Recent Increases in Injury Mortality Among Children and Adolescents Aged 10–19 Years in the United States: 1999–2016

June 4, 2018

NCHS released a new report that presents numbers of injury deaths and death rates for children and adolescents aged 10–19 years in the United States for 1999–2016.

Numbers and rates are presented by sex for 1999–2016, by injury intent (e.g., unintentional, suicide, and homicide) and method (e.g., motor vehicle traffic, firearms, and suffocation). Numbers and rates of death according to leading injury intents and methods are shown by sex for ages 10–14 years and 15–19 years for 2016.

Findings:

  • The total death rate for persons aged 10–19 years declined 33% between 1999 (44.4 per 100,000 population) and 2013 (29.6) and then increased 12% between 2013 and 2016 (33.1).
  • This recent rise is attributable to an increase in injury deaths for persons aged 10–19 years during 2013–2016.
  • Increases occurred among all three leading injury intents (unintentional, suicide, and homicide) during 2013–2016.
  • Unintentional injury, the leading injury intent for children and adolescents aged 10–19 years in 2016, declined 49% between 1999 (20.6) and 2013 (10.6), and then increased 13% between 2013 and 2016 (12.0).
  • The death rate for suicide, the second leading injury intent among ages 10–19 years in 2016, declined 15% between 1999 and 2007 (from 4.6 to 3.9), and then increased 56% between 2007 and 2016 (6.1).
  • The death rate for homicide, the third leading intent of injury death in 2016, fluctuated and then declined 35% between 2007 (5.7) and 2014 (3.7) before increasing 27%, to 4.7 in 2016.
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Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

May 22, 2018

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

Q: What were some of the major findings in your full-year 2017 health insurance estimates?

RC: In 2017, 29.3 million persons were uninsured at the time of interview. This is 19.3 million fewer persons than in 2010. In 2017, 9.1% were uninsured, 36.2% had public coverage, and 62.6% had private coverage at the time of interview.


Q: What are the trends among race and ethnicity groups who were uninsured in 2017 and compared over time?

RC: In 2017, 27.2% of Hispanic, 14.1% of non-Hispanic black, 8.5% of non-Hispanic white, and 7.6% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview.

Significant decreases in the percentage of uninsured adults were observed from 2013 through 2017 for Hispanic, non-Hispanic black, non-Hispanic white, and non-Hispanic Asian adults.

Hispanic adults had the greatest percentage point decrease in the uninsured rate from 2013 (40.6%) through 2016 (25.0%). The observed increase among Hispanic adults between 2016 and 2017 (27.2%) was not significant.


Q: What does your data show this year for Americans who have high-deductible health insurance plans compared to previous years?

RC: In 2017, 43.7% of persons under age 65 with private coverage were enrolled in a high-deductible health plan (HDHP). Enrollment in HDHPs has increased 18.4 percentage points from 25.3% in 2010 to 43.7% in 2017. More recently, the percentage enrolled in an HDHP increased from 39.4% in 2016 to 43.7% in 2017.


Q: What do you see in state-level estimates of health insurance coverage this year?

RC: Among the 18 states presented in this report, there were no significant changes in the percentages of uninsured among persons aged 18–64 between 2016 and 2017.


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

RC: The take-home message from this report is found in the number of Americans who no longer lack health insurance. In 2017, 29.3 million (9.1%) persons of all ages were uninsured at the time of interview. This estimate is not significantly different from 2016, but there are 19.3 million fewer uninsured persons than in 2010.

 


Births: Provisional Data for 2017

May 17, 2018

Questions for Brady E. Hamilton, Ph.D., Demographer, Statistician, and Lead Author of “Births: Provisional Data for 2017

Q: What did you think was the most interesting finding in your new analysis?

BH: The report includes a number of very interesting findings. The general fertility rate, 60.2 births per 1,000 women aged 15–44, declining 3% in 2017 and reaching a record low is certainly noteworthy. In addition, the continued decline in the birth rate for teens, down 7% from 2016 to in 2017, and reaching another record low, is very significant. The increase in the cesarean delivery rate following several years of decline is noteworthy as are the recent increase in rates of preterm and low birthweight births.


Q: Why does fertility keep going down in the U.S.?

BH: In general, there are a number of factors associated with fertility. The data on which the report is based comes from the birth certificates registered for births in the U.S. While the scope of this data is essentially all births in the country, and provides detailed information about rare events, small areas, or small population groups, the data does not provide information about the parent’s decision to have (or not have) a child. And so, accordingly, we cannot examine the “why” of the changes and trends in births.


