QuickStats: Percentage of Children Aged 2–17 Years With >2 Hours of Screen Time Per Weekday, by Sex and Age Group — National Health Interview Survey, United States, 2020

January 21, 2022

Overall, 65.7% of boys and 64.6% of girls aged 2–17 years spent >2 hours of screen time per weekday, in addition to screen time spent for schoolwork.

Among both boys and girls, the percentage of children who spent >2 hours of screen time increased with increasing age group from 47.5% for those aged 2–5 years to 80.2% for those aged 12–17 years.

Source: National Center for Health Statistics, National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7103a6.htm


New NCHS Reports Released This Week

January 21, 2022

QuickStats: Percentage of Adults Aged ≥18 Years Who Received Care at Home From a Friend or Family Member in the Past 12 Months, by Sex and Age Group

January 14, 2022

During July–December 2020, 10.0% of adults aged ≥18 years received care at home from a friend or family member in the past 12 months.

Among both men and women, the percentage of adults who received care in the past 12 months increased with age.

Women were more likely than men to receive care among those aged ≥18 years (11.5% and 8.5%, respectively), 45–64 years (12.4% and 8.5%, respectively), and ≥65 years (17.7% and 13.2%, respectively).

Source: National Center for Health Statistics, National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7102a5.htm


Monthly Provisional Drug Overdose Counts through June 2021

January 12, 2022

NCHS has released the next set of monthly provisional drug overdose death counts.  The monthly counts are released under the Vital Statistics Rapid Release program as an interactive data visualization.

Findings:

  • Provisional data show that the predicted number of drug overdose deaths showed an increase of 20.6% from the 12 months ending in June 2020 to the 12 months ending in June 2021, from 83,992 to 101,263. 
  • The predicted number of opioid-involved drug overdose deaths in the United States for the 12-month period ending in June 2021 (76,002) increased from 61,475 in the previous year.


QuickStats: Distribution of Emergency Department Visits Made by Adults, by Age and Number of Chronic Conditions — United States, 2017–2019

January 7, 2022

During 2017–2019, 38.5% of adult emergency department visits were made by patients with no chronic conditions, 22.9% made by those with one, 15.3% made by those with two, and 23.3% made by those with three or more chronic conditions.

The percentage of adult emergency department visits made by patients with no chronic conditions or one chronic condition decreased with age, from 58.0% among patients aged 18–44 years to 8.5% among patients aged ≥75 years with no chronic conditions and from 24.4% among patients aged 18–44 years to 18.5% among patients aged ≥75 years with one chronic condition.

In contrast, the percentage of visits by patients with two or three or more chronic conditions increased with age, from 10.5% among patients aged 18–44 years to 20.8% among patients aged ≥75 years with two conditions and from 7.1% among patients aged 18–44 years to 52.1% among patients aged ≥75 years with three or more chronic conditions.

Source: The National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2017–2019. https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a6.htm

PODCAST – 2020 Final Death Statistics: COVID-19 as an Underlying Cause of Death vs. Contributing Cause

January 7, 2022

https://www.cdc.gov/nchs/pressroom/podcasts/2022/20220107/20220107.htm

HOST:  NCHS closed out the year in December with the release of final data on deaths in the United States for 2020.  As in past years, these final death statistics focus on conditions or injuries that are listed as the underlying cause of death on the death certificate, and do not include conditions or injuries listed as a contributing cause on the death certs. 

Many of the 2020 findings had been released previously, in preliminary or provisional form:  The final number on life expectancy showed a decline of 1.8 years in 2020.  The final overall death rate in America rose from 715 deaths per 100,000 in 2019 to 835 per 100,000 in 2020 – a nearly 17 percent increase.  Death rates increased for 6 of the 10 leading causes of death in 2020, including a nearly 17 percent increase in deaths from accidents or unintentional injuries… as well as a nearly 15 percent increase in deaths from diabetes.  Meanwhile, death rates decreased for 2 leading causes of death – cancer and chronic lung disease – and remained unchanged for another cause: kidney disease.  Also, suicide fell out of the top 10 leading causes of death in 2020 after the number and rate of suicide dropped for a 2nd consecutive year.

