QuickStats: Age-Adjusted Percentage of Adults Aged 18 Years or Older Reporting Diabetic Retinopathy Among Those with Prediabetes or Diagnosed Diabetes by Age Group

May 31, 2019

During 2016–2017, adults aged 18–64 years with type 1 diabetes were more likely to have ever had diabetic retinopathy than adults with type 2 diabetes (23.8% compared with 5%).

Adults aged 65 years or older with type 1 diabetes were also more likely to have ever had diabetic retinopathy than adults with type 2 diabetes (24.6% compared with 8.7%).

For both age groups, among those with prediabetes, the prevalence of diabetic retinopathy was 0.6%.

Source: National Health Interview Survey, 2016–2017. https://www.cdc.gov/nchs/nhis.htm.


Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016

May 31, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.”

Q: Why did you decide to focus on opioids prescribed at discharge or given during emergency department visits in the United States for this report?

AR:

Prescription opioid abuse and overdose continue to be critical public health issues. Opioid misuse, abuse, and overdose are affected by multiple factors including the number of people exposed. The Emergency Department (ED) is one setting where people could become exposed to opioids. In 2016, 27.5% of adult ED visits included opioids given in the ED, prescribed at ED discharge, or both (data not shown in report). The ED setting is where people frequently receive their first opioid treatment, after which patients with moderate to severe pain are often sent home with a prescription for an opioid, leaving them with the option of filling/not filling the prescription, or diverting filled prescriptions.

In the National Hospital Ambulatory Medical Care Survey (NHAMCS), information is collected on whether drugs are given during the ED visit, prescribed at discharge, or both.  However, in our published reports, the focus is on estimates of drugs and visits with drugs rather than how they are administered.  I wanted to assess visits with opioids prescribed at discharge separately to see how they compared with those given in the ED, in order to glean new information that has not previously been reported.  This could hopefully provide additional insight into patient populations visiting the ED who are exposed to opioids.


Q: How do rates of visits with opioids only given in the ED compare with opioids only prescribed at discharge and visits with both given and prescribed opioids?

AR: Generally, the rate of ED visits with opioids given during the visit was higher than the rate of ED visits with opioids prescribed at discharge.  Compared with the rate of ED visits with opioids prescribed at discharge, the rate where opioids were only given in the ED was higher among patients aged 45 and over and for both women and men.  Adults aged 18-44 were more likely to receive a prescription for an opioid at discharge compared with adults 45 and over.


Q: How did the data vary by emergency department visits where opioids were given, prescribed or both by primary diagnosis?

AR: The type of opioid administration among ED visits where opioids were given, prescribed, or both varied for certain selected diagnoses. For visits with a primary diagnosis of injury or trauma with opioids given or prescribed, the percentage with opioids only prescribed at discharge (40.7%) was higher than both the percentage of visits with opioids only given at the ED visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7). Conversely, at visits for chest pain and abdominal pain with opioids given and/or prescribed, a higher percentage of opioids were only given at the ED visit. There was no variation across the types of opioid administration for back pain and extremity pain.


Q: Was there a specific finding in your report that surprised you?

AR:I was surprised at the high percentages of visits with opioids prescribed at discharge compared with those only given in the ED for certain diagnoses.  For example, among visits with a primary diagnosis of injury or trauma and where opioids were given or prescribed, a total of 73.4% included an opioid prescription at discharge.  Among visits primarily for extremity pain and where opioids were given or prescribed, 67.9% included an opioid prescription at discharge. Finally, among visits primarily for back pain in which opioids were given or prescribed, 64.5% included an opioid prescription at discharge. However I should also note that these estimates are based only on visits where the patient got opioids during the visit or at discharge.  For example, there are other ED visits made for injury where the patient did not get opioids at all, but we did not assess this in the report.


Q: Do you foresee the number of prescription opioids at emergency department visits increasing in the future?

AR: We do not make predictions about future data trends, but other research published by CDC for recent years showed stable or declining trends in the percentage of visits with opioids given in the ED, prescribed at discharge, or both.


Dental Care Among Adults Aged 65 Years and Over, 2017

May 29, 2019

Questions for Lead Author Ellen Kramarow, Health Statistician, of “Dental Care Among Adults Aged 65 Years and Over, 2017.”

Q: Why focus on dental care among adults aged 65 years or older in the United States?

EK: Dental care is often overlooked as people age, but it is an important component of overall health care. Chronic diseases such as diabetes and osteoporosis, which are common among older persons, can affect oral health; in addition, having poor oral health may contribute to some chronic conditions and impact nutrition. Routine dental care is not covered under fee-for-service Medicare, so older adults may have trouble accessing appropriate dental care.


Q: What are the main findings on dental insurance, dental visits, and unmet dental care due to cost?

EK: In 2017, among adults aged 65 and over, 29.2% had dental insurance; 65.6% had a dental visit in the past 12 months; and 7.7% had an unmet need for dental care due to cost.

No statistically significant differences by sex were observed in any of these dental care indicators. Adults aged 65–74 were more likely to have dental insurance, to have visited the dentist in the past 12 months, and to have unmet need for dental care due to cost compared with adults over age 75.

Poor older adults were less likely to have dental insurance and to have visited the dentist, and more likely to have an unmet need for dental care due to cost compared with not-poor older adults.


