New Studies: Geographic and Demographic Variation in Health Insurance Coverage

November 3, 2022

Nearly 25 million working age adults in the United States (ages 18-64) were without health insurance in 2021, according to new data from CDC’s National Center for Health Statistics. Texas, Georgia, and North Carolina had the highest rates of uninsured among this group.

The data are captured in two new reports using data from the National Health Interview Survey: “Demographic Variation in Health Insurance Coverage: United States, 2021” and “Geographic Variation in Health Insurance Coverage: United States, 2021.”

Some of the findings from the demographic report include:

  • Overall, 28 million Americans did not have health insurance in 2021, including almost 3 million children.
  • Among adults ages 18-64, nearly 13% did not have health insurance.
  • Almost two-thirds of people under age 65 with health insurance are covered by private health insurance, including over half with employer-based coverage.

Highlights from the geographic report include:

  • Among adults under age 65, Texas (29.4%), Georgia (19.2%), and North Carolina (17.6%) had uninsured rates that were higher than the national rate of 12.6%.
  • Adults ages 18-64 who live in non-Medicaid expansion states (19.1%) were twice as likely to be uninsured compared to those living in Medicaid expansion states (9.4%).
  • Among adults under age 65, there were several states with uninsured rates that were lower than the national rate: Illinois (8.7%), Ohio (8.7%), Pennsylvania (8.0%), Virginia (8.0%), Washington (8.0%), Wisconsin (7.7%), New York (6.9%), Kentucky (6.5%), Maryland (6.5%), Michigan (6.1%), and Massachusetts (3.0%).

The two reports are available at the following links:

Updated COVID-19 Data Featured in Latest Release from Household Pulse Survey

October 5, 2022

As part of its ongoing partnership with the Census Bureau, NCHS recently added questions to assess the prevalence of post-COVID-19 conditions, sometimes called “long COVID,” on the experimental Household Pulse Survey.

Today, NCHS released the latest round of Pulse data, collected from September 14-26, 2022.  This latest release includes new data on how Long COVID reduces people’s ability to carry out day-to-day activities compared with the time before they had COVID-19.

Data on this topic is available at the following link:



·        4 out of 5 people with ongoing symptoms of COVID lasting 3 months or longer are experiencing a least some limitations in their day-to-day activities.

·        1 out of 4 adults (25.1%) with long COVID have symptoms that significantly impact their ability to carry out day-to-day activities.

·        Out of all U.S. adults, nearly 2% (1.8%) had COVID-19 and still have long COVID symptoms that have a significant impact on their ability to carry out day-to-day activities more than 3 months later.

·        14.2% of adults had ever experienced COVID symptoms that lasted 3 months or longer that they had not had prior to their COVID-19 infection.

·        Among the 14.2% who have ever had long COVID symptoms, more than half (7.2%) currently have long COVID symptoms.  

·        1 out of 3 adults in the U.S. who’d had COVID-19 (29.6%) reported ever having long COVID symptoms.

·        15% of those who’d had COVID-19 reported currently having long COVID symptoms.

QuickStats: Percentage of Children and Adolescents Aged 6–17 Years Who Have Roads, Sidewalks, Paths, or Trails Where They Can Walk or Ride a Bicycle, by Urban-Rural Status and Family Income 

September 2, 2022

During 2020, 88.7% of children and adolescents aged 6–17 years had roads, sidewalks, paths, or trails in their neighborhood or near their home where they could walk or ride a bicycle.

Availability of these spaces was less common among children and adolescents who lived in families with incomes <200% of FPL (85.6%) than among those in families with incomes ≥200% of FPL (90.5%) and was consistent among children and adolescents in both urban (89.4% versus 93.9%) and rural (64.9% versus 77.4%) areas.

Regardless of income, availability of spaces to walk or ride a bicycle was lower among children and adolescents living in rural areas (73.4%) than among those in urban areas (92.1%).

Source: National Center for Health Statistics, National Health Interview Survey, 2020.

Q&A: Physical Activity in Adults Aged 18 Years and Over: United States, 2020

August 30, 2022

Questions for Nazik Elgaddal, Health Statistician and Lead Author of “Physical Activity in Adults Aged 18 Years and Over: United States, 2020.”

Q: Why did you decide to do a report on physical activity among U.S. adults?

NE: Meeting the physical activity guidelines is one of the Healthy People 2030 leading health indicators.  Understanding who does and does not meet these guidelines is important for health care providers and policymakers.

Q: How did the data vary by gender, race, and income level?

