PODCAST: COVID-19 Mortality by Occupation and Industry

October 28, 2022

https://www.cdc.gov/nchs/pressroom/podcasts/2022/20221028/20221028.htm

HOST:  We talked this week with Ari Minino, a statistician with the NCHS Division of Vital Statistics and co-author on a new report out on October 28th on COVID-19 mortality in 2020 by occupation and industry.  The report was a collaborative analysis conducted by NCHS and NIOSH – the National Institute for Occupational Safety and Health.

HOST:  Before we get into what your study is all about, can you briefly tell people or caution people what your study does not cover.

ARI MININO:  The study is limited to information on what the usual occupation and industry of the decedent was.  That is, what was the work or usual job that the person did for most of his working life.  So this is not, for example, a study on exactly where it was that the person contracted the condition – in this case COVID-19.  It is a study trying to associate the co-determinant of work which is co-determinant of health and how that relates to the, in this case the risk of the person died from COVID-19. That is a delicate distinction, but I think it’s important one.

HOST:  So, in this study your coauthors actually were from the National Institute for Occupational Safety and Health, is that correct?

ARI MININO:  That’s correct.  Yeah, it’s important to note that this is a close collaboration between the National Institute for Occupational Safety and Health and the National Center for Health Statistics and this goes back many decades ago.  We used to have data on the usual occupation and at the industry of the decedent included as part of our mortality data for the years 1984 through 1998.  And it was only recently – and probably I’m going to say it started in 2018 – there was a signed agreement between the two agencies that we started working towards trying to incorporate these data again into the mortality data.  And so the first year that we’re including this data is for 2020 and we’re very excited, very happy that these data are finally part of the mortality, national vital statistics file, and this report that we’re discussing is kind of like our introduction to that.  And my colleagues, Dr. Andrea Steege and Dr. Rachael Billock, they were the true driving force for this study, and they produced most of the coding and they did actually all of the analysis, all the analytical work.  And they were with us in NCHS on a detail for the duration of the period of this study, when this study was conducted.

HOST:  It’s obviously very difficult or almost impossible to determine where and how anyone gets COVID, and so that’s one of the limitations you wanted to point out, out front, correct?

ARI MININO:  That is correct.  One other important limitation of this work is that this is not a complete global or universal variable in the sense that it does not cover all of the decedents but has some specific limitations.  We only included data for 46 States and New York City, which is a separate registration area, and we only include information for decedents age 10 years and up to 64.

HOST:  And just for those who aren’t familiar with the terminology, when you say “decedent” you’re talking about the people who died, in this case from COVID-19.

ARI MININO:   That is correct.  This information is entirely based on information collected from the death certificate of all the diseases or in this case the decedents who died from COVID-19.

HOST:  Now, turning to what your study did uncover, your study found some interesting things about mortality from COVID-19 and occupation.  And what was in your view the biggest finding in your new report?

ARI MININO:   Well, the biggest finding is something that was sort of expected which is that when we discuss risk, the specific occupation that the decedent had or the usual occupation of this varied quite substantially in terms of the risk of dying from COVID.  For example, when we look at the death rate, which is only one of the measures that we looked at, we found that workers in protective service occupations were the ones who had the highest death rate from COVID.

HOST:  And when you say “protective services” give us some examples.

ARI MININO:  These are policemen, these are people working building security, that type of occupation.  So the other group that had very high death rates were people who worked in accommodation and food service industries.  These are people who work in, for example, hotels.  These are people who work in restaurants. 

HOST:  OK so these are the occupational settings where you mentioned you would expect to see sort of higher mortality.  Were there any surprises in looking at COVID mortality across different occupational settings?

ARI MININO:  There were some surprises.  In particular, when we looked at the measure that we called the “proportionate mortality ratio.” And this is not an indication necessarily of risk, but rather of a disproportionate amount of or a disproportionate count of people who died from COVID-19 relative to all the other decedents.  This is not a measure that can exactly relate to risk necessarily.  This particular way of looking at decedents, we found some variation when we look at deaths by race and Hispanic origin.  In particular, in the way in the specific occupations that showed higher proportions of COVID-19 mortality.

HOST: I guess what you’re saying is that there were demographic groups with higher COVID mortality and some interesting comparisons along occupational lines, is that correct?

ARI MININO:  Yeah and something that is important is that we used two measures.  The main measure that we use, the statistical measure, is the “proportionate mortality ratio.”  And we use that to analyze the differences.  In particular, among the different race and Hispanic origin groups.  That’s because we didn’t have a good sample size with the denominator data.  And it’s very difficult to get denominator data for these occupation and industry groups because the Census is not geared exactly to look at that, and to produce good estimates for that.  And so we looked at PMRs, and that is something – it’s very important to distinguish that, for example when you look at a high PMR, it does not necessarily mean that there is a higher risk for the condition, just because we found a high PMR for a particular occupation.  It just means that there’s a disproportionate number of COVID-19 deaths among the decedents, and its just the numerator. 

HOST:  Doesn’t that sort of speak to the broader issue – that we’re not really assessing risk with this study, right?

ARI MININO:  Yeah, with the measures that are done using the death rate, yes they do speak to risk because we do use a denominator that was available from census that would fit the numerators but–

HOST:  The other measures, that’s a different story.

ARI MININO:  It’s a different story, yeah.  You see that the results when we look at PMRs and in particular when we look at PMRs by race and Hispanic origin, we find that when we look at the non-Hispanic American Indian and Alaska Native population, for example, as well as for non-Hispanic white, we find that the highest PMRs were for people with occupations in community and social services types of occupations.  However, when we look at non-Hispanic Asian and non-Hispanic Black, decedents were observed among those in protective service occupations – same as we found for the overall population.

HOST:  And again, that is using the “proportionate mortality ratio.”

ARI MININO:  Uh-huh.

HOST:  And you indicated that that isn’t necessarily a measure that defines risk but rather—

ARI MININO:  A disproportionate number of COVID-19 deaths among that particular group when compared with the rest of all of the decedents in that particular group for all other occupations.

HOST:  So we would close then by asking if there’s anything else you’d like to mention about your study?

ARI MININO:   I think this is a good introductory study for bringing in awareness about how we have these data for 2020.  Because these data, even though we had industry and occupation data for a selected number of states between 1984 and 1998, this is the first time that we’ve included these data in the mortality file.  And I think – well, because of course of the pandemic situation – I think I thought that it was a very good idea to do an introductory study focusing on COVID.  But this is only the first of a series of studies that we have planned.  And we’re gonna be looking at drug overdose and industry and occupation on how those how those two relate in terms of mortality.

