PODCAST: Infant Mortality Trends in Appalachia and the Delta

May 28, 2021


podcast-iconHOST:  This week NCHS has released a new report looking at infant mortality trends in two distinct regions of the country: Appalachia and the Delta.  Joining us is the lead author of that report, Anne Driscoll, of the Reproductive Statistics Branch at NCHS.

HOST:  Why did you decide to focus on these regions of the country?

ANNE DRISCOLL:  Well both of these regions, at least the names, people are familiar with and the general locations.  And they have very distinct cultures and histories compared to other regions of the country.  And in addition, both are historically disadvantaged but also very different in terms of their histories, their populations, their geography, their economies.  And a key factor for doing the analysis was that there are official, congressionally-mandated definitions of which counties belong to each region, so that made it possible to be very precise in our definition of each region when we’re doing the analysis itself.

HOST:  When you say “Appalachia,” specifically what areas are you talking about?

ANNE DRISCOLL:  So like I said Appalachia is a official region and Congress established the Appalachian Regional Commission in 1965.  And it includes 420 counties in 12 states – it runs from southern and western New York state, all the way down to northeastern Mississippi.  It includes much of Pennsylvania, every single county in West Virginia, and parts of Virginia, North Carolina, South Carolina, Kentucky, Tennessee, Georgia and Alabama.

HOST:  And so the same question goes for the Delta – what do you mean exactly when you say “the Delta region?”

ANNE DRISCOLL:  Right, so it is also an official region and it was designated by Congress in 2000.  It’s a smaller area – it includes 252 counties spread across eight states, and it basically runs from southern Illinois, a few counties in southern Illinois, along the Mississippi River south and includes parts of Missouri, Kentucky, Tennessee, Arkansas, Mississippi, Alabama and Louisiana.

HOST:  So before we go into the results of your new report, do we have any insight about why infant mortality rates have traditionally been so much higher in these parts of the country?

ANNE DRISCOLL:   Both of these regions have been historically very rural -different kinds of rural but very rural – with high rates of poverty.  Overall, there are lower levels of educational attainment, less access to decent paying jobs and other economic opportunities, less access to health care of all kinds.  So generally there are worse outcomes – health outcomes – across a host of measures, not just infant mortality but including infant mortality.  But also higher rates of disease and disability overall. such as heart disease, cancer, diabetes, obesity, an overall lower life expectancy.  So usually all these health measures move in one direction or the other, so when you have poor health in general you’re going to have in general an area that is going to have higher infant mortality.

HOST:  So would access to prenatal care, for example, be an issue that might be contributing to that?

ANNE DRISCOLL:  Right, and particularly in rural areas that are also poor areas.  A lot of times it might be a long way to a, to drive to a doctor’s office or a hospital, and lower income people might not have access to transportation to receive prenatal care.  Rural hospitals often do not have the incomes they need to sustain themselves so you know some hospitals have gone out of business in rural areas in recent years.  So yeah, so less access to actual health care while you’re pregnant as well as all these other factors that come out of being in low-density populations and poor populations.

HOST:  So your report shows that over the past couple decades rates are dropping fairly significantly in these regions.  Do we have an understanding why that’s happening?

ANNE DRISCOLL:   That’s a general trend in the United States in general that both regions have followed in terms of infant mortality.  So yes, it’s declined in the country in general, it’s declined in Appalachia, it’s declined in the Delta and in the parts of the country that are not either.  And there are various other trends that have also affected the nation in general that affect infant mortality trends, such as lower teen birth rates… generally better treatment and care for at risk infants so for pre term infants we’ve gotten better at saving their lives over time as a society …educational attainment has risen somewhat across the country and that is associated with better outcomes for infants… there’s also been wider access to Medicaid for pregnant women in recent decades and that’s allowed more to access prenatal care.  One factor that we measured directly in this study was the decline in percentage of birth to teens.  And so again infants of teens have a much higher risk of dying, and so when that percentage went down that affected the overall infant mortality rate and accounted for about a fifth of decline in mortality rates in our study.  But that was true across all three regions – across Appalachia, across the Delta, and across the rest of the United States.

