Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013–2015

February 15, 2018

Questions for Danielle Ely, Ph.D., “Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013–2015

Q: Why did you decide to examine differences in mortality rates for the leading causes of infant death between rural and urban areas in the United States?

DE: After finding differences in infant mortality rates between rural and urban places in previous work, we thought causes of death might also differ by urbanization level. Although previous research looked at infant mortality rates by age of death and residence, there had not been research on leading causes of infant death by rural-urban status.


Q: Can you describe the differences in infant, neonatal, and postneonatal mortality rates?

DE: Infant mortality rates are based on all infant deaths. Neonatal mortality specifies the infant was less than 28 days of age at time of death and postneonatal mortality rates are those infant deaths that occurred between 28 days and 11 months of age. In this data brief, as in previous research, we see higher neonatal mortality rates than postneonatal mortality rates. Indeed, neonatal mortality rates were nearly twice as high as postneonatal mortality rates across urbanization levels. Further, there are distinct differences in the leading causes of death for neonatal and postneonatal mortality. Although both include congenital malformations, neonatal deaths are generally associated with more birth related medical issues whereas postneonatal deaths are generally associated with more causes external from the infant.


Q: Overall, how did the mortality rate for the five leading causes of infant death vary by urbanization level?

DE: Rural areas have higher infant, neonatal, and postneonatal mortality rates than urban areas. However, when we drill down by the leading causes of death by age of death, there are specific causes of death where infants in rural areas do experience lower mortality rates, such as mortality from low birthweight and from maternal complications. However, there are markedly higher mortality rates for both neonatal and postneonatal infants from congenital malformations, sudden infant death syndrome, and unintentional injuries in rural places than in urban.


Q: Were there any surprises in the findings from this report?

DE: Although we expected differences in mortality rates by the leading causes of death, I think we were surprised by the marked differences for some causes; particularly SIDS mortality rates being twice as high in rural places than in large urban counties. I also think some of the most interesting findings in the report are related to how rural infant mortality rates are generally higher than rates in urban areas, but there are some causes for which rural places have similar or even lower rates compared to urban places.


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

DE: The message that should be taken from this report is that different types of places– rural and urban– have different issues when it comes to the leading causes of infant death. Although the leading causes are generally the same across areas, there are substantial differences in rates, meaning different public health interventions may be needed for people in rural areas compared to people in urban areas to address these issues.

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Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016

February 13, 2018

Questions for Debra J. Brody, M.P.H., and Laura Pratt, Ph.D., Epidemiologists and Lead Authors of “Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016

Q: What made you decide to focus on the prevalence of depression for the subject of your new report?

DB/LP: Our intent in conducting this study was to provide up-to-date prevalence estimates for depression—a common and serious medical condition that can result in both emotional and physical problems. We focused on U.S. adults 20 and older to determine if there have been any changes in the proportion of adults with depression over the past 10 years. The estimates are based on responses to a series of depression symptom questions asked during the examination portion of the 2013-2016 National Health and Nutrition Examination Survey (NHANES), a nationally representative study.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

DB/LP: The finding that most surprised us was that among adults who are depressed, four out of five, or 80%, have at least some difficulty going to work, doing their regular activities at home, or getting along with people. What was perhaps most striking was to see that impairment due to depression affected both men and women equally—given that the prevalence of depression among men (5.5%) was almost half of what it is among women (10.4%).


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

DB/LP:  We found one notable difference in depression among race and ethnic groups in the 2013-2016 NHANES data. The prevalence of depression in the non-Hispanic Asian subgroup (3.1%) of adults was significantly lower than depression among adults from the three other race-ethnic groups that we examined (non-Hispanic white, non-Hispanic black, and Hispanic.) We would like to acknowledge that the estimate for non-Hispanic Asian adults is for persons self-identified as belonging to any Asian origin subgroup. In our study, adults of Chinese, Indian, Filipino, and every other Asian-origin are all grouped together because we do not have the sample sizes to show the prevalence for separate Asian origin groups. Other studies have found lower and more moderate estimates of depression among Asian adults compared with those from other race and ethnic groups.


Q: How has the prevalence of depression changed in the past 10 years?

DB/LP: Our data show that over the past 10 years, the percentage of adults who have depression has stayed relatively stable. A point to consider is that the NHANES surveys do not include persons in the military, or those living in institutions like hospitals or nursing homes where adults may be at higher risk for depression. In addition, we did not include in our analysis persons currently being treated for depression or taking medications, unless they screened positively for depression in our survey.


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

DB/LP: We think the real take-home message of this study is the seriousness of depression, a common mental disorder—and how emotional and physical problems that are symptoms of depression impact the everyday life of those affected by depression. We found that overall, about one out of every 12 U.S. adults have depression in any given 2-week period. Depression rates are higher in some population subgroups—like among women as compared to men—and among adults from low income families as compared to those from higher incomes. Among U.S adults who have depression, managing daily activities—at work and at home—poses at least some difficulty.


Parental Report of Significant Head Injuries in Children Aged 3–17 Years: United States, 2016

February 9, 2018

Questions for Lindsey Black, Health Statistician and Lead Author of “Parental Report of Significant Head Injuries in Children Aged 3–17 Years: United States, 2016.”

Q: What was the reason you undertook this research?

LB: Previous research has indicated that the incidence is increasing and much of this trend is being driven by an increase among adolescents. Current incidence of concussions among children is estimated to be 3.5-16.5/1,000. Despite what is known, studies conducted thus far regarding the epidemiology of childhood concussions have either been regional and limited in size, focused on injuries related to sports, dependent on insurance claims, or based on emergency department visits.

There is a lack of a national prevalence and we need to understand the problem outside of the scope of sports injuries. Depending on ED visits are also problematic because evidence is emerging that there is an increasing trend in the use of primary care physicians and specialty clinics as the point of entry into the healthcare system for concussion diagnosis and treatment. Also relying on ED or medical claims will not include non-medically attended concussions.

Further, much research focuses on high school and collegiate athletes and therefore there is not much data on younger children. Despite this, there has been recent recognition for concern and appropriate treatment by the medical community. The goal of this study was to provide a national estimate of parent-reported significant head injuries as well as examine disparities by various demographics and socioeconomic indicators.


Q: What did you find most significant?

LB: There was a steady increase in the percentage of children that had ever had a significant head injury by age group. Although overall boys were more likely than boys to have ever had a significant head injury, the difference was only significant for the 15-17 age group.


Q: Are there any data that look at what sports might be contributing to the number of significant head injuries among children?

LB: Yes, in fact there are many studies that focus on sport related injuries. Our survey and study did not. What sets our study apart is that it was not limited to sports related injuries, so it is going to include a wider range of causes of injuries. Please see “Emergency Department Visits for Concussion in Young Child Athletes” (Bakhos, 2010) and “Epidemiology of Concussion and Mild Traumatic Brain Injury” (Laker 2011) to learn more.


Q: Do you have any insight about whether this percentage who’ve had significant head injuries has increased or declined over time?

LB: Unfortunately we do not have any other historical data on this topic from our survey. At this time, these questions were asked only in 2016 as part of content sponsored by the National Instutite of Health’s National Institute on Deafness and Other Communication Disorders.


Q: Any other points you’d like to make about this study?

LB: We found that about 1 in 10 children in the oldest age group 15-17 had ever had a significant head injury. We also found that overall, boys were more likely than girls to have ever had a significant head injury and there were also disparities by race and parental educational attainment.


Emergency Department Visits by Patients aged 45 and over with Diabetes: United States, 2015

February 8, 2018

Questions for Pinyao Rui, Statistician and Author of, “Emergency Department Visits by Patients aged 45 and over with Diabetes: United States, 2015.”

Q: Why did you decide to examine emergency department (ED) visits made by patients aged 45 years older with diabetes?

PR: We decided to examine emergency department visits made by patients aged 45 years and older because we wanted to focus on visits made by older patients who are at higher risk of developing or having diabetes and who comprise a majority of all diabetes cases in the U.S.  Additionally, we wanted to use more recent data not currently available in the literature to examine characteristics of an ED visit for a condition that is projected to rise and contribute to increasing burden of medical care systems.


Q: How did the rate of emergency department visits by patients aged 45 and over with diabetes change with age?

PR: The rate of emergency department visits by patients aged 45 and over increased with age. The rate increased from 69 per 1,000 persons for those aged 45-64 years and more than doubled to 164 per 1,000 persons for those aged 75 years and over.


Q: Were there differences in the percentage of visits that ended in inpatient hospital admission by diabetes status?

PR: Yes, the percentage of ED visits with diabetes that ended in inpatient hospital admission was significantly higher than the percentage of ED visits without diabetes among visits made by patients aged 45-64 and 65 and over.


Q: Are there any findings that surprised you from this report?

PR: One finding from the report that surprised me was that among ED visits made by 45-64 year olds, a higher proportion of diabetes visits were paid by Medicare compared with visits made by patients without diabetes (24% versus 14%).


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

PR: I think the take home message is that the percentage of ED visits by older patients with diabetes reported in the medical record has been increasing in recent years with the highest proportion observed in patients aged 65-74 (32% in 2015).


Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015–2016

February 7, 2018

Geraldine McQuillan, Ph.D., Infectious Disease Epidemiologist

Questions for Geraldine McQuillan, Ph.D., Infectious Disease Epidemiologist and Lead Author of “Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015–2016

Q: In the first bullet in the key findings section of your new report, 47.8% is listed for 2015-2016 herpes simplex type 1 prevalence and 11.9% is listed for type 2. Yet in the last bullet there, it reads that prevalence is 48.1% and 12.1%. Why are these estimates different?

GM: This report offers two statistical estimates – a crude rate, or “real” prevalence estimate, and an age-adjusted one. If you look at the data table for Figure 1, you can see that the unadjusted prevalence — or the true prevalence for herpes simplex virus type 1 (HSV-1) — is 47.8% in the U.S population. In order to compare across subgroups that have differing age distributions, we need to age-adjust the data to allow for a more accurate comparison among groups. The age-adjusted prevalence for the total population is 48.1%. Crude rates are influenced by the underlying age distribution of a population, and age-adjusting the rates assures that differences are not due to the age distribution of the populations being compared.


Q:  What made you decide to focus on the prevalence of the herpes simplex virus for the subject of your new report?

GQ: Our main motivation for conducting this study is to offer a current assessment of herpes prevalence in the United States. Though we have included HSV-1 and -2 testing in the National Health and Nutrition Examination Survey (NHANES) since 1999, we have not looked at the data since 2010 (Bradley et al. Seroprevalence of herpes simplex virus type 1 and 2 – United States, 1999-2010. JID 2014:209; 325-333). With the addition of six more years of data and a sufficient amount of years to look at trends over time, we decided it was time to re-look at the prevalence of these common viruses in the United States.


Q:  Was there a result in your study that you had not expected and that really surprised you?

GQ: The decline in herpes simplex virus type 2 (HSV-2) across all race and ethnic groups was quite striking. The linear decline in prevalence was seen in the previous study for HSV-1 that used data from 1999-2010. There was no decline with the prevalence of HSV-2 at that time. With the addition of six more years of data, we now also see a linear downward trend for HSV-2 and again for HSV-1. We did not expect to see the decline of HSV-2 in all race and ethnic subgroups.


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

GQ: The difference by race and ethnic subgroups in herpes simplex virus prevalence did not differ from previous reports even with the declines in prevalence in both viruses. Mexican-Americans still have the highest prevalence of HSV-1, and non-Hispanic whites have the lowest. The prevalence of HSV-2 is highest in the non-Hispanic black population and lowest in the non-Hispanic Asian population. Non-Hispanic whites and Mexican- Americans have a similar prevalence. All these race/ethnic differences have been seen in many of our infectious diseases especially those that are transmitted sexually.


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

GQ: This is a good news data report. I think its take-home message is that two of our most prevalent viruses, HSV-1 and HSV-2, are steadily declining in the U.S population. Though NHANES provides prevalence estimates (new and old infections), once a person is infected with a herpes virus they are infected for life. The only way we see a decline is if there is a drop in new infections or a decrease in the incidence of both HSV-1 and HSV-2. While this report is a presentation of data findings, and did not go into an analysis of risk factors to determine why we are seeing this decline, other industrialized countries have observed declines in HSV-1 during the past two decades. Improvements in living conditions, better hygiene and less crowding likely explain these declines. Other countries who also have seen a decline in HSV-2 in their populations, suggest that the increase in safe-sex practices in the post-AIDS pandemic may contribute to the decline.


QuickStats: Percentage of Residential Care Communities That Use Electronic Health Records, by Community Bed Size — United States, 2016

February 6, 2018

In 2016, one fourth (26%) of residential care communities used electronic health records (EHRs).

The percentage of communities that used EHRs increased with community bed size.

The percentage was 12% in communities with 4–10 beds, 28% with 11–25 beds, 35% with 26–50 beds, 43% with 51–100 beds, and 50% with more than 100 beds using EHRs.

Source: National Study of Long-Term Care Providers, 2016

https://www.cdc.gov/mmwr/volumes/67/wr/mm6704a8.htm


Births: Final Data for 2016

January 31, 2018

Questions for Joyce A. Martin, M.P.H., Demographer, Statistician, and Lead Author on, “Births: Final Data for 2016.”

Q: Are there any data that are new in this report compared with previous annual final birth reports?

JM: Yes!  This report includes new national data on a number of items including prenatal care utilization in the US, whether the mother received WIC food during pregnancy, cigarette smoking before and during pregnancy, maternal body mass index of overweight or obese, primary cesarean and vaginal birth after previous cesarean delivery and source of payment for the delivery.


Q: Is the U.S. birth rate going up or down in 2016?

JM: Both the number of births and the general fertility rate (births per 1,000 women aged 15-44) declined in the US from 2015 to 2016.


Q: Are teen births in the U.S. continuing to decline?

JM: Yes, the teen birth rate declined 9% from 2015 to another record low.


Q: What did the findings show for the mean age of U.S. mothers at first birth?

JM: The 2016 mean or average age of mothers having a first birth was a record high in 2016, at 26.6 years.


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

JM: Births are down overall and among women 15 to 29 years of age.  The cesarean delivery rate continued to decline but rates of preterm birth and low birthweight are on the rise.  Birth certificate data are a rich source for important information on mothers and their newborns.