Cigarette Smoking During Pregnancy: United States, 2016

February 28, 2018

Questions for Patrick Drake, Health Statistician and Lead Author of “Cigarette Smoking During Pregnancy: United States, 2016.”

Q: Why did you decide to examine smoking during pregnancy?

PD: Questions on tobacco use during pregnancy were first introduced on the US certificate of live birth in 2003, but not all states reported that information until 2016. NCHS’s 2016 natality file provides the first look at nationally representative rates of smoking during pregnancy in the United States from vital statistics data.


Q: Has the National Vital Statistics System ever examined cigarette smoking during pregnancy in the past?

PD: NCHS produced a report on the topic using data from the National Vital Statistics System in 2016. That report presents levels of smoking during pregnancy as well as smoking cessation rates in 46 states and the District of Columbia for 2014.


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

PD: Smoking rates varied widely by state, maternal age, race and Hispanic origin, and by maternal education:

  • Women in West Virginia smoked during pregnancy about five times as often as women in the States with the lowest smoking rates.
  • Non-Hispanic white women smoked during pregnancy nearly six times as often as Hispanic women, and nearly twice as often as non-Hispanic black women.
  • While less than 1.0% of women with a bachelor’s degree or higher smoked during pregnancy, 12.2% of women with a high school diploma or GED smoked during pregnancy.

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

PD: It has been well established that maternal tobacco use during pregnancy is linked to a host of negative infant and child outcomes.  Despite the well-understood risk to mother and child, still about one of every 14 women in the United States smoked during pregnancy. These levels do vary widely by state, maternal age, race and Hispanic origin, and education, but any amount of smoking during pregnancy is too much. These data can be used to better identify which women might be at greater risk of smoking during pregnancy and better inform future preventative strategies.

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QuickStats: Age-Adjusted Percentage of Adults Aged 65 Years or Older Who Had an Influenza Vaccine in the Past 12 Months, by Poverty Status — National Health Interview Survey, United States, 1999–2001 and 2014–2016

February 26, 2018

During 2014–2016, 69.2% of all older adults, aged 65 years or older, had received an influenza vaccine in the past 12 months.

The percentage of older adults with family income ≥200% poverty level who had received an influenza vaccine in the past 12 months significantly increased from 67.9% during 1999–2001 to 72.2% during 2014–2016.

During the same period, the changes from 55.7% to 60.8% among those at the <100% poverty level and from 60.3% to 62.9% for those at the 100% to <200% poverty level were not statistically significant.

During both periods, older adults with income ≥200% poverty level were significantly more likely to receive an influenza vaccine compared with those with lower family income.

Source: National Health Interview Survey, 1999–2016

https://www.cdc.gov/mmwr/volumes/67/wr/mm6707a8.htm


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2017

February 22, 2018

A new NCHS report provides updated health insurance estimates from selected states using 2017 National Health Interview Survey data.

  • In the first 9 months of 2017, 28.9 million (9.0%) persons of all ages were uninsured at the time of interview—not significantly different from 2016, but 19.7 million fewer persons than in 2010.
  • In the first 9 months of 2017, among adults aged 18–64, 12.7% were uninsured at the time of interview, 19.5% had public coverage, and 69.3% had private health insurance coverage.
  • In the first 9 months of 2017, among children aged 0–17 years, 4.9% were uninsured, 41.9% had public coverage, and 54.6% had private health insurance coverage.
  • Among adults aged 18–64, 69.3% (136.5 million) were covered by private health insurance plans at the time of interview in the first 9 months of 2017. This includes 4.4% (8.6 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
  • The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan (HDHP) increased, from 39.4% in 2016 to 43.2% in the first 9 months of 2017.

2015 Restricted-Use Linked Mortality Files

February 21, 2018

NCHS survey data have been linked to the National Death Index data containing information on mortality status, date of death, and cause of death.  These data can be accessed in the NCHS Research Data Center (RDC) or at a federal statistical RDC managed by the U.S. Census Bureau.

The restricted-use Linked Mortality File (LMF) has been updated with mortality follow-up data through December 31, 2015  https://go.usa.gov/xnMTW


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.


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.