And of course there was a new entry to the list of 10 leading causes of death in 2020.  COVID-19 was the 3rd leading cause of death in 2020, with nearly 150,000 more deaths than the 4th leading cause of death, accidents, and over 250,000 fewer deaths than the 2nd leading cause of death, cancer.  The final, official tally of COVID-19 deaths in the U.S. for 2020 was 350,831.  CDC had reported a higher number of deaths from its case surveillance reporting system, and NCHS had also posted a higher number on its web site, closer to 385,000 deaths – which included any death mentioning COVID.  The official 350,831 COVID-19 deaths for 2020 reflects deaths in which COVID was the underlying cause of death.

Joining us today to talk about these 2020 numbers for COVID-19 numbers, as well as the difference between tracking underlying causes of death and contributing causes of death, is Mortality Statistics chief Robert Anderson.

HOST:  The final data for 2020 show over 350,000 deaths from COVID-19, meaning the virus was the underlying cause of death.  Can you explain what the underlying cause of death means?

ROBERT ANDERSON: The underlying cause of death is the condition that initiated the chain of events leading to death.  When the death certificate is filled out, the person who’s reporting the cause of death is asked to identify a chain of events, sort of a causal pathway, working from the immediate cause back to the underlying cause.  So an example of a chain of event or pathway would be viral pneumonia due to COVID-19.  That’s a causal pathway – COVID-19 causes viral pneumonia which then would kill the person, so COVID-19 in that instance is considered the underlying cause of death – that condition that started everything forward.  And the reason why we tend to focus on the underlying cause is because that’s the condition that’s considered most amenable to public health prevention, the idea being that if you can prevent the underlying cause then you can prevent the entire chain of events from occurring.

HOST: Now there might be some confusion because the number that had been reported for 2020 was close to 385,000 deaths.  So what about those other (almost) 34,000 deaths that some people thought were COVID-19 deaths but aren’t included in this latest tally?

ROBERT ANDERSON:  Right, so the 385,000 deaths that we would refer to as “involving COVID-19.” The other 34,000 would be deaths in which COVID-19 was a contributing factor but not the underlying cause.  So it may have exacerbated an existing disease or it may have contributed in some way but it wasn’t what initiated the chain of events leading to death.  And the person who is certifying the cause of death – usually it’s a physician, medical examiner, or coroner – has to determine what role COVID-19 played in causing the death, and this is essentially three options: it was the underlying cause and it initiated that chain of events; it was a contributing factor and played some role but it wasn’t the underlying cause; or it wasn’t a factor at all, in which case it shouldn’t be reported on the death certificate.

HOST: OK so it seems like there’s a fine line there and this sort of prompts another question:  In the new 2020 final data, we see significant increases in deaths from diabetes, for example, also from Alzheimer’s disease… heart disease… and those are the underlying cause of death so is it possible that some of those deaths, COVID-19 was listed as a contributing factor?

ROBERT ANDERSON:  Sure it’s likely, actually, that for some of those conditions COVID-19 was listed as a contributing factor, and it may have been a contributing factor in cases in which COVID-19 wasn’t listed as well – particularly in the beginning of the pandemic back when we didn’t know very much about the disease and when there wasn’t widely available testing.  It’s possible that some of those deaths are actually COVID deaths but were attributed to those other causes.  So the increase may be COVID-related.  There is also this other category that’s sort of important to recognize as well, and these are cases in which the death may have been related to the pandemic but not to the virus specifically.  This would be cases where people perhaps didn’t get the care that they needed for whatever reason – either they were afraid to go to the hospital or the doctor or they weren’t able to get into the doctor.  Particularly with a disease like diabetes that requires a fair amount of maintenance and monitoring.  If people are not going to the doctor to get checked out they’re gonna be at higher risk of dying.

