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

November 20, 2019

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

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

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

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

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

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


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

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


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

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


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

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

 


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

October 17, 2019

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

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

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


Q: How did the data vary by age groups?

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


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

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


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

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


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

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


Is Twin Childbearing on the Decline? Twin births in the United States, 2014-2018

October 3, 2019

Questions for Joyce Martin, Lead Author of, “Is Twin Childbearing on the Decline? Twin births in the United States, 2014-2018.”

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

JM: General information on twin births is published annually in the National Vital Statistics Report series “Births: Final Data.”   A number of special reports have also been published on the topic in the past.


Q: Why did you decide to do a report on trends in twin births?

JM: There appears to be a reversal in the direction of trends in twin childbearing in the US. After increasing for decades, the number and rate of twin births trended downward for 2014-2018.  This is important to public health because of the greater risk of poor pregnancy outcome, such as preterm birth and infant death, for babies born in twin pregnancies compared with those born in single pregnancies.


Q: How did the data vary by maternal age, race and Hispanic origin and state of residence?

JM: Trends differed by all of these characteristics.  Rates for women in their 30s and over declined by 10%-12% and rates for women 40 and over by more than 20%.  In contrast, there was no significant change in trends for women in their twenties.  Among the three race/Hispanic origin groups studied, twin childbearing declined for 2014-2018 among non-Hispanic white women but were essentially unchanged among non-Hispanic black and Hispanic women. Rates declined significantly in 17 states and increased in only three states.


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

JM: The steady decline in twinning from 2014 through 2018 after many years of increases was surprising as was the fairly large declines among women aged 30 and over.


Q: Do you foresee the decline in twins continuing?

JM: As fertility procedures continue to improve, twin births, and especially higher-order multiple births, would be expected to continue to decline.  However, it is important to note that older mothers, those aged 35 and over, are more likely to have a twin delivery without the use of fertility therapies.  The older age of women at birth may also affect twining rates.


Mortality Patterns Between Five States With Highest Death Rates and Five States With Lowest Death Rates: United States, 2017

September 5, 2019

Mortality in the United States varies widely by state . A new NCHS report compares average age-adjusted death rates by sex, race and ethnicity, and five leading causes of death between a group of five states with the highest age-adjusted death rates (Alabama, Kentucky, Mississippi, Oklahoma, and West Virginia) and a group of five states with the lowest age-adjusted death rates (California, Connecticut, Hawaii, Minnesota, and New York) in 2017.

Key Findings:

  • The average age-adjusted death rate for the five states with the highest rates (926.8 per 100,000 standard population) was 49% higher than the rate for the five states with the lowest rates (624.0).
  • Age-specific death rates for all age groups were higher for the states with the highest rates compared with the states with the lowest rates.
  • Age-adjusted death rates were higher for non-Hispanic white and non-Hispanic black populations but lower for the Hispanic population in states with the highest rates than in states with the lowest rates.
  • The age-adjusted death rates for chronic lower respiratory diseases and unintentional injuries for the states with the highest rates (62.0 and 65.5, respectively) were almost doubled compared with the states with the lowest rates (31.0 and 35.8).

Strategies Used by Adults With Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017–2018

August 21, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of ”Strategies Used by Adults with Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017-2018.”

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

RC: Among adults with diagnosed diabetes, more than 13 percent did not take their medication as prescribed to save money and almost 1 in 4 asked their doctor for a lower cost medication.


Q: Do you have other data that would put these diabetes findings in context with other diseases?

RC: We have not looked at strategies adults use to reduce their prescription for other diseases. However, two previously published reports examined strategies used by adults aged 18-64 (https://www.cdc.gov/nchs/products/databriefs/db333.htm) and by adults aged 65 and over (https://www.cdc.gov/nchs/products/databriefs/db335.htm) to reduce their prescription drug costs in 2016-2017.


Q: Do you have any data on this topic for earlier years?

RC: We do not have reports addressing strategies used by adults with diagnosed diabetes for earlier years. However, two previous reports examined strategies used by adults to reduce their prescription drug costs in 2011 and 2013.


Q: Which age group or demographic group seems to be having the biggest problem with the cost of diabetes medication or with taking their medication?

RC: Among U.S. adults with diagnosed diabetes who were prescribed medication in the past 12 months, the percentages of adults who did not take their medication as prescribed to reduce their prescription drug costs were highest among women and adults under age 65.  Among adults aged 18-64, those who were uninsured (35.7%) were more than twice as likely than those with either private (14.0%) or Medicaid (17.8%) coverage to not take their medication as prescribed to save money.