Q: Does the decline in the Total Fertility Rate essentially mean fertility is down below “replacement” levels?  Could you explain this in general terms?

BH: “Replacement” refers to a minimum rate of reproduction necessary for generation to exactly replace itself, that is, enough children born to replace a group of 1,000 women and their partners. For the total fertility rate, this rate is generally considered to be 2,100 births per 1,000 women. In 2017, the total fertility rate, 1,764.5 births per 1,000 women, was below replacement.


Q: Do the increases among women over 40 suggest a “new norm” in people waiting till much later to have children?

BH: Birth rates for women aged 40-44 and 45-49 years have increased generally over the last 3 decades. Given this, it reasonable to expect this trend to continue.


Q: Are the annual declines in teen pregnancy something that we are in danger of taking for granted?

BH: The birth rate for females aged 15-19 has decreased 8% per year from 2007 through 2017. For comparison, the decline in the birth rates for women aged 20-24 and 25-29 was 4% and 2% from 2007 through 2017. The decline in teen births is very noteworthy.


Q: Can you explain how the increases in preterm births and low birthweight are connected?

BH: Infants born preterm are also often, but not exclusively, born low birthweight and vice-versa.  The causes of the recent upward shift in these rates are not well understood.


Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

April 13, 2018

Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist

Questions for Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist and Lead Author of “Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

Q: What made you decide to focus on the prevalence of dental cavities in young children for this study, versus other dental conditions like gum disease or tooth grinding – or some other critical public health concerns today for America’s youth?

EF: Our intent in conducting this study was to provide up-to-date prevalence estimates for dental caries in children. We decided that our study would focus on dental caries because of the serious and negative impact untreated caries can have on children. By the way, dental “caries” is the scientific term for tooth decay or cavities. Dental caries are the most common chronic disease among youth aged 6-19 years. Untreated caries cause pain and infection. Children miss days from school and have their overall quality of life effected by untreated dental caries. This is an important public health concern for America’s youth. While dental conditions like gum disease or tooth grinding are important, the National Health and Nutrition Examination Survey (NHANES) Oral Health Component does not currently collect data on these dental conditions. The component focuses on collecting data on tooth loss, dental caries, and dental sealants.


Q: In your new report, you examine differences in the prevalence of tooth cavities by income level; what is the motivation to look at income, since many children’s dental care might be paid by either public or private health insurance?

EF: We examined family income in this study for a few reasons. One is that income is a significant social determinant of health. For our study, we decided to include family income in addition to age, race and Hispanic origin. We were curious about the differences in untreated and total caries (tooth decay) by family income level. For both total and untreated caries, prevalence decreased as family income level increased. There is also concern among the public health community that children who may have access to Medicaid dental benefits are not receiving the care that they need. The examination of income levels in our new report might offer some needed insight to this concern.

The prevalence of total dental caries decreased as family income levels increased, from 51.8% for youth from families living below the federal poverty level to 34.2% for youth from families with income levels greater than 300% of the federal poverty level.

The prevalence of untreated dental caries decreased from 18.6% for youth from families living below the federal poverty level to 7.0% for youth from families with incomes greater than 300% of the federal poverty level.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

EF: Because our motivation for this study was to provide updated national estimates on untreated and total caries (tooth decay) for 2015-2016, all of the results were very interesting in one way or another — and surprising. National estimates for age, race and Hispanic origin, and income are results that we need to understand for public health surveillance purposes. For me though, the overall estimates for youth by age were especially interesting.

While the untreated dental caries prevalence overall for youth is 13.0%, there were age differences that caught my eye. The low prevalence for 2-5 year-olds is an important and encouraging finding. While we don’t know if it is from prevention efforts, access to care, or other factors, the fact that our youngest youth have the lowest untreated and total caries prevalence shows they’re starting off their young lives with healthy teeth.

The prevalence was lowest in youth aged 2-5 years (8.8%) compared with youth aged 6-11 years (15.3%) and 12-19 years (13.4%). The prevalence of the 6-11 and 12-19 years-olds was significantly different from the prevalence of 2-5 year-olds.

The total caries experience was also lowest for youth aged 2-5 years (17.4%) compared to youth aged 6-11 years (45.2%) and 12-19 years (53.5%). As age increased, the total caries prevalence increased.