HOST:  Well thanks very much for joining us Ari.

MUSIC

HOST: October was a busy month for NCHS, starting with the release of the latest quarterly provisional birth data in the United States on October 11th.  The quarterly dashboard features data on a number of measures, including the fertility rate in the United States.  The general fertility rate is the number of births per 1,000 females ages 15-44, and the rate increased from 55.2 to 56.4 in the one-year ending in Quarter 2 of 2022 compared with the previous year. 

The next day, on October 12th, NCHS released the latest summary health statistics for children and adults in the United States, based on data from the National Health Interview Survey or NHIS.  This dashboard features a wealth of data on a variety of measures, including smoking.  The NHIS data shows the percentage of adults in the U.S. who smoke cigarettes has declined from 14% in 2019 to 11.5% in 2021. 

The same day, NCHS released the latest provisional monthly estimates of drug overdose deaths in the nation.  108,022 Americans died from overdoses in the one-year period ending in May of 2022.

The following day, on October 13, NCHS released a new report on telemedicine use for 2021.  The study, featuring data from the NHIS, showed that 4 in 10 adults in the United States used telemedicine in the past year. 

That busy week closed out on October 14 with a new study on COVID-19 mortality among older Americans age 65 and up.  The study showed that during the first year of the pandemic, the death rate from COVID for people age 85 and up was nearly three times higher than the rate for people ages 75-84, and seven times higher than the rate for people ages 65-74.

The following week, on October 19, NCHS released a new report on fetal deaths in the United States from 2018 to 2020.  The study showed that there were nearly 47,000 fetal deaths at 20 weeks of pregnancy or longer during this period.

NCHS rounded out the month with three new data releases in the last week, starting with an October 25 study on COVID-19 mortality during the first year of the pandemic by urban-rural status, showing as expected that people living in the most urban areas of the country had higher mortality from COVID than in other geographic areas.

And on October 26, NCHS updated another of its quarterly dashboards, this one on leading causes of death in the country, through the one year period ending in Quarter 1 of 2022.  The data show a drop in the country’s death rate during this period compared to the year before.

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Updated COVID-19 Data Featured in Latest Release from Household Pulse Survey

October 5, 2022

As part of its ongoing partnership with the Census Bureau, NCHS recently added questions to assess the prevalence of post-COVID-19 conditions, sometimes called “long COVID,” on the experimental Household Pulse Survey.

Today, NCHS released the latest round of Pulse data, collected from September 14-26, 2022.  This latest release includes new data on how Long COVID reduces people’s ability to carry out day-to-day activities compared with the time before they had COVID-19.

Data on this topic is available at the following link:

WEB DASHBOARD: https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm

KEY FINDINGS:

·        4 out of 5 people with ongoing symptoms of COVID lasting 3 months or longer are experiencing a least some limitations in their day-to-day activities.

·        1 out of 4 adults (25.1%) with long COVID have symptoms that significantly impact their ability to carry out day-to-day activities.

·        Out of all U.S. adults, nearly 2% (1.8%) had COVID-19 and still have long COVID symptoms that have a significant impact on their ability to carry out day-to-day activities more than 3 months later.

·        14.2% of adults had ever experienced COVID symptoms that lasted 3 months or longer that they had not had prior to their COVID-19 infection.

·        Among the 14.2% who have ever had long COVID symptoms, more than half (7.2%) currently have long COVID symptoms.  

·        1 out of 3 adults in the U.S. who’d had COVID-19 (29.6%) reported ever having long COVID symptoms.

·        15% of those who’d had COVID-19 reported currently having long COVID symptoms.

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PODCAST: The Toll of COVID-19 on Physician Practices

September 30, 2022

https://www.cdc.gov/nchs/pressroom/podcasts/2022/20220930/20220930.htm

HOST:  The COVID-19 pandemic took a major toll on the U.S. health care system.  In a new report released on September 28, data from the National Ambulatory Medical Care Survey were used to examine how COVID-19 impacted physician practices around the country.

Joining us to discuss that new study is Zach Peters, a health statistician with the NCHS Division of Health Care Statistics.

HOST:  What did you hope to achieve with this study?

ZACK PETERS:  This study was intended to produce nationally representative estimates of experiences at physician offices.  So it’s a physician level study and we really wanted to highlight some of the important experiences physicians had due to the pandemic, such as shortages of personal protective equipment.  And it highlights whether testing was common in physician, whether physicians were testing positive or people in their office were testing positive for COVID-19 given that they were on the front lines of helping to treat patients.  So we really wanted to touch on a broad set of experiences faced by physicians.  This certainly isn’t the first study to assess experiences and challenges faced by health care providers during the pandemic but often times those other studies are limited to specific facilities or locations or cohorts and can’t be generalized more broadly.  So a big benefit of a lot of the NCHS surveys is that we can produce nationally representative estimates and this study is an example of that.

HOST:  And what kind of impact has the pandemic had on physicians and their practices?

ZACH PETERS:  In having done quite a bit of literature review for this project it became pretty clear – and I think just listening to the news you sort of understood a lot of the impact.  A lot of research has shown that that health care providers experienced a lot of burnout or fatigue.  There was a lot of exposure and what not to COVID-19.  Long hours… So there’s a lot out there in in the literature that sort of cites some of the challenges.  What we really, what this study highlighted was it was the level of shortages of personal protective equipment that were faced.  About one in three physicians said that they had they had experienced personal protective equipment shortages due specifically to the pandemic .  The study highlighted that a large portion of physicians had to turn away patients who were either COVID confirmed or suspected COVID-19 patients.  And I think the last thing this really helped to show was the shift in the use of telemedicine due to the pandemic.  So prior to March of 2020 there were less than half of physicians at physician offices who were using telemedicine for patient care and that number, that percentage jumped to nearly 90% of office based physicians using telemedicine after March of 2020.  So this is sort of adding to the broader literature with some nationally representative estimates of experiences that providers had due to and during the pandemic.

HOST:  So what sort of personal protective equipment was most affected during this study?

ZACH PETERS:  It’s a good question.  The way in which we asked the questions about shortages of “PPE” – I’ll call it I guess – don’t allow us from really untangling that question.  We asked about face mask shortages, N-95 respirator shortages specifically, but then the second question we asked sort of grouped isolation gowns, gloves, and eye protection into one question.  So physicians didn’t really have the chance to check off specifically what they had shortages of other than face masks.  So it’s somewhat hard to untangle that but these results show that about one in five physicians faced N-95 respirator, face mask shortages due to the pandemic and a slightly higher – though we didn’t test significance in this in this report – a slightly higher percentage, about 25% of physicians, had shortages of isolation gowns,  gloves, or eye protection or some combination of those three. 

