FRAX-based Estimates of 10-year Probability of Hip and Major Osteoporotic Fracture Among Adults Aged 40 and Over: United States, 2013 and 2014

March 28, 2017

NCHS released a new report that uses FRAX estimates from the National Health and Nutrition Examination Survey 2013–2014 to describe the hip and major osteoporotic fracture probability distribution (for adults aged 40 and over) and prevalence of elevated probabilities (for adults aged 50 and over) in the United States.

The report defines the distribution of the probabilities of having a hip or major osteoporotic (hip, spine, forearm, humerus) fracture in the next 10 years among middle-aged and older US adults.  For example, prior to this report, NCHS didn’t know what the average 10-year probability of having one of these fracture types was in this age range.  NCHS also looked at the prevalence of elevated probabilities for these fractures in adults age 50+ years using thresholds defined by the National Osteoporosis Foundation for that age range.

FRAX algorithms are proprietary equations developed by researchers at the World Health Organization (WHO) Collaborating Center on Metabolic Bone Diseases, University of Sheffield, UK, to estimate the probability of having a hip or major osteoporotic fracture in the next 10 years.  These equations use age, sex, body mass index, femur neck bone density, and several health and lifestyle variables (smoking, alcohol consumption, personal and parental fracture history, glucocorticoid use, rheumatoid arthritis) to predict these 10-year probabilities.  The equations also account for race and Hispanic origin, because race-specific equations were developed for use in the U.S.

In summary, the report found that the average 10-year probability of hip or major osteoporotic fracture fell below the thresholds considered as an elevated risk in US adults age 50+ in 2013-2014.  However, 8-19% of adults age 50+ had an elevated 10-year probability of experiencing one of these fractures in 2013-2014.

Trends in Infant Mortality in the United States, 2005-2014

March 21, 2017

T.J. Mathews, M.S., Demographer, Statistician

Questions for T.J. Mathews, M.S., Demographer, Statistician, and Lead Author of “Trends in Infant Mortality in the United States, 2005-2014

Q:  Was there a result in your study’s analysis of infant mortality that you hadn’t expected and that really surprised you?

TM:  Though not unexpected, the pervasive and large decrease in infant mortality that is documented in the report is quite striking. While we had been observing slight declines in the infant mortality rate, it’s very good news to see significant declines over the past decade.

Q:  Why did you conduct this study on a decade of infant mortality in the United States?

TM:  We produced this report because infant mortality is an important public health measure. The United States does not compare well with other developed countries. Measuring and understanding the changes in infant mortality rates over time — and identifying who has been impacted by those changes — is critical.

Q:  What differences, if any, did you see in infant mortality among race and ethnic groups?

TM:  We did see a number of significant differences in infant mortality among race and Hispanic origin groups. Rates reached new lows for infants of Hispanic, non-Hispanic white, non-Hispanic black, and Asian or Pacific Islander women, though there was no decline among infants of American Indian or Alaska Native women. The largest decreases we saw were among infants of Asian or Pacific Islander women with a 21% drop over the decade, and among infants of non-Hispanic black women, with a 20% decrease.

Q:  What is the “period linked birth/infant death data set” that you reference as a source for the statistics in your report?

TM: The “period linked birth and infant death data set” is a very valuable tool for monitoring and exploring the complex inter-relationships between infant death and any risk factors present at birth. In the linked birth and infant death data set, the information from the death certificate is linked to the information from the birth certificate for each infant under 1 year of age who dies in the United States, Puerto Rico, the Virgin Islands, and Guam. The purpose of the linkage is to use the many additional variables available from the birth certificate to conduct more detailed analyses of infant mortality patterns. The linked files include information from the birth certificate such as: age, race, and Hispanic origin of the parents, birth weight, period of gestation, plurality, prenatal care, maternal education, live birth order, marital status, and maternal smoking – which is then linked to information from the death certificate such as age at death, and underlying and multiple cause of death.

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

TM: I think the take-home message of this report is that the U.S. infant mortality rate declined significantly for the years 2005 to 2014, however, there is still much work to do. While the majority of race and ethnic groups experienced declines in infant mortality rates–and two-thirds of states showed declines as well–the U.S. infant mortality rate is still higher than many other developed countries. Our statistics show we can do better.

QuickStats: Age-Adjusted Rate for Suicide by Sex — National Vital Statistics System, United States, 1975–2015

March 20, 2017

There was an overall decline of 24% in the age-adjusted suicide rate from 1977 (13.7 per 100,000) to 2000 (10.4).

