Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

April 13, 2018

Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist

Questions for Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist and Lead Author of “Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

Q: What made you decide to focus on the prevalence of dental cavities in young children for this study, versus other dental conditions like gum disease or tooth grinding – or some other critical public health concerns today for America’s youth?

EF: Our intent in conducting this study was to provide up-to-date prevalence estimates for dental caries in children. We decided that our study would focus on dental caries because of the serious and negative impact untreated caries can have on children. By the way, dental “caries” is the scientific term for tooth decay or cavities. Dental caries are the most common chronic disease among youth aged 6-19 years. Untreated caries cause pain and infection. Children miss days from school and have their overall quality of life effected by untreated dental caries. This is an important public health concern for America’s youth. While dental conditions like gum disease or tooth grinding are important, the National Health and Nutrition Examination Survey (NHANES) Oral Health Component does not currently collect data on these dental conditions. The component focuses on collecting data on tooth loss, dental caries, and dental sealants.


Q: In your new report, you examine differences in the prevalence of tooth cavities by income level; what is the motivation to look at income, since many children’s dental care might be paid by either public or private health insurance?

EF: We examined family income in this study for a few reasons. One is that income is a significant social determinant of health. For our study, we decided to include family income in addition to age, race and Hispanic origin. We were curious about the differences in untreated and total caries (tooth decay) by family income level. For both total and untreated caries, prevalence decreased as family income level increased. There is also concern among the public health community that children who may have access to Medicaid dental benefits are not receiving the care that they need. The examination of income levels in our new report might offer some needed insight to this concern.

The prevalence of total dental caries decreased as family income levels increased, from 51.8% for youth from families living below the federal poverty level to 34.2% for youth from families with income levels greater than 300% of the federal poverty level.

The prevalence of untreated dental caries decreased from 18.6% for youth from families living below the federal poverty level to 7.0% for youth from families with incomes greater than 300% of the federal poverty level.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

EF: Because our motivation for this study was to provide updated national estimates on untreated and total caries (tooth decay) for 2015-2016, all of the results were very interesting in one way or another — and surprising. National estimates for age, race and Hispanic origin, and income are results that we need to understand for public health surveillance purposes. For me though, the overall estimates for youth by age were especially interesting.

While the untreated dental caries prevalence overall for youth is 13.0%, there were age differences that caught my eye. The low prevalence for 2-5 year-olds is an important and encouraging finding. While we don’t know if it is from prevention efforts, access to care, or other factors, the fact that our youngest youth have the lowest untreated and total caries prevalence shows they’re starting off their young lives with healthy teeth.

The prevalence was lowest in youth aged 2-5 years (8.8%) compared with youth aged 6-11 years (15.3%) and 12-19 years (13.4%). The prevalence of the 6-11 and 12-19 years-olds was significantly different from the prevalence of 2-5 year-olds.

The total caries experience was also lowest for youth aged 2-5 years (17.4%) compared to youth aged 6-11 years (45.2%) and 12-19 years (53.5%). As age increased, the total caries prevalence increased.


Q: What, if any, is the difference between the two terms you use in your report – primary teeth and permanent teeth?

EF: Primary teeth are baby teeth, or the first teeth that erupt, or come in, which are later shed and replaced by permanent teeth. Primary teeth erupt from around 6 months to age 2 or 3 years. The permanent teeth replace the primary teeth. These teeth start coming in around the age of 6 years and continue until the third molars, or wisdom teeth come in, somewhere between the ages of 17 to 21 years. In our analysis, we combined the two types of teeth in order to focus on dental caries (tooth decay) regardless of tooth type.


Q: In your report, are untreated dental cavities a subset of the number of total cavities, and therefore included in the total cavity statistics?

EF: Yes, untreated dental caries (tooth decay) are included in the total number of dental caries. When we describe total dental caries, we are focused on both untreated and treated dental caries. Essentially, the total of dental caries take into account any tooth decay experience that someone has had. Untreated dental caries represent tooth decay that has not been treated. Untreated dental caries are also known as cavities. What we capture in the untreated caries measure is the active disease of youth.


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

EF: We noted a number of differences among youth by race and Hispanic origin in this analysis. Non-Hispanic black youth had the highest prevalence of untreated caries (tooth decay) (17.1%) compared to other race and Hispanic-origin groups. The prevalence for non-Hispanic black youth was significantly different from non-Hispanic whites (11.7%) and non-Hispanic Asians (10.5%). The prevalence of untreated dental caries in Hispanic youth was 13.5%.

Hispanic youth had the highest prevalence of total caries (52.0%) compared to other race and Hispanic-origin groups. The prevalence was also significantly different from non-Hispanic whites (39.0%) and non-Hispanic Asians (42.6%). The prevalence of total caries for non-Hispanic black youth was 44.3%.


Q: What sort of trend data do you have on this topic so we can see how prevalence has evolved over time?

EF: With six years of data, we can look at the trend in prevalence over time. Because dental caries (tooth decay) is the most common condition of childhood, we thought it was important to include trend analysis in our report.