HOST:  So the national rates are falling, but is there any indication that the disparity between the U.S. as a whole and these two regions are narrowing at all?

ANNE DRISCOLL:  That is exactly the main question we wanted to address for this study.  We know that these regions have lagged behind the rest of the country on a multitude of health measures.  And we know that the infant mortality rates have gone down in these regions as they have in the rest of the United States.  But that is exactly what we wanted to examine: whether the gap between either of these regions and the rest of the country has been, you know, closing or getting wider or staying the same.  And our results support the conclusion that there has been some narrowing in the gap between the Delta and the rest of United States.  In 1995 -96 which is the first year of our trend analysis, first years, the gap was 2.9 deaths per 1000 births – was that much higher in the Delta than the rest of United States.  And by 2017-2018 that had gone on to 2.2.  So another way to think of these numbers is that the gap between the Delta and the rest of the United States was about one quarter smaller in 2017-2018 then it was in 1995-96.  And incidentally, when we track the trend line over that period, most of the decline in infant mortality rates in the Delta occur after 2004.  So it was basically stable from 1995-96 through 2003-2004, and then started declining.  But the gap between Appalachia and the rest of United States hasn’t narrowed.  The infant mortality rates in both regions have declined over the past twenty-some years, but they declined at about the same rate. So the gap between them didn’t close and in both our first year of analysis and our last year – 1995-96 and then 2017-2018 – the infant mortality rates in Appalachia were 0.9 deaths per 1000 births higher than the rest of the country.  So during this time the gap between Appalachia and the rest of the country has been always been smaller than that between the Delta and the rest of the country, but it hasn’t changed.

HOST:  What about movement within the country?  We’ve had the big growth in the “Sun Belt” that may include parts of these regions – a lot of people from the Northeast and Midwest have relocated.  Has the role of migration to these areas played any part in reducing infant mortality?

ANNE DRISCOLL:   Yes I mean it’s true that we know that there’s been this net migration from the northeast and the “Rust Belt” down to the South and the West. And this is not from our data but from Census data we know this, but if you look at the counties that encompass there that are parts of either the Appalachia or the Delta, this is not where most of the migration to those areas tends to go.  It tends to go to more urban areas such as Charlotte or the Raleigh-Durham, the Research Triangle in North Carolina, or to Atlanta in Georgia.  But much of the area that includes Appalachia and the Delta do not include large cities or have other economic opportunities that tend to draw new migrants from other regions of the country.  So for instance Appalachia encompasses the Appalachian and the Great Smoky Mountain chains, where coal mining has been the main economic activity or a main economic activity, but there haven’t been many robust economic areas that have attracted newcomers, so people are moving South but they’re not moving to that part of the South and Southeast.  The Delta is along the Mississippi Delta as I mentioned, but it includes mostly rural agriculture areas, and they’ve always suffered from lack of services and investment.  So again in those States and regions people are not going to those parts of the South but to the bigger economic draws so we can’t say directly but it doesn’t appear that migration has played a role in changing infant mortality rates in these particular regions.

QuickStats: Percentage of Adults Aged 18–26 Years Who Ever Received a Human Papillomavirus Vaccine, by Race and Hispanic Origin§ and Sex

May 28, 2021


Overall, in 2019, 47.0% of adults aged 18–26 years had ever received an HPV vaccination.

Non-Hispanic White adults (49.7%) were more likely than Hispanic adults (40.6%) to have ever received an HPV vaccination; differences between non-Hispanic Black adults (45.8%) and the other two groups were not statistically significant.

Overall, women were more likely than men to have been vaccinated (56.6% versus 37.2%), and this pattern was seen for non-Hispanic White women and men (60.6% versus 38.6%) and for Hispanic women and men (50.2% versus 30.8%).

