Births: Final Data for 2018

November 27, 2019

Questions for Joyce Martin, Health Statistician and Lead Author of “Births: Final Data for 2018

Q: What is new in this report from the 2018 provisional birth report?

JM: In addition to providing final numbers and rates for numerous birth characteristics such as fertility rates, teen childbearing, cesarean delivery and preterm and low birthweight, this report presents final information on  teen childbearing by race and Hispanic origin and by state, births to unmarried women, tobacco use during pregnancy, source of payment for the delivery and twin and triplet childbearing.


Q: Was there a specific finding in the 2018 final birth data that surprised you?

JM: The continued decline in birth rates to unmarried women (down 2% for 2017-2018 to 40.1 births per 1,000 unmarried women), the fairly steep decline in tobacco smoking among pregnant women (down 6% to 6.5% of all women) and the continued declines in twin (down 2%) and triplet (down 8%) birth rates.  Also of note is the decline in the percentage of births covered by Medicaid between 2017 and 2018 (down 2% to 42.3%) and the small rise in the percentage covered by private insurance (49.6% in 2018).


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

JM: These data are based on information for all birth certificates registered in the United States for 2018.


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

JM: Birth certificate data provide a wealth of important current and trend information on demographic and maternal and infant health characteristics for the United States.


Q: Why do you think the birth has dropped in the U.S.?

JM: The factors associated with family formation and childbearing are numerous and complex, involving psychological, cultural, demographic, and socio-economic influences. The data on which the report is based come from all birth certificates registered in the U.S. While the data provide a wealth of information on topics such as the number of births occurring in small areas, to small population groups, and for rare health outcomes, the data do not provide information on the attitudes and behavior of the parents regarding family formation and childbearing. Accordingly, the data in and of itself cannot answer the question of why births have dropped in the U.S.


Vision testing among children aged 3-5 years in the United States, 2016-2017

November 20, 2019

Questions for Lindsey Black, M.P.H., Health Statistician and Lead Author of “Vision testing among children aged 3-5 years in the United States, 2016-2017

Q: Why did you decide to focus on vision testing for children aged 3-5?

LB: Over a quarter of all children aged 0-17 years have vision problems (1). Two common eye problems, amblyopia (lazy eye) and strabismus (crossed eyes) can be treated and prevent further vision problems if they are found early (2). The USPSTF recommends children between 3-5 years old have vision screening (3) and Healthy People 2020 target for vision screening is 44.1% of preschool aged children (1). Despite this, little is known about the current prevalence of vision screening and how this may differ by population subgroups. We focused on children 3-5 years old as they are the focus of the USPSTF recommendations.

  1. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Accessed at : https://www.healthypeople.gov/2020/topics-objectives/topic/vision/objectives
  2. Office of Disease Prevention and Health Promotion. Get your child’s vision checked. Washington DC. Accessed at: https://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-childs-vision-checked
  3. US Preventive Services Task Force. Vision Screening for Children 1 to 5 Years of Age: US Preventive Services Task Force Recommendation Statement. Pediatrics 127, 2 p340

Q: How did the data vary by age, race and health insurance?

LB: Overall, as children aged, they were more likely to have ever had their vision tested. Additionally, as children aged, they were also more likely to have had their vision tested in the past 12 months. There was also variation by race and Hispanic origin. About 65% of Non-Hispanic white children, 63% of non-Hispanic black children and 59% of Hispanic children have ever had their vision tested. Children with private health insurance (66.7%) were most likely to have ever had their vision tested compared with children with public insurance (61.2%) and children who are uninsured (43.3%).


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

LB: It was surprising how much of an impact a recent well-child visit had on ever having a vision test. Children who did not receive a well-child visit in the past 12 months (44.1%) were less likely to have ever had their vision tested when compared to children that had received a well-child visit in the past 12 months (65.9%). Since vision screenings are recommended to be part of well-child visits, these visits provide valuable opportunities to detect problems and offer intervention efforts.