The results show a significant linear decrease in total caries. From 2011-2012 to 2015-2016, the total caries prevalence decreased from 50.0% to 43.1%. The results show a different pattern for untreated dental caries. The prevalence of untreated dental caries increased from 2011-2012 (16.1%) to 2013-2014 (18.0%), and then decreased in 2015-2016 (13.05). There is significant quadratic trend – a single bend either upward or downward — in untreated dental caries from 2011-2012 to 2015-2016.


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

EF: The take-home message from this report is that there are differences in untreated and total caries (tooth decay) by age group, race and Hispanic origin, and income. The trend analysis shows that the prevalence of untreated and total caries are decreasing. However, there are still disparities that exist. Because monitoring prevalence of untreated and total caries is key to preventing and controlling oral diseases, these disparities are important.

The prevalence of untreated dental caries in America’s youth is 13.0%. The prevalence decreased as family income increased, with youth with family incomes less than 100% of the federal poverty level having the highest prevalence. Disparities in untreated dental caries exist along race and Hispanic origin. Non-Hispanic black youth have the highest prevalence compared to Hispanic, non-Hispanic white, and non-Hispanic Asian youth.

Advertisements

Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016

February 13, 2018

Questions for Debra J. Brody, M.P.H., and Laura Pratt, Ph.D., Epidemiologists and Lead Authors of “Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016

Q: What made you decide to focus on the prevalence of depression for the subject of your new report?

DB/LP: Our intent in conducting this study was to provide up-to-date prevalence estimates for depression—a common and serious medical condition that can result in both emotional and physical problems. We focused on U.S. adults 20 and older to determine if there have been any changes in the proportion of adults with depression over the past 10 years. The estimates are based on responses to a series of depression symptom questions asked during the examination portion of the 2013-2016 National Health and Nutrition Examination Survey (NHANES), a nationally representative study.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

DB/LP: The finding that most surprised us was that among adults who are depressed, four out of five, or 80%, have at least some difficulty going to work, doing their regular activities at home, or getting along with people. What was perhaps most striking was to see that impairment due to depression affected both men and women equally—given that the prevalence of depression among men (5.5%) was almost half of what it is among women (10.4%).


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

DB/LP:  We found one notable difference in depression among race and ethnic groups in the 2013-2016 NHANES data. The prevalence of depression in the non-Hispanic Asian subgroup (3.1%) of adults was significantly lower than depression among adults from the three other race-ethnic groups that we examined (non-Hispanic white, non-Hispanic black, and Hispanic.) We would like to acknowledge that the estimate for non-Hispanic Asian adults is for persons self-identified as belonging to any Asian origin subgroup. In our study, adults of Chinese, Indian, Filipino, and every other Asian-origin are all grouped together because we do not have the sample sizes to show the prevalence for separate Asian origin groups. Other studies have found lower and more moderate estimates of depression among Asian adults compared with those from other race and ethnic groups.


Q: How has the prevalence of depression changed in the past 10 years?

DB/LP: Our data show that over the past 10 years, the percentage of adults who have depression has stayed relatively stable. A point to consider is that the NHANES surveys do not include persons in the military, or those living in institutions like hospitals or nursing homes where adults may be at higher risk for depression. In addition, we did not include in our analysis persons currently being treated for depression or taking medications, unless they screened positively for depression in our survey.


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

DB/LP: We think the real take-home message of this study is the seriousness of depression, a common mental disorder—and how emotional and physical problems that are symptoms of depression impact the everyday life of those affected by depression. We found that overall, about one out of every 12 U.S. adults have depression in any given 2-week period. Depression rates are higher in some population subgroups—like among women as compared to men—and among adults from low income families as compared to those from higher incomes. Among U.S adults who have depression, managing daily activities—at work and at home—poses at least some difficulty.


Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015–2016

February 7, 2018

Geraldine McQuillan, Ph.D., Infectious Disease Epidemiologist

Questions for Geraldine McQuillan, Ph.D., Infectious Disease Epidemiologist and Lead Author of “Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015–2016

Q: In the first bullet in the key findings section of your new report, 47.8% is listed for 2015-2016 herpes simplex type 1 prevalence and 11.9% is listed for type 2. Yet in the last bullet there, it reads that prevalence is 48.1% and 12.1%. Why are these estimates different?

GM: This report offers two statistical estimates – a crude rate, or “real” prevalence estimate, and an age-adjusted one. If you look at the data table for Figure 1, you can see that the unadjusted prevalence — or the true prevalence for herpes simplex virus type 1 (HSV-1) — is 47.8% in the U.S population. In order to compare across subgroups that have differing age distributions, we need to age-adjust the data to allow for a more accurate comparison among groups. The age-adjusted prevalence for the total population is 48.1%. Crude rates are influenced by the underlying age distribution of a population, and age-adjusting the rates assures that differences are not due to the age distribution of the populations being compared.


Q:  What made you decide to focus on the prevalence of the herpes simplex virus for the subject of your new report?

