Urban-rural Differences in Visits to Office-based Physicians by Adults with Hypertension: United States, 2014–2016

November 12, 2020

Questions for Danielle Davis, Health Statistician and Lead Author of “Urban-rural Differences in Visits to Office-based Physicians by Adults With Hypertension: United States, 2014–2016.”

Q: Why did you decide to research urban-rural differences in visits to office-based physicians by adults with hypertension?

DD: During grad school, I worked on a project with the Baltimore City Health Department where I learned about racial disparities in Hypertensive Disorders of Pregnancy. Black women, and sometimes their babies were dying from this disorder without concrete reasons as to why. Some of the women had never been diagnosed with hypertension or other risk factors but would still develop this disorder. It led us to looking at other causes, such as environmental and residential stressors considering these women live in a unique urban setting. I decided to take this knowledge and look at hypertension in the US population as a whole to see how hypertension differed by urban-rural residences.

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

DD: It was surprising to see a significantly higher percentage of hypertension in non-Hispanic Black adults in Large metro urban and large metro suburban counties in comparison to non-Hispanic White and Hispanic adults.

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

DD: Data are from the 2014–2016 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal, office-based physicians. This data is collected by the National Center for Health Statistics.

Q: Is this the most recent data you have on this topic?

DD: Yes.  This is the most recent data we have on this topic.

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

DD: I think the take home message for this report is visits by adults who lived in large metro suburban areas was lower than visits by adults who lived in small-medium metro areas and rural areas. Visits by men with hypertension was higher than visits by women overall, in large metro suburban areas, small medium metro areas, and rural areas. The percentage of visits with hypertension increased with age and was observed in all areas. Lastly, the percentage of visits by non-Hispanic Black adults with hypertension was higher than visits for non-Hispanic White adults and for Hispanic adults. The same pattern was observed in large metro urban and large metro suburban areas.

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Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014–2018

August 6, 2020

Questions for Maria Villarroel, Health Statistician and Lead Author of “Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014–2018.”

Q: Why did you decide to do a report on health in American Indian and Alaska Native (AIAN) adults?

MV: There is limited information about the health of the American Indian and Alaska Native adults at the national level. Few national surveys are large enough to be able to provide reliable estimates about American Indian and Alaska Native adults. The National Health Interview Survey (NHIS) is one such survey that can inform on the health status and health conditions of civilian non-institutionalized adults residing in households across the country who identify as American Indian and Alaska Native.

Q: Can you summarize how the data varied by urbanization level?

MV: This report has two objectives.

The first objective was to compare the health of American Indian and Alaska Native adults by urbanization level.  The report findings indicate that the conditions examined did not follow a single pattern by urbanization level. The percentage of American Indian and Alaska Native adults with disabilities increased with higher urbanization level, multiple chronic conditions increased with lower urbanization level, diagnosed diabetes was highest in rural areas, diagnosed hypertension was highest for those in medium and small metropolitan areas and in rural areas, and those in fair or poor health status did not differ by urbanization level.

The second objective was to assess whether the percentage of American Indian and Alaska Native adults with selected conditions was similar to the percentage found, on average, among all U.S. adults. The report findings indicate that American Indian and Alaska Native adults were more likely to be in fair or poor health, have a disability, have multiple chronic conditions, and to have been diagnosed with hypertension and diabetes compared with all U.S. adults. This finding was consistent across most urbanization levels.

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

MV: Among American Indian and Alaska Native adults, the selected conditions examined did not follow a single pattern by urbanization level, and that across most urbanization levels, the percentage of American Indian and Alaska Native adults with these selected conditions was higher than found on average among U.S. adults.

Q: Is this the first time you have reported data on AIAN?  If not, do you have any trend data?

MV: Yes, this is the first time we have used NHIS data to examine selected health conditions among American Indian and Alaska Native adults in the US. We are not aware of a previous trend report and have not examined trends among this population ourselves.

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

MV: Among American Indian and Alaska Native adults, the conditions examined did not follow a single pattern by urbanization level, and across most urbanization levels, the percentage of American Indian and Alaska Native adults with these selected conditions was higher than found on average among U.S. adults.

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2017 Final Deaths, Leading Causes of Death and Life Tables Reports Released

June 24, 2019

NCHS released a report that presents the final 2017 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin and race, state of residence, and cause of death.