However, the difference between non-Hispanic Black women and men (48.9% versus 43.0%) was not statistically significant.

Source: National Center for Health Statistics, National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm


Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018

May 26, 2021

Questions for Anne Driscoll, Health Statistician and Lead Author of “Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018.”

Q: Why did you decide to focus on infant mortality rates in the Appalachia and Delta region?

AD: These two regions are interesting to me because although they are very different in terms of history, geography and population but they are similar in that both have higher poverty rates and worse health outcomes including infant mortality rates (IMRs). In addition, there are official, congressionally-mandated definitions of which counties belong to each region which made it possible to be precise in our definition of each region for the analyses.

Q: Can you summarize how the infant mortality data varied by age and race?

AD: Infants of women in the youngest and oldest age groups (under age 20 and age 40 and over) had the highest mortality rates in all three regions (Appalachia, the Delta and the rest of the US). Infants born to women in their early thirties had the lowest mortality rates. In all three regions, infants of non-Hispanic black women had the highest mortality rates.

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

AD: The main question we asked in this report was whether the gap in infant mortality rates between these two regions and the rest of the U.S. changed over the last two decades. Our results support the conclusion that there has been some narrowing in the gap between the Delta and the rest of the US; the gap decreased from 2.9 deaths per 1,000 births to 2.2. Another way to think of this is that the gap was about one quarter smaller in 2017-2018 than it was in 1995-1996. During the study period, rates did not start declining in the Delta until 2005-2006.

In contrast, the gap between Appalachia and the rest of the US hasn’t narrowed. That is, IMRs have declined in both regions over the last 20 years but since they declined at about the same rate the gap between them didn’t close. In both 1995-96 and 2017-18, IMRs in Appalachia were 0.9 deaths per 1,000 births higher than in the rest of the country. Thus, while the gap between Appalachia and the rest of the US has been smaller than that between the Delta and the rest of the country, it hasn’t narrowed.

Q: Why do you think infant mortality rates have dropped in the Appalachia, Delta, and rest of U.S.?

AD: IMRs have declined for a variety of reasons. Other research has shown that more advanced and effective medical interventions for at-risk infants, particularly for premature infants, have helped lower the mortality rate. In addition, Medicaid is more widely available for pregnant women which allows low-income women to access timely and adequate prenatal care.

Another change which we show in our report is the decline in births to teens. Infants born to teens are at higher risk of poor outcomes, including death. Our analysis shows that the percent of births to teens declined in all three regions and that this accounted for about a fifth of the decline in IMRs in each region.

Q: Do you have infant mortality data on other regions of the United States during the same time-period?

AD: We calculate and publish IMRs for each state every year. But in terms of regions, the key is to have an ‘official’ definition of the region. One of the factors that made this research project possible was that there is an official definition of each of the two regions we studied. That is, we were able to categorize each county as part of Appalachia, the Delta, or the rest of the US.

PODCAST: Children and Mental Health: Part Two

May 21, 2021



podcast-iconHOST:  We now continue our conversation with Ben Zablotsky, health statistician with the Division of Health Interview Statistics on children’s mental health in the United States.

HOST:  You mentioned social media and the Internet – what about more traditional environmental issues that might contribute to mental health issues among children, such as family structure.  Does NCHS have any data on how family structure, including maybe divorce, might impact mental health?

BEN ZABLOTSKY:  So in the past, the National Survey of Children’s Health was run out of our center, and we did have some questions about family structure as it relates to whether a parent had divorced or separated.  And we looked at this within kind of the lens of “stressful life event.”  And we do know generally that, yes, children who experience the stressful life events which can include changes to the family structure have been associated with higher rates of mental health conditions.  But other things that we can look at now right within the NHIS have to do with general adversity that a child might be dealing with as it relates to food security or the availability of health resources.  And so those items are also associated with mental health and actually in 2021, we have a longer list of stressful life events that are being asked of parents that can then be looked at in the lens of health.  And that could be something that is worth exploring further.

