Fact or Fiction – The last time life expectancy in the U.S. declined for two years in a row was 1962 and 1963?December 21, 2017
Q and As on “Mortality in the United States, 2016” and “Drug Overdose Deaths in the United States, 1999-2016”December 21, 2017
Questions for Bob Anderson, Chief of the Mortality Statistics Branch, on the following reports, “Mortality in the United States, 2016” and “Drug Overdose Deaths in the United States, 1999-2016.”
Q: How significant is it that life expectancy¹ in the U.S. has declined two years in a row?
A: This is the first time life expectancy for the U.S. as a whole has declined two years in a row since 1962 and 1963, years in which there were severe flu outbreaks – and an increase in deaths from flu and pneumonia – in the U.S.
Q: Since this is very rare, do we have any idea why this decline in life expectancy has happened again?
A: We first have to look at the leading causes of death and see what is happening there. For 7 out of the 10 leading causes of death in the U.S., mortality actually declined between 2015 and 2016. But mortality from 3 causes of deaths increased. Suicide rates increased 1.5% in 2016, and mortality from Alzheimer’s disease increased 3.1%. However, mortality from accidents/unintentional injuries increased at a rate over three times that the increase of Alzheimer’s disease mortality – a 9.7% increase between 2015 and 2016. And many of these accidental/unintentional deaths were from drug overdoses.
Q: How many deaths in 2016 were attributed to opioids?
A: In 2016, 42,249 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids.
Q: Why is the 63,632 number of overdose deaths smaller than what CDC has previously reported for 2016?
A: The 63,632 number is a final, official number of overdose deaths among U.S. residents for 2016 whereas the previously reported (and slightly higher) numbers were provisional estimates.
BACKGROUND: In August of this year, CDC began calculating monthly provisional data on counts of drug overdose deaths as a rapid response to this public health crisis, in order to provide a more accurate, closer to “real-time” look at what is happening both nationally and at the state level. These monthly totals are provisional counts, and they include all deaths occurring in the U.S. – which include deaths among non-residents (i.e., visitors here on business or leisure, students from abroad, etc). These counts also do not include deaths that are still under investigation. As a result, the monthly numbers are provisional or very preliminary, and the final 2016 number of 63,632 deaths is an official number that only include deaths among U.S. residents and account for any previously unresolved deaths that were under investigation.
Q: In comparing the 2016 numbers with 2015 and past years, is the crisis of drug overdose deaths growing or about the same?
A: From 2015 to 2016, the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths, a 21% increase. Over a longer period of time, from 1999 through 2016, the age-adjusted rate of drug overdose deaths increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 18% per year from 2014 to 2016. So this is a continuing, disturbing upward trend.
Q: Are there any other trends of significance when looking at the types of drugs attributed to overdose deaths?
A: The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, doubled in one year, from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016. In 2016, 30% of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.
Q: Has fentanyl overtaken heroin as a major cause of overdose death?
A: The data brief on drug overdose deaths does not specifically address fentanyl. However the rate of drug overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, doubled between 2015 and 2016. In 2016, the rate of drug overdose deaths involving synthetic opioids other than methadone was 6.2 per 100,000 and the rate of drug overdose deaths involving heroin was 4.9 per 100,000.
Q: There is a lot of stark news in these two reports. Are there any positives to report?
A: As mentioned, mortality from 7 out of the 10 leading causes of death in the U.S. declined in 2016; in fact, the overall mortality rate for the U.S. actually dropped despite the decline in life expectancy. As for drug overdose deaths, the rate of increase in drug overdose deaths involving natural and semi-synthetic opioids, such as oxycodone and hydrocodone, is slowing. From 1999 to 2009, the rate increased on average by 13% per year but from 2009 to 2016, the rate increased by 3% per year. And from 2006 to 2016, the rate of drug overdose deaths involving methadone decreased from 1.8 per 100,000 to 1.0 per 100,000.
The 2015 life expectancy estimate was revised to 78.7 years, down from 78.8 years, which was reported a year ago.
¹BACKGROUND: As a routine matter, for the highest degree of accuracy we blend Medicare data for people ages 66 and over with our vital statistics data to get a final, official estimate of life expectancy. However, the two data sets are released on different schedules and occasionally, as with the 2015 estimates, the Medicare data for that year isn’t available at the time we release our final mortality statistics.
Questions for Tainya C. Clarke, Ph.D., M.P.H., Health Statistician and Lead Author on the “Selected Estimates Based on Data from the January-June 2017 National Health Interview Survey.”
Q: What are some of the findings that you would highlight in this early release report?
TC: More than half (52.9%) of U.S. adults aged 18 and over met the 2008 federal physical activity guidelines for aerobic activity (based on leisure-time activity). This indicates that more adults are engaged in leisure-time physi
cal activity compared with 2015 when they were below the 50% mark (49.0%).
Q: What do the findings in this report tell us about the health of the country overall?
TC: During January–June2017, two in three Americans (66.2%) said they had excellent or very good health. Although, the percentage of persons who had excellent or very good health decreased, from 68.5% in 1997 to 65.9% in2006. Since 2006, the percentage of persons who had excellent or very good health has remained stable.
Q: Are there any trends in this report that Americans should be concerned about?
