Prevalence of Prescription Pain Medication Use Among Adults: United States, 2015–2018

June 24, 2020

FROM THE AUTHOR

In 2015–2018, 10.7% of U.S. adults used one or more prescription pain medications in the past 30 days.  Prescription pain medication use was higher among women than men overall and within each age category. Use increased with age overall and among men and women. Prescription pain medication use was lowest among non-Hispanic Asian adults, and use among Hispanic adults was lower than among non-Hispanic white adults. This same pattern of prescription pain medication use was observed among both men and women.

Additionally, this report estimated the percentage of adults who used one or more opioid prescription pain medications (with or without use of non-opioid prescription pain medications) and the percentage who used one ore more non-opioid prescription pain medication (without use of prescription opioids).  In 2015–2018, 5.7% of U.S. adults used prescription opioids and 5.0% used non-opioid prescription pain medications (without prescription opioids) in the past 30 days. Use of one or more prescription opioids and use of non-opioid prescription pain medications (without prescription opioids) were higher among women than men, and increased with age, and were lowest among non-Hispanic Asian adults.  Use of one or more prescription opioids among Hispanic adults was lower than among non-Hispanic white adults.

From 2009–2010 to 2017–2018, there was no significant increase in use of prescription opioids, but use of non-opioid prescription pain medications (without prescription opioids) increased.

Source: National Health and Nutrition Examination Survey, 2015–2018.


Prevalence of Tooth Loss Among Older Adults: United States, 2015–2018

June 17, 2020

Questions for Eleanor Fleming, Health Statistician and Lead Author of “Prevalence of Tooth Loss Among Older Adults: United States, 2015–2018.”

Q: Why did you decide to do a report on tooth loss among older U.S. adults?

EF: Tooth loss among older U.S. adults is an important public health issue. Reducing complete tooth loss is a national health goal monitored by Healthy People. From a health perspective, tooth loss diminishes quality of life, impacts nutrition as food choices are limited, and can impede social interactions. Tooth loss is also preventable.


Q: Can you summarize how the data varied by sex, age, race and Hispanic origin, and education?

EF: While the prevalence of complete tooth loss has been diminishing since the 1960s, in other words, older adults are retaining their teeth; in 2015-2018, disparities continue to persist. Overall, the prevalence of complete tooth loss was 12.9%. We found differences in the prevalence of complete tooth loss by sex, age, race and Hispanic origin, and education.

The prevalence of complete tooth loss among adults aged 65 and over and increased with age: 8.9% (aged 65–69), 10.6% (70–74), and 17.8% (75 and over). There were also differences among women and men by age. Among women, prevalence increased in a similar pattern with age (6.9% for adults aged 65–69, 11.7% for 70–74, and 16.6% for 75 and over). There was a different pattern among men. Among men, complete tooth loss was higher in the oldest age group (19.5% for 75 and over) compared with the two younger groups (11.1% and 9.4%, respectively, for those aged 65–69 and 70–74). There were no observed significant differences in the prevalence between men and women.

By race and Hispanic origin, the prevalence of complete tooth loss is similar to patterns that we see in other oral health and health outcomes. There are differences among race and Hispanic and origin. Non-Hispanic black older adults (25.4%) had the highest prevalence of complete tooth loss compared with other race and Hispanic-origin groups. Among men, prevalence was also higher among non-Hispanic black men (23.4%) compared with non-Hispanic white (12.5%) and Hispanic (11.9%) men. Among women, prevalence of complete tooth loss was higher in non-Hispanic black women (26.8%) compared with Hispanic (17.8%) and non-Hispanic white (9.5%) women.

We also found differences in the prevalence of complete tooth loss among older adults by education level. We defined education in terms of less than a high education and a high school education or greater. Adults with less than a high school education had a higher prevalence of complete tooth loss (31.9%) compared with adults with a high school education of greater (9.5%).