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

LB: Data are from the pooled 2016-2017 National Health Interview Survey and can be accessed via: https://www.cdc.gov/nchs/nhis.htm. Questions on vision testing are from supplement questions, which focused on expanded content related to child vision. This supplement was asked most recently in 2016-2017.


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

LB: Approximately 64% of children aged 3-5 have ever had their vision tested by a doctor or other health professional. As children age, they are more likely to have had their vision tested. Disparities exist by race, and health insurance status. Receipt of a recent well-child visit was also associated with a higher prevalence of receiving a vision test.

 


Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years, 2010–2016

November 15, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years, 2010–2016.”

Q: What do you think is the most significant finding in this report?

AR: The top activities that caused emergency room (ER) visits for sports injuries by patients ages 5-24 years were football, basketball, pedal cycling, and soccer. There was wide variation by age and sex in the types of activities causing ER visits for sports injuries.


Q: Out of all of the sports, which sport or activity was found to have the largest increase in ER visits over time?

AR: We did not assess trends over time in the report.


Q: Is it accurate to say that the sports in the study are the most dangerous? Or do they have the most ER visits because they are simply the most popular?

AR: There are likely other health care utilization measures besides ER visits that others would want to look at as well, but the purpose of the report was to estimate the number of ER visits for sports injuries, and these are the sports that account for the most visits.


Q: What are some limitations of the report?

AR: The definition of sports and recreational activities relied on data processing and manual review of medical records, which could have resulted in over- or under-estimation of the sports injury ER rate. The study did not include patients who sought care in other settings or who did not seek care; thus the estimates in the report are an underestimate of all health care utilization for sports injuries.


Q: Why is this report important?

AR: Many young Americans engage in some type of sports or recreational activity each year, and sports and recreation-related injuries are a common type of injury seen in hospital ERs. It’s important to understand the types of injuries that are most commonly seen in the ER and which sports account for those injuries in order to monitor and guide injury prevention efforts. In addition, we provide updated estimates of treatments administered in the ER for sports injuries, which provides new information that can be used to monitor improvements to the quality and value of care and serve as a benchmark for future studies.


Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017

October 17, 2019

Questions for Lead Author Sally Curtin, Health Statistician, of “Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017.”

Q: Why did you decide to focus on ages 10 through 24 for suicides and homicides?

SC: Suicide and homicide are among the leading causes of death for this age range.  As there are almost no suicides below the age of 10, we began with age 10 and decided to go through the young adults age range, through age 24.


Q: How did the data vary by age groups?

SC: For the 10-24 age range, rates of both suicide and homicide are lowest for 10-14, intermediate for 15-19 and highest for 20-24.  The patterns differed between age groups.  For children and adolescents aged 10-14, suicide rates nearly tripled from 2007 to 2017 whereas homicide rates gradually declined over the period.  For 15-19 and 20-24, both suicide and homicide rates increased, with the increase beginning earlier for the suicide rates.


Q: Is this the first time you have published a report on this topic?

SC: We have published some similar reports recently, but this is the first one which focuses on these two causes of death for this age range.  Suicide and homicide are often referred to as the two major components of violent death.


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

SC: That both suicide and homicide have increased recently for 15-19 and 20-24 year olds.  Homicide has only been increasing since 2014, but this is after years of decline whereas suicide began to increase sooner.


Q: Why do you think suicide and homicide death rates have risen?

SC: That is for others in the prevention and research community to answer.  However, other studies have shown that some of the risk factors for suicide and homicide have increased.  In particular, depression and other mental health disorders have been shown to be increasing in youth.


Prevalence and Trends of Developmental Disabilities Among U.S. Children

September 26, 2019

A new study from Pediatrics shows looks the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using National Health Interview Survey data.

The study found that from 2009 to 2011 and 2015 to 2017, there were overall significant increases in the prevalence of any developmental disability (16.2%–17.8%), attention-deficit/hyperactivity disorder (8.5%–9.5%), autism spectrum disorder (1.1%–2.5%), and intellectual disability (0.9%–1.2%), but a significant decrease for any other developmental delay (4.7%–4.1%).

