Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016April 27, 2017
Questions for Emily P. Zammitti, M.P.H., Associate Service Fellow and Lead Author on “Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016.”
Q: What do you mean by the “chronically uninsured?”
EZ: For the purposes of this report, persons were defined as chronically uninsured if they were uninsured at the time of interview and had lacked coverage for more than 1 year.
Q: What groups are more likely to be chronically uninsured?
EZ: We have to be careful about how we speak about the results of this report. The focus of this report is the population who are chronically uninsured. Therefore it does not address which groups are more likely to be chronically uninsured. Among the chronically uninsured, certain groups are larger than others. In the first 9 months of 2016, the proportion of chronically uninsured adults who lived in the South was larger than the proportion who lived in the Northeast, Midwest, or West regions. The proportion who were aged 45-64 was larger than the proportion who were aged 18-25, 26-34, and 35-44. The proportion who were Hispanic was larger than the proportion who were non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and non-Hispanic other race. The proportion who rated their health as excellent or very good was larger than the proportion who rated their health as either good or fair or poor. A major focus of this report is how these proportions have changed since 2010.
Q: How many of the chronically uninsured are younger people who in many cases are healthy vs. older people who are much more likely to need insurance?
EZ: In the first 9 months of 2016, we estimate that 16% of chronically uninsured adults aged 18-64 were aged 18-25, 25.2% were aged 26-34, 26.8% were aged 35-44, and 32% were aged 45-64. Since 2010, the proportion of chronically uninsured adults who were aged 18-25 has decreased, and the proportion who were aged 35-44 and 45-64 increased. For this report, we did not disaggregate health status by age.
Q: Are there more chronically uninsured people in states that did not expand Medicaid?
EZ: We did not look at the chronically uninsured population stratified by state Medicaid expansion status for this report. However, we do look at the percent who are uninsured at the time of interview, which includes both chronically and short-term uninsured, by state Medicaid expansion status in our quarterly Health Insurance Early Release report. The percentage who are uninsured is higher in states which have not expanded Medicaid, compared with states which have expanded Medicaid.
Q: What in this new analysis did you find most interesting?
EZ: The first figure in our report shows that since 2010, the percentage of adults aged 18-64 who are chronically uninsured has been cut by more than half from 16.8% in 2010 to 7.6% in the first 9 months of 2016.
Q: When will you have full-year numbers available for 2016?
EZ: Full year 2016 Early Release data will be available on May 17th, 2017 through the Research Data Centers. That’s also when the next Health Insurance Early Release report will come out. Full year final data are expected to be released at the end of June 2017, six months after the completion of data collection.
Q: What do you make of the finding that the percent of chronically uninsured who are unemployed has been dropping while the percent who are employed has been increasing?
EZ: We don’t propose potential explanations for the results of this report, that’s outside of the scope of our work, but we did see a decrease in the proportion of chronically uninsured adults aged 18-64 who were unemployed from 16.3% in 2010 to 10.1% in the first 9 months of 2016, with a corresponding increase in the proportion who were employed during this time period.
Q: Anything else you feel is noteworthy about your study?
EZ: lthough the majority of chronically uninsured adults rate their health as excellent or very good, this proportion has not changed significantly from 2010 to the first 9 months of 2016. This means that the chronically uninsured population aged 18-64 is not more or less healthy (according to their self-rated responses) in the first 9 months of 2016 than in 2010.
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:
QuickStats: Percentage of U.S. Women Aged 21–65 Years Who Never Had a Papanicolaou Test (Pap Test), by Place of Birth and Length of Residence in the United StatesApril 3, 2017
In 2013 and 2015 combined, 6.8% of U.S. women aged 21–65 years had never received a Pap test in their lifetime.
Foreign-born women were more than twice as likely as U.S. born women to have never received a Pap test (13.4% versus 5.2%).
Foreign-born women who lived in the United States for more than 25% of their lifetime were almost twice as likely as those who resided in the United States for 25% or less of their lifetime (21.5% versus 10.9%) to have never received a Pap test.
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.
Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015March 8, 2017
Questions for Anjel Vahratian, Supervisory Statistician (Health) and Lead Author on “Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015”
Q: Why did you decide to look at clinical preventive services for cancer and heart disease among insured adults?
AV: Heart disease and cancer are the top two leading causes of death in the United States. The clinical preventive services discussed in this report are recommended for the prevention or early detection of heart disease and cancer. We limited our analysis to insured adults because most insurance plans were required to cover these clinical preventive services without co-payment from the insured adult in 2015.
Q: What did your report find out about cancer screenings among insured adults?
AV: In 2015, two-thirds of insured adults aged 50-75 were screened for colorectal cancer within the recommended intervals, and screening was significantly associated with age for both men and women. Insured women aged 50-59 were more likely to be screened for colorectal cancer compared with men of the same age. Among insured women, more than 8 out of 10 of those aged 21-65 had been screened for cervical cancer, and nearly 3 out of 4 of those aged 50-74 had been screened for breast cancer within the recommended intervals.
Q: What did your report find out about heart disease screenings among insured adults?
AV: In 2015, more than 8 in 10 insured adults aged 18 and over had their blood pressure checked by a doctor or other health professional, and about 2 in 3 overweight and obese insured adults aged 40-70 had a fasting blood test for high blood sugar or diabetes in the past 12 months. Receipt of these services increased with advancing age and varied by sex. Insured women aged 18-39 and 40-64 were more likely than their male peers to have their blood pressure checked in the past 12 months, and insured overweight and obese women aged 40-49 were more likely than men of the same age and BMI to have a fasting blood test or diabetes in the past 12 months.
Q: Was there a specific finding that you found surprising?
AV: It was surprising that only 49.5% of overweight and obese insured men aged 40-49 had a fasting blood test for diabetes in the past 12 months. Diabetic adults are at increased risk of developing cardiovascular disease, and overweight and obesity and abnormal blood glucose are modifiable cardiovascular risk factors.
Q: What is the take home message of this report?
AV: Utilization of clinical preventive services aimed at the early detection of cancer and cardiovascular disease varied by sex and age among insured adults. Insured adults in their 40s and 50s were less likely than those in their 60s to be screened for colorectal cancer, high blood pressure, and diabetes. Limited knowledge about the recommendations for clinical preventive services may prevent eligible adults from seeking out timely preventive care.
QuickStats: Age-Adjusted Percentage of Adults Aged 65 Years or Older by Number of 10 Selected Diagnosed Chronic Conditions and Poverty StatusFebruary 27, 2017
For the period 2013–2015, 13% of adults aged 65 years or older reported having none of 10 selected diagnosed chronic conditions; 25% had one, 46% had two or three, and 16% had four or more of the conditions.
No differences by poverty status were observed among those who reported having two or three conditions, but those in the lowest income group (100% or less of the poverty threshold) were less likely to have none or only one of the chronic conditions compared with those in the highest income group (400% or more of the poverty threshold).
Those in the lowest income group also were more likely to have four or more conditions when compared with those in the highest income group (21% compared with 12%).