Births Rose for the First Time in Seven Years in 2021

May 24, 2022

The number of births in the United States and the general fertility rate increased for the first time in seven years during 2021. The data released today are featured by CDC’s National Center for Health Statistics (NCHS).

The new report, “Births: Provisional Data for 2021,” analyzes data from more than 99% of birth certificates issued during the year. The report shows a 1% increase in births from 2020, with 3,659,289 births recorded in 2021. The general fertility rate in 2021 was 56.6 births per 1,000 women ages 15–44, also up 1% from 2020. In contrast, the number of births and general fertility rate both declined 4% from 2019 to 2020.

Other findings in the new report:

  • Birth rates declined for women in the age groups between 15 and 24 years, rose for women in the age groups between 25 and 49 years, and were unchanged for adolescents aged 10-14 in 2021.
  • The birth rate for teenagers ages 15–19 declined by 6% in 2021 to 14.4 births per 1,000 females.
  • The teen birth rate has declined every year except for two (2006 and 2007) since 1991. The rates declined in 2021 for both younger (ages 15–17) and older (ages 18–19) teenagers.
  • The cesarean delivery rate increased to 32.1% in 2021. The low-risk cesarean delivery rate
    increased to 26.3%.
  • The preterm birth rate rose 4% in 2021 to 10.48%—the highest rate reported since at least 2007

QuickStats: Percentage of Adults Aged ≥18 Years Who Felt That Crime Makes It Unsafe to Walk, by Sex and Age Group — National Health Interview Survey, United States, 2020

May 20, 2022

In 2020, 11.0% of adults aged ≥18 years felt that crime made it unsafe for them to walk. Percentages were lower for men (8.9%) than for women (13.0%).

Men were less likely than women to feel unsafe walking because of crime in all age groups (18–24 years: 9.3% of men compared with 17.1% of women; 25–44 years: 10.1% of men compared with 14.1% of women; 45–64 years: 8.9% of men compared with 12.7% of women; ≥65 years: 6.5% of men compared with 9.9% of women).

Among both sexes, adults aged ≥65 years were less likely to feel unsafe to walk than those in younger age groups.

Source: National Center for Health Statistics, National Health Interview Survey, 2020.

Biggest Increase in the Marriage Rate During 2020 Occurred in… Montana?

May 16, 2022

There were many social and health markers that were significantly disrupted in 2020 with the arrival of the pandemic.  Increases in mortality and declines in people seeking medical care during 2020 are well-documented, as is the sharp decline in fertility.   Employment levels and other economic indicators were greatly impacted, as was the workplace itself.  Education at all levels was faced with unprecedented challenges in 2020. 

Another social marker greatly impacted by the pandemic was marriage in the United States.  The number of marriages in the country declined 16.8% between 2019 and 2020, from 2,015,603 to 1,676,911¹.  The 2020 number of marriages is the lowest recorded in the U.S. since 1963².  The marriage rate (the number of marriages per 1,000 population) fell 16.4% from 2019 to 2020, from 6.1 marriages per 1,000 to 5.1 per 1,000.


At the state level, the declines in marriage rates were widespread³ – 46 states and the District of Columbia saw declines in marriage during 2020.  The biggest declines occurred in the following states: Hawaii (47.9%), California (43.9%), New Mexico (43.3%), New York (37.5%) and Louisiana (33.3%).  All the declines were statistically significant except for in three states:  Idaho, South Dakota, and Wyoming, where declines were only 2%.

The highest marriage rate in the U.S. in 2020, as in years past, belonged to Nevada – but the rate was down 18.9% in that state from 2019.

There were also four states in which the marriage rate increased in 2020: Montana (31.6%), Texas (8.2%), Alabama (7.5%) and Utah (3.7%).

Some of the changes in 2020 may be partly due to reporting issues, which also became a factor during the pandemic.

State-by-state comparisons are available on the CDC/NCHS web site at:

¹ CDC/NCHS Vital Statistics System,

² CDC/NCHS Vital Statistics System,

³ CDC/NCHS Vital Statistics System,

QuickStats: Percentage of Suicides and Homicides Involving a Firearm Among Persons Aged ≥10 Years, by Age Group — National Vital Statistics System, United States, 2020

May 13, 2022

In 2020, among persons aged ≥10 years, the percentage of suicide deaths that involved a firearm was lowest among those aged 25–44 years (45.1%) and highest among those aged ≥65 years (70.8%).

