PODCAST: Design of Survey Questions during the Pandemic

June 25, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210625/20210625.htm

HOST: The quality of data in any health survey depends on the quality of the questions being asked, as well as the interpretation of those questions by the survey participants.  NCHS has a team in place that directly deals with those issues, the Collaborating Center for Question Design and Evaluation Research, or “CCQDER.”  CCQDER uses cognitive interviewing, a popular method for evaluating survey questions, by offering a detailed depiction of meanings and processes used by respondents to answer questions, which ultimately impact the survey data.  The sample of respondents in these studies is usually small, between 20 and 50 respondents.

This week, the CCQDER team hosted a webinar in which they discussed the design of survey questions about COVID-19, and the administration of those questions during the pandemic.  In addition to cognitive interviewing, the webinar also covered topics such as the Research and Development Survey, or “RANDS.”

As part of the Q and A segment of the webinar, Kristen Miller, the CCQDER Director, was asked whether standardized COVID questions had been developed by NCHS for outside researchers to use in their own studies:

KRISTEN MILLER: So traditionally it hasn’t been in our job scope to come up with standardized questions.  What we have done is – and maybe we want to rethink this for the future – but what we do do is we test these questions…  in these reports you will see specifically what each individual question captures. So what we would like to see people do is to get on, read these reports, see if this question – is this question capturing what I need it to capture – and then you making the decision, “Yes, I’m going to go with this question.”  So again, not anything standardized, but information provided to you so that you can choose the question that is best going to fit your research question.

HOST: The team was also asked what they would recommend in a rapid deployment situation in which there is not enough time to conduct a full evaluation of questions:

KRISTEN MILLER: I fully appreciate the problem.  And at the same time, I think that whenever we’re writing questions we need to have a concerted effort to have a plan how we’re going to go about question evaluation.  So it’s keeping track of the questions that go into the field, having mixed method or having these follow up pro questions that we had on RANDS to be able to see, “OK, this is going to be, there’s going to be error in this question, it’s going to be more error for less educated people, let’s keep that in mind as we interpret the data that’s coming in.”  But then, again, keeping track of what we’re asking so that we can improve our questions.  I mean, we’re so far into this pandemic I’d like to think our questions that we’re asking are much more improved from the questions that we began with when it first started.  So again, it’s just really having a question evaluation plan going forward.

HOST: The reaction to any survey question is highly personal and subjective, and the CCQDER team was asked about whether respondents have been impacted by their fear of COVID-19 when answering the questions.  Dr. Stephanie Willson of the CCQDER team described some of the challenges:

STEPHANIE WILLSON: Right, actually that’s a very astute observation because again the experience that people had – you had people who thought it was a hoax over here to people who were super-afraid of getting it, right?  So that absolutely was filtered through.  One example I didn’t get a chance to talk about was this need — there were questions about, “Did you need medical care for something but not get it because of the pandemic?”  So that kind of fear, the idea of need, was filtered through people’s experience with the pandemic and how afraid they were of catching it.  So certain things were missed, because suddenly now, “I don’t need to get a check-up, I don’t need a well-woman visit, I don’t need a cancer screening because of the pandemic.”  Where in non-pandemic times:  “Yes, I feel like I need those things.”  So that is an element of fear that absolutely did factor into interpretations.

HOST: Dr. Willson also discussed the differences between “remote interviewing” and traditional face-to-face interviews, and whether remote interviewing will continue into the post-pandemic era:

STEPHANIE WILLSON: The interesting thing was, even though I’ve been doing this for a long time, I had never done a virtual interview prior to the pandemic so I went into it kind of skeptical.  But I have to tell you, I’m a convert.  I really feel as though Zoom interviews really gave the same kind of quality cognitive interview data that face-to-face, in-person face-to-face interviews gave, so I think we should continue to use this.  I think that in certain situations, there’s a downside maybe in terms of socioeconomic status, but the upside to this would be geographical diversity that we can now explore that you can’t do… It takes so much more money to, let’s say, go regionally throughout the United States, for example.  And we did have actually geographic diversity in our sample here – not enough to make it count because we were trying to do it quickly but, yeah, I think it should continue to be used.

HOST: All CCQDER studies feature a final report that document the study findings, and are housed on a searchable, publicly accessible database called Q-Bank.