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

EF: The statistical difference between Hispanic men and women was the most surprising finding in this report. It was not surprising that we observed the prevalence of complete tooth loss to be higher among Hispanic women (17.8%) compared to non-Hispanic women (9.5%). Nor, was it surprising that the prevalence of complete tooth loss among Hispanic men (11.9%) was lower compared to non-Hispanic white men (12.5%). However, a statistical difference Hispanic men and women was not expected.

When you look at the prevalence tooth loss by age among men and women, it is also striking that there were no statistical differences between men and women. While the pattern of estimates with age was difference, none of these differences were statistically different. One would hope to see either a similar pattern or statistical differences. Finding neither is striking.


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

EF: This report used National Health and Nutrition Examination Survey data, survey years 1999-2000 to 2017-2018. The survey includes an oral health examination, where dental examiners who are trained and licensed to practice in the United States conduct a tooth count. They assess whether a tooth is present or absence or all 32 teeth. We used these data to assess the absence of teeth in all teeth. Because the protocol for assess tooth count was similar in the survey years, we could combine the data. It should be noted, however, that protocols for the tooth count were similar, the dental examiners were not always dentists; licensed dental hygienists collected data for certain survey cycles.


Q: Is there any trend data that goes back further than 1999?

EF: This report includes trend data starting at 1999 with continuous data, meaning that survey has collected data continuously. While the oral health component has been part of the survey since its inception in 1959, we focused on these more recent, continuous data.

From 1999–2000 through 2017–2018, the age-adjusted prevalence of complete tooth loss decreased from 29.9% to 13.1%. The prevalence has decreased for both men and women.


Q: What is the take home message for this report? (The reporter could also say “Any other comments?”)

EF: Overall, the prevalence of complete tooth loss among adults aged 65 and over was 12.9%, and the age-adjusted prevalence has decreased since 1999-2000. This is great news, as more older adults are retaining their teeth. However, for 12.9% of older adults to be without their teeth has tremendously public health importance and signals that additional work is needed.


QuickStats: Prevalence of High Total Cholesterol Among Adults Aged 20 Years or Older by Age Group and Sex

June 5, 2020

During 2015–2018, the prevalence of high total cholesterol among adults aged 20 years or older was 11.4%, with no significant difference between men (10.5%) and women (12.1%). Prevalence was highest among adults aged 40–59 years (15.7%), followed by those aged 60 years or older (11.4%), and lowest among those aged 20–39 years (7.5%).

Among men, the prevalence was highest among those aged 40–59 years (14.5%), followed by those aged 20–39 years (9.5%), and lowest among those aged 60 years or older (6.0%).

Among women, the pattern was different, with women aged 20–39 years (5.5%) having a lower prevalence than either women aged 40–59 years (16.9%) or women aged 60 years or older (15.9%).

Prevalence among women aged 20–39 years was lower than that among men in this age group, but prevalence was higher among women aged 60 years or older than it was among men of that age group. There was no significant difference between men and women for adults aged 40–59 years.

Sources: Carroll MD, Fryar CD. Total and high-density lipoprotein cholesterol in adults: United States, 2015–2018. NCHS Data Brief, no 363. https://www.cdc.gov/nchs/products/databriefs/db363.htm. National Center for Health Statistics, National Health and Nutrition Examination Survey, 2015–2018. https://www.cdc.gov/nchs/nhanes.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6922a5.htm


Total and High-density Lipoprotein Cholesterol in Adults: United States, 2015–2018

April 22, 2020

Questions for Margaret Carroll, Health Statistician and Lead Author of “Total and High-density Lipoprotein Cholesterol in Adults: United States, 2015–2018.”

Q: How has the prevalence of high total cholesterol among US adults changed since 1999-2000 data and and low high-density lipoprotein cholesterol (HDL-C) since 2007-2008?

MC: There has been a declining trend in the prevalence of high total cholesterol since 1999-2000 and a declining trend in the prevalence of low HDL-C since 2007-2008.


Q: Can you summarize how the data varied by sex, age groups and race?