Q: Any other significant points you’d like to make about your report?

RC: Among adults aged 18-64, those who were uninsured (35.7%) were more than twice as likely than those with either private (14.0%) or Medicaid (17.8%) coverage to not take their medication as prescribed to save money.


Mortality trends by race and ethnicity among adults aged 25 and over: United States, 2000–2017

July 23, 2019

Questions for Lead Author Sally Curtin, Health Statistician, of “Mortality trends by race and ethnicity among adults aged 25 and over: United States, 2000–2017.”

Q: What is different in this report from what you released in the 2017 final deaths report?

SC: The 2017 final death report shows death rates by race and ethnicity for 5- and 10-year age groups.  The difference is that we are using broad age groups to categorize adults and examining mortality trends:

  • Young adults 25-44
  • Middle-aged 45-64
  • Elderly 65+

Q: Why did you decide to focus on death rates by race and ethnicity for this report?

SC: Compared with death rates for non-Hispanic white (NHW) adults, traditionally rates for non-Hispanic black (NHB) have been the higher while rates for Hispanic have been lower.  We wanted to see if these differences were narrowing or widening.  We also wanted to examine whether trends were similar among the race/ethnicity groups for the three age groups of adults.


Q: How did the data vary by age groups?

SC: Trends differed by age group.  For NHW, NHB and Hispanic, all groups experienced increases over the period for young adults 25-44, NHW and NHB experienced increases for middle-aged adults 45-64, and all groups experienced declines in death rates for the elderly.


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

SC: A couple of very interesting findings. First, all race/ethnicity groups are seeing increases in death rates for young adults aged 25-44, by 21% since 2012 for NHW and NHB.  Also, death rates for elderly adults ages 65+ are now higher for NHW than NHB.


Q: Why did the death rate decline for U.S. Hispanic adults?

SC: Some of the causes of death which have caused the rates to stop declining, or even to increase, among NHW and NHB have not affected Hispanic adults similarly.  For example, a recent report showed that heart disease death rates have been increasing among middle-aged NHW and NHB adults, but not for Hispanic adults.

 

 


Eye Disorders and Vision Loss among U.S. Adults Aged 45 and Over with Diagnosed Diabetes

July 18, 2019

Questions for Lead Author Amy Cha, Statistician, of “Eye Disorders and Vision Loss among U.S. Adults Aged 45 and Over with Diagnosed Diabetes.”

Q: Why did you decide to focus on eye disorder and vision loss for adults aged 45 or older with diagnosed diabetes for this report?

AC: The prevalence of diabetes increases with age. Eye disorders are a frequent complication from diabetes and vision loss is a severe condition that often has a negative impact on a person’s quality of life and mental health. Moreover, duration of diabetes is a risk factor for the progression of visual problems.

This report compared the age-adjusted percentages of older adults (aged 45 and over) with diagnosed diabetes who were told by a doctor or other health professional that they had cataracts, diabetic retinopathy, glaucoma, or macular degeneration and vision loss due to these disorders, by years since their diabetes diagnosis.


Q: Do you have data that directly corresponds with this report that goes back further than 2016?

AC: Data on diabetes, cataracts, diabetic retinopathy, glaucoma, and macular degeneration were collected in 2002 and 2008 by the National Health Interview Survey (NHIS). However, this is the first report covering the prevalence of eye disorders and vision loss among older adults with diagnosed diabetes.


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

AC: We were surprised that even after accounting for age, adults who have had diagnosed diabetes for 10 years or more were still more likely to have eye disorders than those having diagnosed diabetes for less than 10 years.


Q: Why is it that so many adults with diagnosed diabetes have cataracts?

AC: Diabetes can affect many parts of the body. This report did not examine the causal pathway of diabetes and cataracts.  This report focused on the prevalence of eye disorders by years since diabetes diagnosis in adults aged 45 and older.  We compared two time intervals, those who were diagnosed more recently – less than 10 years, and those who were  diagnosed with diabetes a longer time – 10 years or more. Cataracts and vision loss due to cataracts were both associated with longer duration since diabetes diagnosis.


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

AC: Adults who have had diagnosed diabetes for 10 years or more were more likely to report cataracts, diabetic retinopathy, glaucoma, and macular degeneration than those with diagnosed diabetes for less than 10 years. In addition, adults who have had diagnosed diabetes for 10 years or more were more likely to report vision loss due to cataracts, diabetic retinopathy, and macular degeneration than those having diagnosed diabetes for less than 10 years.