based on physical measurements

Findings:

  • An estimated 180.3 million (76.2%) U.S. adults had at least one condition during 2015–2018.
  • Approximately 86.4% of non-Hispanic black adults had at least one condition, 58.5% had at least two conditions, and 29% had at least three conditions; these prevalence estimates were significantly higher than among other race and Hispanic-origin groups.
  • Compared with non-Hispanic white adults, Hispanic adults had higher rates of obesity and diabetes.
  • Non-Hispanic Asian adults had lower rates of at least one condition, but higher rates of diabetes compared with non-Hispanic white adults.
  • Non-Hispanic black women were more likely to have multiple conditions, obesity, severe obesity, diabetes, and hypertension compared with non-Hispanic white women.
  • Non-Hispanic black men were more likely to have one or more conditions and hypertension compared with non-Hispanic white men.
  • Hispanic men were more likely to have diabetes compared with non-Hispanic white men.

PODCAST: Healthy People Initiative, Part Three

April 23, 2021

STATCAST, APRIL 2021: DISCUSSION WITH DAVID HUANG, CHIEF, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210423/20210423.htm

podcast-icon

HOST:  David Huang is the chief of the health promotion statistics branch at NCHS, and serves as the center’s primary statistical advisor on the Healthy People initiative. Healthy People for decades now has been identifying science-based objectives with targets to monitor progress and motivate and focus action aimed at improving the health of the nation.  David joined us to discuss the history of the program, what is going on presently, and what the future directions are.

HOST:  Why don’t we turn to the new tables that you’ve released.  Can you tell us a little bit about what’s going on, what’s new with Healthy People?

DAVID HUANG:  Sure.  So although we’ve launched Healthy People 2030 – and it’s been about a year now – we aren’t done with Healthy People 2020 yet.  “Healthy People 2020 Final Review” is a quantitative assessment of the progress  made towards the 2020 goals and objectives by the end of the decade.  Unlike previous Healthy People data publications like the “Healthy People 2020 Midcourse review” that were released as complete publications, the “Healthy People 2020 Final Review” actually consists of a suite of products that will be released by NCHS on a rolling basis over the course of the next year.  Many of these final review components will be released in a web-based format.  The first release in this suite of products is the web-based “Healthy People 2020 Progress Table” which was released on March 31st.  This table provides the final progress status for 1100 measurable objectives, which are those with at least baseline data. And note that this set of 1100 is actually broader than the 985 trackable objectives mentioned earlier, and those are objectives with the baseline and at least one followed data point.  Final progress was generally measured using the latest available data as of January 2020.  The web format will allow users to dynamically filter the table by any of the following categories in any combination: Healthy People 2020 topic area, key term, and final progress status.  This format will also allow users to download customized tables for future use.  We’re really hopeful that this new format is beneficial for users.  One notable feature about these new tables is the ability to look at objectives by topics and themes – also referred to as ‘key terms’ – that cut across Healthy People 2020 topic areas.  And this is actually a feature that also exists on the Healthy People 2030 website.  This ability to look at objectives not just by topic area but also across these broad topics and themes.

HOST:  Earlier you said that about a third of the 2020 objectives have been met or exceeded, I guess.  Could you give us some highlights from the tables that have been released?

DAVID HUANG:  Sure.  Certainly there are a lot of objectives.  For example, in chronic diseases like cancer, the overall cancer death rate, as well as many of the individual cancer death rate targets have been met.  There are also objectives across other topic areas not related to chronic disease that have been met. For example, persons who are unable to obtain or delay needing medical care is another example in the access to health services topic area.  But all in all, a third of objective targets have been met, and these objectives do stand many of the topic areas across Healthy People 2020.

HOST:  I was just scrolling down some of these and there’s some measures dealing with school and education.  It kind of looks like kids are doing better in school – was that sort of what the data show?

DAVID HUANG:  I think it definitely depends on the objective, but yes there is a very large topic area in “Healthy People 2020” on education and community-based programs.  And there are many objectives in that topic area that have met their targets.  Not all of them are necessarily related to how kids are doing in school.  For example, there’s an objective on the nurse to student ratio.  That’s an example of an objective in that topic area that’s been met.

HOST:  It was interesting because there was one measure that showed that kids were doing better than they were at the baseline, but at the same time fewer thought that school was meaningful or important. I thought that was kind of interesting, almost a contradiction if you will.

DAVID HUANG:  Right and you know there’s also consideration that should be given to the data source. I think there there’s obviously a broad range of not just topics but data sources in “Healthy People.” I think that the progress tables do provide a nice, high-level summary of how we’re doing on broad health indicators and hopefully will be useful for stakeholders.

HOST:  It looks like there’s progress made in some of the health care measures –  more people with medical and dental insurance, more with the source of ongoing care, ER wait times above normal were down – most of that looked pretty positive I guess.  But there were some measures that looked like they weren’t necessarily going in the right direction, such as people unable to get prescription medication when they needed.  It looked like that was lower, is that correct?

DAVID HUANG:  Yes that’s correct and that particular objective is actually part of a series of objectives that look at persons unable to obtain or delaying receipt of medical care, dental care, and then prescription medications as you mentioned is the one that is moving in the wrong direction.

HOST:  And just for people who don’t have the level of statistical sophistication, how the tables are laid out is you have a baseline percentage that you started with, and then at the cut point you have what the percentage did – if it changed either up or down – but then also you have another column that determines whether any change was statistically significant, is that correct?

DAVID HUANG:  Yeah and it is actually a little bit more nuanced than that.  The way that we measure movement when objectives are moving towards their targets is really the percentage of the targeted change that’s achieved.  That number will be equal to 100% if an objective exactly meets its target.  And it’s basically a sliding scale for other objectives that are moving in the right direction.  On the other hand, for objectives that are not moving in the right direction, you simply use the magnitude of the percent change from the baseline to assess movement away.  And then there is that column that you mentioned which does let the user know whether this movement – whether it’s in a positive or negative direction relative to the target is statistically significant or not.

HOST:  Anything else you’d like to talk about with regard to the new tables that have been posted?

DAVID HUANG:  Well, as I mentioned this is part of a larger set of components – the full ”Healthy People 2020 Final Review” will be released in components over the next several months.  So we are definitely looking forward to other components being released.  We will actually be working next on a series of pie charts that will actually use the information in this table and summarize it in pie charts so that users can see at a glance, for example, for their set of objectives that they filter down to, what proportion have met, or exceeded, improved, or got worse, for example.

HOST: Our thanks to David Huang for joining us on this edition of “Statcast.”

 


QuickStats: Age-Adjusted Death Rates for Alzheimer Disease Among Adults Aged ≥65 Years, by Sex — National Vital Statistics System, United States, 1999–2019

April 23, 2021

mm7016a5-f

The age-adjusted death rate for Alzheimer disease increased from 128.8 per 100,000 in 1999 to 233.8 in 2019.

The trend for the total population and for men and women alternated between periods of general increase and periods of stability. Rates were stable from 2016 to 2019, and in 2019 were 263.0 for women and 186.3 for men.

Throughout the 1999–2019 period, the rate was higher for women than for men.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 1999–2019. https://www.cdc.gov/nchs/nvss/deaths.htm