HOST:  In a general sense, are there any groups of children at higher risk than others at developing mental illness?

BEN ZABLOTSKY:   So I would certainly say again that older children are more likely to experience some of these internalizing mental health disorders that talked about in terms of depression and anxiety.  Certainly there are children who are dealing with a more adverse living situation who have a higher chance of developing a mental health disorder, but some conditions genetically are actually more likely to occur in boys than girls.  So you see that autism spectrum disorder is an example of that, you see higher rates of ADHD among boys versus girls.  And generally when someone has accessibility to services, you might see higher rates of diagnosis because they are able to see someone who can actually say “Oh yes, that is what this child has.  Here’s a treatment plan we can move forward with.”

HOST:  You mentioned autism and ADHD.  Thirty, forty years ago you didn’t really hear about these conditions.  There’s some that might think that this might be over-diagnosed since they’re relatively new conditions.  Do you have any data about that?

BEN ZABLOTSKY:   So the prevalence of autism spectrum disorder has changed over the years because the criteria for defining the condition itself has changed.  So a lot of the increase you saw in some more recent years have actually been just that – that it wasn’t necessarily as difficult to get a diagnosis based on the criteria of the DSM – but I think there’s also a lot to be said about the awareness of these conditions.  And there have been campaigns within the CDC itself to increase awareness of developmental disabilities generally, and I think that also attributes quite a bit to the increased rate that we’ve seen.

HOST:   And we can certainly have a whole separate podcast on those topics alone – maybe we’ll wait till your next publication on that.  Are there any other topics you’d like to discuss before we sign off?

BEN ZABLOTSKY:   When we’re talking about mental health I think it’s certainly worth talking about mental health within the context of COVID-19 and how the NHIS can capture that.  I think one of the challenges of the NHIS is that it is a very large survey, but it’s also cross-sectional so it’s not possible to follow children longitudinally.  But what we can do is look at estimates that come out of 2019 and come out of 2020 and start to get a picture of how things might be changing for children in this age of COVID-19.  And some things we can look at or just access to care and potentially the use of telemedicine to receive services.  You know, I’ve talked a lot about treatment generally – a lot of the treatment in 2019, you know looking at the 2019 data, was face-to-face treatment that these individuals were receiving.  But a lot of times, you know, a lot of treatment is received through the schools and with schools being virtual, it’s quite likely that some children have lost out in some of the care they normally receive.  So I want to certainly look at that avenue of research moving forward because there’s a lot that’s happened obviously and one thing we don’t want to lose sight of is how children’s mental health have been affected.

HOST:  Well you raise a good point, because with the shuttering of schools and the isolation felt by some children and the disadvantages some children have, are you planning to directly look at the correlation between virtual learning and mental health issues that were tied to the pandemic?

BEN ZABLOTSKY:   So that’s one thing that’s tricky to look at within our survey ’cause we don’t have a lot of data on the specific schools the children are attending and the resources they had prior to COVID and receiving.  But I certainly think that understanding various services – and we ask questions about special education-related services – we have to understand how those might have changed and certainly will have changed when we are dealing with something like virtual schooling.

HOST:  Well that also would be a great topic for its own podcast so thanks very much Ben.

BEN ZABLOTSKY:   No problem – my pleasure.

QuickStats: Age-Adjusted Death Rates for Four Selected Mechanisms of Injury — National Vital Statistics System, United States, 1979–2019

May 21, 2021

In 1979, of the four mechanisms of injury, age-adjusted mortality rates were highest for motor vehicle traffic deaths and lowest for drug poisoning deaths.

From 1979 to 2019, the age-adjusted rate of motor vehicle traffic deaths decreased from 22.1 per 100,000 to 11.1, and the rate of firearm-related deaths decreased from 14.7 to 11.9.