MC: The prevalence of high total cholesterol:

  • Higher in adults aged 40-59 than in adults aged 20-39 and those aged 60 and over
  • Not significantly different between men and women aged 20 and older
  • Not significantly different among non-Hispanic white, non-Hispanic black, non-Hispanic Asians and Hispanics

The prevalence of low HDL-C:

  • Higher in men than in women overall, within each age group and within each race and Hispanic origin group.
  • lower among NH black adults than in non-Hispanic white adults, non-Hispanic Asian adults and Hispanic adults over all and in men.
  • Higher among Hispanic adults than among non-Hispanic white, non-Hispanic black and non-Hispanic Asian adults overall, among men and among women.

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

MC: Although we weren’t surprised because the results have been seen in the past, men continue to have a much higher prevalence of low HDL-C compared to women.


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

MC: Results presented in this report are based on data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross sectional, probability survey representative of the United States non-institutionalized population.  Beginning in 1999 NHANES became a continuous survey and data have been released in 2-year cycles.  Data from 2015-2016 and 2017-2018 were used to test differences in the prevalence of high total and low HDL-C cholesterol between subgroups. Trends in the prevalence of high total cholesterol are based on data from ten 2-year cycles from 1999-2000 through 2017-2018. Trends in the prevalence of low HDL-C are based on six 2-year cycles from 2007-2008 through 2017-2018


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

MC: Over 1 in ten (11%) adults have high total cholesterol and over 17% have low HDL-C. The prevalence of high total cholesterol has declined since 1999-2000; the prevalence of low HDL-C has declined since 2007-2008.


QuickStats: Prevalence of Obesity and Severe Obesity Among Persons Aged 2–19 Years — National Health and Nutrition Examination Survey, 1999–2000 through 2017–2018

April 3, 2020

From 1999–2000 to 2017–2018, the prevalence of obesity among persons aged 2–19 years increased from 13.9% to 19.3%, and the prevalence of severe obesity increased from 3.6% to 6.1%.

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey, 1999–2000 to 2017–2018. https://www.cdc.gov/nchs/nhanes.htm.


Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018

February 27, 2020

Questions for Craig Hales, Health Statistician and Lead Author of “Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018.”

Q: How has the prevalence of obesity and severe obesity in U.S. adults changed since 1999-2000?

CH: The prevalence of obesity and severe obesity among U.S. adults increased since 1999-2000.  The prevalence of obesity was 30.5% among adults in 1999-2000 and increased more than 10 percentage points to 42.4% in 2017-2018.  The prevalence of severe obesity among adults almost doubled from 4.7% in 1999-2000 to 9.2% in 2017-2018.  The prevalence for obesity and severe obesity in 2017-2018 is the highest ever reported among all U.S. adults.


Q: Can you explain the differences between obesity and severe obesity?

CH: The definitions of obesity and severe obesity are based on the body mass index, or BMI, which is based on your weight and your height.  Obesity is defined as having a BMI of 30 or higher, and severe obesity is defined as having a BMI of 40 or higher.


Q: How far back do you have obesity trend data?

CH: The trends reported in this data brief go back to 1999-2000, which is when NHANES began running as a continuous survey.  However, NHANES began collecting height and weight data among adults aged 20-74 in 1960-1962.  At that time, obesity prevalence was 13.4% and severe obesity prevalence was 0.9%.


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

CH:  What I found most striking is that more than 40% of adults in the US had obesity in 2017-2018, which is more than 10 percentage points higher than the prevalence was in 1999-2000.  The prevalence of severe obesity among adults has almost doubled from 4.7% in 1999-2000 to 9.2% in 2017-2018.  The prevalence of obesity and severe obesity in 2017-2018 is the highest ever reported among all U.S. adults.


Q: When will you have 2017-2018 children’s obesity data available?

CH:  NHANES height and weight data for children and adolescents are currently available on the NHANES website.  Estimates for obesity and severe obesity among children and adolescents will be published in the near future.


Q:  Anything else you’d like to note about the new report?