The prevalence of any developmental disability increased among boys, older children, non-Hispanic white and Hispanic children, children with private insurance only, children with birth weight less than 2500 g, and children living in urban areas and with less-educated mothers.

For more information, please click on the link


Characteristics of Asthma Visits to Physician Offices in the United States: 2012–2015 National Ambulatory Medical Care Survey

September 20, 2019

Questions for Lead Author Lara Akinbami, Health Statistician, of “Characteristics of Asthma Visits to Physician Offices in the United States: 2012–2015 National Ambulatory Medical Care Survey.”

Q: Why did you decide to do a report on asthma visits to physician offices?

LK: Asthma is a common chronic condition in the United States: in 2016 8.3% of the population had asthma.  Each year, there are nearly 2 million emergency department visits, over 300,000 hospitalizations and more than 3.500 deaths in the United States due to asthma.

These adverse outcomes arise when episodic asthma attacks become severe.  A key part of preventing these adverse asthma outcomes is the prevention of attacks, and early recognition and management of symptoms.  Physicians in non-emergent community settings have a key role in partnering with people with asthma in identifying and monitoring symptoms, and developing a plan to avoid things that trigger attacks, and providing a medication plan to reduce symptoms when they do arise.  There are evidence-based national asthma guidelines that provide recommendations on how to best manage asthma that are directed toward care in physician offices (https://www.ncbi.nlm.nih.gov/books/NBK7232/).  Furthermore, asthma is now increasingly recognized as a risk factor for chronic obstructive pulmonary disease, the fourth leading cause of death in the US, and diagnosis and management of asthma is as an important part of monitoring lung health through the lifespan.

For all these reasons, assessing trends in visits to physician offices is useful in tracking the characteristics of asthma patients, the reasons asthma patients seek care (routine monitoring or acute care), and the services provided in these visits.  These help answer questions that can direct interventions, for example, “Are certain groups less likely to seek care in office settings?” Or “Are guideline recommendations being followed?”


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

LK: Asthma visit rates tend to reflect the prevalence of asthma in the population, but with some notable exceptions.  Asthma prevalence is higher in children than in adults, and children have higher asthma physician office visit rates than adults.  However, although asthma prevalence peaks in mid-childhood, we see high rates of asthma visits among children 0-4 years of age.  This is because these very young children have smaller airways.  They are more likely to show symptoms with any conditions that further narrows the airways, such as respiratory infections.

Another interesting pattern is that asthma prevalence is higher among boys than girls, in contrast to among adults in whom women have higher asthma prevalence than men.  Asthma visit rates also reflect this pattern with boys having higher visit rates than girls, and women having higher visit rates than men.  However, once the differences in prevalence are accounted for by looking at just people who have asthma, boys with asthma have similar asthma visit rates as girls with asthma, and the same is true for men and women with asthma.  The one exception is that very young boys ages 0-4 yeas with asthma still have higher rates of asthma visits than 0-4 year old girls with asthma.

By race and Hispanic origin, asthma visit rates are similar between groups with no differences seen between asthma visits rates for non-Hispanic white, non-Hispanic black and Hispanic persons.  Asthma visit rates were lower for persons of non-Hispanic other race.  However, this pattern does not reflect asthma prevalence which is higher for non-Hispanic black persons than non-Hispanic white and Hispanic persons.


Q: Is this the first time you have published a report on this topic?

LK: The Centers for Disease Control and Prevention publishes regular asthma surveillance reports on asthma that provide analysis of trends and estimates of the most recent data for asthma prevalence, health care utilization and death.  The CDC also provides a web page with the most recent asthma data: https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm.  However, this report is only the second since 1996 to analyze asthma visits to physician offices in depth, including the degree to which services in asthma visits reflect recommendations in the national asthma guidelines.  These guidelines were originally released in 1991 with the most recent update in 2007.  When findings of this report which analyzed data from 2012-2015 is compared to the 1996 report that analyzed data from 1993-1994, we found that despite an increase in asthma prevalence over this period, the annual average number of asthma visits declined from 11 million in 1993-1994 to 10.2 million in 2012-2015.  Medications in 2012-2015 included newer medications that target airway inflammation.  A similar percentage of asthma visits were seen by primary care physicians as opposed to asthma specialists, 65% in 1993-1994 and 60% in 2012-2015.  However, there was less progress in increasing the implementation of national asthma guidelines than would be expected given the effort to increase uptake of key recommendations such as providing an asthma action plan and documenting asthma severity and control.