The rate increased in most years from 2000 to 2015. The 2015  suicide rate (13.3) was 28% higher than in 2000.

The rates for males and females  followed the overall pattern; however, the rate for males was approximately 3–5 times higher than the rate for females throughout the study period.


Selected Health Conditions Among Native Hawaiian and Pacific Islander Adults: United States, 2014

March 15, 2017

Questions for Adena M. Galinsky, Statistician and Lead Author on “Selected Health Conditions Among Native Hawaiian and Pacific Islander Adults: United States, 2014

Q: What factors led you to undertake this analysis on Native Hawaiian/Pacific Islanders?

AG: NHPI became a race group separate from Asians nearly 20 years ago, but there are still few reliable national NHPI health statistics, because the population is numerically small and hard to include in sufficient numbers in national health surveys.

While NCHS as an agency is committed to collecting and reporting health information about all Americans, our goal with this new survey is to fill the gaps in the country’s knowledge about the health of Native Hawaiian and Pacific Islanders in the United States so that others can make decisions based on accurate, reliable, up to date information.

This research is just the beginning of the exciting work that will be coming out using this data.

Q: What do you feel was the most interesting finding in the study?

AG: The pattern of results was the most interesting finding: that for a whole range of outcomes, from serious psychological distress, to arthritis, to asthma, the NHPI population had a higher prevalence than the Asian population.

Q: Is there any comparable data at the moment? Have there been any other studies done on this population and if so, what conclusions were drawn from those studies?

AG: The annual National Health Interview Survey (NHIS) has been publishing NHPI statistics for a while now (since 2003, when data from the 1999 NHIS were published), but because of small sample sizes many of the statistics were unreliable, and not useful for comparing to other populations’ statistics, such as Asian. A few NHPI statistics have been reliable over the years, such as the high prevalence of diabetes in the NHPI population. But trend data has been hard to come by, because even when an NHPI statistic for a given health condition is reliable one year, it’s generally unreliable or suppressed the next.

Q: So the bottom line here is that NHPIs are in poorer health than the U.S. population as a whole?

AG: That’s suggested here but it’s not really the bottom line. The bottom line here is that the NHPI population differs in many ways from the Asian population, and any analysis that presents combined API statistics will likely only tell the story of the Asian population, since that population is so much larger.

Also, it’s crucial that more work is done using the data file that was just released today. This data source is unprecedented and will allow a much more thorough understanding of the health of the NHPI population. We plan to do more research and we are hopeful that many researchers will do the same.

Q: Why would this population lag behind the rest of the population in certain health indicators?

AG: The data in this report do not address that. Other research has shown that there are socioeconomic differences between the NHPI population and the rest of the population. But our report does not answer this question.

Q: Why is it important to compare this group to single-race Asian adults?

AG: The NHPI population has traditionally been subsumed into the “Asian and Pacific Islander” category. The Asian population is much larger than the NHPI population and the question has been whether API statistics were really telling the story of both the Asian and NHPI population, or just the Asian population.

Of course, even within the Asian population there is variation/heterogeneity, but these results, which show the pattern of differences between the NHPI and Asian populations illustrate the danger of assuming that statistics that describe the Asian population also describe the NHPI population.

QuickStats: Prevalence of Untreated Dental Caries in Primary Teeth Among Children Aged 2–8 Years, by Age Group and Race/Hispanic Origin

March 13, 2017

During 2011–2014, 13.7% of children aged 2–8 years had untreated dental caries in their primary teeth (baby teeth).

The proportion of children with untreated dental caries in their primary teeth increased with age: 10.9% among children aged 2–5 years and 17.4% among children aged 6–8 years.

A larger proportion of Hispanic (19.4%) and non-Hispanic black children (19.3%) had untreated dental caries in primary teeth compared with non-Hispanic white (9.5%) children.


Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015

March 8, 2017

Questions for Anjel Vahratian, Supervisory Statistician (Health) and Lead Author on “Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015

Q: Why did you decide to look at clinical preventive services for cancer and heart disease among insured adults?

AV: Heart disease and cancer are the top two leading causes of death in the United States. The clinical preventive services discussed in this report are recommended for the prevention or early detection of heart disease and cancer. We limited our analysis to insured adults because most insurance plans were required to cover these clinical preventive services without co-payment from the insured adult in 2015.