Q: What, if any, is the difference between the two terms you use in your report – primary teeth and permanent teeth?

EF: Primary teeth are baby teeth, or the first teeth that erupt, or come in, which are later shed and replaced by permanent teeth. Primary teeth erupt from around 6 months to age 2 or 3 years. The permanent teeth replace the primary teeth. These teeth start coming in around the age of 6 years and continue until the third molars, or wisdom teeth come in, somewhere between the ages of 17 to 21 years. In our analysis, we combined the two types of teeth in order to focus on dental caries (tooth decay) regardless of tooth type.


Q: In your report, are untreated dental cavities a subset of the number of total cavities, and therefore included in the total cavity statistics?

EF: Yes, untreated dental caries (tooth decay) are included in the total number of dental caries. When we describe total dental caries, we are focused on both untreated and treated dental caries. Essentially, the total of dental caries take into account any tooth decay experience that someone has had. Untreated dental caries represent tooth decay that has not been treated. Untreated dental caries are also known as cavities. What we capture in the untreated caries measure is the active disease of youth.


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

EF: We noted a number of differences among youth by race and Hispanic origin in this analysis. Non-Hispanic black youth had the highest prevalence of untreated caries (tooth decay) (17.1%) compared to other race and Hispanic-origin groups. The prevalence for non-Hispanic black youth was significantly different from non-Hispanic whites (11.7%) and non-Hispanic Asians (10.5%). The prevalence of untreated dental caries in Hispanic youth was 13.5%.

Hispanic youth had the highest prevalence of total caries (52.0%) compared to other race and Hispanic-origin groups. The prevalence was also significantly different from non-Hispanic whites (39.0%) and non-Hispanic Asians (42.6%). The prevalence of total caries for non-Hispanic black youth was 44.3%.


Q: What sort of trend data do you have on this topic so we can see how prevalence has evolved over time?

EF: With six years of data, we can look at the trend in prevalence over time. Because dental caries (tooth decay) is the most common condition of childhood, we thought it was important to include trend analysis in our report.

The results show a significant linear decrease in total caries. From 2011-2012 to 2015-2016, the total caries prevalence decreased from 50.0% to 43.1%. The results show a different pattern for untreated dental caries. The prevalence of untreated dental caries increased from 2011-2012 (16.1%) to 2013-2014 (18.0%), and then decreased in 2015-2016 (13.05). There is significant quadratic trend – a single bend either upward or downward — in untreated dental caries from 2011-2012 to 2015-2016.


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

EF: The take-home message from this report is that there are differences in untreated and total caries (tooth decay) by age group, race and Hispanic origin, and income. The trend analysis shows that the prevalence of untreated and total caries are decreasing. However, there are still disparities that exist. Because monitoring prevalence of untreated and total caries is key to preventing and controlling oral diseases, these disparities are important.

The prevalence of untreated dental caries in America’s youth is 13.0%. The prevalence decreased as family income increased, with youth with family incomes less than 100% of the federal poverty level having the highest prevalence. Disparities in untreated dental caries exist along race and Hispanic origin. Non-Hispanic black youth have the highest prevalence compared to Hispanic, non-Hispanic white, and non-Hispanic Asian youth.


Parental Report of Significant Head Injuries in Children Aged 3–17 Years: United States, 2016

February 9, 2018

Questions for Lindsey Black, Health Statistician and Lead Author of “Parental Report of Significant Head Injuries in Children Aged 3–17 Years: United States, 2016.”

Q: What was the reason you undertook this research?

LB: Previous research has indicated that the incidence is increasing and much of this trend is being driven by an increase among adolescents. Current incidence of concussions among children is estimated to be 3.5-16.5/1,000. Despite what is known, studies conducted thus far regarding the epidemiology of childhood concussions have either been regional and limited in size, focused on injuries related to sports, dependent on insurance claims, or based on emergency department visits.

There is a lack of a national prevalence and we need to understand the problem outside of the scope of sports injuries. Depending on ED visits are also problematic because evidence is emerging that there is an increasing trend in the use of primary care physicians and specialty clinics as the point of entry into the healthcare system for concussion diagnosis and treatment. Also relying on ED or medical claims will not include non-medically attended concussions.

Further, much research focuses on high school and collegiate athletes and therefore there is not much data on younger children. Despite this, there has been recent recognition for concern and appropriate treatment by the medical community. The goal of this study was to provide a national estimate of parent-reported significant head injuries as well as examine disparities by various demographics and socioeconomic indicators.