CH:  Measured height and weight is the gold standard for generating accurate estimates of obesity prevalence.  The National Health and Nutrition Examination Survey is unique in that it combines both interviews in the home and physical examinations in mobile examination centers, and it is the only national survey where people’s height and weight are physically measured.

Other surveys report obesity prevalence based on self-reported height and weight, but several studies have found serious inaccuracies with self-reported or proxy-reported height and weight.  Among adults, self-reported height tends to be overreported and weight is underreported, although misreporting can vary among subgroups of the population – but this misreporting leads to underestimates of obesity prevalence.


Cognitive Performance in Adults Aged 60 and Over, NHANES 2011-2014

September 18, 2019

Questions for Debra Brody, Lead Author of ”Cognitive Performance in Adults Aged 60 and Over, NHANES 2011-2014.”

Q: What was your objective in conducting this study?

DB: Our objective was to describe the cognitive performance, based on objective assessments, of U.S. adults aged 60 and over. We examined selected areas of cognition such as language, memory, attention, reasoning, and processing speed.


Q: Is this a topic you have looked at before?

DB: Cognitive performance has been evaluated periodically in the National Health and Nutrition Examination Survey, but the assessment method and age group has not always been the same.  Of the assessments conducted during 2011-2014, only one had been administered previously.


Q: Which cognitive tests were administered?

DB: Cognitive performance was evaluated with selected standardized instruments, including a 10 word list learning test consisting of 3 immediate recalls, and a delayed recall; a 1 minute animal naming test, and the digit symbol substitution test that required matching numbers with symbols.  There are other subdomains of cognitive ability that were not assessed. The tests were administered during the examination portion of the survey.


Q:  What are your most important findings from this study?

DB: Cognitive assessment scores varied by sociodemographic characteristics.  Overall, mean scores decreased with increasing age; for example, persons 80 years and older, on average, named 5 fewer animals  and remembered 2 fewer words than persons in the 60-69 year old category.   We also found that mean scores were lower for persons with less education and income, for persons reporting fair or poor health status, and for those who were aware of a change in their memory over the past year.  These results are generally consistent with other published studies.


Q: What is the main point you want people to take away from this study?

DB: The report showed the wide range of cognitive performance among adults 60 and older in the U.S.  Further examination of these data in relation to other medical conditions may provide insight in understanding how cognition changes as we age.

 


Attempts to Lose Weight Among Adolescents Aged 16–19 in the United States, 2013–2016

July 17, 2019

Questions for Lead Author Kendra McDow, Health Statistician, of “Attempts to Lose Weight Among Adolescents Aged 16–19 in the United States, 2013–2016.”

Q: What was the most significant finding in your report?

KM: Almost 40% of adolescents 16-19 years old tried to lose weight in the past year and the groups with the highest percentages were girls, Hispanic teens and teens with obesity.


Q: Why do more Hispanic teens attempt to lose weight than other race/ethnic groups?

KM: Yes, that was an interesting finding. Data from another source – the Youth Behavioral Risk Surveillance System (YBRSS) support this finding. In 2017 YBRSS also found that Hispanic teens were more likely to try to lose weight compared to other racial/Hispanic-origin groups. Our study did not look at motivations or the reason why adolescents attempt to lose weight. This a great area for further study!


Q: Do we have any sense of whether the number/percent of teens trying to lose weight has increased or declined over time?

KM: Our study period was from 2013-2016. For this analysis we didn’t look at trends but we started to look into this and found some changes in the way the data were collected over time. We need to explore this more fully. Trend analysis using YRBSS (9th through 12th graders) showed a significant increase in weight loss attempts from 1991 through 2017 (41.8% to 47.1%).


Q: What type of exercising do teens do to lose weight?

KM: Exercise was the most commonly reported method to lose weight. Our study did not specifically look at the type or intensity of exercise adolescents are doing to lose weight. Regular physical activity among adolescents is important for life-long health.


Q: Is there a public health “take home message” here?

