Sleep Duration and Quality Among Women Aged 40-59, by Menopausal Status

September 7, 2017

Questions for Anjel Vahratian, Ph.D., Author of “Sleep Duration and Quality Among Women Aged 40-59, by Menopausal Status

Q: What made you decide to conduct this study on sleep duration and sleep quality for this group of women?

AV: My research focuses on the health of women as they age and transition from the childbearing period. During this time, women may be at increased risk for chronic health conditions such as diabetes and cardiovascular disease. As insufficient sleep is a modifiable behavior that is associated with these chronic health conditions, I wanted to examine how sleep duration and quality varies by menopausal status.

Q: Was there a finding in your new study that surprised you, and if so, why?

AV: I was surprised to learn that nearly one in two women aged 40-59 did not wake up feeling well rested four times or more in the past week and that postmenopausal women aged 40-59 were more likely to experience disruptions in sleep quality compared with premenopausal women in the same age group.

Q: How did the women from your survey track their sleep behavior; for example, did they use a wearable sleep tracker?

AV: In this report, information on sleep duration and quality are based on self-report. Trained interviewers asked survey participants on average, how many hours of sleep did they get in a 24-hour period. In addition, they asked participants to recall how many times they had problems falling asleep and staying asleep and how many days they woke up not feeling well rested in the past week.

Q: In addition to menopausal status, do you have any other lifestyle information that could impact women’s sleep quality for this age group; for example, shift work employment or having infants or very young children in the home?

AV: While this report did not specifically look at other lifestyle factors that could affect women’s sleep duration and quality – other than age and menopausal status — my colleagues released a report in January 2016 on sleep duration and quality by sex and family type. This report looked at the presence of young children in the household. In addition, we have produced estimates of sleep duration and quality across several sociodemographic characteristics such as race and ethnicity, education, poverty status, marital status, and region.

Q: This report seems to offer just a single year of data – 2015; do you have any trend data to compare these findings to previous years, or any newer data?

AV: Unfortunately, we do not have any long-term trend data on sleep duration and quality among women aged 40-59 by menopausal status. The National Health Interview Survey, or NHIS, has included questions on sleep duration and quality since 2013, while the questions on menopausal status were a part of the 2015 NHIS cancer control supplement.

Q: What is the take-home message from this report?

AV: I think the real take-home message of this report is that sleep is critical for optimal health and wellbeing, and it is a modifiable risk factor for diabetes and cardiovascular disease. As sleep duration and quality vary by menopausal status, it is an area for targeted health promotion for women at midlife.


Infant Mortality Rates in Rural and Urban Areas in the United States, 2014

September 6, 2017

Questions for Danielle Ely, Ph.D., Statistician and Lead Author of “Infant Mortality Rates in Rural and Urban Areas in the United States, 2014

Q: What is the most significant finding in your study?

DE: The most significant finding in this study was the consistency with which infants in rural areas have significantly higher mortality rates than infants in urban places. Higher rural infant mortality was generally observed by race and Hispanic origin, mother’s age, and by infant age at death.

Q: Why are infant mortality rates higher in rural areas vs urban areas?

DE: Generally, previous research shows that health outcomes are poorer in rural places compared with urban places and this study is consistent with those findings. This study did not examine the factors that might be influencing the higher rural infant mortality in comparison with urban infant mortality.

Q: Is this surprising, or are problems with poverty, substance abuse, and health care that much worse in rural areas?

DE: Higher infant mortality in rural places compared with urban places is not necessarily surprising based on the number of other poor health outcomes (such as higher overall mortality rates, higher rates of disability) that rural residents have in comparison to urban residents.

Q: Are there any theories in the literature as to why this infant mortality disparity exists between rural and urban?

DE: Given there are some poorer health outcomes in rural areas, it is possible more pregnant women in rural areas have poorer general health than pregnant women in urban areas that can lead to poor infant outcomes. Further, there is generally less access to health care due to distance and number of providers available in rural areas, which can impact health outcomes.

Q: Any other findings of note that you find significant?

DE: These findings highlight the importance of place for infant survival and suggests the need for including place in research on health outcomes, as well as a need for further research on the greater risk of infant death in rural settings.

Selected Health Conditions Among Native Hawaiian and Pacific Islander Adults: United States, 2014

March 15, 2017

Questions for Adena M. Galinsky, Statistician and Lead Author on “Selected Health Conditions Among Native Hawaiian and Pacific Islander Adults: United States, 2014

Q: What factors led you to undertake this analysis on Native Hawaiian/Pacific Islanders?

AG: NHPI became a race group separate from Asians nearly 20 years ago, but there are still few reliable national NHPI health statistics, because the population is numerically small and hard to include in sufficient numbers in national health surveys.

While NCHS as an agency is committed to collecting and reporting health information about all Americans, our goal with this new survey is to fill the gaps in the country’s knowledge about the health of Native Hawaiian and Pacific Islanders in the United States so that others can make decisions based on accurate, reliable, up to date information.