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

LK: Given the emphasis on the importance of assessing and documenting asthma control, only 40.9% of asthma visits to physician offices had a level of asthma control documented.  The distribution between levels of asthma control was expected with 29.1% of patients with well controlled asthma, 10.5% with not well controlled asthma and 1.3% of patients with very poorly controlled asthma.  However, that 59.1% of asthma patients had no level of control documented was surprising given the concerted efforts to have asthma control assessed and documented.  These efforts included quality of care measurements, physician continuing education, a Guideline Implementation Report (https://www.nhlbi.nih.gov/files/docs/guidelines/gip_rpt.pdf), and local quality improvement projects.


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

LK: Asthma is a common chronic condition and a common reason for physician office visits.  Given its high burden in morbidity, health care use, and mortality, it is important to assess the content of asthma physician office visits given that physicians are the on the “front line” of asthma care and provide the majority of asthma care.  Rates for asthma visits to physician offices started to decline before total office visit rates declined.  Asthma education, objective monitoring (pulmonary function  testing) and level of asthma control were documented in a minority of visits.  Quick-acting relief medication remained the most frequently mentioned medication class.  Additional research can explore the underlying reasons for trends, and future policy can target low implementation rates of guideline recommendations.


Births: Provisional Data for 2018

May 15, 2019

Questions for Brady E. Hamilton, Ph.D., Demographer, Statistician, and Lead Author of “Births: Provisional Data for 2018.”

Q: How does the provisional 2018 birth data compare to previous years?

BH: The  number of births, the general fertility rate, the total fertility rate, birth rates for women aged 15-34, the cesarean delivery rate and the low-risk cesarean delivery rate declined from 2017 to 2018, whereas the birth rates for women aged 35-44 and the preterm birth rate rose.


Q: When do you expect the final 2018 birth report to come out?

BH: The 2018 final birth report is scheduled for release in the fall of 2019.


Q: How did the data vary by age and race?

BH:  Birth measures shown in the report varied widely by age and race and Hispanic origin groups. Birth rates ranged from 0.2 births per 1,000 females aged 10-14 to 99.6 births per 1,000 women aged 30-34. By race and Hispanic origin, the cesarean delivery rate ranged from 28.7% of births for non-Hispanic American Indian or Alaska Native women to 36.1% for non-Hispanic black women and the preterm birth rate ranged from 8.56% for non-Hispanic Asian women to 14.12% for non-Hispanic black women.


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

BH: The report includes a number of interesting findings. The record lows reached for the general fertility rate, the total fertility rate and birth rates for females aged 15-19, 15-17, 18-19, and 20-24 are noteworthy. In addition, the magnitude of the continued decline in the birth rate for teens aged 15-19, down 7% from 2017 to 2018, is also historic.


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

BH:  The number of births for the United States was down 2% from 2017 to 2018, as were the general fertility rate and the total fertility rate, with both at record lows in 2018. Birth rates declined for nearly all age groups of women under 35, but rose for women in their late 30s and early 40s. The birth rate for teenagers aged 15–19 was down 7% from 2017 to 2018. The cesarean delivery rate and low-risk cesarean delivery rate were down in 2018. The preterm birth rate rose for the fourth year in a row in 2018.


Q: Do you anticipate this drop will continue?

BH: The factors associated with family formation and childbearing are numerous and complex. The data on which the report are based come from all birth certificates registered in the U.S. While the scope of these data is wide, with detailed demographic and health   information on rare events, small areas, or small population groups, the data do not provide information on the attitudes and behavior of the parents regarding family formation and childbearing. Accordingly, these data do not answer the question of why the number of births dropped in 2018 or if the decline will continue.