Q: What did you find most significant?

LB: There was a steady increase in the percentage of children that had ever had a significant head injury by age group. Although overall boys were more likely than boys to have ever had a significant head injury, the difference was only significant for the 15-17 age group.


Q: Are there any data that look at what sports might be contributing to the number of significant head injuries among children?

LB: Yes, in fact there are many studies that focus on sport related injuries. Our survey and study did not. What sets our study apart is that it was not limited to sports related injuries, so it is going to include a wider range of causes of injuries. Please see “Emergency Department Visits for Concussion in Young Child Athletes” (Bakhos, 2010) and “Epidemiology of Concussion and Mild Traumatic Brain Injury” (Laker 2011) to learn more.


Q: Do you have any insight about whether this percentage who’ve had significant head injuries has increased or declined over time?

LB: Unfortunately we do not have any other historical data on this topic from our survey. At this time, these questions were asked only in 2016 as part of content sponsored by the National Instutite of Health’s National Institute on Deafness and Other Communication Disorders.


Q: Any other points you’d like to make about this study?

LB: We found that about 1 in 10 children in the oldest age group 15-17 had ever had a significant head injury. We also found that overall, boys were more likely than girls to have ever had a significant head injury and there were also disparities by race and parental educational attainment.


Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014–2016

November 29, 2017

Questions for Ben Zablotsky, Ph.D., Health Statistician and Lead Author of “Estimated Prevalence of Children with Diagnosed Developmental Disabilities in the United States, 2014-2016.”

Q: Why did you decide to analyze children with diagnosed developmental disabilities?

BZ: We decided to analyze children with diagnosed developmental disability because children diagnosed with developmental disabilities typically require a substantial number of services and treatment to address both behavioral and developmental challenges.  Measuring the prevalence of children with these conditions aids in assessing the adequacy of available services and interventions that may improve long-term outcomes.


Q: Can you explain the differences between the diagnosed developmental disabilities studied in this report?

BZ: The three conditions studied in this report included autism spectrum disorder, intellectual disability, and any other developmental delay.  All three conditions are considered to be developmental disabilities.  Autism spectrum disorder refers to a group of neurodevelopmental disorders characterized by impairments in social communication and the presence of repetitive or restricted interests.  Intellectual disability is a term used when there are limits to a child’s ability to learn at an expected level and function in daily life.  Other developmental delay serves as a catch-all for children who are delayed for various developmental milestones, for example taking first steps, smiling for the first time, and speaking.


Q: What do you think is the most interesting demographic finding among your new study’s findings?

BZ: I found the fact that the prevalence of any developmental disability was lowest among Hispanic children compared with all other race and ethnicity groups to be the most interesting finding.  The prevalence of any developmental disability among Hispanic children was 4.69% compared to 7.04% for non-Hispanic white children, 6.20% for non-Hispanic black children, and 6.16% for non-Hispanic other children.


Q: Are there any previous reports released from NCHS on diagnosed developmental disabilities in children?

BZ: Yes, this report can be viewed as a follow-up to a National Health Statistics Report (No. 87) from 2015, where the prevalence of any developmental disability in 2014 was also reported (5.76%).  The current report shows this prevalence subsequently increased to 6.99% in 2016.


Q: Can you explain the methodology used for this analysis?

BZ: Children with developmental disabilities were identified through a series of survey questions within the child component of the National Health Interview Survey (NHIS) from 2014 to 2016.  Characteristics of these children were examined, including whether differences exist in prevalence by survey year.


Q: What do you think is the take home message from this report?

BZ: There was a notable increase in the prevalence of developmental disabilities between 2014-2016, which is largely the result of an increase in the prevalence of children diagnosed with developmental delay other than autism spectrum disorder or intellectual disability.


QuickStats: Percentage of Children and Teens Aged 5–17 Years Who Missed >10 School Days in the Past 12 Months Because of Illness or Injury, by Sex and Age — National Health Interview Survey, 2013–2015

July 7, 2017

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During 2013–2015, 3.9% of boys and 4.3% of girls missed >10 school days in the past 12 months because of illness or injury.

Among children aged 15–17 years, girls were more likely than boys to miss >10 school days (6.8% compared with 3.9%).

Among girls, those aged 15–17 years were more likely than girls aged 5–10 years and girls aged 11–14 years to miss >10 school days (6.8% compared with 3.2% and 4.0%, respectively).

Among boys, there was no difference by age.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a8.htm