The percentage of homicide deaths that involved a firearm decreased with age, from 91.6% among those aged 10–24 years to 46.0% among those aged ≥65 years.

Persons aged ≥65 years had the highest percentage of suicide deaths that involved a firearm but the lowest percentage of homicide deaths that involved a firearm.

Source: National Vital Statistics System, Mortality Data, 2020.

Telemedicine Use in Children Aged 0–17 Years: United States, July–December 2020

May 10, 2022

Questions for Maria Villarroel, Health Statistician and Lead Author of “Telemedicine Use in Children Aged 0–17 Years: United States, July–December 2020.”

Q: Why did you decide to look at telemedicine among U.S. children during the pandemic?

MV: We know that telemedicine use expanded during the COVID-19 pandemic. Telemedicine became a key practice in health care that supports social distancing and decreases contact between health care staff and other patients for the receipt of health care services and reduce the spread of infection. However, there are limited estimates of telemedicine use, especially in children, and this report aims to address that gap.

Q: How did the data vary by age groups, income level and region?

MV: We examined telemedicine use in two ways: 1) telemedicine use in the past 12 months from the time of interview in July-December 2020, so this included both pre-pandemic and pandemic periods; and 2) telemedicine use because of reasons related to the coronavirus pandemic during the first year of the pandemic – 2020.

We found that telemedicine use in the past 12 months varied by age of the child and family income. Telemedicine use in the past 12 months was highest for younger children (aged 4 years and under) and older children (12 to 17 years), and lowest for children aged 5 to 11 years.  Telemedicine use in the past 12 months was highest for children with family incomes below the federal poverty level and at or above 400% of the federal poverty level, and lowest for children with family incomes at 100%–199% of the federal poverty level.  Although not statistically significant, a similar pattern by age was observed for telemedicine use due the pandemic, while telemedicine use due to the pandemic was highest for children with family income at or above 400% of the federal poverty level.

Telemedicine use in the past 12 months and telemedicine use because of the pandemic varied by region. Children living in the Northeast were more likely to have used telemedicine than children living in the Midwest and South regions, and similarly as likely to have used telemedicine as children living in the West region. 

Q: How did telemedicine use vary between urban and rural areas?

MV: In this study, we used the NCHS Urban–Rural Classification Scheme for Counties to classify urbanization level, and we compared telemedicine use in children living in large metropolitan areas, medium and small metropolitan areas, and nonmetropolitan areas.

We found that both telemedicine use in the past 12 months and telemedicine use because of the pandemic were lower in nonmetropolitan areas compared with metropolitan areas. But we also observed that the percentage point difference between metropolitan and nonmetropolitan areas was wider for the use of telemedicine because of the pandemic than for telemedicine use in the past 12 months. For example, we observed that children residing in metropolitan areas were more than two times as likely to have use of telemedicine because of the pandemic compared with children residing nonmetropolitan areas, but children in metropolitan areas were only about 1.3 to 1.4 more likely than children in nonmetropolitan areas to have used telemedicine in the past 12 months.   

Q: Do you have comparative trend data that goes further back than the second half of 2020?

MV: No. Telemedicine questions were introduced into the NHIS survey in July 2020 as one of the emerging public health topics affecting the United States related to the COVID-19 pandemic, which was declared in March 2020 by the World Health Organization.

Trend data on telemedicine use in children is limited.  Since April 2020, the experimental data system called the Household Pulse Survey, which is a collaboration between multiple federal agencies, began collecting data on telemedicine use in the past 4 weeks in households with at least one child under 18 years of age, among other social and economic impacts of the COVID-19 pandemic. 

Q: What is the main takeaway message here?

MV: Approximately 12.6 million children in the U.S.—corresponding to 17.5% of children aged 0–17 years—used telemedicine in the past 12 months from the time of interview in July-December 2020 (a period that included time before and during the coronavirus pandemic).  

Telemedicine use in the past 12 months varied by age of the child, family income, and region of the country.