During the same period, the rate of drug poisoning (overdose) deaths increased from 3.0 to 21.6, and the rate of fall-related deaths increased from 6.2 to 10.1. In 2019, the rates were highest for drug poisoning deaths and lowest for fall-related deaths.

Source: National Vital Statistics System compressed mortality file, underlying cause of death. https://wonder.cdc.gov/mortsql.html


Hepatitis Awareness Month: Deaths From Viral Hepatitis Have Dropped in Recent Years

May 17, 2021
SOURCE: National Vital Statistics System, CDC WONDER.

QuickStats: Percentage of Adults Aged 50 Years or Older with Osteoporosis, by Race and Hispanic Origin — United States, 2017–2018

May 14, 2021


During 2017–2018, the age-adjusted prevalence of osteoporosis among adults aged 50 years or older was 12.6%.

A lower percentage of non-Hispanic Black adults (6.8%) had osteoporosis compared with non-Hispanic White adults (12.9%), non-Hispanic Asian adults (18.4%), and Hispanic adults (14.7%).

The observed differences among non-Hispanic White, non-Hispanic Asian, and Hispanic adults did not reach statistical significance.

Sources: Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. National Center for Health Statistics (NCHS) data brief, no. 405. https://www.cdc.gov/nchs/products/databriefs/db405.htm; NCHS, National Health and Nutrition Examination Survey (NHNES) data, NHNES 2017–2018. https://www.cdc.gov/nchs/nhanes.htm


PODCAST: Children and Mental Health: Part One

May 14, 2021



HOST:  May is Mental Health Month in the United States.  In recent years, mental health awareness has grown as a major public health issue, with suicide being one of the leading causes of death in the country.  The arrival of the COVID-19 pandemic in 2020 placed even more of a spotlight on the subject, and NCHS collects data on topics such as anxiety and depression as well as mental health treatment in the U.S. during the pandemic, all part of the new national Household Pulse Survey.  During the period April 14-26, Pulse data showed that over 27 percent of adults suffered from anxiety in the past week, and that almost 23 percent suffered from depression.  A third, or 32 percent of adults, suffered from both. 

These numbers are the lowest in over a year, but still pose a significant impact on American society and on the American health care system.  21 percent of adults used prescription drugs for mental health problems in the past four weeks, and nearly 10 percent received mental health counseling.  However, the number of suicides and the rate of suicide in the U.S. declined in 2019 and appeared to also decline in 2020, which runs somewhat counter to the fact that 1 in 4 adults either used prescription drugs or received counseling for mental health issues, while another 10 percent needed mental health treatment but did not receive it.

Mental health concerns are also significant among children, and last week the country observed “Children’s Mental Health Awareness Week.”  Suicide is the 2nd leading cause of death among children between ages 10 and 14, and there is a great deal of concern about the impact of the pandemic on children’s mental health.

NCHS has several measures that provide insight into children’s mental health in the U.S.  And joining us today is Benjamin Zablotsky, a health statistician for the Division of Health Interview Statistics at NCHS.

HOST: What did the data tell us about the scope of mental health concerns among children in the U.S.? 

BEN ZABLOTSKY: Sure, I think when we are talking about mental health concerns, we can break that down into two separate things – two different bins if you will.  The first would be the prevalence of mental health disorders in the United States.  And this includes developmental disabilities like autism spectrum disorder and intellectual disabilities, but it also includes behavioral and mental disorders like ADHD, anxiety, and depression.  And when we look at the prevalence of conditions we see about one in five or one in six, depending on what you look at, that seems to be about the prevalence of mental health concerns.  But I think we need to look beyond just the prevalence of these disorders.  The other “bin” I would talk about as it relates to mental health concerns is also what percentage of children are receiving treatment for mental health.  And when we’re talking about mental health treatment, we talk about whether a child is on a pharmaceutical medication or receiving counseling or therapy – and we look at those two things to get a sense of what percentage of the child population is on mental health treatment.  And the report I wrote in 2019 found that about 14% of children have received either a therapy or a mental health-related medication in the past 12 months. 