This research is just the beginning of the exciting work that will be coming out using this data.

Q: What do you feel was the most interesting finding in the study?

AG: The pattern of results was the most interesting finding: that for a whole range of outcomes, from serious psychological distress, to arthritis, to asthma, the NHPI population had a higher prevalence than the Asian population.

Q: Is there any comparable data at the moment? Have there been any other studies done on this population and if so, what conclusions were drawn from those studies?

AG: The annual National Health Interview Survey (NHIS) has been publishing NHPI statistics for a while now (since 2003, when data from the 1999 NHIS were published), but because of small sample sizes many of the statistics were unreliable, and not useful for comparing to other populations’ statistics, such as Asian. A few NHPI statistics have been reliable over the years, such as the high prevalence of diabetes in the NHPI population. But trend data has been hard to come by, because even when an NHPI statistic for a given health condition is reliable one year, it’s generally unreliable or suppressed the next.

Q: So the bottom line here is that NHPIs are in poorer health than the U.S. population as a whole?

AG: That’s suggested here but it’s not really the bottom line. The bottom line here is that the NHPI population differs in many ways from the Asian population, and any analysis that presents combined API statistics will likely only tell the story of the Asian population, since that population is so much larger.

Also, it’s crucial that more work is done using the data file that was just released today. This data source is unprecedented and will allow a much more thorough understanding of the health of the NHPI population. We plan to do more research and we are hopeful that many researchers will do the same.

Q: Why would this population lag behind the rest of the population in certain health indicators?

AG: The data in this report do not address that. Other research has shown that there are socioeconomic differences between the NHPI population and the rest of the population. But our report does not answer this question.

Q: Why is it important to compare this group to single-race Asian adults?

AG: The NHPI population has traditionally been subsumed into the “Asian and Pacific Islander” category. The Asian population is much larger than the NHPI population and the question has been whether API statistics were really telling the story of both the Asian and NHPI population, or just the Asian population.

Of course, even within the Asian population there is variation/heterogeneity, but these results, which show the pattern of differences between the NHPI and Asian populations illustrate the danger of assuming that statistics that describe the Asian population also describe the NHPI population.

Mortality in the United States, 2015

December 8, 2016

Questions for Jiaquan Xu, Epidemiologist and Lead Author on “Mortality in the United States, 2015.”

Q: Is it true that death rates in the U.S. have been increasing over the past few years?

JX: Not exactly. The age-adjusted death rate for total US population increased 1.2% from 724.6 per 100,000 standard population in 2014 to 733.1 in 2015. This was the first significant increase since 1999. We have seen the decrease in mortality for most race/ethnic groups in most of years since 2006. Especially the rates decreased significantly for all male, all female, non-Hispanic white male, non-Hispanic white female, non-Hispanic black male, non-Hispanic black female, Hispanic male, and Hispanic female in 2014 from 2013.

Q: What are some of the reasons why the death rate increased between 2014 and 2015?

JX: We don’t know exactly what caused the increase in mortality in the United States from 2014 to 2015. The results have shown that the age-adjusted death rates increased for 8 (heart disease, chronic lower respiratory, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease, and suicide) of the 10 leading causes of death. Only decrease in mortality among 10 leading causes of death in 2015 from 2014 was for cancer. Death rates increased significantly for 20 states and decreased for 1. The change for the rest of states were not significant.

Q: Do your findings for 2015 suggest we have reached a peak as far as increases in life expectancy goes?

JX: We don’t think we have reached a peak in life expectancy. Many people died of non-age-related causes because they have aged. Those deaths are preventable. For example, there are 146,571 deaths caused by accidents which accounted for 5.4% of total deaths in 2015. About 65% of deaths from these unintentional injuries were those aged under 65. Among accidental deaths, unintentional poisoning accounted for 32.4 % and motor vehicle traffic accidents accounted for 24.5%. We also don’t know if the increase in mortality in 2015 will continue in 2016. But preliminary data have shown that the mortality for most of the 10 leading causes of death in 2015 went down in second quarter from first quarter, 2016 ( But it is too early to say that the mortality in 2016 will go down or continue going up. We will see what happens when the 2016 final file is available.

Q: What accounts for the decline in life expectancy at birth in 2015 from 2014?

JX: For the total US population, life expectancy decreased 0.1 year from 78.9 years in 2014 to 78.8 in 2015, mainly because of increases in mortality from the 13 causes of death among the 15 leading causes of death, such as heart disease, chronic lower respiratory disease, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease, suicide, septicemia, , chronic liver disease, hypertension, Parkinson’s disease, and pneumonitis due to solids and liquids. From 2014 to 2015, life expectancy decreased 0.1 year for females largely because of increases in mortality from 12 of 15 leading causes of death such as heart disease, chronic lower respiratory disease, stroke, Alzheimer’s disease, unintentional injuries, influenza and pneumonia, septicemia, hypertension, chronic liver disease, Parkinson’s disease, suicide, and pneumonitis due solids and liquids. The deaths from those 12 leading causes of death accounted for 52.9% of total female deaths.