Approximately 10.2 million U.S. children—corresponding to 14.1% of children aged 0–17 years—used telemedicine in 2020 because of the pandemic.

Telemedicine use because of the pandemic varied by education of the parents living with the child and region of the country and urbanization level of residence.

Telemedicine use in the past 12 months and because of the pandemic was higher for children with current asthma, a developmental condition, and disability.

QuickStats: Percentage of Adults Aged ≥18 Years Who Met the Federal Guidelines for Muscle-Strengthening Physical Activity, by Age Group and Sex — National Health Interview Survey, United States, 2020

May 6, 2022

In 2020, 35.2% of men and 26.9% of women aged ≥18 years met the federal guideline for muscle-strengthening physical activity.

The percentage of men who met the muscle-strengthening guideline decreased with age from 44.5% for those aged 18–44 years, to 29.9% for those aged 45–64 years, and to 22.0% for those aged ≥65 years.

The percentage also decreased with age among women from 34.1% for those aged 18–44 years, to 23.8% for those aged 45–64 years, and to 17.2% for those aged ≥65 years.

Men were more likely to have met the muscle-strengthening guideline than women in all age groups.

Source: National Center for Health Statistics, National Health Interview Survey, 2020.

QuickStats: Percentage of Currently Employed Adults Aged ≥18 Years Who Had Paid Sick Leave Benefits at Last Week’s Job or Business, by Region — National Health Interview Survey, United States, 2019 and 2020

April 29, 2022

The percentage of currently employed adults who had access to paid sick leave increased from 62.1% in 2019 to 66.5% in 2020.

During this period, increases were noted among all regions of the country (Northeast: from 65.6% to 69.8%, Midwest: from 60.1% to 64.5%, South: from 59.1% to 63.5%, and West: from 65.8% to 70.3%).

In both years, rates were highest in the Northeast and West and lowest in the Midwest and South.

Source: National Health Interview Survey, 2019–2020 data.

PODCAST: NHANES Pre-Pandemic Data Release, Part I

April 22, 2022

(Based on the June 16, 2021, webinar, National Health and Nutrition Examination Survey 2017–March 2020 Pre-pandemic Data Release )

HOST: NHANES – the National Health and Nutrition Examination Survey – is designed to assess the health and nutritional status of adults and children in the United States. The survey uses complex sampling design to ensure that the data collected are nationally representative. And it also combines information collected across several different survey components. During a home interview, participants provide information on demographic characteristics, health conditions, and risk factors and behaviors, such as which dietary supplements and prescription medications they are using. Then, participants are invited to travel to a nearby mobile examination center to participate in a health exam, in which they undergo tests, provide lab specimens, and take part in additional interviews. After the exam, participants may be contacted again to participate in post-exam content. This could include activities such as dietary recall, interviews, or wearing a physical activity monitor. The survey content varies over time and covers a wide variety of health conditions and public-health topics. Conducting examinations, along with health interviews, provides data that is invaluable for public health. But it also poses operational and statistical challenges.

Dr. Lara Akinbami, a pediatrician and medical officer with the Division of Health and Nutrition Examination Surveys at NCHS, discussed some of those challenges in a webinar last year:

AKINBAMI: NHANES is conducted in 15 sites per year due to the intricate field operations of the survey. The mobile exam centers, or MECs, must be driven to each new site and set up and maintained according to exact specifications. Teams includes interviewers, clinicians, technicians, and engineers live in the field full time as they travel among the different survey locations over the year. Each MEC contains a mobile laboratory with all the equipment needed for specimen processing and storage until specimens can be shipped to laboratories for testing. On-site testing is also performed for some health measures to provide immediate results to participants. There’s also other equipment for medical testing in the MECs. For example, a spirometer has been used to measure lung function and a sound-isolating room is used to test hearing. Depending on which health exams and measures are being performed, equipment can be swapped in and out of the MECs. The range of pre-pandemic activities that occurred in the MECs was broad. These included body measures, such as weight and height, Blood-pressure measurements, DEXA scans to assess bone density, oral health exams, and phlebotomy and urine collection to collect specimens for a wide array of lab tests. In addition, participants responded to additional interviews, such as audio computer-assisted self-interviews for more sensitive topics that included reproductive health and alcohol and substance use. The MECs provide a way to standardize protocols, equipment, and exam environments across different locations and across time, so that results are comparable. This allows for more accurate interpretation of health differences between groups and of trends over time. NHANES began continuous field operations in 1999.