HOST:  And you say that nearly four in 10 physicians had to turn away COVID patients.  Now, was this due to a high volume of patients or a lack of staff?

ZACH PETERS:  Again that’s another great question. I think unfortunately we weren’t able to ask a lot of these really interesting follow-ups to some of these experiences. We didn’t get to pry physicians on some of the reasons why they had these experiences, including why they had to turn away patients.  So unfortunately we’re not able to answer some of the “why” questions that we would like with these data.

HOST:  And do you have any data on where these patients were referred to, the ones that were turned away?  Do you have any information on that?

ZACH PETERS:  Again unfortunately this specific question wasn’t something that we asked in the set of new COVID questions introduced in the 2020 NAMCS we did ask a question about whether physicians who had to turn away patients had a location where they could refer COVID-19 patients.  So there are a few reasons – we haven’t assessed that measure in this work so far, but it’s certainly an area we can dig into more especially as we have additional data from the 2021 NAMCS and can try to combine over time.

HOST:  Does it look like the shift to telemedicine visits is here to stay?

ZACH PETERS:  The broader literature sort of highlights that these changes are broad and likely indicate that physician offices and different health care settings have built up the infrastructure to allow for telemedicine use in the future.  And so it’ll be interesting to see if, as waves of COVID or other infections ebb and flow, if we see that the use of telemedicine kind of ebbs and flows along with that.  But I think the option for telemedicine is something that health care settings won’t get rid of now that they have them. 

HOST:  Sticking with the topic of telemedicine – did physicians list any benefits to telemedicine visits other than limiting exposure to COVID-19?

ZACH PETERS:  The set of questions that we asked physicians were limited in scope and we didn’t really have that level of follow-up.  There are some additional questions about telemedicine use that we asked and hope to be able to dig into further.  We asked physicians what percentage of their visits they had used telemedicine and some other questions about just kind of the scope of use, but not necessarily the benefits that they felt they received due to using telemedicine.

HOST:  Is it possible that you might be getting some data on these questions in the future?

ZACH PETERS:  These questions were introduced part way through the 2020 survey year, so we were only able to ask half of our physician sample about these experiences in the 2020 survey.  But we kept the exact same set of COVID related questions in the 2021 NAMCS survey year and so we’re working to finalize the 2021 data and hope to be able to look into some of the more nuanced aspects of this that we might be interested in, such as trends over time if we combine years.  So we might be able to assess differences in experiences based on the characteristics of physicians.  So yeah, we asked these specific questions in the 2021 survey year so hope to have some additional information to put out for folks.

HOST:  You were talking a little bit about the fact that you made changes to the National Ambulatory Medical Care Survey, which this study is based on, which allowed you to collect more complete data during this period. Could you again sort of go over what sort of changes you made?

ZACH PETERS:  Yes the NAMCS team with the Division of Health Care Statistics, we made changes to a few of our surveys partway through the 2020 survey year.  Partly out of necessity and partly out of just interest in an unfolding public health crisis.  So for NAMCS two big changes were made. The first was that we had to cancel visit record abstraction at physician offices.  So historically we have collected a sample of visit records or encounter records from physicians to be able to publish estimates on health care utilization at physician offices due to sort of wanting to keep our participants safe, our data collectors safe, and patients safe.  We cancelled abstraction partly into the 2020 survey year so that was an important change in that we won’t be able to produce visit estimates from the survey year.  But the other change that we made – I think I alluded to it earlier – was that partway through the survey year we introduced a series of COVID-19 related questions, which is what this report summarizes.  And the reason it came partway through the survey year is simply due to the fact that adding a series of new questions to a national survey takes a lot of planning and a lot of levels of review and approval.  So this is partly why we were only able to ask these questions of half of our survey sample.

HOST:  Are there any other changes forthcoming in the NAMCS or for that matter any of your other health care surveys?

ZACH PETERS:  Historically there have been a few different types of providers that have been excluded from our sample frame.  We didn’t include anesthesiologists working in office-based settings, radiologists working in office-based settings.  So we had a few different types of promoting specialties that we couldn’t speak to in terms of their office characteristics and their care that they provided.  In future years we are hoping to expand to include other provider types that we haven’t in the past so I think that’s the big change going forward for the traditional NAMCS.  We also have a kind of a second half of NAMCS that looks at health centers in the U.S., and the big change for that survey in the 2021 survey years that we are in is instead of abstracting a sample of visit records, are we are starting to collect electronic health record data from health centers.  So that’s another a different portion of NAMCS but those are a couple of the big changes at high level that are implementing in NAMCS. 

HOST:  What would you say is the main take-home message you’d like people to know about this study?

ZACH PETERS:  I think the main strength of using data from NCHS in general is that many of our surveys allow for nationally representative estimates and NAMCS is the same in that regard.  We sampled physicians in a way that allows us to produce nationally representative estimates.  And so I think this study highlights how we’re able to leverage our surveys in a way that other studies that you might see in the literature can’t in that they’re more cohort-based.  So I think another important aspect of this is just that it highlights an example of some of the adaptations that DHCS end and NCHS more broadly, some of the adaptations that we made during the pandemic to better collect data and disseminate data.  And so outside of the topic being hopefully important to understand how physicians nationally experienced various things related to the pandemic, this highlights some of the ways in which NCHS was able to remain nimble during a public health crisis.

MUSIC

HOST:  On September 1, NCHS released a new report looking at emergency department visits for chronic conditions associated with severe COVID illness.  The data, collected through the National Hospital Ambulatory Medical Care Survey, were collected during the pre-pandemic period of 2017-2019 and serve as a useful baseline, since it is well established that chronic conditions increase the risk of hospitalization among COVID patients.  The report showed that during this pre-pandemic period, hypertension was present in one-third of all emergency department visits by adults, and diabetes and hypertension were also present together in one-third of these visits.

On the 7th of September, NCHS released a study focusing on mental health treatment among adults during both the pre-pandemic and pandemic period, 2019 to 2021.  It has been documented by the Household Pulse Survey and other studies that anxiety and depression increased during 2020 and the beginning of 2021, and this new study focuses on the use of counseling or therapy, and/or the use of medication for mental health during this period.   The study found there was a small increase in the use of mental health treatment among adults from 2019 to 2021, with slightly larger increases among non-Hispanic white and Asian people.