Life expectancy declined 0.2 year for males largely because of increases in mortality from 11 of 15 leading causes of death such as unintentional injuries, chronic lower respiratory disease, stroke, diabetes, suicide, Alzheimer’s disease, chronic liver disease, septicemia, Parkinson’s disease, Homicide, and hypertension. And about 65% of accidental deaths were under 65 years old, while 81% of suicides were aged 15-64, and 95% of homicides were under 65 years. More young people dying from preventable causes drags life expectancy down.

Q: Is it unusual that mortality rates for so many leading causes of death increased in 2015?

JX: We haven’t seen the increase in mortality from so many leading causes of death for a long time. The age-adjusted death rates increased significantly for 3 of 10 leading causes of death in 2014, 2 in 2013, 1 in 2012, and 5 in 2011. It is an unusual year. Again we don’t know why.

Q: Does the increase in mortality among white females suggest another drop in life expectancy for that group?

JX: We don’t have life expectancy numbers for white females yet. It is possible that the life expectancy numbers in 2015 for white women will drop again in 2015 since the life expectancy decreased 0.1 year for all females in 2015 from 2014 and mortality from 12 of 15 leading causes of death for white females increased significantly in 2015 from 2014 (heart disease, chronic lower respiratory diseases, Alzheimer’s disease, stroke, unintentional injuries, diabetes, influenza and pneumonia, hypertension, chronic liver disease, Parkinson’s disease, suicide, pneumonitis due to solids and liquids).


COPD-Related Mortality by Sex and Race Among Adults Aged 25 and Over: United States, 2000-2014

September 8, 2016

Questions for Hanyu Ni, Ph.D., M.P.H., Associate Director for Science and Lead Author on “COPD-Related Mortality by Sex and Race Among Adults Aged 25 and Over: United States, 2000-2014

Q: How have trends in chronic obstructive pulmonary disease (COPD) related deaths changed since 2000?

HN: Overall, the COPD-related death rate decreased 12.3% from 2000 through 2014 after adjustment for age. The crude death rate remained flat over time.

Q: What is the difference between COPD-related deaths and chronic lower respiratory disease mortality – the latter which is listed as the third leading cause of death in the United States?

HN: Chronic lower respiratory disease (CLRD) comprises three major diseases, i.e., chronic bronchitis, emphysema, and asthma — that are all characterized by shortness of breath caused by airway obstruction. Chronic obstructive pulmonary disease (COPD) includes mainly emphysema and chronic bronchitis. From 2000 through 2014, COPD accounted for approximately 96% of all CLRD deaths every

Q: How has COPD-related mortality changed among men and women over time?

HN: The COPD-related death rate declined more rapidly among men than among women. The age-adjusted rate for men declined 22.5% from 183.0 per 100,000 standard population in 2000, to 141.9 in 2014. The rate for women declined 3.8% from 104.9 in 2000 to 100.9 in 2014.

Q: Are there differences among race and age groups in COPD-related deaths?

HN: The changes over time in the COPD-related death rate differed by sex, race, and age. Between 2000 and 2014, the COPD-related death rate declined among men aged 65 and older and among women aged 65 and 84. However, the death rate increased among middle-aged men and women aged 45-64 and women aged 85 years and older. During the same period, the rate declined among white men and black men, remained stable among white women, but increased among black women.

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

HN: Using multiple-cause-of death data, this analysis found that the COPD-related death rate is roughly twice as high as the previously reported rate based on the underlying cause of death. This analysis also revealed an increased risk in COPD-related mortality among black women, both men and women aged 45-64, and women aged 85 and over.

Cesarean delivery – more popular than ever before

March 24, 2010

A report released yesterday from the National Center for Health Statistics showed that the cesarean rate rose by 53% from 1996 to 2007, reaching 32%, the highest rate ever reported in the United States. The 1.4 million cesarean births in 2007 represented about one-third of all births in the United States.

Although clear clinical indications often exist for a cesarean delivery, the short- and long-term benefits and risks for both mother and infant have been the subject of intense debate for over 25 years. Despite this, the rate continues to rise for women in all racial and ethnic groups, as well as for women of every age, as shown below.

Rates of cesarean delivery typically rise with increasing maternal age. As in 1996 and 2000, the rate for mothers aged 40–54 years in 2007 was more than twice the rate for mothers under age 20 (48% and 23%, respectively).For more from this recent release, visit

Depression in the United States

January 20, 2010

Depression is a common and debilitating illness. According to the American Psychiatric Association, depression is characterized by changes in mood, self-attitude, cognitive functioning, sleep, appetite, and energy level. Here’s some facts about depression in the U.S. you may not know:

  • More than 1 in 20 Americans age 12 and over have depression.
  • More than 1 in 7 poor Americans have depression.
  • Rates of depression were higher in 40-59 year olds, women, and non-Hispanic black persons than in other demographic groups (see the chart below).

For more information, please visit the NCHS FastStats page on depression at, or visit