And, although data collection continued from year to year, data were released in two-year cycles. Each two-year cycle is drawn from a multiyear sample design. These sample designs have changed over time to keep up with changes in the U.S. population. For instance, the 2015-to-2018 sample design selected 60 locations to be visited over four years. The 2015-to-2016 data-collection cycle visited the other 30. Although data are available for two-year cycles, NHANES advises combining cycles together into four-year data sets to calculate reliable estimates for subgroups. For example, estimating the prevalence of a health condition by age group separately for men and women, or for race and Hispanic-origin groups among children, is best done with a four-year data set.

HOST: Dr. Akinbami also discussed in the webinar how the pandemic impacted NHANES data collection.

AKINBAMI: So, like almost everything else, NHANES was affected by the COVID-19 pandemic. The 2019-to-2022 sample design also chose 60 locations to be sampled over four years. NHANES entered the field in 2019 with a plan of visiting the first 30 locations in the 2019-to-2020 data collection cycle. In March 2020, a growing number of cases of COVID-19 disease were being reported to CDC. This suggested that community spread was occurring. Widespread shutdowns had not yet occurred, but the environment was starting to change. For example, mobility data show that, during March, normal patterns and movements started to decline. The NHANES program needed to decide whether continuing field operations posed a risk of coronavirus transmission to participants and staff and their close contacts. On March 16, field operations for NHANES were suspended. And, although it wasn’t clear at the time, this meant that the 30 locations planned for the 2019-to-2020 cycle would not all be visited. When field operations were stopped in March of 2020, the survey had been to 18 of 30 planned locations. And, as 2020 progressed, it was clear that there was no feasible way to resume in-person exams. The potentially long pause before field operations could be resumed raised questions about how a break in data collection would affect estimates of health conditions. Resuming data collection when it was safe to do so would mix pre-pandemic data and pandemic data together and potentially introduce bias into the estimates, especially for a two-year cycle that would have to be extended.

Therefore, it was decided not to collect more data for this cycle. Because no additional data would be collected, the 2019-to-March 2020 sample was not nationally representative. There was no method to create sample weights using the 2019-to-2022 sample design. Additionally, publicly releasing the data for fewer than 30 locations could pose disclosure risks for participants. However, the data that were collected represented a significant investment by survey participants, the federal government, and collaborators; and simply not using the data wasn’t an option. So, a solution was found in the creation of a pre-pandemic data file. The 2017-to-2018 two-year cycle contained a complete sample and was nationally representative. It could be used to build a larger data set. And methodology to combine a probability sample with a nonprobability sample was used but adapted to this situation. The probability sample in this case was the 2017-to-2018 sample. And, rather than a nonprobability sample, the2019-to-March 2020 sample was a partial probability sample, because it was selected based on the 2019-to-2022 sample design.

So here’s an overview of how a 2017-to-March 2020 pre-pandemic data set was created and some analytic considerations when working with the data. The 2015-to-2018 sample design specified the locations chosen for the 2017-to-2018 data collection cycle. And, as we mentioned previously, all 30 locations were visited in 2017 to 2018. The 2019-to-2022 sample design specified 30 locations that were supposed to have been visited in the 2019-to-2020 data collection cycle and only 18 were visited. Combining the 2017-to-2018 sample with the 2019-to-March 2020 sample posed a problem. The 2015-to-2018 and the 2019-to-2022 sample designs were different because the 2019-to-2022 sample design was updated to reflect the changing United States. So the chosen solution was to pick one of these sample designs. Because the 2017-to-2018 data collection cycle fully adhered to the 2015-to-2018 sample design, this design was chosen. The 18 sites that were visited in 2019 to March 2020 were reassigned to the 2015-to-2018 sample design. Now that a design was chosen, the sample weights could be calculated. However, there were still some issues that needed to be resolved. The 2019-to-March 2020 locations didn’t line up exactly with the 2015-to-2018 sample design. The result was that some portions of the country were underrepresented in the data. An adjustment factor was used to equalize representation over the sites visited from 2017 to March 2020. And, once that was done, interview weights and exam weights were then calculated using previous methodology. Extensive assessments confirmed that the final sample was nationally representative by making demographic comparisons to the American Community Survey, which is a population survey administered by the U.S. Census.