Also this month, NCHS updated two of its interactive web dashboards, featuring data from the revamped National Hospital Care Survey.  On September 12, the dashboard on COVID-19 data from selected hospitals in the United States was updated, and two days later the dashboard featuring data on hospital encounters associated with drug use was updated. 

On the same day, September 14, NCHS released the latest monthly estimates of deaths from drug overdoses in the country, through April of this year, showing 108,174 people died from overdoses in the one-year period ending in April.  This death total was a 7% increase from the year before.  Over two-thirds of these overdose deaths were from fentanyl or other synthetic opioids. 

On September 29, the latest infant mortality data for the U.S. was released, based on the 2020 linked birth and infant death file, which is based on birth and death certificates registered in all 50 states and DC. 

Finally, September is Suicide Prevention Month, and on the final day of the month, NCHS released its first full-year 2021 data on suicides in the country.  For the first time in three years, suicide in the United States increased.  A total of 47,646 suicides took place in 2021, according to the provisional data used in the report.  The rate of suicide was 14 suicides per 100,000 people.

MUSIC FADES

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PODCAST: Life Expectancy Fell in 2021 for the Second Year in a Row

August 31, 2022

https://www.cdc.gov/nchs/pressroom/podcasts/2022/20220831/20220831.htm

HOST: In 2020, the United States experienced the biggest one-year drop in life expectancy since World War II, mostly due to the pandemic.  All 50 states had declines in life expectancy that year.  These declines were detailed in a new report released in mid-August.  On the last day of the month, NCHS released new estimates for 2021, showing life expectancy dropped nearly one more year for the country from the 2020 level.

There were some significant differences between the declines that took place in 2020 and those which occurred in 2021, particularly among different race/ethnic groups.

We talked to NCHS Mortality Statistics Chief Robert Anderson about this and other matters related to the two new studies on life expectancy.

HOST:  So there are two new reports out this month on life expectancy – the first was a report on 2020 life expectancy by state.  First of all, how did the arrival of the pandemic impact life expectancy on the country as a whole in 2020?

ROBERT ANDERSON:  Well by the time we got to the end of 2020, life expectancy had dropped almost two years, it was like 1.8 years, and COVID was, you know, largely responsible for that decline.

HOST:  So what were some of the striking declines in life expectancy from 2019 to 2020 at the state level.

ROBERT ANDERSON:  Certainly there was some state variation in the change in life expectancy, but you know overall we saw declines for every state from 2019 to 2020.  Overall the change was I said almost two years, 1.8 years, a 1.8 year decline from 2019 to 2020 overall, but then if you look at the declines by state of course they vary from about a three-year decline to about a two-year decline. So it’s quite a bit of variation in the decline in life expectancy, although we did see declines for all states.

HOST:  So presumably, the states with the largest declines in life expectancy during 2020 were also the states that have the highest mortality from COVID?

ROBERT ANDERSON:  That’s essentially correct.  I mean it’s a little more complicated than that because there’s some other things going on.  We saw increases for some other causes of death and of course increases in drug overdose deaths also had an impact, but overall COVID-19 was the primary factor.

HOST:  And so I guess the converse would be true as well – states with the smallest declines in life expectancy in 2020 were those states that had lowest mortality from COVID – would that be correct?

ROBERT ANDERSON:  Yeah that’s essentially correct.

HOST:  Now are there any other interesting findings in the state life expectancy report?

ROBERT ANDERSON:  Yeah you know the declines, if you look at things on a regional basis you see larger declines in the South, Southwest and in the Northeast. Well, New York, New Jersey in particular.  And then you know a much smaller declines in the upper Northeast – you know, Maine, New Hampshire, Vermont.  And in the Northwest – Washington, Oregon, Idaho, that area.  And of course that corresponds as we said with the level of COVID mortality in those states during 2020.

HOST:  So turning to the 2021 national report – did the decline in life expectancy continue in year two of the pandemic?

ROBERT ANDERSON:  It did… We saw an additional decline of nearly a year – 0.9 years overall – so yeah, we saw an additional decline in life expectancy.

HOST:  And so I guess this lines up with the fact that there were more COVID-19 deaths in 2021 than in 2020 right?

ROBERT ANDERSON:  That’s right, yeah that’s what we expected – because of the higher mortality in 2021 compared with 2020, we expected an additional decline in life expectancy.  And in fact that’s what we’re seeing.

HOST:  And what about the disparity between the sexes and life expectancy?  It’s always existed but it appears the pandemic has widened that gap.

ROBERT ANDERSON:   Yeah that’s right.  Typically, men have lower life expectancy than women and that’s because men have higher mortality than women overall.  And we do know that men were disproportionately affected by the pandemic – COVID-19 death rates were higher for men than for women – and so it’s not surprising that we would see a slightly larger disparity between males and females during the pandemic.

HOST:   So what race ethnic groups saw the biggest decline in life expectancy during 2021?

ROBERT ANDERSON:   From 2020 to 2021, the American Indian population really was most affected – there was a 1.9 year decline in life expectancy.  That’s followed by the non-Hispanic white population by about a year.  Then non-Hispanic black population about 7/10 of a year… and then the Hispanic population and the Asian population – the declines were much smaller during 2021. A 0.2 year decline for the Hispanic population, about a 0.1 year decline for the Asian population.

HOST:  Now over the span of the entire pandemic, what has been the cumulative impact on life expectancy among those race ethnic groups?

ROBERT ANDERSON:  Yeah I think that’s an important question.  Overall, the decline in life expectancy is about 2.7 years, a nearly three-year decline which is quite substantial.  And then quite a lot of variability by race and ethnicity.  For the American Indian population, the decline was 6.6 years from 2019 to 2021.  That’s just astounding.  For the Hispanic population it was a 4.2 year decline; for the black population about a four-year decline; for the white population, 2.4 years and for the Asian population 2.1 years.

HOST:  So it sounds like for the Hispanic population there is a lot more of an improvement I guess in 2021 is that correct?

ROBERT ANDERSON:  I’m not really sure I would say it was an improvement. The decline wasn’t as large in 2021 as it was in 2020, that’s true, but it did not improve – it continued to drop, just didn’t drop by as much.

HOST:  So besides COVID, were there any other leading causes of death that contributed to this decline in life expectancy?

ROBERT ANDERSON:  Yes – the main one is unintentional injuries, and this is mostly drug overdoses.  You know, there’s some other causes that’re grouped with unintentional injuries, includes motor vehicle accidents and falls and things like that.  But what really stands out in terms of sort of increasing mortality and which is responsible for the decline in life expectancy would be the drug overdose deaths so it’s second to COVID-19 in terms of its impac.