MUSICAL BRIDGE

HOST: Urgent care centers and health clinics located within grocery or retail stores are able to provide acute health care services for non-emergency visits, and they also can provide preventive care services, such as routine vaccinations. The availability and utilization of urgent care has risen dramatically in recent years.

A new report released this week examines urgent care center and retail health clinic visits among adults in the past year by sex and selected characteristics.  The report uses data from the 2019 National Health Interview Survey, and reveal that 1/3 of women and slightly over ¼ of men made one or more visit to an urgent care center or retail health clinic in the past year.

Older adults are less likely to use urgent care centers or retail health clinics than younger adults, and non-Hispanic white adults are more likely to have visited an urgent care center or retail health clinic at least once in the past year compared to Hispanic, non-Hispanic black or NH Asian adults.  In addition, adults with higher education levels are more likely to use urgent care centers or retail health clinics.

A second report came out this week which compares provisional or preliminary 2020 data with final 2019 and 2018 data on changes in the number of births in the United States by month and by state.  The report also includes data on the race and Hispanic origin of the mother, and sheds some light on the impact of the COVID-19 pandemic on fertility in the country.

From 2019 to 2020, the number of births declined for each month.  In comparison, from 2018 to 2019, the number of births declined for only 9 months of the year.  The largest declines in 2020 occurred in December, followed by August, and then October and November.  The number of births in the U.S. declined 8% more in December 2020 than it did the previous year.

In other words, the decline in births between 2019 and 2020 was larger in the second half of the year than in the first half of the year – 6% in the second half of the year vs. only 2% in the first half.   Between 2018 and 2019, the number declined 2% in the first half of the year and 1% in the second half.

Ultimately, more information on fertility during the pandemic won’t be known until 2021 data are available. The first provisional data for 2021 should be available by early Fall.


Latest Mental Health Data from Household Pulse Survey

June 16, 2021

NCHS partnered with the Census Bureau on an experimental data system called the Household Pulse Survey to monitor recent changes in mental health, telemedicine and health care access during the pandemic.

The latest data collected from May 26 through June 7, 2021 shows 3 out of 10 U.S. (28.8%) reported symptoms of an anxiety or a depressive disorder in the past 7 days.  This is the lowest percentage since the start of the Household Pulse Survey more than a year ago.  However, the percentage is almost 60% for those with a disability.

The data also shows that 20.6% of U.S. adults took prescription medication for mental health and 9.5% received counseling or therapy in the last 4 weeks.


PODCAST: The 2020 Increase in Death Rates Were The Highest Ever Recorded

June 11, 2021

STATCAST, JUNE 2021: DISCUSSION WITH FARIDA AHMAD, STATISTICIAN, ABOUT LATEST PROVISIONAL QUARTERLY MORTALITY DATA.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210611/20210611.htm

podcast-iconHOST:  Each quarter NCHS releases provisional data on mortality from leading causes of death in the U.S. on an interactive web-based dashboard.   This week the dashboard was updated to include Quarter 4 data from 2020 and gives a complete account of provisional death rates in the U.S. for the year.  Joining us to discuss some of the key findings is Farida Ahmad of the Division of Vital Statistics.

HOST: First question: how much did the death rate in the U.S. increase in 2020?

FARIDA AHMAD:  The death rate for the U.S. increased by about 16% in 2020 compared to 2019-

HOST:  Now is it safe to say that almost all of the increase can be attributed to COVID-19.

FARIDA AHMAD:  A large part of it, yes, but we also saw increases in other causes of death like heart disease, Alzheimer’s disease, and diabetes.  Unintentional injuries like drug overdose also increased throughout 2020.  This report only includes drug overdose rates for the first half of the year but you do see very large increases in the second quarter of 2020.

HOST:  Some say that certain causes of death like influenza and pneumonia declined in 2020 due to COVID – is that true?

FARIDA AHMAD:  No, not really – that’s due to influenza and pneumonia were actually higher in 2020 than in 2019.  That’s likely driven by the pneumonia more so than influenza though.

HOST:  Is there any sense whether some of those pneumonia deaths are miscategorized, that maybe they should be in the COVID category?

FARIDA AHMAD:  Yes, you know it’s definitely possible.  We don’t have hard numbers on that and to account for maybe miscategorized COVID deaths we would we would look at excess mortality.  So a different kind of measure to look at that.

