A new NCHS report presents trends in prepregnancy obesity for 2016 through 2019 by maternal race and Hispanic origin, age, and educational attainment. Trends by state for 2016–2019 and 2019 rates also are shown.
Key Findings:
Prepregnancy obesity in the United States rose from 26.1% in 2016 to 29.0% in 2019 and increased steadily for non-Hispanic white, non-Hispanic black, and Hispanic women.
From 2016 through 2019, prepregnancy obesity increased among women of all ages and was lowest for women under age 20 (20.5% in 2019).
From 2016 through 2019, women with less than a bachelor’s degree were more likely to have prepregnancy obesity than those with a bachelor’s degree or higher, but obesity increased over time among all education levels.
Compared with 2016, prepregnancy obesity rose in every state but Vermont in 2019.
This week, NCHS published the latest “life tables” for the United States, through the year 2018. Life expectancy estimates for 2019 are expected to be released in the coming weeks. The new report, “United States Life Tables 2018,” features a rich collection of historical data, extending back to the beginning of the 20th century, when life expectancy at birth in the U.S. was only 47.3 years (see Table 13). The tables in the report document how life expectancy for the total population has increased over time and is now 78.7 years for the U.S. as a whole.
Over the past 50 years, declines in life expectancy have been relatively rare. However, in the early part of the 20th century, life expectancy was quite volatile, declining 13 times between 1902 and 1928 – including a staggering 11.8 year decline in life expectancy during the height of the influenza pandemic of 1918, in which life expectancy at birth dropped from 50.9 years in 1917 to 39.1 years in 1918. As the pandemic subsided, life expectancy reversed course and increased 15.6 years in 1919 to 54.7 years.
This phenomenal two-year period illustrates that historically, declines in life expectancy can be usually traced to significant health events occurring nationally and globally. During the years of the Great Depression and World War II, for example, there were four years when life expectancy in the U.S. declined. In 1957, as the so-called “Asian Flu” began to take a foothold globally, life expectancy in the U.S. ticked down.
Most often, declines in life expectancy have been only one-year events, before resuming an upward trend. Remarkably, between 1924 and 2018, only once did life expectancy decline for two consecutive years – in 1962 and 1963. In 2015 and 2017, life expectancy at birth declined, but remained unchanged in 2016 and increased slightly in 2018.
Disparities in life expectancy at birth between racial groups have long existed, and continue today. Life expectancy is higher for non-Hispanic whites than for non-Hispanic blacks – a gap of 3.9 years in 2018 (see Table A). At the same time, life expectancy is higher for U.S. Hispanics than for non-Hispanic whites (a gap of 3.2 years). With age, these gaps start to narrow – at age 65 the gap in life expectancy between non-Hispanic whites and non-Hispanic blacks was 1.4 years in 2018, and the gap between Hispanics and non-Hispanic whites was 2.0 years. By age 75, the gap in life expectancy narrowed to 0.3 years between non-Hispanic whites and non-Hispanic blacks, and to 1.7 years between Hispanics and non-Hispanic whites. By age 79, the gap in life expectancy disappears between non-Hispanic whites and non-Hispanic blacks and by age 80, life expectancy is actually slightly higher for non-Hispanic blacks than non-Hispanic whites (9.2 years vs. 9.1 years). The gap in life expectancy between Hispanics and non-Hispanic whites and non-Hispanic blacks remains at least one year throughout the life tables.
Possible explanations for the gap in life expectancy and the reduction in the gap as people age includes the fact that death rates for external or “premature” causes of death are higher among younger non-Hispanic blacks vs. non-Hispanic whites and Hispanics, though there are no data in this particular report on possible reasons for the disparities. Other NCHS reports, however, do address causes of death that contribute to life expectancy.
During 2000–2018, the death rate from septicemia among persons aged 65 years or older generally decreased from 70.8 to 58.7 deaths per 100,000 population.
The death rate was lower in 2018 than in 2000 among persons aged 75–84 years (80.4 compared with 69.4) and among persons aged 85 years or older (215.7 compared with 167.4).
The death rate for persons aged 65–74 was similar in 2000 (31.0) and 2018 (30.0). In each year during 2000–2018, the death rate was highest among persons aged 85 years or older and lowest among persons aged 65–74 years.
From 1999 to 2018, death rates from unintentional falls among persons aged ≥65 years increased among all age groups.
The largest increase occurred among persons aged ≥85 years, from 110.2 per 100,000 in 1999 to 270.5 in 2018.
For persons aged 75–84 years, the rate increased from 31.5 to 63.1, and among those aged 65–74 years, the rate increased from 9.0 to 16.8.
Throughout the period, rates were highest among persons aged ≥85 years, followed by rates among persons aged 75–84 years, and were lowest among persons aged 65–74 years.
Hypertension is a major risk factor for cardiovascular disease, and lowering blood pressure to normal levels has been shown to decrease the incidences of stroke, heart attack, and heart failure. Hypertension was the 13th leading cause of death in the United States in 2018, responsible for nearly 36,000 deaths nationwide. That number has more than doubled since 1999. Death rates from hypertension have increased over 43% in that time. In four states plus D.C., hypertension was the 10th leading cause of death in 2018, and in three states – New York, California and Nebraska – hypertension was the 9th leading cause of death.