GQ: Our main motivation for conducting this study is to offer a current assessment of herpes prevalence in the United States. Though we have included HSV-1 and -2 testing in the National Health and Nutrition Examination Survey (NHANES) since 1999, we have not looked at the data since 2010 (Bradley et al. Seroprevalence of herpes simplex virus type 1 and 2 – United States, 1999-2010. JID 2014:209; 325-333). With the addition of six more years of data and a sufficient amount of years to look at trends over time, we decided it was time to re-look at the prevalence of these common viruses in the United States.


Q:  Was there a result in your study that you had not expected and that really surprised you?

GQ: The decline in herpes simplex virus type 2 (HSV-2) across all race and ethnic groups was quite striking. The linear decline in prevalence was seen in the previous study for HSV-1 that used data from 1999-2010. There was no decline with the prevalence of HSV-2 at that time. With the addition of six more years of data, we now also see a linear downward trend for HSV-2 and again for HSV-1. We did not expect to see the decline of HSV-2 in all race and ethnic subgroups.


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

GQ: The difference by race and ethnic subgroups in herpes simplex virus prevalence did not differ from previous reports even with the declines in prevalence in both viruses. Mexican-Americans still have the highest prevalence of HSV-1, and non-Hispanic whites have the lowest. The prevalence of HSV-2 is highest in the non-Hispanic black population and lowest in the non-Hispanic Asian population. Non-Hispanic whites and Mexican- Americans have a similar prevalence. All these race/ethnic differences have been seen in many of our infectious diseases especially those that are transmitted sexually.


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

GQ: This is a good news data report. I think its take-home message is that two of our most prevalent viruses, HSV-1 and HSV-2, are steadily declining in the U.S population. Though NHANES provides prevalence estimates (new and old infections), once a person is infected with a herpes virus they are infected for life. The only way we see a decline is if there is a drop in new infections or a decrease in the incidence of both HSV-1 and HSV-2. While this report is a presentation of data findings, and did not go into an analysis of risk factors to determine why we are seeing this decline, other industrialized countries have observed declines in HSV-1 during the past two decades. Improvements in living conditions, better hygiene and less crowding likely explain these declines. Other countries who also have seen a decline in HSV-2 in their populations, suggest that the increase in safe-sex practices in the post-AIDS pandemic may contribute to the decline.


Total and High-density Lipoprotein Cholesterol in Adults: United States, 2015–2016

October 26, 2017

Questions for Margaret Carroll, M.S.P.H., Health Statistician and Lead Author on “Total and High-density Lipoprotein Cholesterol in Adults: United States, 2015–2016

Q: How has the prevalence of high total cholesterol and low levels of high-density lipoprotein (HDL) in U.S. changed since 1999-2000 to 2015-2016?

MC: The prevalence of high total cholesterol (>=240 mg/dL) of adults 20 years and older declined from 1999-2000 to 2015-2016; the prevalence of low high-density lipoprotein(HDL) cholesterol (<40 mg/dL) declined  in adults 20 years and older from 2007-2008 to 2015-2016.  No change was seen from 2013-2014 to 2015-2016 in either high total cholesterol or low HDL cholesterol.


Q: Why is it important to study the prevalence of high total and low HDL cholesterol?

MC: High levels of total cholesterol and low levels of HDL cholesterol are risk factors for cardiovascular disease, the leading cause of death in the United States.

Also, as part of its objectives to improve the health of the U.S. population, Healthy People 2020 has included the goal of reducing the proportion of adults with high total blood cholesterol to less than 13.5%. Both men and women aged 20 and over currently meet this goal. However, not all subgroups meet this target.


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

MC: The findings did not particularly surprise me.  Based on the earliest available and comparable data from the National Health and Nutrition Examination Survey (NHANES), declining trends were observed in high total cholesterol from 1999–2000 to 2015–2016 and in low HDL cholesterol from 2007–2008 to 2015–2016. However, the observed change for high total and low HDL cholesterol from 2013–2014 to 2015–2016 was not statistically significant.


Q: How does the prevalence of high total and low HDL cholesterol breakdown by age and gender in U.S.?

MC: Men ages 40-59 years have a higher prevalence of high total cholesterol than men ages 20-39 years and 60 years and older but there is no significant difference between men 20-39 years and those 60 years and older.  The prevalence of high total cholesterol is lower in women ages 20-39 years than in women 40-59 years and 60 years and older but there is no significant difference between women 40-59 years and 60 years and older.

Men ages 40-59 years have a higher prevalence of low HDL cholesterol than men 60 years and older.  A declining trend in the prevalence of low HDL cholesterol was seen in women from 20-39 years and 60 years and older.


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

MC: High total cholesterol has declined in adults 20 years from 1999-2000 to 2015-2016 and low HDL cholesterol has declined from 2007-2008 to 2015-2016.


Stat of the Day – October 25, 2017

October 25, 2017


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.


Fact or Fiction: Has the percentage of adults in the U.S. who are obese leveled off in the last several years?

October 16, 2017

Source: National Health and Nutrition Examination Survey

https://www.cdc.gov/nchs/data/databriefs/db288.pdf