HOST:  I guess then the same would be true for other causes of death, particularly those that occur at the very beginning of 2020.  Is there any chance there will be more COVID deaths added to the tally?

FARIDA AHMAD:  It’s certainly possible but we haven’t closed out the 2020 data year.  So we could still get additional changes but we don’t anticipate a significant number of deaths data will change.

HOST:  So the data aren’t final yet is that correct?

FARIDA AHMAD:   Yes that’s correct.

HOST:   So what are some of the more striking changes you saw in the death rates from 2019 to 2020 as far as certain leading causes go?

FARIDA AHMAD:  Diabetes deaths increased by almost 14%… Chronic liver disease increased by 17% … and then hypertension and Parkinson disease those increased by 12% and 11% respectively.

HOST:  So in a normal year those would be considered very large increases is that correct?

FARIDA AHMAD:  Yes, yeah shifts that large would be notable.

HOST: But there’s no way to sort of link that back to the pandemic, either directly or indirectly?

FARIDA AHMAD:   Not with the death certificate data that we have, unless these deaths – you know these deaths which were the underlying cause is what we’re looking at.  For these deaths COVID-19 might also be listed on the death certificate, in which case you could say that COVID-19 played a role in that death but otherwise we wouldn’t necessarily know if it was a direct or indirect cause of the pandemic in terms of disrupted access to healthcare or other contributing factors.  The death certificate data wouldn’t necessarily tell us that.

HOST: So in general 2020 was a very rough year for mortality but were there any declines in leading causes of death in 2020?

FARIDA AHMAD:  There were a few – there were declines in cancer, in chronic lower respiratory diseases, and pneumonitis due to solids and liquids>

HOST: Did the pandemic – did COVID-19 — have any impact on death rates at the state level?  Were there any unusual changes in 2020?

FARIDA AHMAD:  West Virginia and Mississippi had the highest death rates overall, but the largest increases in death rates were actually seen in New York and New Jersey.

HOST:  Is there anything else in this new data that you’d like to note?

FARIDA AHMAD: What this report allows us to look at is not just the deaths due to COVID-19, which have been understandably a huge focus of public health surveillance in last year, but with this report we get to look at some of the other leading causes of death that might not be in the top five, or the top ten, but these are issues of public health importance and concern.  To look at these various diseases and causes of death, so I think that’s really what this report adds is to be able to take a broader look.

MUSICAL BRIDGE:

HOST: Our thanks to Farida Ahmad for joining us on this edition of “Statcast.”

HOST:  On Wednesday of this week, NCHS also released a new report on screening for breast, cervical and colorectal cancer.  The study featured data on women age 45 and over from the National Health Interview Survey, and concluded that regular cancer screening is much more likely among women of higher socio-economic status, as well as women who are married or living with a partner, and women who engage in healthy behaviors — such as not smoking, regularly exercising, and getting a flu shot.


NCHS Releases Latest Quarterly Provisional Mortality Data Through Full-Year 2020

June 8, 2021

NCHS has released the latest quarterly provisional mortality rates for the U.S., through full-year 2020 for most causes of death. 

Estimates are presented for 15 leading causes of death plus estimates for deaths attributed to coronavirus disease 2019 (COVID-19), drug overdose, falls for persons aged 65 and over, firearm-related injuries, human immunodeficiency virus (HIV) disease, and homicide. 

The data is featured on an interactive web site dashboard at: https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm.

NCHS has also released state maps showing COVID-19 death rates for provisional quarter 4 mortality data. You can access the 12-month ending map here and quarterly map here.


PODCAST: Effects of the Pandemic on Births in New York City

May 7, 2021

STATCAST, MAY 2021: DISCUSSION WITH ELIZABETH GREGORY, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210507/20210507.htm

podcast-iconHOST:  Elizabeth Gregory is a health scientist with the CDC’s National Center for Health Statistics.  Elizabeth has authored a new study examining the effects of the pandemic on births in New York City, one of the hardest-hit areas by COVID-19.  The study looked at changes in the percentage of births to women who are residents of New York City but who gave birth outside the city.  The data covered the period between 2018-2019 and 2019-2020.

HOST:  So this is a different study than what we usually get from NCHS.  Can you explain why you chose this topic?