Q: Are there any reasons why more U.S. adults aged 65 years or older don’t have dental insurance?

EK: Most older adults have access to health insurance through Medicare, which does not cover routine dental care.  Older adults who do have dental insurance may have obtained it through purchase of a separate dental plan, through retiree health benefits, through a Medicare Advantage plan, or through Medicaid.


Q: Was there a specific finding in your report that surprised you?

EK: Only 30.3% of older adults who were edentate (had no natural teeth) had a dental visit in the past 12 months, compared with 73.6% who had at least some natural teeth.  Even edentate adults need dental care to help maintain good oral health.


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

EK: Many older adults do not receive dental care, and access to dental care varies by age, poverty status, and race and Hispanic origin.


Quickstats: Rates of Injury from Sports, Recreation, and Leisure Activities Among Children and Adolescents Aged 1–17 Years, by Age Group — National Health Interview Survey, United States, 2015–2017

May 24, 2019

In 2015–2017, the rate of sports, recreation, and leisure injuries among children and adolescents aged 1–17 years was 82.9 per 1,000 population.

The rate of sports, recreation, and leisure injuries increased with age from 48.4 for those aged 1–4 years, to 72.7 for those aged 5–11 years, and to 117.1 for those aged 12–17 years.

Source: National Health Interview Survey, 2015–2017.

https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a6.htm


Trends in Cancer and Heart Disease Death Rates Among Adults Aged 45–64: United States, 1999–2017

May 22, 2019

Questions for Sally Curtin, M.A., Statistician, and Lead Author of “Trends in Cancer and Heart Disease Death Rates Among Adults Aged 45–64: United States, 1999–2017.”

Q:  Why are death rates from cancer dropping steadily over time and why are death rates from heart disease starting to rise?

SC: The death rates are a reflection of a few things—the prevalence of a disease, how often is occurs in the population, as well as its treatment and survival.  As this is purely a statistical analysis, others can speak to the trends in these factors.


Q:  You write that cancer treatments might contribute to subsequent heart disease for patients and might help explain the increase in heart disease mortality.  Which cancer treatments are contributing to this subsequent heart disease among cancer patients?

SC: The cardiotoxicity of cancer treatments is just one way that these two seemingly disparate diseases are related.  It is well known in the medical community that radiation and many chemotherapies can increase the risk of subsequent heart disease. In our analysis, we didn’t examine which treatments might be contributing to heart disease risk.


Q:  Which groups are seeing the biggest decline in cancer death rates?

SC: Non-hispanic black men, who have the highest cancer death rates, also had the largest percentage decline over the period at 34%.  In general, the percentage declines were greater for men than for women.


Q:  Which groups are seeing the biggest increase in heart disease death rates?

SC: Non-hispanic white women had a 12% increase since 2009 in heart disease death rates, the greatest of all groups.  In total, middle-aged women had a 7% recent increase compared with 3% for middle-aged men.  Another interesting finding is that Hispanic women, who had the lowest heart disease death rates of all groups, had a 37% decline over the period, the only group to experience a decline over the entire period.


Q:  Does this analysis suggest that cancer will not overtake heart disease as the leading cause of death in the U.S., which many have been predicting?

SC:  The focus of this report was on the middle-age population, and Cancer is the leading cause of death in the 45-64 year old population as shown in this report, whereas heart disease remains the leading cause in the total population.  While we do not make predictions about what data trends will look like in the future, it is safe to say that if the recent upturn in heart disease continues, it is unlikely that this switch will occur anytime soon.

 


Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

May 22, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of “Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

Q: Why did you decide to do a report on strategies used to reduce prescription drug costs in the United States?

RC: Although most adults aged 65 and over have prescription drug coverage through either Medicare Part D or some other source such as private health insurance Medicaid, or VA coverage, previous data indicate that some older adults may still use strategies to reduce prescription drug costs including not taking medication as prescribed or asking their doctor for a lower cost medication.


Q: Do you have data that directly corresponds with this report that goes back further than 2016-2017?

RC: We previously examined this topic using the 2013 National Health Interview Survey. However, this previous report was not solely focused on adults aged 65 and over.


Q: How did the data vary by age, sex and insurance coverage?

RC: In 2016–2017, among U.S. adults aged 65 and over who were prescribed medication in the past 12 months, the percentage who did not take their medication as prescribed or asked their doctor for a lower-cost medication to reduce their prescription drug costs varied by sex, age, insurance status, and poverty status. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.


Q: Was there a specific finding in your report that you did not expect?

RC: No, the findings in this report were similar to those previously published with earlier data. However in this report we were able to expand on previous research by focus on adults aged 65 and over and examine differences by sex, age group, health insurance status, and poverty status.


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

RC: Among adults aged 65 and over who were prescribed medication in the past 12 months, 4.8% did not take their medication as prescribed to reduce their prescription drug costs, and 17.7% asked their doctor for a lower-cost medication. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.

 


Melanoma Deaths Down Four Years in a Row in 2017

May 15, 2019

SKIN_CANC2

Source:  National Vital Statistics System, CDC WONDER, 1999-2017 (http://wonder.cdc.gov).  This chart represents the number of deaths from ICD-10 code C 43 “Malignant melanoma of the skin”