HOST:  So there’s a lot of information out there.  Now, are teenagers at particular risk of mental health problems compared to adults, given all the changes they’re going through?

BEN ZABLOTSKY: I would say that older children are more likely to be diagnosed with anxiety and depression, and they’re typically along the same lines in terms of prevalence as adults.  And a lot of this just has to do with the stresses of being a teenager – it’s a challenging time.  Teenagers tend to experience a lot of transitions during that time period as it relates to school and their own development. So yeah, I would say certainly teenagers are more likely to experience the mental health conditions than their younger peers, and sometimes comparable to those of adults.

HOST:  Is there any sense that these issues have worsened or become more prevalent over time?

BEN ZABLOTSKY:  You know, people have looked at things like the prevalence of developmental disabilities over time and we have seen an increase in the prevalence of some of those disorders.  As it relates to teenagers and mental health, as it relates to both anxiety and depression, I believe there are some findings that have found higher rates of those two conditions – depression and anxiety – and some of it might be tied to the introduction of social media and the prevalence of bullying generally, including the kind of the more present cyber-bullying that wasn’t something that necessarily existed, you know, a few decades ago.

HOST:  So the social media and the cyber-bullying – is that something you’ve done any research on yourself?

BEN ZABLOTSKY: I haven’t looked at that personally but we actually are now including some questions on the National Health Interview Survey on bullying to get a sense of that from the parent perspective, and interestingly enough later this year as part of a CDC data modernization initiative, the Division of Health Interview Statistics is going to be launching a survey of adolescents.  These are actually people who were the subjects at the National Health Interview Survey, and we are going to be including some questions on cyber-bullying and bullying in general. This should be really great to look at to get a sense of that from the adolescent perspective.

HOST: You mentioned some of your research – could you talk a little bit more about some of the studies you’ve been involved in and what you found?

BEN ZABLOTSKY: Sure.  So as I was mentioning I kind of think of two different domains that my research lies in.  The first part is looking at the prevalence of mental health conditions generally, and most of that work has been focused around developmental disabilities.  And using the NHIS we explored how there might have been changes in the prevalence over time in children in the United States between (ages) 3 and 17.  And we actually did find a significant increase in the prevalence of developmental disabilities over time, with the current prevalence being about one in six children in the United States.  And then some of the other work that I do which focuses on the treatment side of things – which I think is really important just to make the point that even though we’re talking about the prevalence of these disorders, we’re really only talking for the most part about the prevalence “diagnosed” disorders.  And so it’s quite possible that children could be receiving treatment for their mental health that’s not affiliated or to a specific disorder.  So that mental health treatment side, we are finding in a report that used data from 2019 that about 14% of children are receiving mental health treatment, either in the form of taking a medication for their mental health or receiving counseling or therapy from a mental health professional in the past 12 months.

HOST:  So often times mental health is something that’s viewed as kind of a silent problem, and therefore it’s assumed that people who need treatment aren’t getting it.  Would you say that your data support that or does it show that on contrary kids are actually getting treatment for some of these problems?

BEN ZABLOTSKY: Right.  So there are situations where if you were to kind of do a crosstab of children who have a diagnosed condition and a child who has received mental health treatment, it’s not a one-to-one match.  So there are certainly situations where children who don’t have a diagnosis are still receiving mental health treatment, and a lot of times it might be a situation where the child doesn’t have access to services to get a diagnosis but they certainly can find resources in the community to get treatment of some sort to help in the treatment of the diagnosis that just might be not actually diagnosed by a professional.

HOST:  Next week we will continue our discussion with Ben Zablotsky about his research on mental health issues facing children in the U.S.

