QuickStats: Percentage of Adults Aged 18 Years or Older With or Without Psychological Distress† Who Were Current Smokers, by Age Group and Level of Distress — National Health Interview Survey, 2014–2016

June 18, 2018

During 2014–2016, 37.2% of adults aged 18 years or older with serious psychological distress were current smokers, followed by 27.6% of those with mild to moderate psychological distress and 14% of those with no psychological distress.

Among adults aged 18–44 and 45–64 years, the percentage of adults who were current smokers increased with the level of psychological distress.

Among adults aged 65 years or older, the percentage who were current smokers was less among adults with no psychological distress than among adults with mild to moderate or serious psychological distress.

Source: National Health Interview Survey, 2014–2016. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6723a6.htm

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Describing the Increase in Preterm Births in the United States, 2014–2016

June 13, 2018

Questions for Joyce Martin, Statistician, and Lead Author of “Describing the Increase in Preterm Births in the United States, 2014–2016

Q: What did you think was the most interesting finding in your report?

JM: Two things – that the rate has increased for three straight years following several years of decline, and that the increase generally occurred among babies born late preterm.


Q: Why are total preterm birth rates increasing?

JM: The reasons for the rise are not well understood, but appear to be largely among births occurring at the highest end of the preterm/late range, that is, at 36 weeks.  That said, it is important to note that early preterm births, those at the greatest risk of poor outcome increased among non-Hispanic black births.


Q: Why did you decide to examine preterm birth rates?

JM: The preterm birth rate is a basic indicator of the maternal and infant health of a nation and, accordingly, changes in the preterm rate have important implications for the public health. Babies born prior to 37 weeks of gestation are more likely to die within the first year of life and more likely to suffer life-long morbidities than those born later in pregnancy.


Q: How did preterm birth rates vary among U.S. states from 2014-2016?

JM: Preterm rates rose significantly in 23 states and the District of Columbia and non-significant increased were seen in an additional 22 states.  In short, rates are trending upward for the vast majority of states.


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

JM: The incidence of infants born too soon is on the rise in the US, appears to be largely among late preterm births and the rise does not appear to be limited to any specific maternal race, age or geographic group.


QuickStats: Homicide and Suicide† Death Rates for Persons Aged 15–19 Years — National Vital Statistics System, United States, 1999–201

June 8, 2018

In 1999, the homicide death rate for persons aged 15–19 years (10.4 per 100,000) was higher than the suicide rate (8.0). By 2010–2011, the homicide and suicide rates had converged.

After 2011, the suicide rate increased to 10.0 in 2016; the homicide rate declined through 2013 but then increased to 8.6 in 2016.

Source: National Vital Statistics System. 1999–2016. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a7.htm


Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

June 6, 2018

Donald Cherry, M.S., Health Statistician

Questions for Donald Cherry, M.S., Health Statistician, and Lead Author of “Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

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

DC:  Most of the results confirmed what we’ve seen in current research, so there really was not a finding in this study that surprised me. But confirming existing knowledge is an important finding! Specifically, the results examining urban-rural visit differences are exactly in the expected direction; that is, in large metropolitan areas, psychiatrists are more concentrated (as suggested by prior research), and we would expect to see a higher percentage of visits to them for mental health-related issues. Rural areas have less psychiatrists and more primary care physicians (PCPs) (as suggested by prior research), and seeing 54% of mental health-related visits occurring at primary care physician offices suggests that in these rural areas, availability of provider type for outpatient mental health treatment might be limited.

Also, the results show no difference in a couple of areas. One area where you can see this is in the percent of health-related visits to psychiatrists vs. PCPs when Medicare is the expected source of payment. We see this too, in the rate of visits when the patient age is 65 years and older – which is interesting for its possible implications.  These results together may indicate that older adults, who are also assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


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

DC:  I think the real take-home message of this report is that continued monitoring of the utilization of mental health services is important in identifying the present and future needs of the U.S. adult population. As one might expect, the composite of mental health-related visits occur in psychiatrists’ offices; however, this does not seem to be a phenomenon that is always consistent. Differences in mental health-related visits by physician specialty did vary by age, payment type, and within patient sex. The most interesting difference is in large metropolitan areas where a higher percentage of mental health-related office visits are to psychiatrists compared to primary care physicians (PCPs). In rural areas, an opposite trend is observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas.


Q:  What made you decide to conduct this study on mental health-related doctor’s office visits?

DC:  My background is in psychology, and I’m very interested in mental health issues, so mental-health related doctor’s office visits is a natural topic for me to explore. Having access to the National Ambulatory Medical Care Survey (NAMCS) data has given me the opportunity to examine different research topics. In the past, I have also been privileged to collaborate with prominent researchers in the field who have used NAMCS data. I have specifically been interested in where people are going to get treatment for mental health issues. Data accessibility in NAMCS is especially useful becauses it collects visit details on both primary care physicians and psychiatrists in the same survey sample design.


Q:  What differences or similarities did you see between or among various demographic groups in this analysis?

DC:  We did note some differences among different age groups, between sexes, and between rural and urban areas of the United States. When examining age, the mental health-related office visit rate to psychiatrists is higher compared with the rate to primary care physicians among all adults, and among adults in age groups 18–34, 35–49, and 50–64. But there was no significant difference among adults aged 65 and over. Not seeing a difference in rates for the oldest patients is interesting, and some researchers indicate that psychiatrists have a proportionately smaller role in office-based mental health care among older adults — than younger — perhaps due to age-related attitudinal differences toward psychiatric services.

Looking at sex, mental health-related office visit rates to psychiatrists are higher compared with primary care physicians for both men and women, but the visit rate is higher for women compared to men (1,380 vs. 1,111 visits per 10,000 adults).  Within-sex differences were expected given the overall premise of where adults as a group are getting their care. Within-sex differences follow 2016 data presented by The National Institutes of Mental Health that show the prevalence of any mental health illness is higher in women (21.7%) vs. men (14.5%).

Large metropolitan areas experienced a higher percentage of mental health-related office visits to psychiatrists compared to PCPs. In rural areas, an opposite trend was observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas. In medium to small metropolitan areas there was no difference in the percent of visits to either physician specialty, suggesting a possible absence of a supply-demand issue.


Q:  What sort of trend data do you have on this topic that will help us see how mental health-related doctor’s office visits have evolved over time?

DC:  Although we did not examine mental health-related office visits across years for this analysis, we certainly have the ability to examine the same characteristics in future research. An interesting finding in our current report is that mental health-related office visit rates to psychiatrists are higher compared with primary care physician visit rates in all age groups — except for adults aged 65 and over, and as a percentage of visits among all primary expected payment types except Medicare. These results together may indicate that older adults, who are assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


Q:  What information do you have on the differences between or among the different types of physicians that are visited for mental health, e.g. what do patients get at a psychiatrist’s office visit that they may not receive at a primary care physician’s – and vice versa?

DC:  There is information available about the type of care patients receive for mental health from different types of physicians. We do have the ability to determine some components of care which patients receive at mental health-related visits; for example, did the patient receive psychotherapy, health education/counseling, psychotropic medications, etc. However, this topic has been examined before as researchers outside The National Center for Health Statistics (NCHS) have studied care received at psychiatrist vs. PCP offices, so this data brief did not explore these factors extensively. Perhaps in a future NCHS study! The uniqueness of this research in how we define a mental health-related office visit should be recognized – and will be very useful in future studies. By using the patient’s reason for a visit, and not a physician’s diagnosis, we attempt to control that at least the initial reason for the visit was for a mental health issue.


Characteristics of Office-based Physician Visits, 2015

June 5, 2018

Jill Ashman, Ph.D., Health Statistician

Questions for Jill Ashman, Ph.D., Health Statistician, and Lead Author of “Characteristics of Office-based Physician Visits, 2015

Q: What made you write this report on doctors’ office visits?

JA: Our intent in producing this data brief is to provide the annual summary of National Ambulatory Medical Care Survey (NAMCS) data. Last year we created the format for this NAMCS summary report using 2014 data, and we are currently working on the 2016 summary. These summary reports provide a snapshot of the care provided at office-based physician offices.


Q: Was there a result in your study that surprised you?

JA:  While there is a notable finding in the report, generally the patterns are what we expected to find and are consistent with a similar report looking at office visits in 2014. One notable finding is the relatively low percentage of visits for preventive care among adults 18 years or older (21% for ages 18-64 and 13% for those aged 65 years or older).


Q: What differences or similarities did you see between or among various demographic groups, such as age and sex, in this analysis?

JA:  We noted a number of differences among various groups examined in this report. In terms of visit rates, we found that females visited the doctor’s office at a higher rate than males. We also found that the visit rate for infants and older adults exceeded the rates for those aged 1-64 years.

We also found age variation with primary expected sources of payment, the major reason for a doctor’s office visit, and for the services provided at the physician visit. Medicaid was the primary expected source of payment at a higher percentage of visits by children (38%) than adults, and Medicare was the primary expected source of payment at a higher percentage of visits by adults aged 65 and older (79%) compared with patients under 65 years. Having no insurance at all was at a higher percentage of visits by adults aged 18-64 (9%) than those aged 65 and over (2%). Also, compared with adults, a larger percentage of office visits by children were for either preventive care (33%) or a new problem (41%). Additionally, visits by children (compared with adults) were less likely to include a laboratory test, imaging service, or procedure that was ordered or provided. No variation by age was observed for office visits for an injury or that included an examination or screening service.


Q:  What is new in this report that has not already been published?

JA: This report provides the most recent nationally representative estimates of office-based physician visits in the United States. To our knowledge, age differences in the selected characteristics of patients accessing the doctor’s office in 2015 have not already been published.


Q: What sort of trend data do you have on this topic that will help us see how doctor’s office visits have evolved over time?

JA: With a number of years of data, we can look at trends over time by examining other National Center for Health Statistics reports. We released a similar report last year that looked at age variation in the same selected characteristics of office-based physician visits made in 2014. Comparing the results of both reports shows little change in the patterns of selected characteristics from 2014 to 2015. However, one notable change was an observed increase from 2014 to 2015 in the percentage of health education and counseling services ordered or provided overall and among the three age groups examined.

For older years of data, we provide detailed summary tables on our website going back as far as 2008 that can be used to help see how office-based physician visits have evolved over time. The summary tables can be found here.


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

JA: The take-home message from this report is that there is a wide variation by age in the characteristics of visits to office-based physicians in the United States in 2015. Larger differences were observed in the services ordered or provided and in the major reason for the office visit between children under 18 years and adults aged 18 or older.


QuickStats: Breast Cancer Death Rates Among Women Aged 50–74 Years, by Race/Ethnicity — National Vital Statistics System, United States, 2006 and 2016

June 4, 2018

The U.S. death rate from breast cancer among all women aged 50–74 years decreased 15.1%, from 53.8 per 100,000 in 2006 to 45.7 in 2016.

In both 2006 and 2016, the death rate was higher among non-Hispanic black women compared with non-Hispanic white women and Hispanic women.

From 2006 to 2016, the death rate from breast cancer decreased for non-Hispanic white women from 54.6 per 100,000 to 46.2, for Hispanic women from 34.8 to 31.0, and for non-Hispanic black women from 71.7 to 64.1.

Source: National Vital Statistics System, 2006 and 2016. https://wonder.cdc.gov/ucd-icd10.html.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a8.htm


Recent Increases in Injury Mortality Among Children and Adolescents Aged 10–19 Years in the United States: 1999–2016

June 4, 2018

NCHS released a new report that presents numbers of injury deaths and death rates for children and adolescents aged 10–19 years in the United States for 1999–2016.

Numbers and rates are presented by sex for 1999–2016, by injury intent (e.g., unintentional, suicide, and homicide) and method (e.g., motor vehicle traffic, firearms, and suffocation). Numbers and rates of death according to leading injury intents and methods are shown by sex for ages 10–14 years and 15–19 years for 2016.

Findings:

  • The total death rate for persons aged 10–19 years declined 33% between 1999 (44.4 per 100,000 population) and 2013 (29.6) and then increased 12% between 2013 and 2016 (33.1).
  • This recent rise is attributable to an increase in injury deaths for persons aged 10–19 years during 2013–2016.
  • Increases occurred among all three leading injury intents (unintentional, suicide, and homicide) during 2013–2016.
  • Unintentional injury, the leading injury intent for children and adolescents aged 10–19 years in 2016, declined 49% between 1999 (20.6) and 2013 (10.6), and then increased 13% between 2013 and 2016 (12.0).
  • The death rate for suicide, the second leading injury intent among ages 10–19 years in 2016, declined 15% between 1999 and 2007 (from 4.6 to 3.9), and then increased 56% between 2007 and 2016 (6.1).
  • The death rate for homicide, the third leading intent of injury death in 2016, fluctuated and then declined 35% between 2007 (5.7) and 2014 (3.7) before increasing 27%, to 4.7 in 2016.