Q: What did your report find out about cancer screenings among insured adults?

AV: In 2015, two-thirds of insured adults aged 50-75 were screened for colorectal cancer within the recommended intervals, and screening was significantly associated with age for both men and women. Insured women aged 50-59 were more likely to be screened for colorectal cancer compared with men of the same age. Among insured women, more than 8 out of 10 of those aged 21-65 had been screened for cervical cancer, and nearly 3 out of 4 of those aged 50-74 had been screened for breast cancer within the recommended intervals.

Q: What did your report find out about heart disease screenings among insured adults?

AV: In 2015, more than 8 in 10 insured adults aged 18 and over had their blood pressure checked by a doctor or other health professional, and about 2 in 3 overweight and obese insured adults aged 40-70 had a fasting blood test for high blood sugar or diabetes in the past 12 months. Receipt of these services increased with advancing age and varied by sex. Insured women aged 18-39 and 40-64 were more likely than their male peers to have their blood pressure checked in the past 12 months, and insured overweight and obese women aged 40-49 were more likely than men of the same age and BMI to have a fasting blood test or diabetes in the past 12 months.

Q: Was there a specific finding that you found surprising?

AV: It was surprising that only 49.5% of overweight and obese insured men aged 40-49 had a fasting blood test for diabetes in the past 12 months. Diabetic adults are at increased risk of developing cardiovascular disease, and overweight and obesity and abnormal blood glucose are modifiable cardiovascular risk factors.

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

AV: Utilization of clinical preventive services aimed at the early detection of cancer and cardiovascular disease varied by sex and age among insured adults. Insured adults in their 40s and 50s were less likely than those in their 60s to be screened for colorectal cancer, high blood pressure, and diabetes. Limited knowledge about the recommendations for clinical preventive services may prevent eligible adults from seeking out timely preventive care.

QuickStats: Number of Deaths Resulting from Unintentional Carbon Monoxide Poisoning by Month and Year — National Vital Statistics System, United States, 2010–2015

March 6, 2017

During 2010–2015, a total of 2,244 deaths resulted from unintentional carbon monoxide poisoning, with the highest numbers of deaths each year occurring in winter months.

In 2015, a total of 393 deaths resulting from unintentional carbon monoxide poisoning occurred, with 36% of the deaths occurring in December, January, or February.



Prevalence of Low High-density Lipoprotein Cholesterol Among Adults, by Physical Activity: United States, 2011-2014

March 3, 2017

Questions for Marissa L. Zwald, Ph.D., M.P.H., Epidemic Intelligence Service Officer and Lead Author on “Prevalence of Low High-density Lipoprotein Cholesterol Among Adults, by Physical Activity: United States, 2011-2014

Q: Why did you conduct this study?

MZ: We produced this report because we wanted to offer statistics that highlight how regular physical activity can reduce illness from chronic diseases and premature death. In 2008, the Department of Health and Human Services released the Physical Activity Guidelines for Americans. We wanted to provide the most recent national estimates of low high-density lipoprotein (HDL) cholesterol (or serum HDL cholesterol less than 40 mg/dL) by whether or not adults met these national physical activity guidelines, and to understand how these patterns differed by sex, age, race and Hispanic origin, and education level.

Q: What caused you to focus your report on low HDL cholesterol and physical activity?

MZ: HDL cholesterol is known as the “good” cholesterol because having high levels can reduce the risk for cardiovascular disease. We know from previous research that regular physical activity can help increase HDL cholesterol levels.

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

MZ: The differences among some subgroups that we examined were quite striking. Our study confirmed that less active adults were more likely to have low HDL cholesterol. Interestingly, differences in low HDL cholesterol by physical activity were more pronounced in some subgroups we examined, including older adults (aged 60 and over), non-Hispanic whites, non-Hispanic blacks, and college graduates. More in-depth research is needed to explore why the association between physical activity and low HDL cholesterol levels is stronger for some groups than others.

Q: What differences, if any, did you see among race and ethnic groups?

MZ: Among non-Hispanic white and non-Hispanic black adults, low HDL cholesterol prevalence was significantly higher among those who did not meet the physical activity guidelines compared with those who met the guidelines.

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

MZ: I think the take home message of this report is that while sex and age can affect HDL cholesterol levels, there are also lifestyle changes that can improve HDL levels – and this includes being physically active and meeting the national physical activity guidelines.