There are also major disparities along race/ethnic lines related to hypertension. Death rates from hypertension are twice as high for the non-Hispanic black population as they are for the Hispanic or white population. Other data, captured in a report issued by NCHS this week, shows that the percentage of visits to doctors offices, in which hypertension was diagnosed, is much greater among non-Hispanic black adults than other groups. In over 47% of doctor visits by non-Hispanic black adults there was documented hypertension, compared with approximately 35% of visits for both non-Hispanic white adults and Hispanic adults.
In 2017, the American College of Cardiology and the American Heart Association issued an updated definition of hypertension, lowering the previous threshold levels of 140 over 90 millimetres of mercury to 130 over 80 mmHg. As a result of this change, a greater percentage of people in the U.S. are now categorized as having hypertension. The 2017-2018 National Health and Nutrition Examination Survey (NHANES) documented that over 45% of adults have hypertension, according to the new lower threshold. Over half of men and about 40% of women have hypertension, according to NHANES.
The new definition does not change the disparities along race/ethnic lines – 57% of non-Hispanic black adults have hypertension, according to the new lower threshold, compared with approximately 44% of Hispanic or white adults. Overall, the trend in hypertension prevalence has been shifting: Two decades ago, in 1999-2000, 47% of adults had hypertension. That percentage declined to less than 42% in 2013-2014 – but has increased since that time. And now, there is an even greater urgency to keep hypertension under control, as 2020 provisional data through October show that hypertension contributed to more than one-fifth of all COVID-19 deaths in the U.S.
Q: Why did you decide to research urban-rural differences in visits to office-based physicians by adults with hypertension?
DD: During grad school, I worked on a project with the Baltimore City Health Department where I learned about racial disparities in Hypertensive Disorders of Pregnancy. Black women, and sometimes their babies were dying from this disorder without concrete reasons as to why. Some of the women had never been diagnosed with hypertension or other risk factors but would still develop this disorder. It led us to looking at other causes, such as environmental and residential stressors considering these women live in a unique urban setting. I decided to take this knowledge and look at hypertension in the US population as a whole to see how hypertension differed by urban-rural residences.
Q: Was there a specific finding in the data that surprised you from this report?
DD: It was surprising to see a significantly higher percentage of hypertension in non-Hispanic Black adults in Large metro urban and large metro suburban counties in comparison to non-Hispanic White and Hispanic adults.
Q: How did you obtain this data for this report?
DD: Data are from the 2014–2016 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal, office-based physicians. This data is collected by the National Center for Health Statistics.
Q: Is this the most recent data you have on this topic?
DD: Yes. This is the most recent data we have on this topic.
Q: What is the take home message for this report?
DD: I think the take home message for this report is visits by adults who lived in large metro suburban areas was lower than visits by adults who lived in small-medium metro areas and rural areas. Visits by men with hypertension was higher than visits by women overall, in large metro suburban areas, small medium metro areas, and rural areas. The percentage of visits with hypertension increased with age and was observed in all areas. Lastly, the percentage of visits by non-Hispanic Black adults with hypertension was higher than visits for non-Hispanic White adults and for Hispanic adults. The same pattern was observed in large metro urban and large metro suburban areas.
In 2018, the age-adjusted death rate for Alzheimer disease among adults aged 65 years or older was higher for women (267.9 deaths per 100,000) than for men (191.9).
Among men, non-Hispanic White men had the highest death rate (201.7) compared with non-Hispanic Black (176.8) and Hispanic (168.4) men.
Among women, non-Hispanic White women (285.1) had the highest death rate, followed by non-Hispanic Black (234.7) and Hispanic (218.8) women.
Compared with men, women had higher age-adjusted death rates from Alzheimer disease in all three race and Hispanic-origin groups.
Mortality from leading causes of death in the United States have shown distinct patterns over the years, with shifts in trends depending heavily on which years are being examined. Using a slightly different approach, crude death rates for five selected leading causes of deaths were examined for the past 15 election years, 1960 thru 2016 [provisional data for 2020 are only available for the first quarter (January thru March) of this year]. This short analysis, using mortality data from the National Vital Statistics System and the WONDER database, produced some interesting patterns. Death rates for heart disease, the leading cause of death in the United States, has declined in every election year since 1960 except for three years – 1968, 1980 and 2016. The death rate from cancer, the second leading cause of death in the United States, increased for eight straight election years between 1960 and 1992, but has declined in every election year since then. Death rates from stroke have followed a similar pattern as heart disease, declining every in election year since 1960 except for three years – 1968, 1996 and 2016. Death rates from diabetes declined in four straight election years from 1972 to 1984, but have increased in every election year since then except for one (2008). Finally, death rates from accidents/unintentional injuries increased in each election year from 1960 to 1968, then declined for two straight election years (1972 and 1976), and have increased in all but three election years since then (1984, 1992, and 2000). More significantly, the death rate from accidents/unintentional injuries has been increasing rapidly during this recent period, and was higher in 2016 than in any election year since 1972.
NCHS has a new podcast interview with Bryan Stierman, an epidemic intelligence officer with the CDC’s National Center for Health Statistics. Dr. Stierman works with the NCHS National Health and Nutrition Examination Survey, or NHANES, and he is the lead author on a study on Special Diets among American adults that was released on November 3, 2020.
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