HOST: So again, for those who might be confused about this, obviously with COVID-19 you have a very wide spectrum of severity – you’ve got people who may have had it but never knew they had it, or people who have tested positive but never had any symptoms, to the other end where people are severely ill.  How is it determined on the death certificate for COVID to be just a contributing cause?  It would seem like, wouldn’t it be like one or the other?  Either it was an underlying cause or didn’t really play a factor?

ROBERT ANDERSON:  Well it’s a complicated issue.  So you could have for example somebody with COVID who has symptoms, is symptomatic, but the symptoms aren’t particularly severe, but in a case with somebody with like chronic obstructive pulmonary disease or somebody with a heart condition, a serious heart condition, even fairly mild COVID symptoms could sort of push them over the edge and then the certifier has to make a judgment as to what role COVID played in that scenario.   And it’s not not always easy – sometimes it can be quite straightforward, other times not so much, particularly when you have somebody who has multiple serious chronic diseases or people who perhaps are terminally ill. The certifier has to decide what caused that person to die when they did and in some cases it might be that COVID caused them to die when they did, but it might also be a case where COVID just sort of made things worse and they died from the pre-existing condition.  It can be a difficult decision to make.

HOST: I know I’ve asked you this one before but just again to clarify: If someone is admitted to the hospital with an injury – a car accident for example – and they are tested for COVID and test positive, and then they die from their injuries in the crash –COVID would not be a “contributing cause” on the death certificate correct?

ROBERT ANDERSON:   In most cases I think not, but it is possible that COVID could complicate the clinical situation such that it makes survival less likely.  It would depend on the severity of the injuries – maybe the person comes in and they’ve got a very severe injury and they simply test positive for COVID and there are no symptoms that are likely be incidental to death.  But if you had somebody who let’s say had chest trauma from the car accident and they were, they’re struggling to breathe already… They get COVID in the hospital and they’re showing some symptoms… there, it could contribute.  So it’s really – the certifier has to look at the whole clinical picture and then make a judgment as to whether COVID played a role and then what role it played in the death, if they determine that it played a role.

HOST:  In looking at some other examples the one that comes to mind would be influenza –does influenza turn up a lot on death certificates as a contributing but not an underlying cause of death?

ROBERT ANDERSON:  Not very often – influenza is substantially underreported on death certificates to begin with.  It’s a little better now than it used to be with the rapid testing, but very often when people die from the flu they’re dying of the complications of the flu, and often after the point at which it can be determined that they had the flu.  So somebody gets the flu, they’re at home for seven to 10 days with that, they develop a secondary infection, bacterial infection, let’s say bacterial pneumonia, and struggle with that for a few more days and then go to the hospital.  Even if they’re tested for the flu they’re not going to test positive, flu is not gonna show up, so it can be very difficult unless the certifier knows that the person had the flu and understands the chain of events to figure out what happened.  So I think we’d have similar issues with COVID if COVID wasn’t so prevalent.  And if the flu was a lot more prevalent and we did a lot more testing for the flu, I think it would tend to show up on death certificates more often.  Again, it goes to trying to figure out what the chain of events looks like and what initiated that chain of events.  And the certifier needs some sort of evidence that the flu was a factor and if they don’t have it, they’re not likely to report it on the death certificate.  So what we end up with is, we end up with a few thousand deaths a year where the flu is reported on death certificates, where modeling analysis show that it’s more like 30 to 60,000 depending on the severity of the flu season.

HOST:  Are there any other conditions which often turn up as “contributing” but “not underlying?”

ROBERT ANDERSON:  Yeah I mean diabetes is one of those conditions.  If you look at the total number of diabetes deaths where diabetes is the underlying cause, you see, well just take 2020 for example, the number is about 100,000 deaths but if we look at how often it’s actually reported on the death certificate we see a whole lot more.  Something on the order of – I don’t know what the number is for 2020 at this point but in in previous years it’s been somewhere on the order of 250,000 cases.  So diabetes is one of those conditions that frequently shows up as a contributing factor and it certainly does often contribute, it complicates the clinical picture and makes survival a lot less likely in many instances.  It’s also one of those conditions where it’s hard to understand for sure where it fits in the chain of events, unless somebody has sort of a hyper osmolar reaction or something like that, they kinda have to figure out – OK, well, this person had diabetes, it wasn’t well controlled, and they died from stroke, what role did diabetes play if any?  And it likely would have played a role because it tends to make cardiovascular diseases like heart disease and cerebrovascular disease worse. 

