Health, United States, 2017

September 20, 2018

Renee Gindi, Ph.D., Chief, Analytic Studies Branch, Office of Analysis and Epidemiology

Questions for Renee Gindi, Ph.D., Chief, Analytic Studies Branch, Office of Analysis and Epidemiology, who led production of “Health, United States, 2017

Q: Why did you produce this report?

RG: We produced this report for a number of reasons. Health, United States, 2017 with Special Feature on Mortality is the 41st edition of the Congressionally-mandated annual report on the health of the nation from the Secretary of the Department of Health and Human Services to the President of the United States and to Congress.

This report benefits the public health community and the general public by bringing key national health data from different sources into one location. In this wide-ranging report, users can find graphs, tables, and descriptions of trends and current information on selected measures of health and disease. The Special Feature section of the report more closely examines a topic of public health interest and policy relevance.

Q: What made you decide to focus on deaths in the United States as the Special Feature for this study?

RG: It was the recent decrease in life expectancy at birth that caused us to want to look more deeply into what groups were most affected by this marked change. Life expectancy at birth decreased for the first time since 1993 by 0.2 years between 2014 and 2015 and then decreased another 0.1 years between 2015 and 2016. We found that between 2000 and 2016, death rates for 5 of the 12 leading causes of death increased: unintentional injuries, Alzheimer’s disease, suicide, chronic liver disease, and septicemia.

Q: Was there a finding in this edition of “Health, United States” that you hadn’t expected and that really surprised you?

RG: In addition to the decrease in life expectancy at birth, we found several trends that were particularly noteworthy. Here are a few of them:

  • The increases (and acceleration of those increases) in death rates for specific causes of death in specific age groups:
    • In particular, drug overdose death rates among men aged 25–34 increased by an average of 26.7% per year during 2014-2016. For women aged 15-24, drug overdose death rates increased by an average of 19.4% per year during 2014-2016.
    • The suicide rate among children and young adults aged 15-24 has been increasing since 2006, with a recent increase of 7.0% per year during 2014-2016.
    • The rate of deaths from Alzheimer’s among adults aged 65 and older has also been increasing, by an average of 6.9% per year during 2013-2016.
  • Current cigarette smoking has been decreasing among adults (18+), with declines observed in every age group in recent years.
  • Among adolescents, cigarette smoking in the past 30 days has decreased between 2011 and 2016, but e-cigarette use in the past 30 days has increased more than seven-fold, from 1.5% in 2011 to 11.3% in 2016.
  • The rate of births to teen mothers has been decreasing in recent years among all races and ethnic groups examined.

Q: What is new in the report this year?

RG: There are a couple of new items worth highlighting from this year’s edition of Health, United States. The Special Feature on mortality, with its look at when, why, and where individuals are dying in the United States, is a new focus this year.

Also new this year is the examination of trends in disability and functional limitation using a new data source, the Washington Group Short Set on Functioning (WG-SS). These questions are considered the international standard and replace the questions used to describe disability in previous editions of Health, United States.

Health, United States, 2017 includes information on the functional status of civilian noninstitutionalized adults. Level of difficulty in six basic, universal domains—seeing, hearing, mobility, communication, cognition (remembering or concentrating), and self-care—identify the population with disability, namely those at greater risk than the general population for participation restrictions due to these, if appropriate accommodations are not made. Functional status is summarized using three mutually exclusive categories: “a lot of difficulty” or “cannot do at all/unable to do” in at least one domain; “some difficulty” in at least one domain but no higher level of difficulty in any domain;  and those with “no difficulty” in all domains.

Q: What does this publication tell us about the health of our nation?

RG: This year’s Health, United States publication tells us a lot about the health of our nation. The overall age-adjusted death rate has decreased between 2006 and 2016 by 8%, from 791.8 to 728.8 deaths per 100,000 resident population. However, the majority of deaths (73%) are among persons aged 65 and older. The death rates for nearly all of the leading causes of death in this age group have been decreasing since 2006, including heart disease and cancer, the two leading causes of death in this age group.

However, the death rates in other age groups paint a different picture. Among persons aged 15-24, 25-44 and 45-64, death rates for several causes have been increasing in recent years—including unintentional injuries, suicide, homicide, and chronic liver disease.


Fact or Fiction: Is Undiagnosed diabetes more prevalent among American adults than diabetes that has already been diagnosed by a physician?

September 19, 2018

Source: National Health and Nutrition Examination Survey, 2013-2016

Prevalence of Total, Diagnosed, and Undiagnosed Diabetes Among Adults: United States, 2013-2016

September 19, 2018

Questions for Mark Eberhardt, Health Statistician and Lead Author of “Prevalence of Total, Diagnosed, and Undiagnosed Diabetes Among Adults: United States, 2013-2016

Q: Why did you decide to focus on diabetes in the United States for this report?