HOST:  And a lot of people would say that that increase in overdose deaths may or may not be indirectly tied to the pandemic stress right?

ROBERT ANDERSON:  Yeah it’s hard to say for sure exactly how it’s related or whether individual cases are related, but you know we were seeing sort of a flattening and even slightly declining drug overdose death rates just prior to the pandemic and of course a quite steep increase in drug overdose mortality during the pandemic.  So it’s hard to tie it directly because we started to see increases late in 2019 before the pandemic became, before it emerged, but then once it did, once the pandemic did emerge, then the increase in drug overdose mortality really went up quite steeply.

HOST: Any other points of either of these reports you like to make?

ROBERT ANDERSON:  Well I’ll just mention with the 2021 report, that the data are provisional still.  The data for 2021 probably won’t be final until December, that’s our target date for release of the 2021 final data.  So there could be some slight differences once we finalize the data, but at the point at which we cut the data to produce this report we had more than 99% of deaths so I don’t expect any substantial differences between this provisional report and what we will have based on our final data.

HOST:  Dr. Anderson thank you for joining us.

ROBERT ANDERSON: Thank you very much.

MUSIC BRIDGE:

HOST:  Overall, August was an extremely busy month at NCHS.  The month started off with a new report on physical therapy, speech therapy, and rehabilitative and occupational therapy among veterans compared with non-veterans, using data from the National Health Interview Survey.  The study showed that veterans are more than 50% likelier than non-veterans to have had any of these therapies.  The same week, NCHS released its latest annual report on fetal mortality in the United States for 2020.  A total of 20,854 fetal deaths at 20 weeks of pregnancy or longer were reported in 2020.

Another study, using NHIS data, looked at organized sports participation among U.S. children ages 6-17.  The study showed that over half of kids in this age group participate in organized sports.

On August 18th, NCHS released the latest monthly data on drug overdose deaths in the country, documenting that over 109,000 overdose deaths occurred in the United States during the one-year period ending in March 2022.

The official public use file for births in the United States for 2021 was released on August 29, accompanied by a Data Brief summarizing the key findings from these final data.  On the same day, the quarterly provisional release of infant mortality data was released in an interactive data visualization for the web, featuring full-year 2020 numbers. The post neonatal mortality rate in the U.S. increased in 2020 from the same point in 2019.  The post neonatal mortality rate is the number of deaths among infants between 28 and 364 days of age per 1,000 live births.

And last, a new report using data from the 2020 National Health Interview Survey shows that about one-quarter of adults in the United States age 18 and over have met the national physical activity guidelines for both aerobic and muscle-strengthening activities.

Leave a Comment » | COVID-19, Deaths, life expectancy, National Vital Statistics System, podcasts, Vital Statistics System | Permalink
Posted by briantsai

Telemedicine Use in Children Aged 0–17 Years: United States, July–December 2020

May 10, 2022

Questions for Maria Villarroel, Health Statistician and Lead Author of “Telemedicine Use in Children Aged 0–17 Years: United States, July–December 2020.”

Q: Why did you decide to look at telemedicine among U.S. children during the pandemic?

MV: We know that telemedicine use expanded during the COVID-19 pandemic. Telemedicine became a key practice in health care that supports social distancing and decreases contact between health care staff and other patients for the receipt of health care services and reduce the spread of infection. However, there are limited estimates of telemedicine use, especially in children, and this report aims to address that gap.

Q: How did the data vary by age groups, income level and region?

MV: We examined telemedicine use in two ways: 1) telemedicine use in the past 12 months from the time of interview in July-December 2020, so this included both pre-pandemic and pandemic periods; and 2) telemedicine use because of reasons related to the coronavirus pandemic during the first year of the pandemic – 2020.

We found that telemedicine use in the past 12 months varied by age of the child and family income. Telemedicine use in the past 12 months was highest for younger children (aged 4 years and under) and older children (12 to 17 years), and lowest for children aged 5 to 11 years.  Telemedicine use in the past 12 months was highest for children with family incomes below the federal poverty level and at or above 400% of the federal poverty level, and lowest for children with family incomes at 100%–199% of the federal poverty level.  Although not statistically significant, a similar pattern by age was observed for telemedicine use due the pandemic, while telemedicine use due to the pandemic was highest for children with family income at or above 400% of the federal poverty level.

Telemedicine use in the past 12 months and telemedicine use because of the pandemic varied by region. Children living in the Northeast were more likely to have used telemedicine than children living in the Midwest and South regions, and similarly as likely to have used telemedicine as children living in the West region. 

Q: How did telemedicine use vary between urban and rural areas?

MV: In this study, we used the NCHS Urban–Rural Classification Scheme for Counties to classify urbanization level, and we compared telemedicine use in children living in large metropolitan areas, medium and small metropolitan areas, and nonmetropolitan areas.

We found that both telemedicine use in the past 12 months and telemedicine use because of the pandemic were lower in nonmetropolitan areas compared with metropolitan areas. But we also observed that the percentage point difference between metropolitan and nonmetropolitan areas was wider for the use of telemedicine because of the pandemic than for telemedicine use in the past 12 months. For example, we observed that children residing in metropolitan areas were more than two times as likely to have use of telemedicine because of the pandemic compared with children residing nonmetropolitan areas, but children in metropolitan areas were only about 1.3 to 1.4 more likely than children in nonmetropolitan areas to have used telemedicine in the past 12 months.   

Q: Do you have comparative trend data that goes further back than the second half of 2020?

MV: No. Telemedicine questions were introduced into the NHIS survey in July 2020 as one of the emerging public health topics affecting the United States related to the COVID-19 pandemic, which was declared in March 2020 by the World Health Organization.

Trend data on telemedicine use in children is limited.  Since April 2020, the experimental data system called the Household Pulse Survey, which is a collaboration between multiple federal agencies, began collecting data on telemedicine use in the past 4 weeks in households with at least one child under 18 years of age, among other social and economic impacts of the COVID-19 pandemic. 

Q: What is the main takeaway message here?

MV: Approximately 12.6 million children in the U.S.—corresponding to 17.5% of children aged 0–17 years—used telemedicine in the past 12 months from the time of interview in July-December 2020 (a period that included time before and during the coronavirus pandemic).  

Telemedicine use in the past 12 months varied by age of the child, family income, and region of the country.

Approximately 10.2 million U.S. children—corresponding to 14.1% of children aged 0–17 years—used telemedicine in 2020 because of the pandemic.

Telemedicine use because of the pandemic varied by education of the parents living with the child and region of the country and urbanization level of residence.

Telemedicine use in the past 12 months and because of the pandemic was higher for children with current asthma, a developmental condition, and disability.

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Posted by briantsai

PODCAST – 2020 Final Death Statistics: COVID-19 as an Underlying Cause of Death vs. Contributing Cause

January 7, 2022

https://www.cdc.gov/nchs/pressroom/podcasts/2022/20220107/20220107.htm

HOST:  NCHS closed out the year in December with the release of final data on deaths in the United States for 2020.  As in past years, these final death statistics focus on conditions or injuries that are listed as the underlying cause of death on the death certificate, and do not include conditions or injuries listed as a contributing cause on the death certs. 

Many of the 2020 findings had been released previously, in preliminary or provisional form:  The final number on life expectancy showed a decline of 1.8 years in 2020.  The final overall death rate in America rose from 715 deaths per 100,000 in 2019 to 835 per 100,000 in 2020 – a nearly 17 percent increase.  Death rates increased for 6 of the 10 leading causes of death in 2020, including a nearly 17 percent increase in deaths from accidents or unintentional injuries… as well as a nearly 15 percent increase in deaths from diabetes.  Meanwhile, death rates decreased for 2 leading causes of death – cancer and chronic lung disease – and remained unchanged for another cause: kidney disease.  Also, suicide fell out of the top 10 leading causes of death in 2020 after the number and rate of suicide dropped for a 2nd consecutive year.

And of course there was a new entry to the list of 10 leading causes of death in 2020.  COVID-19 was the 3rd leading cause of death in 2020, with nearly 150,000 more deaths than the 4th leading cause of death, accidents, and over 250,000 fewer deaths than the 2nd leading cause of death, cancer.  The final, official tally of COVID-19 deaths in the U.S. for 2020 was 350,831.  CDC had reported a higher number of deaths from its case surveillance reporting system, and NCHS had also posted a higher number on its web site, closer to 385,000 deaths – which included any death mentioning COVID.  The official 350,831 COVID-19 deaths for 2020 reflects deaths in which COVID was the underlying cause of death.

Joining us today to talk about these 2020 numbers for COVID-19 numbers, as well as the difference between tracking underlying causes of death and contributing causes of death, is Mortality Statistics chief Robert Anderson.

HOST:  The final data for 2020 show over 350,000 deaths from COVID-19, meaning the virus was the underlying cause of death.  Can you explain what the underlying cause of death means?

ROBERT ANDERSON: The underlying cause of death is the condition that initiated the chain of events leading to death.  When the death certificate is filled out, the person who’s reporting the cause of death is asked to identify a chain of events, sort of a causal pathway, working from the immediate cause back to the underlying cause.  So an example of a chain of event or pathway would be viral pneumonia due to COVID-19.  That’s a causal pathway – COVID-19 causes viral pneumonia which then would kill the person, so COVID-19 in that instance is considered the underlying cause of death – that condition that started everything forward.  And the reason why we tend to focus on the underlying cause is because that’s the condition that’s considered most amenable to public health prevention, the idea being that if you can prevent the underlying cause then you can prevent the entire chain of events from occurring.

HOST: Now there might be some confusion because the number that had been reported for 2020 was close to 385,000 deaths.  So what about those other (almost) 34,000 deaths that some people thought were COVID-19 deaths but aren’t included in this latest tally?

ROBERT ANDERSON:  Right, so the 385,000 deaths that we would refer to as “involving COVID-19.” The other 34,000 would be deaths in which COVID-19 was a contributing factor but not the underlying cause.  So it may have exacerbated an existing disease or it may have contributed in some way but it wasn’t what initiated the chain of events leading to death.  And the person who is certifying the cause of death – usually it’s a physician, medical examiner, or coroner – has to determine what role COVID-19 played in causing the death, and this is essentially three options: it was the underlying cause and it initiated that chain of events; it was a contributing factor and played some role but it wasn’t the underlying cause; or it wasn’t a factor at all, in which case it shouldn’t be reported on the death certificate.

HOST: OK so it seems like there’s a fine line there and this sort of prompts another question:  In the new 2020 final data, we see significant increases in deaths from diabetes, for example, also from Alzheimer’s disease… heart disease… and those are the underlying cause of death so is it possible that some of those deaths, COVID-19 was listed as a contributing factor?

ROBERT ANDERSON:  Sure it’s likely, actually, that for some of those conditions COVID-19 was listed as a contributing factor, and it may have been a contributing factor in cases in which COVID-19 wasn’t listed as well – particularly in the beginning of the pandemic back when we didn’t know very much about the disease and when there wasn’t widely available testing.  It’s possible that some of those deaths are actually COVID deaths but were attributed to those other causes.  So the increase may be COVID-related.  There is also this other category that’s sort of important to recognize as well, and these are cases in which the death may have been related to the pandemic but not to the virus specifically.  This would be cases where people perhaps didn’t get the care that they needed for whatever reason – either they were afraid to go to the hospital or the doctor or they weren’t able to get into the doctor.  Particularly with a disease like diabetes that requires a fair amount of maintenance and monitoring.  If people are not going to the doctor to get checked out they’re gonna be at higher risk of dying.

HOST: So again, for those who might be confused about this, obviously with COVID-19 you have a very wide spectrum of severity – you’ve got people who may have had it but never knew they had it, or people who have tested positive but never had any symptoms, to the other end where people are severely ill.  How is it determined on the death certificate for COVID to be just a contributing cause?  It would seem like, wouldn’t it be like one or the other?  Either it was an underlying cause or didn’t really play a factor?

ROBERT ANDERSON:  Well it’s a complicated issue.  So you could have for example somebody with COVID who has symptoms, is symptomatic, but the symptoms aren’t particularly severe, but in a case with somebody with like chronic obstructive pulmonary disease or somebody with a heart condition, a serious heart condition, even fairly mild COVID symptoms could sort of push them over the edge and then the certifier has to make a judgment as to what role COVID played in that scenario.   And it’s not not always easy – sometimes it can be quite straightforward, other times not so much, particularly when you have somebody who has multiple serious chronic diseases or people who perhaps are terminally ill. The certifier has to decide what caused that person to die when they did and in some cases it might be that COVID caused them to die when they did, but it might also be a case where COVID just sort of made things worse and they died from the pre-existing condition.  It can be a difficult decision to make.

HOST: I know I’ve asked you this one before but just again to clarify: If someone is admitted to the hospital with an injury – a car accident for example – and they are tested for COVID and test positive, and then they die from their injuries in the crash –COVID would not be a “contributing cause” on the death certificate correct?

