QuickStats: Percentage of Persons Who Had a Stomach or Intestinal Illness That Started in the Past 2 Weeks by Sex and Age Group

January 31, 2020

In 2018, 4.7% of males and 5.3% of females had a stomach illness that started in the past 2 weeks.

Among children and adolescents aged 0–17 years, no difference was observed in the percentage of males and females who had a stomach illness that started in the past 2 weeks. However, among adults, women were more likely to have had a stomach illness than men.

This held for those aged 18–64 years (5.3% of women compared with 4.5% of men) and those aged 65 years or older (5.8% versus 4.2%).

Source: National Health Interview Survey, 2018 data. https://www.cdc.gov/nchs/nhis.htm.


Q & A: New Release of 2018 Mortality Data and New Data on Maternal Mortality

January 30, 2020



Robert Anderson is Chief of the Mortality Statistics Branch at NCHS. Dr. Anderson joined me to discuss the new release of 2018 mortality data as well as the new data on maternal mortality in the United States:

Q:           Before we get into the subject of maternal mortality, there are a number of other mortality topics in this release that are significant. Let’s start with life expectancy.

RA:         So as I’m sure you’re aware, life expectancy has, we’ve experienced a decline in life expectancy over the last few years. Since 2014, life expectancy declined 2 out of 3 years through 2017, and from 2017 to 2018, though, we saw a slight increase, so it appears that that trend is reversed.

Q:           Do we know what causes of death contributed to this increase in life expectancy?

RA:         Yeah we do – we did an analysis of the causes of death that contributed to that change and the main causes that are contributing to the increase in life expectancy are declines in cancer mortality and declines in unintentional injuries and in most instances that involves drug overdoses – so a slight decline in the rate for drug overdose.

Q:           How much of that impact you think was due to the decline in drug overdoses?

RA:         It probably accounts for about 15% of the decline – it’s not a whole lot.

Q:           Can you talk about which drugs we’re making progress on as far as overdose deaths and which are now emerging as the biggest threat to the country?

RA:         So, between 2017-2018 in particular we saw declines in the natural and semi synthetic opioids which are drugs that are commonly available by prescription – like oxycodone and hydrocodone. We saw declines in methadone overdose. And we also saw declines, a slight decline, in overdose deaths due to heroin. But the synthetic opioids, other than methadone, seem to be a continuing problem – the overdose death rate for the synthetic opioids other than methadone continued to increase from 2017 to 2018.

Q:           So just to be clear – these synthetic opioids we’re talking about are fentanyl?

RA:         Fentanyl and tramadol – a very large proportion of those deaths involve fentanyl.

Q:           Now, pivoting to maternal mortality. With maternal mortality there’s a whole back story – can you share that with us?

RA:         Yeah, it’s sort of a long and involved process that we’ve gone through over the last decade and a half or so. So in the past, as we’ve collected data on maternal deaths – and here we’re talking about years prior to 2003 in particular – research had shown that we tended to underestimate maternal deaths. And so in order to address that issue, we felt that adding a checkbox item to the death certificate asking whether the decedent was pregnant or recently pregnant was a good idea. And so we revised our standard death certificate – this is the standard that the states use to base their own state death certificates on – we revised that to include this checkbox item. So that was implemented in 2003 but only in a few states. Unfortunately, not all states implemented at the same time and so over the next, well, decade and a half – a little bit more than that actually – we had states implementing gradually this checkbox item and as a result that we saw increases in maternal mortality. And it got to the point that in 2007, we decided that we couldn’t adequately interpret what was going on and so we stopped reporting maternal mortality altogether, waiting for all of the states to get onto the standard certificate at which point we planned to resume. So the final state implemented the checkbox item in mid-year 2017, so 2018 is the first data year for which we have data from all states that is based on that checkbox. So we decided we needed to do an evaluation though, of the data because research post 2003 showed that there were some problems with the checkbox – some errors that were evident. And so we did this evaluation and we found indeed there were some problems and so we had to come up with a new method to code maternal mortality that would mitigate those errors. So with the 2018 data we’re now releasing a figure that we believe reasonably represents the risk of maternal mortality in the United States.

RA:         We’re releasing data for 2018 and it’s based on this new coding method. We will be releasing some data for previous years as well, coded in multiple ways. Our goal is to make the data as transparent as possible so that the researchers can see what we did and what went into the new coding method and, you know, what went into the statistics that we’re releasing. But also, you know, if they choose to make some different decisions in their research they would be able to do that as well – they’ll be able to count them however they like.

Q:           So how many maternal deaths are we seeing in the U.S. according to 2018 data?

RA:         In 2018, we found 658 maternal deaths for the United States – it’s a rate of 17.4 deaths for every 100,000 live births.