This week, NCHS released the latest quarterly data on infant mortality in the U.S., showing a rate of an estimated 5.50 infant deaths per 1,000 live births in the one-year period ending in mid-year 2020, the lowest rate on record. 

NCHS also released the latest monthly data on drug overdose deaths in the country, for the one-year period ending in October 2020.  Over 91,000 Americans died from drug overdoses during this period, a 30% increase from the same period a year ago.

Finally, NCHS released an analysis of total fertility rates by educational attainment, which showed that women with no high school diploma are giving birth at above-replacement levels whereas women with the highest educational attainment are giving birth at levels considerably below replacement. 

Total Fertility Rates, by Maternal Educational Attainment and Race and Hispanic Origin: United States, 2019

May 12, 2021

NVSR70_5_cover1Questions for Brady Hamilton, Health Statistician and Lead Author of “Total Fertility Rates, by Maternal Educational Attainment and Race and Hispanic Origin: United States, 2019.”

Q: What is the difference between general fertility rates and total fertility rates?

BH: The general fertility rate is the number of births per 1,000 females aged 15–44 in a given year, whereas, the total fertility rate is the estimated number of births that a group of 1,000 women would have over their lifetimes, based on age-specific birth rates in a given year.

Q: Why did you decide to compare educational attainment with total fertility rates?

BH: Educational attainment is considered an important measure of socioeconomic status and can be useful in interpreting patterns and differences in fertility behavior both overall and among population groups. Maternal education has been shown to be associated with contraceptive use, the timing of childbearing, and the total number of children women have in their lifetimes. I wanted to examine the association between educational attainment and the expected number of births for women using the latest available vital statistics birth data (2019) from NCHS.

Q: How did the total fertility rates differ by educational attainment?

BH: Total fertility rates decreased as level of education increased from women with a 12th grade education or less through an associate’s and bachelor’s degree, and then increased from bachelor’s degree through a doctorate or professional degree, although the increase from master’s to doctorate or professional degree was not statistically significant.

Q: How did the total fertility rates by educational attainment differ by race?

BH: The patterns in and levels of the total fertility rates by educational attainment differed across the three race and Hispanic-origin groups shown in the report.

Total fertility rates generally declined from the lowest educational level through a bachelor’s degree for non-Hispanic white women, and through an associate’s degree for Hispanic women, and then generally rose for both groups for women with advanced degrees. Rates for non-Hispanic black women declined by educational level through a master’s degree.

Total fertility rates for non-Hispanic black and Hispanic women with some college credit or less were generally higher than the rates for non-Hispanic white women, but TFRs for non-Hispanic black and Hispanic women with a master’s degree or more were generally lower than the rates for non-Hispanic white women

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

BH: Yes, the span of the range in the total fertility rates was surprising, from the low of 1,284 for women with a bachelor’s degree to the high of 2,791 for women with a 12th grade education or less. To put this difference in perspective, a woman with a 12th grade education or less would be expected to have more than one additional birth compared with a woman with a bachelor’s degree.

QuickStats: Percentage of Adults Aged 18 or Older with Diagnosed Diabetes by Urbanization Level and Age Group

May 7, 2021

mm7018a4-fIn 2019, the percentage of adults aged 18 years or older with diagnosed diabetes was higher among those living in nonmetropolitan areas (12.4%) than among those living in metropolitan areas (8.9%).

Percentages of adults with diagnosed diabetes were higher in nonmetropolitan than metropolitan areas for those aged 18–44 years (3.5% versus 2.3%) and 45–64 years (15.2% versus 11.6%).

Among adults aged 65 years or older, the difference by urbanization level (21.9% in nonmetropolitan areas versus 19.8% in metropolitan areas) did not reach statistical significance.

The prevalence of diagnosed diabetes increased with age in both nonmetropolitan and metropolitan areas.

Source: National Center for Health Statistics, National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm