Concussions and Brain Injuries in Children: United States, 2020

December 1, 2021

A new NCHS report presents national estimates of lifetime symptomatology and health care professional diagnoses of concussions or brain injuries as reported by a knowledgeable adult, usually a parent, in children aged 0–17 years using data from the 2020 National Health Interview Survey.

Key Findings:

  • In 2020, 6.8% of children aged 17 years and under had ever had symptoms of a concussion or brain injury.
  • Non-Hispanic White children were more likely than children of other race and Hispanic-origin groups to have ever had symptoms of a concussion or brain injury.
  • The percentage of children aged 17 years and under who had ever had a diagnosis of a concussion or brain injury by a health care provider was 3.9%.
  • Compared with their peers, boys (4.7%) and non-Hispanic White children (5.2%) were more likely to have ever had a diagnosis of a concussion or brain injury.

Sepsis-related Mortality Among Adults Aged 65 and Over: United States, 2019

November 10, 2021

NCHS releases new report that describes sepsis-related mortality among adults aged 65 and over by age, sex, race and Hispanic origin, and urbanicity.

Key Findings:

  • Sepsis-related death rates for adults aged 65 and over varied from 2000 through 2019 but generally declined over this period.
  • Among adults aged 65 and over, sepsis-related death rates in 2019 increased with age; rates were about five times higher among adults aged 85 and over (750.0 per 100,000) compared with adults aged 65–74 (150.7).
  • In 2019, sepsis-related death rates for adults aged 65 and over were highest among non-Hispanic black adults (377.4 per 100,000) compared with non-Hispanic white (275.7), non-Hispanic Asian (180.0), and Hispanic (246.4) adults.
  • Among adults aged 65 and over, sepsis-related death rates in 2019 were higher in rural areas compared with urban areas.

Q & A with Author: Rural-urban Differences in Unintentional Injury Death Rates Among Children Aged 0-17: United States, 2018-2019

October 27, 2021

DB421_fig1Questions for Matthew Garnett, Health Statistician and Lead Author of “Rural-urban Differences in Unintentional Injury Death Rates Among Children Aged 0-17: United States, 2018-2019.”

Q: Can you describe what unintentional injury deaths are?

MG: Unintentional injury deaths include fatal injuries that were unintended, unplanned, and did not occur on purpose. In contrast, intentional injuries include homicide or assault and suicide or self-harm. Unintentional injury deaths include a wide array of mechanisms, with the four most common being: poisoning, motor vehicle crashes, drowning, and falls.


Q: How did the data vary by age groups?

MG: Rates of unintentional injury deaths differ across age groups. In both urban and rural areas, unintentional injury death rates were highest among children aged under 1 year, followed by a decline in the 1–4 and 5–13 age groups, and then increasing in the 14–17 group. Although this pattern was seen in both urban and rural areas, rural rates were consistently higher than urban rates for all age groups.

The high rates experienced among children under the age of 1 year were driven by high rates of suffocation (includes choking, asphyxiation, and strangulation). Among children aged 1-4 years, the leading mechanisms diverged based on urban-rural status, with drowning being the leading mechanism in urban areas, and with both drowning and motor vehicle traffic being the leading mechanism among in rural areas. In the older age groups, including those aged 5-13 and 14-17, motor vehicle traffic was the leading mechanism.

The decrease in overall rates from the under 1 year group to the 1-4 age group can be explained by a lower suffocation rates, which decreased from 24.9 in urban areas and 42.1 in rural areas among children under 1, to 0.7 and 1.1, respectively, in the 1-4 age group. The increase in overall rates between the 5-13 and 14-17 age groups is partially due to the increase in motor vehicle traffic rates, which increased from 1.5 in urban areas and 3.1 in rural areas among the 3-13 age group to 5.1 and 12.5, respectively, in the 14-17 age group.


Q: Do you have trend data that goes further back than 2018?

MG: This information is not presented in the report, but additional national data is available through CDC’s query system – CDC WONDER. Since 1999, rates of unintentional injury death among children aged 0-17 years have decreased from a high of 12.7 (per 100,000 population) in 1999 to 7.2 in 2019, a 43% decrease. Decreases were seen both in urban and rural areas. In urban areas the rate decreased from 11.0 in 1999 to 6.4 in 2019, a 42% decrease. In rural areas, the rate decreased from 21.5 in 1999 to 12.7 in 2019, a decrease of 41%. The unintentional injury death rate has decreased among children in both areas between 1999 and 2019; however, the gap between urban and rural rates has been maintained over time.

Rates of Unintentional Injury Death Among Children Aged 0-17 Years by Urban-rural Status, United States, 1999-2019

Year

Total

Rate per 100,000

Urban

Rate per 100,000

Rural

Rate per 100,000

1999

12.7

11.0

21.5

2000

12.3

10.7

21.1

2001

11.9

10.4

20.3

2002

11.9

10.6

19.7

2003

11.5

10.0

20.2

2004

11.7

10.2

20.3

2005

11.1

9.7

19.4

2006

10.8

9.4

18.6

2007

10.7

9.5

17.6

2008

9.3

8.1

16.6

2009

8.6

7.5

14.9

2010

8.1

7.0

14.4

2011

8.0

6.9

14.2

2012

7.7

6.7

13.8

2013

7.4

6.4

13.2

2014

7.2

6.3

12.9

2015

7.6

6.7

13.6

2016

7.8

7.0

13.2

2017

7.7

6.8

13.4

2018

7.1

6.3

12.2

2019

7.2

6.4

12.7

NOTES: Unintentional injury deaths are identified using International Classification of Diseases, 10th Revision underlying cause-of-death codes V01–X59 or Y85–Y86. The decedent’s county of residence was classified as urban or rural based on the 2013 NCHS Urban–Rural Classification Scheme for Counties. Rates shown are crude rates (deaths per 100,000).

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.


Q: What is the main takeaway message here?

MG: There are two main takeaways here. The first is that when discussing unintentional injury deaths, there are disparities for children between urban and rural areas. These disparities are found across age groups, and across multiple injury mechanisms.

The second takeaway is that the reasons for unintentional injury deaths change with age. Among the youngest children, under 1 year of age, suffocation is the leading mechanism of death, with the highest rate of any mechanism for both urban and rural children across all age groups. Among slightly older children aged 1-4 years, the leading mechanism becomes motor vehicle traffic and drowning. After this age group, the mechanism with the highest rates is motor vehicle traffic for children aged 5-13 and 14-17. For all of these leading mechanisms, rates were higher for children in rural areas.


Q: What are the reasons why unintentional injury death rates are higher in rural vs. urban areas?

MG: Data from this report suggests that different mechanisms drive the overall unintentional injury rate for each age group. Urban-rural disparities between mechanisms provide insight into the larger disparities seen in the overall unintentional rates. For example, among children under the age of 1, the rural rate of deaths involving suffocation were significantly higher (42.1 per 100,000 population) than urban rates (24.9). For that age group, suffocation was a major driver of disparity seen in the total unintentional injury death rate, which was 48.8 for rural areas and 29.3 for urban areas.

Among children aged 1-4, all reportable mechanisms show significantly higher rates among children in rural areas compared to children in urban areas. For some mechanisms, these disparities are smaller, such as natural or environmental deaths where the rural rate was 0.5 compared to the urban rate of 0.3. In other mechanisms the disparity is larger, such as for deaths involving fire or flames, where the rural rate was 1.7 compared to the urban rate of 0.4, more than 4 times higher.  

Among children aged 5-13 and 14-17, not all mechanisms show a significant disparity. However, some of the largest drivers of the overall unintentional death rate (that is, mechanisms with a larger number of deaths) for each group did. For example, motor vehicle traffic death rates were twice as high in rural areas compared to urban areas for both age groups. 

This data brief does not get into the specific reasons for disparities within specific mechanisms. However, there is a wide body of research that has associated urban-rural differences in injury mortality to a variety of factors. These include differences in types of activities undertaken by children living in rural and urban areas and the built environments that they undertake these activities in. Studies have also suggested that differences in patterns of safety equipment use and the practice of safety-related behaviors may play a role in differing mortality rates. Access to care has also been pointed to as an issue, when considering first responder response times in rural settings compared to urban settings, and access to medical facilities, including high level trauma care. The introduction to the report cites several of these studies.

Additional information on unintentional injuries, and strategies to address unintentional injuries are available from the CDC’s National Center for Injury Prevention and Control.


Q & A: Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019

September 21, 2021

DB417_cover1

Questions for Sally Curtin, Health Statistician and Lead Author of “Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019.”

Q:  Why did you decide to do a report comparing death rates in rural and urban areas?

SC: In many of our reports, we have examined trends in various causes of death by urban-rural status.  However, we had not published data on trends in all-cause mortality by urban-rural status.  In addition, we had not analyzed death rates for all of the 10 leading causes of death by urban-rural status in one report.  Thus, we felt that a report showing national statistics on urban-rural disparities by leading causes of death might be informative to those interested in delving more into these findings at a state or local level.


Q:  How does the data vary by leading causes of death?

SC:  The data in this report present a compelling picture of rural health as the age-adjusted rates for all 10 leading causes of death were higher in rural than urban areas.  In addition, we show that the differences between rates in rural and urban areas were greatest for the top causes of heart disease, cancer and chronic lower respiratory diseases and the gap widened over the 1999-to-2019 period.


Q:  What is the take home message in this report

SC: The gap in mortality between rural and urban areas has widened over the last 20 years with the overall age-adjusted rate in rural areas increasing from 7% higher than in urban areas in 1999 to 20% higher by 2019.  In addition, higher death rates in rural than urban areas were evident for all 10 leading causes of death with the greatest differences for some of the top causes: heart disease, cancer, and chronic lower respiratory diseases.


Q:  Do you have any predictions to how 2020 death rates will look for urban/rural areas will look?

SC:  We (NCHS) are not into forecasting so I will not speculate, but I can tell you that a report on COVID-19 deaths by urban-rural status for 2020 is planned.


Q:  Any other comments?

SC: In the introduction of the report, we point out that there are health challenges that are greater in rural than urban areas such as more limited access to health care, less health insurance, and more poverty.  Hopefully the findings in this report will alert the research community, health practitioners, and the public that the mortality disparity between rural and urban areas is widening and cannot be pinpointed to just a few causes of death but extends to all 10 leading causes.


NCHS Releases New Reports This Week on Hearing Difficulty and Back/Limb pain among U.S. Adults

July 29, 2021

NCHS Releases two new reports this week on hearing difficulty and back/limb pain.

DB414_COver1The first report presents difficulties with hearing even when using a hearing aid among U.S. adults aged 18 and over by level of difficulty and age, sex, and race and Hispanic origin. It also presents estimates of the prevalence of hearing aid use among adults aged 45 and over to focus on the age group with higher rates of hearing difficulties.

Key Findings:

  • In 2019, 13.0% of adults aged 18 and over had some difficulty hearing even when using a hearing aid and 1.6% either had a lot of difficulty hearing or could not hear at all, even when using a hearing aid.
  • Hearing difficulties increased with age with 26.8% of those aged 65 and over having some difficulty and 4.1% having a lot of difficulty or could not hear at all.
  • Among adults aged 45 and over, men were more likely than women to have had some or a lot of difficulty or could
    not hear at all.
  • Non-Hispanic white adults aged 45–64 had higher rates of some difficulty, a lot of difficulty, or being unable to
    hear at all, compared with other race and Hispanic origin groups.
  • In 2019, 7.1% of adults aged 45 and over used a hearing aid; use was higher among men than women in all age groups.

DB415_Cover1The second report provides national estimates of any pain regardless of body region as well as estimates of back, lower limb (hips, knees, or feet), and upper limb (hands, arms, or shoulders) pain in the past 3 months among U.S. adults aged 18 and over by selected sociodemographic characteristics.

Key Findings:

  • In 2019, 39.0% of adults had back pain, 36.5% had lower limb pain, and 30.7% had upper limb pain in the past 3 months.
  • Adults aged 65 and over, women, non-Hispanic white adults, and those with income below 100% of the federal poverty level (FPL) were most likely to experience back pain.
  • Adults aged 18–29 (21.0%), men (33.5%), non-Hispanic Asian adults (20.6%), and those with income 200% of FPL or
    above (35.2%) were least likely to experience lower limb pain.
  • Adults aged 65 and over, women, non-Hispanic white adults, and those with income below 100% of FPL were most likely to experience

Influenza Vaccination in the Past 12 Months Among Children Aged 6 Months–17 Years: United States, 2019

April 15, 2021

21-323150-visual-abstract-db407-child-flu-vacQuestions for Lindsey Black, Health Statistician and Lead Author of “Influenza Vaccination in the Past 12 Months Among Children Aged 6 Months–17 Years: United States, 2019.”

Q: Is this the most recent data you have on this topic?  If so, when will you release 2020 vaccination data?

LB: Yes, this is the most recent data. 2020 data will be released in the fall of 2021.


Q: Do you have influenza vaccination data for adults?

LB: Yes, some information on adults is available in the interactive summary health statistics for adults, located at : https://www.cdc.gov/nchs/nhis/shs.htm


Q: Do you have trend data that goes further back than 2019?

LB: Influenza vaccination has been collected as part of the sample child on NHIS since about 2005. However, in 2019, there were significant changes to the survey and we have not yet evaluated how that may result in a break in the trend, or the appropriateness of assessing trends across survey period (2019 vs earlier than 2019).


Q: Was there a specific finding in the data that surprised you from this report?

LB: I found it surprising that the amount of regional differences observed. It is so interesting that starting at the East South Central states, and moving North, we see a gradual improvement to 65.3% of children lving in New England that had a vaccination.


Q: Where can I get COVID vaccination data?  Will this be included in future NHIS data?

NHIS began collecting that and it will be included in the 2021 data release in the fall of 2022. In the meantime, Covid-19 vaccinations in the United States provided by CDC are located at:  https://covid.cdc.gov/covid-data-tracker/#vaccinations


Motor Vehicle Traffic Death Rates, by Sex, Age Group, and Road User Type: United States, 1999–2019

March 18, 2021

A new NCHS report provides national trends in motor vehicle traffic deaths by sex, age group, and type of road user (i.e., motor vehicle occupant, motorcyclist, pedestrian, or pedal cyclist) from 1999 through 2019 using the latest mortality data from the National Vital Statistics System.

Findings:

  • Motor vehicle traffic death rates were stable from 1999 to 2006, declined on average by 8% each year from 2006 (14.5 per 100,000) to 2010 (10.7), and then increased from 2010 through 2019 (11.1).
  • Among males, differences in the rates by age group diminished over time; by 2019, the rate for males aged 15–24, the group with the highest rate in 1999, was lower than the rate for males aged 25–64 and 65 and over.
  • Among females, rates for all age groups decreased from 1999 through 2019.
  • Rates for motor vehicle occupants decreased by 37% from 12.0 in 1999 to 7.6 in 2019.

Dietary Supplement Use Among Adults: United States, 2017–2018

February 25, 2021

NCHS releases a new report that describes recent prevalence estimates for dietary supplement use among U.S. adults, the distribution of the number of dietary supplements used, and the most common types of dietary supplements used.

Trends in dietary supplement use from 2007–2008 through 2017–2018 are also reported.

Findings:

  • Among U.S. adults aged 20 and over, 57.6% used any dietary supplement in the past 30 days, and use was higher among women (63.8%) than men (50.8%).
  • Dietary supplement use increased with age, overall and in both sexes, and was highest among women aged 60 and over (80.2%).
  • The use of two, three, and four or more dietary supplements increased with age, while the percentage of adults not using any dietary supplement decreased with age.
  • The most common types of dietary supplements used by all age groups were multivitamin-mineral supplements, followed by vitamin D and omega-3 fatty acid supplements.
  • From 2007–2008 through 2017–2018, the prevalence of dietary supplement use increased in all age groups among U.S. adults.

Fruit and Vegetable Consumption Among Adults in the United States, 2015–2018

February 5, 2021

A new NCHS report examines the percentage of adults aged 20 and over who consumed fruit and vegetables on a given day by sex and income in 2015–2018 and trends in fruit and vegetable consumption.

Key Findings:

  • More than two-thirds (67.3%) of adults aged 20 and over consumed any fruit on a given day, and fruit consumption was higher among women (70.5%) compared with men (63.8%).
  • Approximately 95% of adults consumed any vegetables on a given day.
  • The percentage of adults who consumed any fruit; citrus, melon, or berries; and other types of whole fruit on a given day increased with income.
  • The percentage of adults who consumed dark green, red and orange, other vegetables, and any vegetable types on a given day increased with income.
  • The percentage of adults who consumed any fruit on a given day decreased from 77.2% in 1999–2000 to 64.9% in 2017–2018, but there was no change in the percentage consuming any vegetables.

Urgent Care Center and Retail Health Clinic Utilization Among Children: United States, 2019

December 3, 2020

Questions for Lindsey Black, Health Statistician and Lead Author of “Urgent Care Center and Retail Health Clinic Utilization Among Children: United States, 2019.”


Q: Why did you decide to research urgent care center and retail health clinic utilization among children? 

LB: This is a growing segment of health care delivery system where many American’s seek both preventative and acute care. In addition, 2019 was the first time that utilization of urgent care was assessed among respondents of the National Health Interview Survey.


Q: Was there a specific finding in the data that surprised you from this report?

LB: I was surprised there was not a linear relationship between age and utilization. Often, we see as age increases, service utilization decreases, and other work specific to urgent care utilization has found that adolescents and young adults are more likely to utilize urgent care and retail-based clinic care compared to children.


Q: Can you explain what retail health clinic utilization is?

LB: Urgent care and retail health clinics are facilities that provide health care services to patients and you do not need to make an appointment ahead of time. They can be free standing, or within a grocery store or retail store setting. Services provided often range from routine vaccination to non-emergency acute care.


Q: Is there any trend data for this report?

LB: No. This is the only year of data available that includes urgent care and retail health clinic utilization measures.


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

LB: More than 1 in 4 U.S. children (26.4%) have had one or more visits to an urgent care center or retail health clinic in past year according to 2019 data from the National Health Interview Survey.