Q:           Can we say that the maternal mortality deaths and the maternal mortality rate increased over time?

RA:         Well, we can’t really say that with any sort of certainty. We do know that the increases that we’ve seen compared to the older data that we released, the increases that we’ve seen are largely – mostly even – due to implementation of the checkbox. They don’t appear to be real increases.

RA:         We did an analysis based on 2015 and 2016 data. The purpose of that particular analysis was to look at the effect of the checkbox on maternal mortality and what we found was that there was a dramatic increase in the number of maternal deaths detected as a result of using the checkbox. And we also found that that increased very dramatically by age, so at the older ages, the checkbox increased the number of maternal deaths detected by quite a lot

Q:           So the checkbox you feel then is giving a clearer picture of what the scope of the problem is?

RA:         I wish I could say that was the case – we feel like it is definitely allowing us to detect maternal deaths that we weren’t able to detect before. That said, we know that there are some errors in the checkbox and we’re not entirely sure why these errors are occurring. This is something that we’re going to be exploring over the course of the next year. We’re trying to sort that out so we can actually correct it. But the effect of these errors on the checkbox is that we are finding deaths to women who were not pregnant but for whom that the checkbox was checked that they were pregnant. And some of these women are quite old actually – beyond reproductive age.

Q:           So when did you start uncovering those problems along this process?

RA:         Well, we didn’t actually discover this. There were some states that were doing their own research on this – the state of Texas, for example, did some important research and they found errors. CDC’s Division of Reproductive Health did some work with four states recently, that they recently published, that showed that this was the case as well. And so we were really taking the results of that research, along with our own evaluation, to determine what was going on.

Q:           What else have you found – are there any geographic patterns that suggest maternal deaths are more prevalent in certain parts of the country?

RA:         Well, we can’t really say much about maternal mortality by state or by region. Unfortunately, we really don’t understand very well the variation in data quality from state to state and in addition you’re talking about 658 deaths in a year spread over 50 states. The numbers get quite small and it’s difficult to make judgments based on small numbers – the death rates, mortality rates, get to be very unstable with small numbers.

Q:           So some have been saying or arguing that the problem has been getting worse over time, that even now we don’t have a complete picture. What would you say to that?

RA:         Well, I would agree that we don’t have a complete picture. The evidence that we’re seeing suggests that the problem isn’t really getting worse, but it doesn’t appear to be getting better either. And that’s, uh, that’s something to be concerned about. We have data from maternal mortality back to 1915 and we saw substantial declines – they’re really dramatic declines, we’ve seen dramatic decline since then and in recent decades the rate has been rather flat in comparison.

Q:           So one of these new reports looks at a 20 year period prior to the 2018 data. Could you talk about that?

RA:         Sure. As part of our evaluation we did this initial study based on the 2015 and 2016 data to get a sense of the impact of the checkbox and that was based on actual data that we had, we recoded not using the checkbox and then compared it to what we had with the checkbox. This other study was a little more involved and involves some statistical modeling, and so what we wanted to do with that study was to get a sense for what things would have looked like had all of the states implemented in 2003. So that was the goal and so we have this trend based on these statistical modeling procedures that shows a fairly stable trend .

Q:           The second report was more focused on the years 2015 and 2016 – can you talk about that work?

RA:         Sure. Yeah, the report based on the data years 2015 and 2016 is really an evaluation of the effect of the checkbox. And those years were chosen because those were years for which we had data coded without the checkbox. So we took these data, assuming no checkbox existed, and then we compared that with the data that we had that included the checkbox to get a sense for, to evaluate the effect of the checkbox on the maternal mortality.

Q:           Looking forward, are there any more initiatives underway in terms of improving this whole process and the quality of the data?

RA:         Yeah, there’s a lot of, a lot more work to do, really. I mean, we have to understand better why these errors are occurring in the checkbox. It may have something to do with electronic registration systems in the way they’re configured. We’re not really sure, but what we really need to understand if we’re going to correct these errors – we really need to understand why they are occurring and so that’s something that we’ll be working on over the course of the next year. In addition, we need to work with states and our plan is to do this, to work with states to investigate deaths to women of reproductive age to determine if a pregnancy or recent pregnancy was a factor in their death and this is this can be done using some data linkage to look in birth records and fetal death records for evidence of a pregnancy. I think we can glean a lot of information if we just, you know, take the time and effort to go and look and see. What we have to do is, we have to work with the states to do this because they are the keeper of those records. They’re the ones that will have to do it and if we can support them in those efforts then hopefully we can get information that will feed back into the vital statistics system and provide us with better data in the future.