TC: The prevalence of obesity among U.S. adults 20 years and older increased from 19.4% in 1997 to 31.5% in January–June 2017. Also of note, during this time period, the prevalence of adults who had ever been diagnosed with diabetes has almost doubled (5.1% to 9.8%).
Q: Why did you decide to the look at these 15 key health indicators?
TC: These 15 indicators were chosen over 15 years ago as the most important for the National Health Interview Survey to monitor on a quarterly basis. Other health indicators are monitored in different National Center for Health statistics reports or by other agencies.
Problems Paying Medical Bills Among Persons Under Age 65: Early Release of Estimates From the National Health Interview Survey, 2011-June 2017December 18, 2017
Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Problems Paying Medical Bills Among Persons Under Age 65: Early Release of Estimates From the National Health Interview Survey, 2011-June 2017”
Q: What made you decide to focus on this special topic of Americans having problems paying medical bills?
RC: This report is the seventh in a series of reports looking at Americans having problems paying medical bills, and presents updated estimates using data from the first 6 months of 2017. Financial burden for medical care may put the entire family’s ability to pay medical bills — and its overall financial well-being — at risk. This report serves to continue to monitor the financial burden of health care in the United States.
Q: What do you think is the most significant finding in this study?
RC: Most noteworthy in this new report is the finding that since 2011, 13.2 million fewer persons under age 65 are in families having problems paying medical bills in the past 12 months.
Q: What kind of data do you have for persons who are specifically having problems paying for health insurance premiums and high deductibles in insurance plans?
RC: While this report does not specifically look at the details of persons’ health insurance plans, a report titled “High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates From the National Health Interview Survey, 2016” was published in June 2017, and that report did take a look at some insurance plan details. The June report found that among privately insured adults aged 18-64 with employment-based coverage, those enrolled in a high-deductible health plan (HDHP) were more likely than those enrolled in a traditional plan, to forgo or delay medical care and to be in a family having problems paying medical bills. However, among privately insured adults aged 18-64 with directly purchased coverage, the pattern of results was different: there was no significant difference in financial barriers to health care according to the type of directly purchased plan.
Q: What are the trends among race and ethnicity groups who are having problems paying medical bills this year and compared over time?
RC: All race and ethnicity groups studied in this report saw decreases in the percentage of persons under age 65 who were in families having problems paying medical bills between 2011 and the first 6 months of 2017. Within each year from 2011 through 2017, non-Hispanic Asian persons were the least likely to be in families having problems paying medical bills.
Q: What type of demographics do you examine in this report, and what are those trends for those having problems paying medical bills this year and compared over time?
RC: This report provides trends for persons under age 65 who were in families having problems paying medical bills in the past 12 months from 2011 through the first 6 months of 2017 disaggregated by sex, age, race and ethnicity, health insurance coverage status, poverty status, and out-of-pocket medical expenses. Generally for all measures examined in the report, there has been a decrease in the percentage of persons in families having problems paying medical in the past 12 months between 2011 and the first six months of 2017. For example, among adults aged 18-64, the percentage who were in families having problems paying medical bills decreased from 20.6% in 2011 to 15.6% in the first 6 months of 2017.
Q: What is the take-home message of your report?
RC: I think the take-home message from this research is that among persons under age 65, one in six was in a family having problems paying medical bills in the first 6 months of 2017.
A new Health, United States Spotlight Infographic from the National Center for Health Statistics is now available online. This infographic features data on teenage childbearing, tobacco use, suicide deaths and obesity.
Health, United States Spotlights are infographics of selected health data available in Health, United States, the annual report on the health of the nation sub
mitted by the Secretary of the Department of Health and Human Services to the President and Congress.
Content includes selected indicators on important public health issues from the report’s four subject areas: health status and determinants, utilization of health resources, health care resources, and health care expenditures and payers. Like the report, the Spotlights display the most current data available and, where possible, trends over a ten-year period.
For some indicators, a different set of data years or combined years of data may be shown, depending on survey cycles and design changes. Data sources are identified for each health indicator to enable further exploration and include data systems from both the National Center for Health Statistics and partnering government and private agencies. Changes over time and differences among groups are presented using standard statistical techniques used in Health, United States.
Each Spotlight displays approximately four health indicators allowing users to visualize and interpret complex information from different data systems and Health, United States subject areas. Multiple infographics will be released throughout the year to spotlight important and relevant health data from Health, United States.
For more information on past and present infographics, please visit: https://www.cdc.gov/nchs/hus/hus_infographic.htm.
In 2014, most Americans had a usual place to receive health care (86% of adults and 97% of children). A majority of children and adults listed a doctor’s office as the usual place they received care. In 2014, there were an estimated 885 million office-based physician visits in the United States.
A new NCHS report examines office-based physician visit rates by age and sex. It also examines visit characteristics, including insurance status, reason for visit, and services, by age. Estimates use data from the 2014 National Ambulatory Medical Care Survey (NAMCS).
- In 2014, there were an estimated 282 office-based physician visits per 100 persons.
- The visit rate among females exceeded the rate for males, and the rates for both infants and older adults exceeded the rates for those aged 1–64 years.
- Compared with other age groups, a higher percentage of visits by adults aged 18–64 indicated no insurance.
- A larger percentage of visits by children under age 18 years were for either preventive care or a new problem, compared with adults aged 18 and over.
- Compared with children, a larger percentage of visits by adults included a laboratory test, imaging service, or a procedure being ordered or provided.