Key Findings:

  • In 2017, a total of 2,813,503 deaths were reported in the United States.
  • The age-adjusted death rate was 731.9 deaths per 100,000 U.S. standard population, an increase of 0.4% from the 2016 rate.
  • Life expectancy at birth was 78.6 years, a decrease of 0.1 year from the 2016 rate.
  • Life expectancy decreased from 2016 to 2017 for non-Hispanic white males (0.1 year) and non-Hispanic black males (0.1), and increased for non-Hispanic black females (0.1).
  • Age-specific death rates increased in 2017 from 2016 for age groups 25–34, 35–44, and 85 and over, and decreased for age groups under 1 and 45–54.
  • The 15 leading causes of death in 2017 remained the same as in 2016 although, two causes exchanged ranks.
  • Chronic liver disease and cirrhosis, the 12th leading cause of death in 2016, became the 11th leading cause of death in 2017, while Septicemia, the 11th leading cause of death in 2016, became the 12th leading cause of death in 2017.
  • The infant mortality rate, 5.79 infant deaths per 1,000 live births in 2017, did not change significantly from the rate of 5.87 in 2016.

NCHS also released the 2017 U.S. Life Tables and Leading Causes of Death Reports.

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Hypertension Prevalence and Control Among Adults: United States, 2015-2016

October 18, 2017

Questions for Cheryl Fryar, M.S.P.H., Health Statistician and Lead Author on “Hypertension Prevalence and Control Among Adults: United States, 2015-2016”

Q: What made you decide to conduct this study on hypertension prevalence and control?

CF: The primary motivation for conducting this study was to offer the public updated data on U.S. adults who have high blood pressure. Every two years new data are available for us to provide updated estimates of hypertension prevalence and control. Data were recently released for the 2015-2016 National Health and Nutrition Examination Survey, and our next step was to analyze the data and provide accessible statistical information that might guide actions to improve the health of the American people.

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

CF: The findings were pretty consistent with what’s been previously reported. The prevalence of hypertension hasn’t changed much since 1999. Among those with hypertension, controlled hypertension increased between 1999 and 2010, and then has remained stable since that time. There was an observed decrease in hypertension control since 2013-2014, but this change was not statistically significant. It is too early to tell whether or not a change in hypertension control is occurring.

Q: What do you think is the most interesting demographic finding among your new study’s findings for 2015-2016 – age, race, sex?

CF: There are a number of interesting demographic findings in this report, and we still find disparities among demographic subgroups. Hypertension prevalence was highest among non-Hispanic black men and women. Hypertension also increases with age — from 7.5% in the youngest age group 18-39, to 63.1% in the oldest age group 60 and over.

On the other hand, among adults with hypertension, about half of adults 40 and over with hypertension had controlled hypertension compared to about a third of young adults. Overall, women with hypertension had higher controlled hypertension than men with hypertension.

Q: When you identified adults with controlled hypertension in your study, was that through participants’ self-reporting that they were on medication for high blood pressure or another method? If it was self-reporting, how do you know it’s true?

CF: One of the strengths of the National Health and Nutrition Examination Survey, or NHANES, is that it combines both interviews in the home and physical examinations in mobile examination centers, including blood pressure measurement. In order to identify people with controlled hypertension, we looked at the measured blood pressure of adults who were taking medication for their hypertension. If they had a measured systolic blood pressure reading < than 140 mmHg AND a diastolic reading of <90 mmHg, then their hypertension was considered controlled.

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

CF: I think the take-home message of this report is that hypertension prevalence has remained unchanged since 1999 at around 29%, and that just under half of adults with hypertension have their hypertension under control. High blood pressure among U.S. adults is a persistent and prevalent concern that is a serious factor in the health and well-being of the nation. The statistics in this new report show that we have yet to meet the Heathy People 2020 Goal of 61.2% for hypertension control.

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Stat of the Day – April 26, 2017

April 26, 2017

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Fact or Fiction: Is a growing percentage of Americans with hypertension unaware they have it?

April 26, 2017

Source: https://www.cdc.gov/nchs/data/databriefs/db278.pdf

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Characteristics of Adults with Hypertension who are Unaware of their Hypertension, NHANES 2011–2014

April 26, 2017

Questions for Ryne Paulose, NHANES’ Associate Director for Science and Lead Author of “Characteristics of Adults with Hypertension who are Unaware of their Hypertension, NHANES 2011–2014”

Q: What made you want to do a report on adults with hypertension who are unaware of their hypertension?

RP: We have a number of NCHS brief reports on prevalence of hypertension, awareness, control, and treatment.  We wanted to publish a brief report that further characterizes adults who are unaware of their hypertension. Being undiagnosed and unaware of having hypertension is a problem since these blood pressure for these adults will remain above normal levels and have potentially damaging effects.

Q: It looks there was a major decline in the number of adults with hypertension that were unaware they had it since 1999-2002 data?  Do you know why there has been a significant decline?

RP: Yes, there was a 46% decline from 1999-2002 to 2011-2014, in the percent of adults with hypertension who were unaware. The decline was seen across all age groups. But the decline was greater for those 60 years and older.