Q:           Robert Anderson thank you for joining us.

Over 900 Americans Have Died in Helicopter Crashes Since 1999

January 27, 2020

The death of former NBA superstar Kobe Bryant has put a public spotlight on air transportation safety.  Vital Statistics obtained from the public online WONDER database show that 940 Americans were killed in helicopter crashes between 1999 and 2017, with the death toll ranging from a high mark of 79 deaths in 2003 to a low mark of 26 deaths in 2015, the year before Bryant retired from professional basketball.  SOURCE:  National Vital Statistics System, ICD-10 code V95.0, http://wonder.cdc.gov

Demographic, Health Care, and Fertility-Related Characteristics of Adults Aged 18-44 Who Have Ever Been in Foster Care: United States, 2011-2017

January 22, 2020

Questions for Colleen Nugent, Health Statistician and Lead Author of “Demographic, Health Care, and Fertility-Related Characteristics of Adults Aged 18-44 Who Have Ever Been in Foster Care: United States, 2011-2017,”

Q: Why did you decide to do a report on adults who have ever been in foster care?

CN: The National Survey of Family Growth is one of the few U.S. nationally representative surveys that collects information on having ever been in foster care during childhood from adult respondents across the full reproductive age span.  Combining that with other content specific to the NSFG provides a rare opportunity to get nationally representative estimates on how outcomes related to health service access and use and fertility related milestones might differ between those who had ever been in foster care and those who had not.

Q: How did the data vary by adults who have ever been in foster care?

CN: Women and men who had been in foster care had lower levels of educational attainment, had higher percentages receiving public assistance in the past year, and were less likely to be currently working or attending school than adults who had never been in foster care.  Those who had been in foster care were less likely to have private health insurance, were more likely to experience time without health insurance in the past year, and were less likely to use a private doctor’s office as their usual place of care.  Adults ever in foster care also had higher probabilities of first sexual intercourse and first births at younger ages than those never in foster care.

Q: Was there a specific finding in the data that surprised you?

CN: Although those who had never been in foster care were more likely to have completed a bachelor’s degree or higher than those who had ever been in foster care, the rates of those completing some college were actually more similar for both groups.

Q: What were some of the limitations when interpreting the data?

CN: There are several limitations.  One is that we didn’t have information on what ages respondents were in foster care, how long ago they exited, and what types of foster care settings they were in—whether those were relative or nonrelative family foster homes, group homes, or institutional settings. Differences in outcomes could vary by the timing of foster care in a child’s development, and also by the type of foster care setting.  Another is that these analyses are bivariate and cross-sectional and cannot be used to assess causation. This means that outcomes may not be due solely to foster care itself and may be linked with characteristics of those entering foster care that preceded their experience in the system.

Q: Will you have an update to this report in the future?

CN: The number of respondents who have ever been in foster care is relatively small in our survey and we needed to combine data over several file releases to be able to produce reliable estimates. If we update this report in the future, it will require waiting for several more data releases that we can combine to have a large enough sample of respondents ever in foster care.

QuickStats: Percentage of Emergency Department Visits for Pain at Which Opioids Were Given or Prescribed, by Geographic Region of the Hospital — United States, 2005–2017

January 17, 2020

The percentage of emergency department visits for pain at which an opioid was given or prescribed increased from 37.4% in 2005 to 43.1% in 2010 and then decreased to 30.9% in 2017.

A similar pattern was observed in all four regions. Percentages for the Northeast were lower than for the nation as a whole for all years analyzed.

In 2017, the percentage was 21.1% in the Northeast, compared with 32.0% in the Midwest, 32.0% in the South, and 34.7% in the West.

Source: National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey, 2005–2017. https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.

QuickStats: Expected Number of Births over a Woman’s Lifetime — National Vital Statistics System, United States, 1940–2018

January 10, 2020

During 1940–2018, the expected number of births a woman would have over her lifetime, the total fertility rate (TFR), was highest for women during the post-World War II baby boom (births during 1946–1964). In 1957, the TFR reached a peak of 3.77 births per woman.

The TFR generally declined for the birth cohort referred to as Generation X from 2.91 in 1965 to 1.84 in 1980.

For the birth cohorts referred to as Millennials (Generation Y) and Generation Z, the TFR first increased to 2.08 in 1990 and then remained generally stable until it began to decline in 2007.

By 2018, the expected number of births per women fell to 1.73, a record low for the nation. Except for 2006 and 2007, the TFR has been below the level needed for a generation to replace itself (2.10 births per woman) since 1971.

Source: National Vital Statistics System. Birth data, 1940–2018. https://www.cdc.gov/nchs/nvss/births.htm.


Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017

January 8, 2020

Questions for Lead Author Anna Rui, Health Statistician, of “Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017.”

Q: Why did you decide to look at opioid prescribing at emergency department discharges?

AR: There is a large body of research reporting increases in opioid prescription rates from 1999 to 2010 but less is known about how rates have changed from 2010 on, particularly in the emergency department setting, where many patients present with pain symptoms and are likely to receive opioids for treatment. In response to the opioid epidemic, hundreds of local, state, and federal programs were implemented in recent years with the goal of changing prescribing practices. A goal of this report was to evaluate recent trends in opioid prescribing, in order to monitor the effects of public health policy.

Q: How did the data vary by patient/hospital characteristics and in the type of opioids prescribed at discharge?

AR: Variation in the rate of change was found for age, patient residence, and primary expected source of payment. The rate of decrease in the percentage of visits with an opioid prescribed at discharge by younger patients aged 18-44 from both the beginning of the study period (2006-2007) and from the inflection point (2010-2011) to the end of the study period (2016-2017) was the highest across all age groups. Similarly, the percentage of visits by patients living in medium or small metropolitan counties decreased by the highest percentage across the study period among all urban and rural categories. Both Medicaid and self-pay/no charge/charity experienced the highest rate of decrease from 2010-2011 through 2016-2017 whereas the percentage of visits by patients with Medicare that included an opioid prescribed at discharge remained stable across the study period.

In terms of hospital characteristics, among the four regions, the largest decrease in opioids prescribed at discharge from 2006-2007 to 2016-2017 was observed in the Northeast region. Generally, a higher percentage of visits at proprietary (or for-profit) hospital EDs, compared with nonprofit and government hospital EDs, included an opioid prescribed at discharge. Despite the high percentage, the rate of decrease among visits made to proprietary hospital EDs from 2006-2007 through 2016-2017 was modest.

In terms of the type of opioids prescribed, the percentage of opioid mentions with acetaminophen-hydrocodone (e.g., Vicodin) prescribed remained stable through 2012-2013 and decreased starting from 2014-2015. Corresponding to this decrease, the percentage of opioid mentions with tramadol and acetaminophen-codeine, which are known as having a lesser risk of dependence, increased starting in 2014-2015 and continued through 2016-2017.

Q: Was there a specific finding in the data that surprised you?

AR: One finding that surprised me was the magnitude of decrease in the percentage of opioids prescribed from 2010-2011 through 2016-2017 for most of the pain-related diagnoses. For example, the percentage of visits for extremity and back pain decreased by 68.8% and 49.1%, respectively, between 2010-2011 and 2016-2017.

Q: How did you obtain this data for this report?

AR: Restricted data (available from the Research Data Center) collected from the National Hospital Ambulatory Medical Care Survey were used for this report. Masked public use data are available for download from the Ambulatory Health Care Data website (https://www.cdc.gov/nchs/ahcd/datasets_documentation_related.htm)

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

AR: I think the take home message of the report is recent trends show a decrease in the percentage of visits with opioids prescribed at discharge from 2010-2011 through 2016-2017, and this trend was observed for most of the patient and hospital characteristics examined, as well as for most of the pain-related diagnoses prompting the ED visit.

Human Papillomavirus Vaccination Among Adults Aged 18−26, 2013−2018

January 7, 2020

A new NCHS report describes trends in self-reported HPV vaccination initiation and completion by selected demographic characteristics among adults aged 18−26.

  • Among adults aged 18−26, the percentage who ever received one or more doses of human papillomavirus (HPV) vaccine increased from 22.1% in 2013 to 39.9% in 2018.
  • The percentage of adults aged 18−26 who received the recommended number of doses of HPV vaccine increased from 13.8% in 2013 to 21.5% in 2018.
  • In 2018, non-Hispanic white adults were more likely than Hispanic adults to have ever received one or more doses of HPV vaccine.
  • Among adults aged 18−26 who ever received one or more doses of HPV vaccine, the majority received the first dose between the ages of 13 and 17 years.

QuickStats: Percentage of Adults Aged 18 Years or Older Who Had Lower Back Pain in the Past 3 Months, by Sex and Age Group

January 3, 2020

In 2018, 28.0% of men and 31.6% of women aged 18 years or older had lower back pain in the past 3 months.

The percentage of women who had lower back pain increased as age increased.

Among men, the percentage increased with age through age 74 years and then decreased.

Women in the age groups 18–44, 45–64, and 75 years or older were more likely to have lower back pain in the past 3 months than were men in the same age groups, but percentages were similar between men and women in the age group 65–74 years.

Source: National Health Interview Survey, 2018. https://www.cdc.gov/nchs/nhis/index.htm.