HOST: So for the 2020 data then there could be some diabetes deaths where COVID-19 was a contributing factor.  And it could also be the opposite, right?  Where it could be a COVID-19 death where diabetes was maybe a contributing cause?

ROBERT ANDERSON:  Sure yeah, I mean, we do know people with diabetes are very susceptible to severe disease and COVID.  And so it’s likely in many cases that you would see diabetes reported along with COVID on the death certificate, as a contributing factor.

HOST:  Just one more question about the contributing causes.  So then, that section of the death certificate would also be where contributing health behaviors — or unhealthy behaviors more likely  — would that be where, like, smoking, alcoholism, drug abuse… would that be listed as a contributing cause assuming it wasn’t like an overdose or something like that?

ROBERT ANDERSON:  Yeah it could be and we do see that.  It’s not reported very consistently though – a lot of certifiers don’t like to list behaviors on the death certificate.  They want to report clinical conditions, diseases, or injuries, and so they will often leave off sort of behavioral type things.  So while we do see it – you can see smoking reported, for example, and there’s a checkbox item as well that asks the certifier of tobacco played a role or not.  That’s one of the reasons why we added that checkbox was to try to capture that information because it wasn’t reported consistently on the death certificate.  We do see things like drug abuse and alcohol abuse reported on the death certificate but normally if alcohol abuse contributed to, say, cirrhosis of the liver and killed someone, normally the certifier would report alcoholic cirrhosis and so the alcohol abuse would be implied there.

HOST:  Any other points about this you feel are important to note?

ROBERT ANDERSON:  I think it’s important to note – you mentioned the 385,000 deaths that we were reporting in our surveillance website and compared with the 350,000 underlying cause deaths.  And some have asked questions about that and my answer typically is that for surveillance purposes we like to cast a slightly wider net, because we want to get a better sense for the impact of the disease or the pandemic on overall mortality.  But when we start to really boil down the numbers and start comparing causes of death, we need to have a single cause reported for each person and that’s the underlying cause of death.  Because we don’t want to double-count deaths in our in our tabulation so we limit to the underlying cause when we’re ranking leading causes, for example, or when we’re creating a table of various causes of death.  But for surveillance purposes, when we’re trying to capture the impact of the disease we cast a slightly wider net and so we look at both underlying and contributing factors.

HOST:  Thanks for joining us again Dr. Anderson.

ROBERT ANDERSON:  Happy to do it. 

(MUSICAL BRIDGE)

HOST: NCHS capped the year with four more reports released in the final week of 2021.  The first report focused on emergency department visits to people with mental health disorders, featuring data from the National Hospital Ambulatory Medical Care Survey.  A second report looked at pre-pregnancy body mass index and infant outcomes, showing that infants fared better among women who were at normal weight prior to their pregnancy.  A third report also looked at pregnancy – in particular, maternal and infant health outcomes among women who had confirmed or presumed COVID-19 during their pregnancy.  Data from 14 states and DC were examined for this study.  The fourth and final study from NCHS in 2021 featured the final, official numbers of drug overdose deaths in the U.S. for 2020, a report that is updated annually.


New 2022 NCHS Release Schedule

January 5, 2022

Happy New Year! The 2022 NCHS release schedule is now available with upcoming statistical products and reports. This page will be updated daily throughout the year.

https://www.cdc.gov/nchs/pressroom/calendar/2022_schedule.htm

QuickStats: Distribution of Hours per Day That Office-Based Primary Care and Specialist Care Physicians Spent Outside Normal Office Hours Documenting Clinical Care in Their Medical Record System — United States, 2019

December 17, 2021

In 2019, 91.0% of office-based physicians spent time outside normal office hours documenting clinical care: 17.0% spent <1 hour, 41.4% spent 1–2 hours, 24.0% spent >2 hours–4 hours, and 8.6% spent >4 hours per day.