ROBERT ANDERSON:   In most cases I think not, but it is possible that COVID could complicate the clinical situation such that it makes survival less likely.  It would depend on the severity of the injuries – maybe the person comes in and they’ve got a very severe injury and they simply test positive for COVID and there are no symptoms that are likely be incidental to death.  But if you had somebody who let’s say had chest trauma from the car accident and they were, they’re struggling to breathe already… They get COVID in the hospital and they’re showing some symptoms… there, it could contribute.  So it’s really – the certifier has to look at the whole clinical picture and then make a judgment as to whether COVID played a role and then what role it played in the death, if they determine that it played a role.

HOST:  In looking at some other examples the one that comes to mind would be influenza –does influenza turn up a lot on death certificates as a contributing but not an underlying cause of death?

ROBERT ANDERSON:  Not very often – influenza is substantially underreported on death certificates to begin with.  It’s a little better now than it used to be with the rapid testing, but very often when people die from the flu they’re dying of the complications of the flu, and often after the point at which it can be determined that they had the flu.  So somebody gets the flu, they’re at home for seven to 10 days with that, they develop a secondary infection, bacterial infection, let’s say bacterial pneumonia, and struggle with that for a few more days and then go to the hospital.  Even if they’re tested for the flu they’re not going to test positive, flu is not gonna show up, so it can be very difficult unless the certifier knows that the person had the flu and understands the chain of events to figure out what happened.  So I think we’d have similar issues with COVID if COVID wasn’t so prevalent.  And if the flu was a lot more prevalent and we did a lot more testing for the flu, I think it would tend to show up on death certificates more often.  Again, it goes to trying to figure out what the chain of events looks like and what initiated that chain of events.  And the certifier needs some sort of evidence that the flu was a factor and if they don’t have it, they’re not likely to report it on the death certificate.  So what we end up with is, we end up with a few thousand deaths a year where the flu is reported on death certificates, where modeling analysis show that it’s more like 30 to 60,000 depending on the severity of the flu season.

HOST:  Are there any other conditions which often turn up as “contributing” but “not underlying?”

ROBERT ANDERSON:  Yeah I mean diabetes is one of those conditions.  If you look at the total number of diabetes deaths where diabetes is the underlying cause, you see, well just take 2020 for example, the number is about 100,000 deaths but if we look at how often it’s actually reported on the death certificate we see a whole lot more.  Something on the order of – I don’t know what the number is for 2020 at this point but in in previous years it’s been somewhere on the order of 250,000 cases.  So diabetes is one of those conditions that frequently shows up as a contributing factor and it certainly does often contribute, it complicates the clinical picture and makes survival a lot less likely in many instances.  It’s also one of those conditions where it’s hard to understand for sure where it fits in the chain of events, unless somebody has sort of a hyper osmolar reaction or something like that, they kinda have to figure out – OK, well, this person had diabetes, it wasn’t well controlled, and they died from stroke, what role did diabetes play if any?  And it likely would have played a role because it tends to make cardiovascular diseases like heart disease and cerebrovascular disease worse. 

HOST: So for the 2020 data then there could be some diabetes deaths where COVID-19 was a contributing factor.  And it could also be the opposite, right?  Where it could be a COVID-19 death where diabetes was maybe a contributing cause?

ROBERT ANDERSON:  Sure yeah, I mean, we do know people with diabetes are very susceptible to severe disease and COVID.  And so it’s likely in many cases that you would see diabetes reported along with COVID on the death certificate, as a contributing factor.

HOST:  Just one more question about the contributing causes.  So then, that section of the death certificate would also be where contributing health behaviors — or unhealthy behaviors more likely  — would that be where, like, smoking, alcoholism, drug abuse… would that be listed as a contributing cause assuming it wasn’t like an overdose or something like that?

ROBERT ANDERSON:  Yeah it could be and we do see that.  It’s not reported very consistently though – a lot of certifiers don’t like to list behaviors on the death certificate.  They want to report clinical conditions, diseases, or injuries, and so they will often leave off sort of behavioral type things.  So while we do see it – you can see smoking reported, for example, and there’s a checkbox item as well that asks the certifier of tobacco played a role or not.  That’s one of the reasons why we added that checkbox was to try to capture that information because it wasn’t reported consistently on the death certificate.  We do see things like drug abuse and alcohol abuse reported on the death certificate but normally if alcohol abuse contributed to, say, cirrhosis of the liver and killed someone, normally the certifier would report alcoholic cirrhosis and so the alcohol abuse would be implied there.

HOST:  Any other points about this you feel are important to note?

ROBERT ANDERSON:  I think it’s important to note – you mentioned the 385,000 deaths that we were reporting in our surveillance website and compared with the 350,000 underlying cause deaths.  And some have asked questions about that and my answer typically is that for surveillance purposes we like to cast a slightly wider net, because we want to get a better sense for the impact of the disease or the pandemic on overall mortality.  But when we start to really boil down the numbers and start comparing causes of death, we need to have a single cause reported for each person and that’s the underlying cause of death.  Because we don’t want to double-count deaths in our in our tabulation so we limit to the underlying cause when we’re ranking leading causes, for example, or when we’re creating a table of various causes of death.  But for surveillance purposes, when we’re trying to capture the impact of the disease we cast a slightly wider net and so we look at both underlying and contributing factors.

HOST:  Thanks for joining us again Dr. Anderson.

ROBERT ANDERSON:  Happy to do it. 

(MUSICAL BRIDGE)

HOST: NCHS capped the year with four more reports released in the final week of 2021.  The first report focused on emergency department visits to people with mental health disorders, featuring data from the National Hospital Ambulatory Medical Care Survey.  A second report looked at pre-pregnancy body mass index and infant outcomes, showing that infants fared better among women who were at normal weight prior to their pregnancy.  A third report also looked at pregnancy – in particular, maternal and infant health outcomes among women who had confirmed or presumed COVID-19 during their pregnancy.  Data from 14 states and DC were examined for this study.  The fourth and final study from NCHS in 2021 featured the final, official numbers of drug overdose deaths in the U.S. for 2020, a report that is updated annually.

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Posted by briantsai

PODCAST: Interview with Elizabeth Gregory on Home Births During the Pandemic

December 10, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211210/20211210.htm

HOST: Though no historical data are available, it is widely accepted that most births prior to the 20th century occurred in the home.  With the arrival of the 20th century and the advances in modern medicine that came with it, home births became far less common – as low as 0.56% of all births in 2004.  But in 2020, driven at least in part by the pandemic, home births increased 22% from 2019, to 1.26% in 2020 – the highest percentage since at least 1990.