ME: The National Health and Nutrition Examination Survey (NHANES) is the only nationally representative survey that can estimate undiagnosed diabetes, since more recent data are available to consider this subject, it was appropriate to present it.

Q: Can you explain the differences between diagnosed and undiagnosed diabetes?

ME: People with diagnosed diabetes are those who report a medical history of diabetes (that is, a health care provider previously told them that they have diabetes). People with undiagnosed diabetes are those who do not report a previous medical history of diabetes, but who have laboratory results from blood specimens obtaining in NHANES which are in the diabetic range, as defined by the American Diabetes Association.

Q: How did the findings vary by sex, age, race and weight?

ME: The percent of adults with diabetes increases with age; a higher percent of men, compared to women, have total diabetes (which includes diagnosed and undiagnosed diabetes); a higher percent of non-Hispanic black and Hispanic adults have diabetes and total diabetes compared to non-Hispanic white adults. The percent of adults with diabetes (diagnosed, undiagnosed, or total diabetes) is higher among those who are overweight or obese.

Q: How did you obtain this data?

ME: The data were obtained in 2013-2016 by NHANES. This is a population-based community health survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). NHANES has staff and mobile examination centers that travel around the US and obtain health-related interview, examination and laboratory information from a nationally representative sample of people in the US.

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

ME: Diabetes remains a serious common health condition among adults in the US, and a substantial percent of adults with diabetes still report not having it.

Fact or Fiction: Do soft drinks account for one-fifth of all beverages consumed by American youth between ages 2 and 19?

September 13, 2018

Sources : National Health and Nutrition Survey, 2013-2016

Beverage Consumption Among Youth in the United States, 2013-2016

September 13, 2018

Kirsten A. Herrick, Ph.D., M.Sc, NCHS Epidemiologist

Questions for Kirsten A. Herrick, Ph.D., M.Sc, Epidemiologist and Lead Author of “Beverage Consumption Among Youth in the United States, 2013-2016

Q: What made you decide to focus on what children in the United States drink for this study?

KH: In a previous report, we described the consumption of sugar-sweetened beverages among youth. This current study looks at beverage consumption in a different way. We are looking at all types of beverages, rather than focusing on only those that contain sugar or calories (energy.) Specifically in this new report, we look at beverage types by amount (grams) rather than by calories.

Q: Was there a finding in your new report that you hadn’t expected and that really surprised you?

KH: While there was nothing in this report that I hadn’t expected to see or that was surprising to me, the data results in this analysis do offer some new perspective. A new contribution from this research is a look at beverage consumption among non-Hispanic Asian youth and how this compares to other race and Hispanic origin groups. A notable finding is that non-Hispanic Asian youth drink more water compared to other groups.

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

KH: We observed quite a few variations among demographic groups in our analysis of what youth in the United States are drinking. One interesting observation was that the contribution of milk and 100% juice to all beverage consumption, decreased with age—while the contribution of water and soft-drinks increased with age. While the types of beverages boys and girls drink are similar, we found that for Asian youth water accounted for the largest share of all beverages consumed compared with other race groups. The amount of beverages consumed as soft drinks was largest for non-Hispanic Black youth compared with other race groups, and the contribution of milk to overall beverage consumption is lowest among non-Hispanic Black youth in America.

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

KH: I think the real take-home message of this report is that beverage consumption is not the same for all U.S. youth. Since beverages contribute to hydration, energy and vitamin and mineral intake, these choices can impact diet quality and total caloric intake. It is very valuable for the U.S. Public Health Community to have this information, which can help guide their important work throughout America. I think it’s valuable information for families to have as well—and for youth in the U.S. to also be aware of the potential impact of these choices.

Q: What type of trend data do you have for U.S. children’s beverage consumption, and how has it changed over time, for example the last 20 years?

KH: While this report did not look at trends, the reason it does not present trends can tell us a lot about beverage consumption analysis over the years. The types of beverages available today are different than 20 years ago or in other years past. So trends wouldn’t strictly be comparing the same things over time.

Plus, this new report isn’t directly comparable with previous reports. For example, in this new Data Brief we looked at soft drinks and defined them as diet and non-diet forms of soda and fruit drinks. So this soft drink category is not equivalent to sugar-sweetened beverages—which has been the focus of some of our earlier analyses. Also, many past reports where we might have looked for trends—were interested in the energy from beverages. But water, an important beverage for hydration, doesn’t have calories, and therefore is often left out of earlier discussions and analyses about beverage consumption. In our new report we looked at total beverage consumption by amount (in grams) so we could include ALL beverages, not just those that contribute to calorie consumption.

Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics -The National Study of Long-Term Care Providers, 2016

September 12, 2018

Jessica Lendon, Health Statistician

Questions for Jessica Lendon, Health Statistician and Lead Author of “Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics -The National Study of Long-Term Care Providers, 2016

Q: Can you describe what an advance directive is?

JL: An advance directive is any written statement that expresses a person’s health care preferences in the event that she or he are unable to make decisions. The types of advance directives include documents that designate a health care decision maker, proxy, or surrogate, do-not-resuscitate orders, physician or medical orders for life-sustaining treatments, and living wills.  Advance directives can be completed by adults at any age and any health status.

Q: Why did you decide to focus on advance directives in the United States?

JL: Advance directives are an important component of care planning for individuals with serious illnesses who require long-term care services and supports or need end-of-life care, which may improve quality and satisfaction with end-of-life care. Advance directives has been examined in many healthcare settings in the United States, but has not yet been studied in adult day services centers (ADSCs).

ADSCs are not federally mandated to provide information about advance directives to users or to maintain documentation, like other long-term care settings. ADSCs are licensed by a variety of requirements at the state level.

Q: How many adult day service centers maintain documentation of advance directives?

JL: An estimated 3,300 (78%) adult day services centers reported that they maintain documentation of advance directives in their participants’ files.

Q: How did the findings vary by region?

JL: A larger percentage of adult day services centers in the Northeast reported that they maintained documentation and had participants with an advance directive, compared to the other regions. The West had the lowest percentage of centers that maintained documentation and prevalence among participants.

Q: Is this the most recent data that you have on this topic and will you be continuing to examine in future data?

JL: Yes. This is the most recent data on advance directives in adult day services centers. My co-authors and I are preparing another report, which will be a more in-depth examination of the relationship between policy, practices, and prevalence of advance directives in adult day services centers in 2016. The 2018 National Study of Long-Term Care Provider’s survey of adult day services centers also includes questions about advance directives, which will be analyzed in the future.

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

JL: The majority of adult day services centers document advance directives, which may be an important part of ensuring individuals’ end-of-life wishes are fulfilled, and only 38% of participants have a documented advance directive.

This report shows policy-relevant differences regarding advance directives, for example, adult day services centers that are Medicaid licensed are more likely to maintain documentation and have a larger percentage of participants with advance directives.

Deaths from Terrorism in the United States: 2001-2016

September 10, 2018

Beginning with data for 2001, NCHS introduced categories *U01-*U03 for classifying and coding deaths due to acts of terrorism. The asterisks before the category codes indicate that they are not part of the International Classification of Diseases, Tenth Revision (ICD-10). Description of the specific 4-digit codes can be found at NCHS Classifications of Diseases, Functioning and Disability: Appendix I. Deaths classified to the terrorism categories are included in the categories for Assault (homicide) and Intentional self-harm (suicide) in the 113 cause-of-death list. Additional information on these new categories can be found at NCHS Classifications of Diseases, Functioning and Disability: Classification of Death and Injury Resulting from Terrorism. Terrorism related deaths in this data do not represent a final count of deaths resulting from the terrorist attacks on September 11, 2001, as this figure had not been determined. As of October 24, 2002, death certificates were issued for 2,957 of the estimated 3,028 individuals believed to have died as a result of the September 11, 2001 attacks. Of these, four were issued for terrorists and are classified as suicides. The criteria for issuing a death certificate for those believed to have died in the attacks differed by state, reflecting differences in state laws regarding death certification. Pennsylvania issued a death certificate for every individual, including the terrorists. Death certificates were not issued for any of the terrorists in Virginia or New York City. Virginia issued a death certificate only for those victims whose remains were identified. New York City issued a death certificate for those whose remains were identified or, if remains were not recovered, for those whose families applied for a death certificate. For more detailed information regarding New York City’s processing of these deaths, see Deaths in World Trade Center Terrorist Attacks—New York City, 2001.

The specific special codes are:  U01.0 (Terrorism involving explosion of marine weapons), U01.1 (Terrorism involving destruction of aircraft), U01.2 (Terrorism involving other explosions and fragments), U01.3 (Terrorism involving fires, conflagration, and hot substances), U01.4 (Terrorism involving firearms), U01.5 (Terrorism involving nuclear weapons), U01.6 (Terrorism involving biological weapons), U01.7 (Terrorism involving chemical weapons), U01.8 (Terrorism, other specified), U01.9 (Terrorism, unspecified), U02 (Sequelae of terrorism), U03.0 (Terrorism involving explosions and fragments), U03.9 (Terrorism by other and unspecified means).

In the subsequent years after 9-11, from 2002 through 2016 (the most recent year for final data), there were 9 deaths in the United States attributed to terrorism.