ELIZABETH GREGORY:  Sure.  Early on during the height of the pandemic in New York City in 2020 there were a lot of news stories about residents leaving the city and busy hospitals with a brief ban on support persons during labor and delivery at some hospitals.  So we decided to take a look at what are these things resulted in women going out of the city to give birth.

HOST: Now a lot of people are anxiously awaiting new data from 2021 to see if there were any major changes in fertility due to the pandemic, but your report is showing really that the pandemic did impact births in New York, at least from a health care utilization, from a delivery perspective, is that correct?

ELIZABETH GREGORY:  So we found that from 2019 to 2020 the percentage of New York City residents giving birth outside the city increased overall for all months from March through November, peaking in April and May.  And the timing of these increases in these out-of-city births correspond with the height of the early pandemic in New York City.

HOST:  is there any indication that these patterns were also true for other cities that were hard hit that in the early stages of the pandemic?

ELIZABETH GREGORY:   We didn’t look at any other cities – but this would be something that would be really interesting to look at.

HOST:  Is there any indication whether these New York City residents were just going across the state line and into New Jersey or Connecticut to have their babies or were they actually traveling further than that? Do you have any information on that?

ELIZABETH GREGORY:   So this is also another thing that be really interesting to look at but for this report we didn’t specifically look at where the out-of-city births were occurring.

HOST:  NCHS of course is also releasing their annual births report on Wednesday and there will be state data and also data for New York City available soon.  Now what happens data-wise in the situation your study focuses on – so for example if a New York City woman goes to New Jersey to give birth does that count as a New Jersey birth or is it still a New York birth?

ELIZABETH GREGORY:  So birth certificates are filed in the state where the birth occurred but are usually looked at by the mother’s state of residence for NCHS reports.  So in this report, a birth to a mother that lived in New York City occurring outside of the city will be considered a birth to a New York City resident.  And in this report it would just be classified as an out-of-city birth.

HOST:   Did we see a surge in births in these neighboring states like New Jersey or Connecticut for 2020?

ELIZABETH GREGORY:  So we didn’t specifically look at where the out-of-city births were occurring but maybe that’s something that could be looked at in the future.

HOST:  So what are some of the conclusions that you’ve drawn from this research?

ELIZABETH GREGORY:  Well from 2019 to 2020 the percent of New York City residents giving birth outside the city increased overall from March through November, peaking in April and May, with the timing of the increases in these out-of-city births corresponding with the height of the early pandemic in New York City.  And additionally, the overall rise in out-of-city births is largely the result of increases among non-Hispanic white women while increases were less pronounced for births to non-Hispanic black and Hispanic residents.

HOST:   Are you planning any other similar geographic studies based on the 2020 data?

ELIZABETH GREGORY:  We currently have a report in the works that will be looking at whether there were any changes between 2019 and 2020 in the percentage of births by whether the mother was born inside or outside the U.S.  I just wanted to mention that we are also working on another report about home births, just to see whether there was a change in the percentage of home births that were occurring in the U.S. from 2019 to 2020.

HOST:  Elizabeth Gregory’s new study was released on the same day that the full-year 2020 birth statistics for the U.S. were released.  These new data were based on over 99% of birth certificates issued in the U.S. during the year, and were featured in a new report that had a number of noteworthy findings:

The nation’s general fertility rate, which is the number of births per 1,000 women age 15-44, reached another record low in 2020, dropping 4% from 2019.  The total number of births in 2020 also fell 4%, to 3,605,201 – the sixth straight year the number of births declined.

The new report also revealed that births in the U.S. continue to be at below replacement levels, based on another decline in the total fertility rate.  Birth rates declined for females of all age groups except two:  adolescents age 10-14 and women age 45-49.

The birth rate for teenagers age 15–19 declined by 8% in 2020 to 15.3 births per 1,000 women in that age group.  The teen birth rate has declined every year going all the way back to 1991 except for two – 2006 and 2007.  The rates in 2020 declined for both younger teens age 15–17 and older teens age 18–19.

Nearly one-third of all births in 2020 were by cesarean delivery, and over one-fourth of births were low-risk cesarean deliveries.  Also, the preterm birth rate in the U.S. declined in 2020 for the first time since 2014, to just over 10% of all births in 2020.