NE: There are differences in who meets the guidelines by gender, race and Hispanic origin, and poverty level.  Men are more likely than women to meet both physical activity guidelines across all age groups. Hispanic men were less likely than other race and Hispanic origin groups among men to meet the guidelines, and non-Hispanic White women were more likely than other female groups. The percentage of people meeting the guidelines increased as family income levels increased.

Q: Do you have comparative trend data that goes further back than 2020?

NE: Starting in January 2019, a redesigned NHIS questionnaire with new content and structure was implemented. Physical activity questions are in the rotating core section every other year starting in 2020. Estimates for years prior to 2019 are available in Health, US and Healthy People

Q: How was this data collected?

NE: Data from the 2020 NHIS were used for this analysis. Interviews are typically conducted in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Due to the COVID-19 pandemic, data collection procedures in 2020 were disrupted: From April through June 2020, all interviews were conducted by telephone only, and from July through December 2020, interviews were attempted by telephone first, with follow-ups to complete interviews by personal visit.

Q: What is the main takeaway message here?

NE: In 2020, only about one-quarter of adults fully met the Federal physical activity guidelines for aerobic and muscle-strengthening activities. 

QuickStats: Percentage of Adults Aged ≥65 Years Who Drank Four or More Alcoholic Drinks Per Week, by Sex and Age — National Health Interview Survey, United States, 2020

August 19, 2022

In 2020, 18.3% of adults aged ≥65 years reported drinking four or more alcoholic drinks per week. Among adults aged ≥65 years, men were more likely (25.6%) than women (12.4%) to have four or more drinks.

Percentages of those having four or more drinks were higher among men than women for the following age groups: 65–74 years (27.7% versus 13.4%), 75–84 years (23.6% versus 12.1%) and ≥85 years (17.6% versus 8.1%).

Among both men and women, the percentage of adults aged ≥65 years who drank four or more alcoholic drinks per week decreased as age increased, from 20.0% for those aged 65–74 years to 11.8% for those aged ≥85 years.

Source: National Health Interview Survey, 2020.

QuickStats: Percentage of Uninsured Adults Aged 18−64 Years, by Race, Hispanic Origin, and Selected Asian Subgroups — National Health Interview Survey, United States, 2019−2020

July 15, 2022

During 2019–2020, the percentage of U.S. adults aged 18–64 years who were uninsured was 14.4%.

Among all race and Hispanic origin groups, non-Hispanic Asian adults (7.8%) were the least likely to be uninsured followed by non-Hispanic White (9.7%), non-Hispanic Black (14.6%), and Hispanic adults (30.4%).

Among the non-Hispanic Asian subgroups shown, adults of Korean (14.3%) origin were more likely to be uninsured than adults of Asian Indian (4.8%) and Chinese (6.5%) origin.

Other observed differences were not statistically significant.

Source: National Health Interview Survey, 2019 and 2020 data.

QuickStats: Age-Adjusted Percentage of Adults Aged ≥18 Years Who Met the 2018 Federal Physical Activity Guidelines for Both Muscle-Strengthening and Aerobic Physical Activity, by Urbanization Level — National Health Interview Survey, United States, 2020

July 8, 2022

In 2020, 25.3% of adults aged ≥18 years met the 2018 federal physical activity guidelines for both muscle-strengthening and aerobic physical activity.

The percentage meeting both guidelines was highest in adults living in large central metropolitan (28.0%) and large fringe metropolitan areas (27.6%), followed by those living in medium and small metropolitan areas (23.4%) and lowest in those living in nonmetropolitan areas (18.1%).

Source: National Center for Health Statistics, National Health Interview Survey, 2020.

PODCAST: Sleep Difficulties & Patterns Among Americans

June 30, 2022

HOST: The American Academy of Sleep Medicine recommends between 9 and 12 hours of sleep for children between ages 6 and 12, and 8 to 10 hours of sleep for teens ages 13 to 18.  However, only two-thirds of school-age children meet these recommendations.

At the same time, the American Academy of Sleep Medicine and the Sleep Research Society recommend that adults receive at least 7 hours of sleep per night, and yet, more than a quarter of adults do not meet this recommendation. Signs of good sleep quality include taking less time to fall asleep and not waking up often or for long periods of time.

Last week, NCHS released two new reports on sleep habits among children and adults, using data from the 2020 National Health Interview Survey – or NHIS.

Today, we’re joined by the lead author of the report on adults, Dzifa Adjaye-Gbewonyo, who is also a co-author on the report on children’s bedtime habits.

