Fact or Fiction: Is Undiagnosed diabetes more prevalent among American adults than diabetes that has already been diagnosed by a physician?

September 19, 2018

Source: National Health and Nutrition Examination Survey, 2013-2016

https://www.cdc.gov/nchs/data/databriefs/db319.pdf

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Prevalence of Total, Diagnosed, and Undiagnosed Diabetes Among Adults: United States, 2013-2016

September 19, 2018

Questions for Mark Eberhardt, Health Statistician and Lead Author of “Prevalence of Total, Diagnosed, and Undiagnosed Diabetes Among Adults: United States, 2013-2016

Q: Why did you decide to focus on diabetes in the United States for this report?

ME: The National Health and Nutrition Examination Survey (NHANES) is the only nationally representative survey that can estimate undiagnosed diabetes, since more recent data are available to consider this subject, it was appropriate to present it.


Q: Can you explain the differences between diagnosed and undiagnosed diabetes?

ME: People with diagnosed diabetes are those who report a medical history of diabetes (that is, a health care provider previously told them that they have diabetes). People with undiagnosed diabetes are those who do not report a previous medical history of diabetes, but who have laboratory results from blood specimens obtaining in NHANES which are in the diabetic range, as defined by the American Diabetes Association.


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

ME: The percent of adults with diabetes increases with age; a higher percent of men, compared to women, have total diabetes (which includes diagnosed and undiagnosed diabetes); a higher percent of non-Hispanic black and Hispanic adults have diabetes and total diabetes compared to non-Hispanic white adults. The percent of adults with diabetes (diagnosed, undiagnosed, or total diabetes) is higher among those who are overweight or obese.


Q: How did you obtain this data?

ME: The data were obtained in 2013-2016 by NHANES. This is a population-based community health survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). NHANES has staff and mobile examination centers that travel around the US and obtain health-related interview, examination and laboratory information from a nationally representative sample of people in the US.


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

ME: Diabetes remains a serious common health condition among adults in the US, and a substantial percent of adults with diabetes still report not having it.


Fact or Fiction: Do soft drinks account for one-fifth of all beverages consumed by American youth between ages 2 and 19?

September 13, 2018

Sources : National Health and Nutrition Survey, 2013-2016

https://www.cdc.gov/nchs/data/databriefs/db320.pdf


Beverage Consumption Among Youth in the United States, 2013-2016

September 13, 2018

Kirsten A. Herrick, Ph.D., M.Sc, NCHS Epidemiologist

Questions for Kirsten A. Herrick, Ph.D., M.Sc, Epidemiologist and Lead Author of “Beverage Consumption Among Youth in the United States, 2013-2016

Q: What made you decide to focus on what children in the United States drink for this study?

KH: In a previous report, we described the consumption of sugar-sweetened beverages among youth. This current study looks at beverage consumption in a different way. We are looking at all types of beverages, rather than focusing on only those that contain sugar or calories (energy.) Specifically in this new report, we look at beverage types by amount (grams) rather than by calories.


Q: Was there a finding in your new report that you hadn’t expected and that really surprised you?

KH: While there was nothing in this report that I hadn’t expected to see or that was surprising to me, the data results in this analysis do offer some new perspective. A new contribution from this research is a look at beverage consumption among non-Hispanic Asian youth and how this compares to other race and Hispanic origin groups. A notable finding is that non-Hispanic Asian youth drink more water compared to other groups.


Q: What differences or similarities did you see between or among various demographic groups in this analysis?

KH: We observed quite a few variations among demographic groups in our analysis of what youth in the United States are drinking. One interesting observation was that the contribution of milk and 100% juice to all beverage consumption, decreased with age—while the contribution of water and soft-drinks increased with age. While the types of beverages boys and girls drink are similar, we found that for Asian youth water accounted for the largest share of all beverages consumed compared with other race groups. The amount of beverages consumed as soft drinks was largest for non-Hispanic Black youth compared with other race groups, and the contribution of milk to overall beverage consumption is lowest among non-Hispanic Black youth in America.


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

KH: I think the real take-home message of this report is that beverage consumption is not the same for all U.S. youth. Since beverages contribute to hydration, energy and vitamin and mineral intake, these choices can impact diet quality and total caloric intake. It is very valuable for the U.S. Public Health Community to have this information, which can help guide their important work throughout America. I think it’s valuable information for families to have as well—and for youth in the U.S. to also be aware of the potential impact of these choices.


Q: What type of trend data do you have for U.S. children’s beverage consumption, and how has it changed over time, for example the last 20 years?

KH: While this report did not look at trends, the reason it does not present trends can tell us a lot about beverage consumption analysis over the years. The types of beverages available today are different than 20 years ago or in other years past. So trends wouldn’t strictly be comparing the same things over time.

Plus, this new report isn’t directly comparable with previous reports. For example, in this new Data Brief we looked at soft drinks and defined them as diet and non-diet forms of soda and fruit drinks. So this soft drink category is not equivalent to sugar-sweetened beverages—which has been the focus of some of our earlier analyses. Also, many past reports where we might have looked for trends—were interested in the energy from beverages. But water, an important beverage for hydration, doesn’t have calories, and therefore is often left out of earlier discussions and analyses about beverage consumption. In our new report we looked at total beverage consumption by amount (in grams) so we could include ALL beverages, not just those that contribute to calorie consumption.


QuickStats: Percentage of Adults Aged 20 Years or Older Told Their Cholesterol Was High Who Were Taking Lipid-Lowering Medications by Sex and Age Group — National Health and Nutrition Examination Survey, 2005–2006 to 2015–2016

July 16, 2018

The percentage of men told by a health professional that their cholesterol was high who were taking lipid-lowering medications increased from 36% in 2005–2006 to 50% in 2015–2016 among those aged 60 years or older but not among those aged 20–39 years (1% to 2%) or 40–59 years (16% to 17%).

The percentage taking lipid-lowering medications also increased (from 33% to 38%) among women aged 60 years or older but not among women aged 20–39 years (1% to 0.7%) or 40–59 years (from 13% to 11%).

For each survey year from 2005–2006 to 2015–2016, the percentage of both men and women with high cholesterol taking lipid-lowering medications was higher among those aged ≥60 years than those in younger age groups.

Source:  Carroll MD, Mussilino ME, Wolz M, Srinivas PR. Trends in apolipoprotein B, non–high-density lipoprotein, and low-density lipoprotein for adults 60 years and older by use of lipid-lowering medications: United States, 2005–2006 to 2013–2014 [Research Letter]. Circulation 2018;138:208–10. http://circ.ahajournals.org/content/138/2/208

https://www.cdc.gov/mmwr/volumes/67/wr/mm6727a6.htm?s_cid=mm6727a6_e


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.


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.