HOST: Dr. Akinbami concludes by discussing some important analytic considerations for users of the data.

AKINBAMI: The resulting 2017 to March 2020 pre-pandemic data can be used to calculate nationally representative estimates of health conditions and behaviors. It can be used as the previously released data sets for two-year cycles. However, the data from the partial 2019-to-March 2020 cycle by themselves are not nationally representative.

Therefore 2017-to-2018 data cannot be compared to the 2019-to-March 2020 data. And remember that, because the 2019-to-March 2020 data did not conform to the 2019-to-2020 survey design, no separate survey weights could be constructed for this cycle. It is not appropriate to use the 2017-to-March 2020 pre-pandemic weights for the partial sample collected in 2019 to March 2020. The weight adjustment that was applied to the 2017-to-March 2020 data was designed for overall estimates but not necessarily for subgroups. So, therefore, when 2017-to-March 2020 estimates for subgroups are compared to earlier estimates, trends should be interpreted with caution. For example, when the adjustment factor and other measures were applied to the survey weights, national representation by sex

was achieved and so is representation by age. But some sex-specific age

groups, for example, may have larger variation in estimates depending on how the participants are distributed across survey locations.


HOST: In part two of this feature on pre and post-pandemic NHANES, Dr. Bryan Steirman discusses a published report on health estimates from this NHANES data set.  This webinar is accessible on the NCHS website.

HOST:  On April 12, NCHS released its quarterly mortality data on several leading causes of death, with disease-related mortality rates featured through the third quarter of 2021.  The web feature “Stats of the States” was also updated the same day.  “Stats of the States” features key vital statistics on topics such as Births, Deaths, and Marriages & Divorces by state.  Users can rank States according to rates, either highest to lowest or lowest to highest.  This data visualization was updated with final 2020 data for all these measures.  Included in each State fact sheet are the 10 leading causes of death for each state, which always presents some interesting variation from state to state.  2020, of course, features the introduction of COVID-19 as the 3rd leading cause of death in the U.S.  And at the state level, COVID-19 indeed was the 3rd leading cause of death in 44 states and DC.  As for the other states, COVID was 4th among the leading killers in 3 states:  Alaska, New Hampshire, and Utah.  The virus was the 5th leading cause of death in 2 states:  Washington and West Virginia., as well as the 7th leading cause of death in 2 states:  Hawaii and Oregon, and the 8thth leading cause of death in 2 states:  Maine and Vermont.  Provisional data for 2021 suggests some changes to those rankings, based on regional outbreaks of the virus.

Finally, on April 20th, NCHS released a new report comparing dental utilization rates among adults in 2019 with the arrival of the pandemic in 2020.

Next month promises to be a more active month of data releases for NCHS, including full-year 2021 drug overdose death data, full-year 2021 birth data, and a new report on sexual orientation differences in access to care and health status, behaviors and beliefs.


QuickStats: Percentage of Adults Aged 18–64 Years Who Had a Dental Visit in the Past 12 Months, by Dental Insurance and Year — National Health Interview Survey, United States, 2019–2020

April 22, 2022

The percentage of adults aged 18−64 years who had a dental visit during the past 12 months decreased from 65.5% in 2019 to 62.7% in 2020.

From 2019 to 2020, the percentage of adults aged 18−64 years who had a dental visit during the past 12 months decreased for those with dental insurance (75.0% to 72.0%) and those without dental insurance (47.8% to 45.4%).

In both 2019 and 2020, adults with dental insurance were more likely to have a dental visit than those without dental insurance.

Source: National Center for Health Statistics, National Health Interview Survey, 2019 and 2020.

Testicular Cancer Deaths in U.S. from 1999-2020

April 19, 2022


ICD-10 Codes: C62.0, C62.1, and C62.