HOST:  OK Dzifa, thank you for joining us.  Could you talk a little bit about why your team conducted these analyeis on sleep and sleep behaviors?

DAG:  Sure.  So the 2020 National Health interview survey or NHIS was the first time that data on sleep had been collected on adults since the survey was redesigned in 2019, and we wanted to be able to provide updated information on adult sleep.  The sleep questions had also changed slightly from earlier versions of the NHIS and the 2020 survey was also the first time that sleep data had ever been collected on children in the NHIS.  So we wanted to be able to analyze the adult and child sleep content and produce estimates for some of these measures.

HOST:  So – second question – just stepping back… In a general sense, why is sleep an important part of a healthy lifestyle?

DAG:  So sleep is vital for health and well-being.  Inadequate sleep and issues with falling or staying asleep have been associated with poor health outcomes such as high blood pressure, heart disease, diabetes, obesity and even mortality.  Insufficient sleep also affects children’s physical and mental health, and increases the likelihood of cognitive and behavioral issues, Type II diabetes, obesity and injuries.

HOST: OK and what is the recommended amount of sleep for an adult?

DAG:  So for adults this suggested amount of sleep is at least seven hours a night based on recommendations from the American Academy of Sleep Medicine and the Sleep Research Society.

HOST: OK and what about the what is recommended for children?

DAG:  For children, the American Academy of Pediatrics recommends between 10 to 16 hours of sleep for children under five years, 9 to 12 hours for children 6 to 12 years, and eight to 10 hours for adolescents aged 13 to 18.

HOST:  In your study on adults how did you define sleep difficulties?

DAB: We defined, we looked at two measures for sleep difficulties which we called “trouble falling asleep” and “trouble staying asleep” and those were based on survey questions in the questionnaire so the question on trouble falling asleep was based on a response of if adults answered “most days” or “every day” to the question “During the past 30 days how often did you have trouble falling asleep?” and similarly for” trouble staying asleep” it was also based on a response of “most days” or “every day” to the question “During the past 30 days how often did you have trouble staying asleep?”

HOST: OK now getting into your studies, what were the key findings in your study on adults?

DAB: We found that one in seven adults in the US had trouble falling asleep and about 18% of adults had trouble staying asleep.  These sleep difficulties were more common in women than men, and older adults aged 65 and over had less trouble falling asleep while younger adults aged 18 to 44 had less trouble staying asleep.  Problems falling and staying asleep decreased as family income increased and as place of residence became more urban.  Sleep difficulties also varied by race and ethnicity stand by education level.

HOST: Now your study used 2020 data – was there any insight about how the pandemic impacted sleep patterns?

DAG:  We looked at 2020 data as a whole, so analysis on changes in sleep patterns during the pandemic were beyond the scope of this report.  There is more specific information about when the data were collected, but it might be difficult to tease out the reasons for any changes observed across time periods.  Especially because the data collection process also changed during the pandemic. Prior to 2020 data on sleep were last collected in the 2018 NHIS.  However, they may not be directly comparable to 2020 data due to changes in the survey questions.

HOST:  Would it be accurate to say that your findings here suggest that economic or money concerns have an impact on people sleep habits?

DAG:  Well we can say that there is a link between economic factors and sleep difficulties and that complaints of trouble falling and staying asleep and adults are lower with increasing family income, but we cannot say with certainty what the direction of this impact is from these data alone.  For example, a family’s economic situation may affect someone’s ability to fall or stay asleep, and sleep difficulties could also have some effects on economic status.  So since the survey is a snapshot in time either or both impacts may be possible.

HOST:  Right and anecdotally that would certainly make sense.  So your other study in which you were a co-author on looked at children’s bedtime habits.  How important is it bedtime routine for kids?

DAG:  Studies show that children who have regular bedtimes are more likely to get the amount of sleep they need.  And sleep routines are also linked to other outcomes in children.  For instance, better cognitive performance and a lower risk of obesity.  So bedtime routines are quite important for children.

HOST:  So does your study show that kids are getting the recommended amount of sleep then?

DAG:  Well our data did not look specifically at the amount of sleep children are receiving, but based on other sources just under 2/3 of children get the recommended amount of sleep.  So about 1/3 of children in the U.S. do not get enough sleep.

HOST:  And how does your study define a regular bedtime for kids?

DAG:  For a regular bedtime for children, we define that based on responses to the question “In a typical school week, how often does the child go to bed at the same time?” and so the response options were “Never,” “Some days,” “Most days,” or “Every day,” and we use “Most days” or “Every day” to define having a regular bedtime.