This week NCHS has released a new report documenting the increase in home births during the pandemic.  Joining us to discuss the findings in the report is the lead author of the study, Elizabeth Gregory…

HOST: Are women who give birth at the home – and their babies – more at risk for adverse outcomes?

EG: So, this report doesn’t address the safety of home births – what it does is it examines changes in home births before and during the COVID-19 pandemic by month and by race and Hispanic origin and state of residence of the mother.

HOST: Home births have been higher in recent years than 10-15 years ago, is that correct?

EG: Home births have been increasing for the last 15 years or so.  The pace of increase had slowed from 2014 to 2019, and then there was a large increase in 2020.

HOST: The data suggest the low mark for home births in the United States occurred around 2004, is that correct?

EG: Yes that’s correct, but it’s important to note that we don’t have comparable data on home births prior to the 1989 revision of the US standard certificate of live birth.  But for 1990 through 2020 the lowest percentage of home births which was 0.56% occurred in 2004.

HOST: So even though it’s accepted that back in the 19th century, for example, most births occurred in the home, we don’t really have data prior to 1989, is that correct?

EG: So for vital statistics data, previous to the 1989 revision the question for place of birth – the response could either be in hospital or not in hospital.  We don’t really have the more detailed information about where the birth may have occurred outside the hospital.

HOST: I see.  So the pandemic would help explain the sharp rise in 2020, but what explains the higher rates since 2004?

EG: We didn’t look at what might have caused the increases for those earlier years, but we did look at when and where the increases occurred for 2019 to 2020.  So for example, in 2019 to 2020 the percentage of home births rose 22% for all women, with increases ranging from 21 to 36% for the three largest race and Hispanic origin groups.  And the percentage of home births for all women increased for each month, March through December, peaking in May, and this pattern of home births by month was also generally observed for each of the three largest race and Hispanic origin groups.

HOST: What factors related to the pandemic accounted for the big increase in 2020?

EG: So other researchers have found that some reasons included: increasing number of cases of COVID-19 in the U.S. combined with concerns about contracting COVID-19 while in the hospital… limitations or bans on support persons in the hospital… and the separation of infants from mothers suspected to have COVID-19.

HOST: What were some geographic differences we saw in 2020 as far as home births go?

EG: This report found increases in home births for the vast majority of states from 2019 to 2020.  The percentage of home births increased significantly in 40 states, with non-significant increases seen in an additional nine States and the District of Columbia.

HOST: What about race and ethnicity?  Were there similar increases in home births along those demographic lines?

EG: Historically non-Hispanic white women have been more likely to give birth at home, and this pattern continued into 2020.  However, increases ranging from 21 to 36% were seen for all of the three largest race and Hispanic origin groups from 2019 to 2020.

HOST: Any other topics in your study you’d like to mention?

EG: Yes, the report found that the percentage of home births rose for each month, March through December 2020, compared with the same months in 2019 and peaked in May.  And the timing of increases in home births generally corresponds with the initial surge of COVID-19 cases in the United States in late March and early April 2020.

HOST: Thanks for joining us Elizabeth.

EG: You’re welcome.

MUSICAL BRIDGE

HOST: December got off to a busy start with two reports focusing on children’s health, using 2020 data from the National Health Interview Survey.  The 2020 NHIS included questions on concussion, to measure both symptoms and diagnosis from a health care provider to provide a more complete understanding of the public health burden, as children with mild injuries may not see a doctor or receive a diagnosis.  On Dec. 1, NCHS released a new study on concussions and brain injuries among children in the U.S.  The new study found that nearly 7% of children in the U.S. under the age of 18 have had symptoms of a concussion or brain injury.  And 4% have been diagnosed with these conditions by a health care provider.   Boys are more likely than girls to have had these symptoms, and non-Hispanic White children are more likely than children in other race categories to have had these symptoms. 

While the report on concussions and brain injuries doesn’t have any direct correlation to the pandemic, a second report looked at dental exam visits among children in 2020 compared with 2019. It is known that in 2020, dental practices across the country adjusted their services in response to the COVID-19 pandemic, and access to dental care was disrupted for many Americans. This new study found that there was a decline in visits for dental exams or cleanings from 2019 to 2020, which likely was driven by the pandemic.  The decline was greater among younger children ages 1 to 4, as well as among lower income children and children living in the northeastern United States. 

Capping off the first week of the month was the latest quarterly provisional birth data for the U.S.  This latest release features mid-year 2021 data, and shows that fertility in the U.S. appears to be continuing its steady decline from the past several years, including a sharp decline in the U.S. fertility rate in the one year ending in mid-year 2020 compared to the same point the year before.

MUSICAL BRIDGE

HOST: This week NCHS also released data from its 2019 linked birth and infant death file.  These data are considered to be more comprehensive than infant mortality data from death certificates alone, due to the linking of the two sources of information.  As a result, much more accurate demographic and geographic data on infant mortality are available from this linked file.  However, the general “bottom line” remains the same – infant mortality in the United States continues to decline, as it has for nearly a century.

Finally, today NCHS released a report looking at trends in mortality from the leading cause of death in America, heart disease.  The new study covers most of the past two decades, with a special focus on changes by state.  The report shows that in the first decade of the millennium, 2000 to 2011, heart disease death rates declined in all 50 states and DC.  However, from 2012 through 2019, heart disease death rates fell in only half the states plus DC – and actually increased in one state (Arkansas). 

Later this month, on Dec. 22, NCHS will release its final death data for 2020, which will include the final, official number of COVID-19 deaths for the country in 2020.  Rounding out the last week of the year are several new reports, including one on emergency department visits by adults who have mental health disorders, using data from the National Hospital Ambulatory Medical Care Survey.  Two pregnancy-related reports are slated for release that week as well:  one on pre-pregnancy body mass index and infant outcomes and another on maternal and infant health outcomes among mothers with confirmed or presumed COVID-19 during pregnancy.  And last, the annual final report on drug overdose deaths for 2020 will be released, which comes on the heels of the latest monthly release of provisional overdose death numbers, running through May of 2021.

Leave a Comment » | Births, COVID-19, home birth, Home Births, National Vital Statistics System, Vital Statistics System | Permalink
Posted by briantsai

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.

Leave a Comment » | CCQDER, COVID-19, RANDS | Permalink
Posted by briantsai

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.

Leave a Comment » | COVID-19, mental health, National Health Interview Survey, Prescription Drugs | Permalink
Posted by briantsai

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.

Leave a Comment » | COVID-19, Deaths, Influenza, leading causes of death, National Vital Statistics System, Vital Statistics Rapid Release, Vital Statistics System | Permalink
Posted by briantsai

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