Latest Pulse Survey on Anxiety and Depression during Pandemic

May 6, 2021

The latest Household Pulse Survey shows 1 out of 3 U.S. adults (32.1%) had symptoms of an anxiety or a depressive disorder in the past week.  This is the lowest percentage since the start of the survey a year ago.  Also, more than half of 18-29 year olds experienced the same symptoms.

More Findings:

  • Almost 10% of U.S. adults say they needed counseling or therapy, but did not get it the past month.  This is a 1.2 percentage decrease from more than a year ago.
  • Almost 1 out of 4 U.S. adults (24%)  delayed or did not get needed medical care in the past month due to the pandemic. This estimate is almost 5 percentage points lower than the estimate from March 17-29, 2021.
  • 25% of U.S. adults had an appointment with a health professional over video or phone in the past month.  
  • 2 out of 5 U.S. adults with a disability (40.5%) had an appointment with a health professional over video or phone in the past month.

To rapidly monitor recent changes in mental health, NCHS partnered with the Census Bureau on an experimental data system called the Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. The data collection period for Phase 1 of the Household Pulse Survey occurred between April 23, 2020 and July 21, 2020. Phase 2 data collection occurred between August 19, 2020 and October 26, 2020. Phase 3 data collection occurred between October 28, 2020 and March 29, 2021. Data collection for Phase 3.1 of the survey began on April 14, 2021 and will continue through July 5, 2021.


Race and Hispanic-origin Disparities in Underlying Medical Conditions Associated With Severe COVID-19 Illness: U.S. Adults, 2015–2018

April 28, 2021

Figure_02192021A new NCHS report calculates the prevalence of selected conditions by race and Hispanic origin among U.S. adults (aged 20 and over) during 2015–2018.

Data were used from the National Health and Nutrition Examination Survey. Conditions included asthma, chronic obstructive pulmonary disease, and heart disease based on self-report; and obesity, severe obesity, diabetes, chronic kidney disease, smoking, and hypertension based on physical measurements

Findings:

  • An estimated 180.3 million (76.2%) U.S. adults had at least one condition during 2015–2018.
  • Approximately 86.4% of non-Hispanic black adults had at least one condition, 58.5% had at least two conditions, and 29% had at least three conditions; these prevalence estimates were significantly higher than among other race and Hispanic-origin groups.
  • Compared with non-Hispanic white adults, Hispanic adults had higher rates of obesity and diabetes.
  • Non-Hispanic Asian adults had lower rates of at least one condition, but higher rates of diabetes compared with non-Hispanic white adults.
  • Non-Hispanic black women were more likely to have multiple conditions, obesity, severe obesity, diabetes, and hypertension compared with non-Hispanic white women.
  • Non-Hispanic black men were more likely to have one or more conditions and hypertension compared with non-Hispanic white men.
  • Hispanic men were more likely to have diabetes compared with non-Hispanic white men.

PODCAST: Death Certificate Data & COVID-19, Part 3

March 26, 2021

STATCAST, MARCH 2021: DISCUSSION WITH ROBERT ANDERSON, A STATISTICIAN, ABOUT DEATH CERTIFICATE DATA & COVID-19.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210326/20210326.htm

HOST:  In Part Three of our conversation with Dr. Robert Anderson, the chief of mortality statistics at NCHS, we discussed the subject of excess deaths in the United States during the pandemic, and also the differences between when COVID-19 is listed as the underlying cause of death on the death certificate and those occasions when it is listed as a contributing cause but not the primary cause of death.

HOST:  So now you mentioned excess deaths – what are excess deaths, how has COVID-19 contributed to these excess deaths?

ROBERT ANDERSON:  So excess deaths are defined as the difference between the observed number of deaths in a specific time period and the expected or normal number of deaths in the same time period. So with the pandemic we’re looking at the total number of weekly deaths that occurred in 2020 and so far in 2021, and we’re comparing it with what we would expect in a comparable time period, essentially based on average weekly data from previous years.  The advantage of looking at excess deaths is that it’s not dependent on the accuracy of cause of death reporting – the focus is just on the total deaths, not deaths by cause.  Now at this point COVID-19 explains about 3/4 of total excess deaths and the other quarter likely includes three components: there are deaths that should have been attributed to COVID-19 but were instead attributed to some other cause for whatever reason.  Second, indirect deaths.  And these are deaths that can be attributed to the circumstances of the pandemic but not directly to the virus.  And this may be things like people not able to get health care during a crisis not related to the virus.  Or perhaps they’re afraid to seek care because the hospitals are full of people with COVID.  And then, three: a third component is other causes of excess deaths.  So you know there may be some excess deaths not associated with pandemic.  This could include things like deaths due to natural disasters.  This is generally going to be relatively small in comparison to what we’re dealing with the pandemic but these are sort of another category of excess deaths.