HOST:  What does that study tell us about family structure and bedtime habits and children?

DAG:  Well our results showed that there does seem to be a difference in regular bedtime habits depending on children’s family structure.  Children living in single parent families were less likely to have a regular bedtime every day or most days compared with children living in two-parent families.

HOST:  And which children are more likely not to have a structured bedtime routine?

DAG:  Older children aged 12 to 17 are more likely to not have a regular bedtime, as well as Hispanic and non-Hispanic black children, children living in families with lower incomes, and children to live in communities that are more socially vulnerable.

HOST:  One would assume, too, if they have parents who work evenings or something, or a parent travels a lot, that that would have an impact on bedtime routine?

DAG:  Yeah that’s possible – we didn’t get to look specifically at work schedules and travel but that would be something to look into to tease out some of those impacts.

HOST:  OK so do you have any other take home messages about either report you’d like to emphasize?

DAG:  Well, I think one thing that we would like to emphasize we hope is that these reports will improve our understanding of sleep difficulties in adults and of children’s bedtime routines.  So we hope that they can be useful sources of information that can help inform future research and also inform sleep interventions and targeting sleep interventions for subgroups that may be more at risk.


HOST: NCHS is part of a team of federal agencies, led by the Census Bureau, that collaborate on the Household Pulse Survey, which has produced mental health and health care access data, along with several other topics, during the pandemic.  On June 22, the Pulse Survey for the first time included data on “long COVID,” defined as “symptoms lasting three or more months after first contracting the virus, and that they didn’t have prior to their COVID-19 infection.”  The first round of data, collected from June 1st to June 13 showed that nearly 1 in 5 Americans who have had COVID-19 still have long COVID.

NCHS released two other new reports this month as well.  On June 23, data from the National Ambulatory Medical Care Survey was examined in a new report on Health Centers in the United States.  The report found that a third of the visits to these health centers were for preventive care.  Another third of visits were due to chronic problems and the other third were due to new problems.  6 in 10 health care center visits involved screening, exams, and health education or counseling.  4 in 10 visits involved lab tests of some kind.  Most of these visits to health care centers were paid for by Medicaid.

And finally, this month NCHS released a report on maternal health characteristics and infant outcomes to women born both in and outside the United States. The report reveals that over 1 in 5 women who gave birth in the United States were born outside the U.S.  Over half of these women born outside the U.S. were from Latin America, who accounted for 12% of all women giving birth in 2020.  Over a quarter of women born outside the U.S. were born in Asia, and accounted for 6% of all births.

QuickStats: Percentage of Uninsured Adults Aged 18–64 Years, by Race and Selected Hispanic Origin Subgroup — National Health Interview Survey, United States, 2019−2020

June 24, 2022

During 2019–2020, the percentage of U.S. adults aged 18–64 years who were uninsured was 14.4%.

Among all race and Hispanic origin subgroups, those most likely to be uninsured were Hispanic adults (30.4%) followed by non-Hispanic Black (14.6%), non-Hispanic White (9.7%), and non-Hispanic Asian (7.8%) adults.

Among the Hispanic origin subgroups included, those most likely to be uninsured were of Central American (42.2%) origin followed by Mexican or Chicano (33.6%) origin.

Adults of Cuban (22.7%) origin were more likely to be uninsured than those of Puerto Rican (14.8%) and Dominican (12.9%) origin. Other observed differences were not statistically significant.

Source: National Center for Health Statistics, National Health Interview Survey, 2019 and 2020.

QuickStats: Percentage of Adults Aged ≥18 Years with Diagnosed Heart Disease, by Urbanization Level and Age Group — National Health Interview Survey, United States, 2020

June 10, 2022

In 2020, 6.3% percent of adults aged ≥18 years had diagnosed heart disease.

The prevalence of heart disease among adults aged ≥18 years was higher among those living in nonmetropolitan areas (8.8%) compared with those living in metropolitan areas (5.8%).

Prevalence increased with age from 0.9% among adults aged 18–44 years to 5.9% among those aged 45–64 years and 18.2% among those aged ≥65 years.

Among adults aged 45–64 years, those living in nonmetropolitan areas (7.8%) were more likely to have heart disease than those living in metropolitan areas (5.6%).

There was no statistically significant difference by urbanization level for adults aged 18–44 or ≥65 years.

Source: National Center for Health Statistics, National Health Interview Survey, 2020.