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?

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: Percentage of Families That Did Not Get Needed Medical Care Because of Cost by Poverty Status

June 12, 2020

The percentage of all families that did not get needed medical care because of cost in the past 12 months decreased from 12.1% in 2013 to 9.7% 2018.

From 2013 to 2018, the percentage of poor families that did not get medical care decreased (22.7% to 17.3%) as did the percentage of near-poor families (20.4% to 16.0%); no significant change occurred for not-poor families (7.1% and 6.6%).

In 2013 and 2018, the percentage of families that did not get needed medical care because of cost was lowest among the not poor.

Source: National Health Interview Survey, 2013 and 2018 data. https://www.cdc.gov/nchs/nhis.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6923a4.htm


Hearing Difficulty, Vision Trouble, and Balance Problems Among Male Veterans and Nonveterans

June 12, 2020

Questions for Jacqueline Lucas, Health Statistician and Lead Author of “Hearing Difficulty, Vision Trouble, and Balance Problems Among Male Veterans and Nonveterans.”

Q: Why does NCHS conduct studies on U.S. Veterans?

JL: Veterans are known to differ in their health and health care access and utilization from non-veterans. NCHS surveys are uniquely positioned to collect information on all US veterans in the civilian noninstitutionalized population of the United States.


Q: Why did you specifically focus on male Veterans?

JL: We focused on male veterans in the report because of the small number of female veterans in the 2016 NHIS.


Q: Can you summarize how the data varied by male Veterans and nonveterans?

JL: Male veterans were more likely to have hearing difficulty (a little/moderate hearing difficulty, as well as a lot of hearing difficulty or to be deaf), dual sensory impairment (vision trouble and hearing difficulty), and balance problems than nonveterans. When we looked at the data by age, younger veterans were more likely to hearing difficulty compared with nonveterans in comparable age groups.


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

JL: We hadn’t seen much in the literature about balance problems in veterans, so we were surprised to see that veterans were more likely to have balance problems than nonveterans. Additionally, we were surprised to see that male veterans aged 18-44 were 3 times more likely to have a little or moderate hearing trouble than nonveterans in the same age group.


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

JL: We’ve tended to think of veterans with health concerns as older men who served years ago in earlier conflicts. The population of post 9/11 veterans is increasing relative to the population of veterans from previous combat cohorts. This includes younger veterans whose serviced in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Our findings can be a starting point for expanded research into other demographic and health comorbidities that may be related to hearing loss and other sensory impairments in veterans.


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


Stats of the States: Arizona

June 3, 2020

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Arizona’s fertility rate of 58.6 births per 1,000 women ages 15-44 is lower than the national fertility rate of 60.1. Arizona mostly ranks around the middle of the pack in key health measures, including: 18th highest in teen birth rates, 30th in preterm birth rates, tied for 31st in low birthweight rates and 38th in cesarean deliveries. The Grand Canyon State also ranks 18th in gun-related death rates, tied for 22nd in homicide rates, 20th in drug overdose death rates, and tied for 30th in infant mortality rates. Heart Disease is the leading cause of death in Arizona, followed by: (2) Cancer (3) Accidents (4) Chronic Lung Disease (5) Alzheimer Disease (6) Stroke (7) Diabetes (8) Suicide (9) Liver Disease and Cirrhosis, and (10) Influenza/Pneumonia. The marriage rate in Arizona of 5.5 marriages per 1,000 is significantly lower than the national rate, but the divorce rate in the state of 3.0 divorces per 1,000 is slightly higher than the national rate.

SOURCE: National Vital Statistics System, 2018

LINK:     https://www.cdc.gov/nchs/pressroom/states/arizona/az.htm


Leading Causes of Death in 2018 Among U.S. Men Ages 45-64

June 2, 2020

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SOURCE:  National Vital Statistics System, CDC WONDER, 2018


Quickstats: Cancer and Heart Disease Death Rates Among Men and Women Aged 45–64 Years — United States, 1999–2018

May 29, 2020

The cancer death rate for both men and women aged 45–64 years declined steadily from 247.0 per 100,000 in 1999 to 194.9 in 2018 for men and from 204.1 to 166.3 for women.

The heart disease death rate for men declined from 1999 (235.7) to 2011 (183.5) but then increased to 192.9 in 2018. For women, the heart disease death rate declined from 1999 (96.8) to 2011 (74.9), increased through 2016 (80.3), and then leveled off.

In 2018, the cancer death rate for men aged 45–64 years was 1% higher than the heart disease death rate; for women, the cancer death rate was approximately twice the heart disease death rate.