The percentage of primary care physicians who spent no hours per day documenting clinical care (5.3%) was lower than the percentage of specialist care physicians (12.3%) who spent no hours per day documenting clinical care.

In other time categories, there was no statistically significant difference between primary care and specialist care physicians.

Source: National Center for Health Statistics, National Electronic Health Records Survey, 2019. National Electronic Health Records Survey public use file national weighted estimates, 2019. https://www.cdc.gov/nchs/data/nehrs/2019NEHRS-PUF-weighted-estimates-508.pdf

https://www.cdc.gov/mmwr/volumes/70/wr/mm7050a4.htm


QUICKSTAT: Percentage of Employed Adults Who Needed to Work Closer Than 6 Feet from Other Persons All or Most of the Time at Their Main Job by Occupation

December 10, 2021

During July–December 2020, 30.7% of all currently employed workers needed to work closer than 6 ft (2 m) from other persons at their job all or most of the time.

The four occupations with the highest percentages were health care practitioners and technicians (70.5%), health care support (69.7%), food preparation and serving (58.9%), and personal care and service (57.8%) occupations.

Source: National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis/2020nhis.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7049a7.htm


PODCAST: Interview with Elizabeth Gregory on Home Births During the Pandemic

December 10, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211210/20211210.htm

HOST: Though no historical data are available, it is widely accepted that most births prior to the 20th century occurred in the home.  With the arrival of the 20th century and the advances in modern medicine that came with it, home births became far less common – as low as 0.56% of all births in 2004.  But in 2020, driven at least in part by the pandemic, home births increased 22% from 2019, to 1.26% in 2020 – the highest percentage since at least 1990.

This week NCHS has released a new report documenting the increase in home births during the pandemic.  Joining us to discuss the findings in the report is the lead author of the study, Elizabeth Gregory…

HOST: Are women who give birth at the home – and their babies – more at risk for adverse outcomes?

EG: So, this report doesn’t address the safety of home births – what it does is it examines changes in home births before and during the COVID-19 pandemic by month and by race and Hispanic origin and state of residence of the mother.

HOST: Home births have been higher in recent years than 10-15 years ago, is that correct?

EG: Home births have been increasing for the last 15 years or so.  The pace of increase had slowed from 2014 to 2019, and then there was a large increase in 2020.

HOST: The data suggest the low mark for home births in the United States occurred around 2004, is that correct?

EG: Yes that’s correct, but it’s important to note that we don’t have comparable data on home births prior to the 1989 revision of the US standard certificate of live birth.  But for 1990 through 2020 the lowest percentage of home births which was 0.56% occurred in 2004.

HOST: So even though it’s accepted that back in the 19th century, for example, most births occurred in the home, we don’t really have data prior to 1989, is that correct?

EG: So for vital statistics data, previous to the 1989 revision the question for place of birth – the response could either be in hospital or not in hospital.  We don’t really have the more detailed information about where the birth may have occurred outside the hospital.

HOST: I see.  So the pandemic would help explain the sharp rise in 2020, but what explains the higher rates since 2004?

EG: We didn’t look at what might have caused the increases for those earlier years, but we did look at when and where the increases occurred for 2019 to 2020.  So for example, in 2019 to 2020 the percentage of home births rose 22% for all women, with increases ranging from 21 to 36% for the three largest race and Hispanic origin groups.  And the percentage of home births for all women increased for each month, March through December, peaking in May, and this pattern of home births by month was also generally observed for each of the three largest race and Hispanic origin groups.

HOST: What factors related to the pandemic accounted for the big increase in 2020?

EG: So other researchers have found that some reasons included: increasing number of cases of COVID-19 in the U.S. combined with concerns about contracting COVID-19 while in the hospital… limitations or bans on support persons in the hospital… and the separation of infants from mothers suspected to have COVID-19.