We did not specifically examine reasons for the decline in this brief report. But in our report, we do see that the percent unware was lower among adults with health insurance or with increased healthcare visits in the prior year. This implies that increased contact with a healthcare provider increases the chances that high blood pressure will be identified and diagnosed.

Q: Were there major differences in income and education level among adults with hypertension who were unaware of their hypertension?

RP: Generally, there were no differences by income or education level in the percent of adults with hypertension who were unaware. About 14-18% of adults at different income levels were unaware and about 14-19% of adults at different education levels were unaware.

Q: Was there anything in your report that surprised you?

RP: The oversampling of Asian Americans in NHANES is new as of 2011. So, the estimates for Non-Hispanic Asians was an unknown from earlier years. So, the differences we reported did surprise me. Further analysis is in progress to better understand these differences.

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

RP: Although we’ve seen a significant decline in the percent of adults with hypertension who were unaware of their hypertension, nearly 1 in 6 adults with hypertension is unaware of his/her hypertension. Additional efforts may be needed to identify and diagnose these individuals for management and control of their high blood pressure.

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State by State Health Data Source Updated on NCHS Web Site

April 19, 2017

CDC’s National Center for Health Statistics has updated its “Stats of the States” feature on the NCHS web site.  This resource features the latest state-by-state comparisons on key health indicators ranging from birth topics such as teen births and cesarean deliveries to leading causes of death and health insurance coverage.

Tabs have been added to the color-coded maps to compare trends on these topics between the most recent years (2015 and 2014) and going back a decade (2005) and in some cases further back.

To access the main “Stats of the States” page, use the following link:

https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm

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Age Differences in Visits to Office-based Physicians by Adults with Hypertension: United States, 2013

November 17, 2016
Jill J. Ashman, Ph.D., Health Statistician

Jill J. Ashman, Ph.D., Health Statistician

Questions for Jill J. Ashman, Ph.D., Health Statistician and Lead Author on “Age Differences in Visits to Office-based Physicians by Adults With Hypertension: United States, 2013”

Q: Why did you choose age differences as the demographic focus of your study?

JA: I wanted to examine this demographic because of the dramatic differences by age I was seeing in preliminary analyses. For instance, the increase by age in the percentage of adult visits to office-based physicians made by adults with hypertension is large–going from 9% of adults aged 18-44 to 58% of adults aged 75 and over.

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

JA: Probably, the most significant finding is that 34% of all adult visits to office-based physicians were made by adults with hypertension, representing an estimated 259 million office visits in 2013.

Q: How likely was it that medication(s) for high blood pressure were included as part of the treatment that Americans with hypertension were getting at their doctors’ offices?

JA: VERY LIKELY! Hypertensive medications were provided, prescribed, or continued at 62% of office-based physician visits made by adults with hypertension, and the percentage with hypertensive medications increased with age. Half of visits by patients aged 18-44 with hypertension included hypertensive medications whereas this percentage increased to 65% for visits by patients aged 75 and over with hypertension.

Q: Among American adults with high blood pressure, is hypertension the only condition they have when they visit their doctors’ offices?

JA: Hypertension is NOT their only health concern. Eighty-two percent of visits in 2013 that were made by adults with hypertension were made by patients who had been diagnosed with other chronic conditions. A quarter of the visits by adults with hypertension were made by patients who had been diagnosed with 4 or more chronic conditions.

Q: What is the take home message of your report?

JA: I think it’s important to note that regardless of age, adults with hypertension use extensive health resources as evidenced by frequent visits to the doctor (47% of all such visits including four or more visits to the same doctor in the past year) and that there is extensive use of hypertensive medications, with 62% of all such visits including one or more hypertensive medications.

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Hypertension Prevalence and Control Among Adults: United States, 2011–2014

November 17, 2015

Hypertension is a public health challenge in the United States because it directly increases the risk for cardiovascular disease.

An NCHS report presents updated estimates for the prevalence and control of hypertension in the United States for 2011–2014.

Key Findings:

  • Prevalence of hypertension among adults was 29.0% in 2011–2014 and increased with age: 18–39, 7.3%; 40–59, 32.2%; and 60 and over, 64.9%.
  • Hypertension prevalence was higher among non-Hispanic black (41.2%) than non-Hispanic white (28.0%), non-Hispanic Asian (24.9%), or Hispanic (25.9%) adults.
  • Prevalence of controlled hypertension was 53.0%, and adults aged 18–39 were less likely to have controlled hypertension than those aged 60 and over.
  • Overall, prevalence of controlled hypertension was higher among non-Hispanic white (55.7%) than non-Hispanic black (48.5%), non-Hispanic Asian (43.5%), or Hispanic (47.4%) adults.
  • From 1999 to 2014, hypertension prevalence was unchanged, but control of hypertension increased.

 

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