HOST:  There was some other speculation out there – rumors or what have you – that 2020 might have been actually a normal year in terms of total mortality in comparison to past years despite COVID-19.  How were people getting confused about that?

ROBERT ANDERSON:   Yeah the problem was that some folks were comparing incomplete counts for 2020 with complete counts for earlier years.  And so it did look like there were about a normal number of deaths.  The problem was that they weren’t including all of the deaths that occurred for 2020.  So we’ve made some changes to our website to try to make it more clear what the total number of deaths were for 2020.

HOST:  So NCHS ranks leading causes of death according to the underlying cause of death, and you mentioned earlier that in 92%, approximately, of COVID-19 related deaths, COVID-19 was listed as the underlying cause of death. And in roughly the other 8% of COVID-19 related deaths COVID-19 was not listed as the underlying cause of death.  Could you talk about that a little bit?

ROBERT ANDERSON:  Sure.  Let me start by saying that leading causes are ranked by the total number of deaths, and it’s based on a standard cause of death tabulation list that we typically used.  And if folks are interested in that we have a publication called “Deaths: Leading Causes for… insert the year – I think the most recent one that we have published right now is for 2018 -but you get the idea of exactly how NCHS does the rankings and how all of that came about.  Now when tabulating and comparing causes of death it’s important that we assign a single cause to each death so that we don’t double count.  We don’t want to have deaths falling into multiple categories, so we select a single cause.  And as we discussed earlier, certifiers typically report more than one condition on death certificates.  Now fortunately, as we also discussed, the death certificate is designed to elicit the single underlying cause, and that’s defined as the disease or injury that initiated that sequence of events leading to death.  That sequence gets reported in Part One on the certificate, and if completed correctly the underlying cause will be at the beginning of the sequence on the lowest use line in Part One.  So as I mentioned before you could have a sequence like respiratory distress due to viral pneumonia due to COVID-19.  That’s a logical sequence starting with the immediate cause – which is respiratory distress – and then working backwards through viral pneumonia, back to COVID-19, which is the underlying cause.  So that is the condition then that we would select for tabulation when comparing causes of death.  Now if the certificate is not completed correctly – and this does happen – we actually have a set of standardized selection rules to choose the best underlying cause for among those conditions listed.  These rules are part of ICD-10, which we used to code mortality, and they’re an international standard.  So the all those rules get applied regardless of the cause of death in the same way and as a result we would select an underlying cause from among those conditions, assuming that the certificate is not completed correctly.  Now with regard to the other 8 or 9 percent – I think it’s something on the order of 91 point-something percent, underlying cause and then about 8 point-something percent not underlying cause.  In cases where COVID-19 is not the underlying cause, we’re typically seeing it reported in Part Two as a significant contributing factor.  So if reported in Part Two, it may not be the underlying cause. It should be considered a significant factor that contributed to death.  And this is an important distinction – if COVID-19 is not a factor it’s not supposed to be reported on the death certificate.

MUSIC BRIDGE

HOST:  Still to come next week in our discussion with Dr. Robert Anderson:  How COVID-19 will be categorized among the other leading causes of death in the country, as well as more complicated scenarios facing certifiers on how to list COVID-19 on the death certificate.

MUSIC BRIDGE

HOST:  The rate of multiple births in the United states declined in 2019, according to the latest final birth data released this week by NCHS.  The new report also shows that more than 3 in 4 women began prenatal care during the first trimester of pregnancy.  The percentage of women who smoke during pregnancy declined in 2019 – to 6% of all women who gave birth. Medicaid was the source of payment for over 4 in 10 births that occurred in 2019.

Another report published this week by NCHS looks at drug overdose death rates in the U.S. on a state by state basis.  The report documents that the highest death rates from overdoses in 2019 were concentrated in jurisdictions that are in fairly close geographical proximity to one another: West Virginia, Delaware, DC, Ohio, Maryland and Pennsylvania.  Nebraska had the lowest overdose death rate in the nation in 2019.