Source: National Vital Statistics System, Mortality Data. https://www.cdc.gov/nchs/nvss/deaths.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6921a4.htm


Stats of the States: Arkansas

May 28, 2020

ArkansasArkansas has the highest teen birth rate in the nation (30.4 live births per 1,000 females ages 15-19), and the 10th highest overall fertility rate for women of all ages. Arkansas also has the 3rd highest marriage rate in the country, behind Nevada and Hawaii, but also the 2nd highest divorce rate (behind Nevada). The leading cause of death in the state is Heart Disease, followed by (2) Cancer (3) Chronic Lower Respiratory Disease (4) Stroke (5) Accidents (6) Alzheimer disease (7) Diabetes (8) Kidney Disease (9) Influenza & Pneumonia, and (10) Suicide. The infant mortality rate in Arkansas is the 3rd highest in the country. The state ranks 6th in cesarean deliveries and in low birthweight births and 5th in preterm births. However, the drug overdose rate in Arkansas of 15.7 overdose deaths per 100,000 people is among the lower rates in the country and is 27% lower than the national rate.

SOURCE: National Vital Statistics System, 2018

LINK:     https://www.cdc.gov/nchs/pressroom/states/arkansas/ar.htm


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2019

May 28, 2020

Questions for Robin Cohen, Health Statistician and Lead Author of “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2019.”

Has the percentage of people without health insurance changed much in recent years?

RC: This most recent release from the National Health Interview Survey (NHIS) includes estimates for January through June 2019. In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. Due to changes in weighting and design methodology, direct comparisons between estimates for 2019 and earlier years should be made with caution, as the impact of these changes has not been fully evaluated at this time. A working paper entitled, “Preliminary Evaluation of the Impact of the 2019 National Health Interview Survey Questionnaire Redesign and Weighting Adjustments on Early Release Program Estimates” discusses both these issues in greater detail.


Q: Why did NCHS redesign the NHIS?

RC: In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. The redesign aimed to improve measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal surveys, establish a long-term structure of ongoing and periodic topics and incorporate advances in survey methodology and measurement.


Q: Has the NHIS ever been redesigned before?

RC: The NHIS has undergone several questionnaire redesigns since its inception in 1957. The last major questionnaire redesign occurred in 1997.


Q: How was the health insurance data strengthened by this redesign?

RC: The flow and content of the health insurance questions in the redesign are similar to those from 1997-2018. The main difference is that instead of a family respondent providing health insurance information for all family members as a proxy, health insurance is now asked directly of the sample adult and the parent or guardian of the sample child.


Q: Do we have a sense of how COVID-19 has impacted health insurance coverage in the U.S.?

RC: The estimates from this report are based on data collected from January through June 2019. This is prior to the COVID-19 pandemic. There are some estimates of health insurance coverage during the COVID-19 pandemic available from the Household Pulse Survey (https://www.cdc.gov/nchs/covid19/pulse/health-insurance-coverage.htm). The Household Pulse Survey is a 20-minute survey on how the COVID-19 pandemic may impact households across the country. However, these estimates of health insurance coverage may not be comparable with those using NHIS data. 


Q: When will NHIS have data on the impact of COVID-19 on health insurance coverage?

RC: Data collection from the 2020 NHIS is ongoing, and the early release of estimates from the 2020 NHIS has not been determined.


Q: Is the uninsured # for kids higher than previously reported?

RC: This most recent release from the National Health Interview Survey (NHIS) includes estimates for January through June 2019. In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. Due to changes in weighting and design methodology, direct comparisons between estimates for 2019 and earlier years should be made with caution, as the impact of these changes has not been fully evaluated at this time.


Q: Anything else of note in your report that you’d like to mention?

RC: In January 2019, the National Health Interview Survey launched a redesigned questionnaire. The new design collects health insurance information from one randomly selected adult and child from each household in the survey. Estimates in this report are based on the first two quarters of 2019.


QuickStats: Percentage of Adults Aged 18 Years or Older with Disability by Diagnosed Diabetes Status and Age Group

May 22, 2020

In 2018, among adults aged 18 years or older, those ever receiving a diagnosis of diabetes were more likely to have disability than those never receiving a diagnosis of diabetes (27.1% versus 8.1%).

This pattern was consistent among adults aged 18–44 (16.3% versus 4.4%), 45–64 (24.5% versus 8.1%), and 65 years or older (33.3% versus 18.5%).

Regardless of diabetes status, the percentage of adults with disability increased with age.

Source: National Health Interview Survey, 2018. https://www.cdc.gov/nchs/nhis.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6920a5.htm