KM: Teens are employing multiple methods to lose weight. The vast majority, over 83%, of teens trying to lose weight were exercising. Over half were drinking water and almost half were eating less. And certain populations are more likely to attempt to lose weight, including girls, Hispanic adolescents and adolescents with obesity. The American Academy of Pediatrics recommends the promotion of healthy weight loss and adoption of healthy eating and physical activity.


Q: Anything else you’d like to add?

KM: We saw that the majority of adolescents who attempted to lose weight used recommended lifestyle modification strategies of healthy eating and exercise. In addition to exercise, drinking more water and eating less, 44.7% of adolescents reported they ate less junk food or fast food and 44.6% ate more fruits, vegetables and salads. This is promising! Of note, 16.5% (1 in 6 adolescents) reported skipping meals as a weight loss method. The American Academy of Pediatrics discourages unhealthy weight loss strategies, such as skipping meals and dieting, and encourages healthy eating and physical activity behaviors for adolescents


Contribution of Whole Grains to Total Grains Intake Among Adults Aged 20 and Over: United States, 2013–2016

July 9, 2019

New NCHS report provides estimates of the percentage of total grains intake consumed from whole grains sources, for U.S. adults aged 20 and over who reported consumption of grains (98.6%) on a given day during 2013–2016.

Findings:

  • During 2013–2016, whole grains accounted for 15.8% of total grains intake among adults on a given day. This percentage increased with age from 12.9% among adults aged 20–39 to 19.7% for adults 60 and over.
  • Overall, the contribution of whole grains to total grains intake was lower among men (14.8%) than women (16.7%).
  • The contribution of whole grains to total grains intake was lowest among Hispanic adults (11.1%) compared with non-Hispanic white (16.5%), non-Hispanic black (13.7%), and non-Hispanic Asian (18.3%) adults.
  • The contribution of whole grains to total grains intake on a given day increased with increasing family income.
  • From 2005–2006 to 2015–2016, the contribution of whole grains to total grains intake increased for adults overall, and for men and women.

Prescription Drug Use in the United States, 2015–2016

May 8, 2019

Questions for Lead Author Crescent Martin, Health Statistician, of “Prescription Drug Use in the United States, 2015–2016.”

Q: Why did you decide to do a report on prescription drug use in the United States?

CM: We wanted to update a previous report that found an increase in prescription drug use from 1999–2000 through 2007–2008, using the latest available data from 2015–2016.


Q: Do you have data for the years between 2007-2008 and 2015-2016 on prescription drug use?

CM: Yes, the trends analysis (shown in Figure 4) includes an estimate for each two-year survey cycle from 2007–2008 through 2015–2016 (i.e. 5 time points over the decade.)


Q: How did the data vary by age, sex and race?

CM: The percentage of the population that used prescription drugs increased with age among every group we looked at: overall, among both males and females, and among each race and Hispanic origin group.

By sex, prescription drug use was higher among females than males, though this overall difference was primarily driven by the difference observed among adults aged 20–59. Among children age 11 and younger, a higher percentage of boys than girls used prescription drugs.

Prescription drug use was highest among Non-Hispanic white persons, followed by non-Hispanic black persons, and was lowest among non-Hispanic Asian and Hispanic persons. This pattern also varied by age, and among adults aged 60 and over no differences were observed between race and Hispanic origin groups.


Q: Was there a specific finding in your report that surprised you?

CM: I was interested to see the different types of prescription drugs that were most commonly used within each age group. The most commonly used types of prescription drugs were bronchodilators (such as asthma rescue inhalers) for children aged 11 and under, central nervous system stimulants for adolescents aged 12-19, antidepressants for adults aged 20-59, and cholesterol-lowering drugs for adults aged 60 and over.

The top drug type for each age group was actually the same drug type that was most commonly used in 2007–2008, from the earlier report.


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

CM: Overall, almost half of the U.S. population took one or more prescription drugs in the past 30 days during 2015–2016.

When we look at trends over time and take into account how the age distribution of the US population has gotten older over this decade, we see a decline in the use of prescription drugs from 2007–2008 through 2015–2016.