HOST: What were some geographic differences we saw in 2020 as far as home births go?

EG: This report found increases in home births for the vast majority of states from 2019 to 2020.  The percentage of home births increased significantly in 40 states, with non-significant increases seen in an additional nine States and the District of Columbia.

HOST: What about race and ethnicity?  Were there similar increases in home births along those demographic lines?

EG: Historically non-Hispanic white women have been more likely to give birth at home, and this pattern continued into 2020.  However, increases ranging from 21 to 36% were seen for all of the three largest race and Hispanic origin groups from 2019 to 2020.

HOST: Any other topics in your study you’d like to mention?

EG: Yes, the report found that the percentage of home births rose for each month, March through December 2020, compared with the same months in 2019 and peaked in May.  And the timing of increases in home births generally corresponds with the initial surge of COVID-19 cases in the United States in late March and early April 2020.

HOST: Thanks for joining us Elizabeth.

EG: You’re welcome.

MUSICAL BRIDGE

HOST: December got off to a busy start with two reports focusing on children’s health, using 2020 data from the National Health Interview Survey.  The 2020 NHIS included questions on concussion, to measure both symptoms and diagnosis from a health care provider to provide a more complete understanding of the public health burden, as children with mild injuries may not see a doctor or receive a diagnosis.  On Dec. 1, NCHS released a new study on concussions and brain injuries among children in the U.S.  The new study found that nearly 7% of children in the U.S. under the age of 18 have had symptoms of a concussion or brain injury.  And 4% have been diagnosed with these conditions by a health care provider.   Boys are more likely than girls to have had these symptoms, and non-Hispanic White children are more likely than children in other race categories to have had these symptoms. 

While the report on concussions and brain injuries doesn’t have any direct correlation to the pandemic, a second report looked at dental exam visits among children in 2020 compared with 2019. It is known that in 2020, dental practices across the country adjusted their services in response to the COVID-19 pandemic, and access to dental care was disrupted for many Americans. This new study found that there was a decline in visits for dental exams or cleanings from 2019 to 2020, which likely was driven by the pandemic.  The decline was greater among younger children ages 1 to 4, as well as among lower income children and children living in the northeastern United States. 

Capping off the first week of the month was the latest quarterly provisional birth data for the U.S.  This latest release features mid-year 2021 data, and shows that fertility in the U.S. appears to be continuing its steady decline from the past several years, including a sharp decline in the U.S. fertility rate in the one year ending in mid-year 2020 compared to the same point the year before.

MUSICAL BRIDGE

HOST: This week NCHS also released data from its 2019 linked birth and infant death file.  These data are considered to be more comprehensive than infant mortality data from death certificates alone, due to the linking of the two sources of information.  As a result, much more accurate demographic and geographic data on infant mortality are available from this linked file.  However, the general “bottom line” remains the same – infant mortality in the United States continues to decline, as it has for nearly a century.

Finally, today NCHS released a report looking at trends in mortality from the leading cause of death in America, heart disease.  The new study covers most of the past two decades, with a special focus on changes by state.  The report shows that in the first decade of the millennium, 2000 to 2011, heart disease death rates declined in all 50 states and DC.  However, from 2012 through 2019, heart disease death rates fell in only half the states plus DC – and actually increased in one state (Arkansas). 

Later this month, on Dec. 22, NCHS will release its final death data for 2020, which will include the final, official number of COVID-19 deaths for the country in 2020.  Rounding out the last week of the year are several new reports, including one on emergency department visits by adults who have mental health disorders, using data from the National Hospital Ambulatory Medical Care Survey.  Two pregnancy-related reports are slated for release that week as well:  one on pre-pregnancy body mass index and infant outcomes and another on maternal and infant health outcomes among mothers with confirmed or presumed COVID-19 during pregnancy.  And last, the annual final report on drug overdose deaths for 2020 will be released, which comes on the heels of the latest monthly release of provisional overdose death numbers, running through May of 2021.