QuickStats: Percentage of Injury Deaths That Occurred in the Decedent’s Home for the Five Most Common Causes† of Injury Death — United States, 2016

July 9, 2018

In 2016, 31% of deaths from all causes of injury occurred in the person’s home.

The percentage varied by the cause of injury. More than half of the deaths attributable to poisoning (52%) occurred in the home.

Approximately 44% of deaths from firearms and suffocation occurred in the home.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality File. https://www.cdc.gov/nchs/nvss/deaths.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6726a6.htm

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QuickStats: Percentage of Residential Care Communities That Use Electronic Health Records by Census Region — United States, 2016

July 2, 2018

In 2016, 26% of residential care communities used electronic health records (EHRs).

The percentage that used EHRs was 36% of communities in the Northeast, 41% of communities in the Midwest, 24% of communities in the South, and 17% of communities in the West.

Source: National Study of Long-Term Care Providers, 2016 data. https://www.cdc.gov/nchs/nsltcp/index.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6725a8.htm


State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

June 28, 2018

Questions for Lead Authors Debra L. Blackwell, Ph.D., Demographic Statistician, and Tainya C. Clarke, Ph.D., M.P.H., Health Statistician, of “State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

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

DB/TC:  The result that we found most surprising – and it really is quite striking – is the state-level variation in  the percentages of adults who were meeting the federal physical activity guidelines through their leisure-time physical activity. We were also surprised that many of the states with the highest percentages of meeting the guidelines through leisure-time physical activity were “cold weather” states that get more snow during winter months. How are people in these states meeting these guidelines during the colder winter months? Are they participating in outdoor winter sports, do they exercise at indoor facilities, or some combination of outdoor and indoor activities? Unfortunately we can’t answer these questions with our data, but it would be interesting to know. In addition, previous research has generally shown higher rates of leisure-time physical activity for men than for women. This also includes studies that look at meeting the 2008 federal guidelines for aerobic and muscle-strengthening activities through leisure-time physical activity. While our current study also found that men were more likely than women to meet the guidelines through leisure-time physical activity, some states were exceptions – especially Colorado, but also in Massachusetts, Washington, New Hampshire, Utah, and Wyoming, where men and women had statistically comparable percentages.


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

DB/TC:  This is a “good news” data report – for the most part. We think the real take-home message of this report is that, overall, American adults aged 18-64 are exceeding guideline targets for physical activity through their leisure-time physical activity. The Healthy People 2020 objective regarding physical activity specifies that 20.1% of all adults meet both aerobic and muscle-strengthening federal guidelines by 2020. We found that in 2010-2015, nearly 23% of adults aged 18-64 were accomplishing this through their leisure-time physical activity– a truly positive finding. But when we looked at differences by gender and work status, we found that among all women aged 18–64, 18.7% met the guidelines through their leisure-time physical activity, which is nearly two percentage points lower than the Healthy People target. While the average for working women (20.9%) was above the target, the average among all nonworking women was only 14.6%, almost six percentage points lower than the Healthy People 2020 target. Nonworking women in just five states—Colorado, Idaho, New Hampshire, Utah, and Washington—met the objective through their leisure-time physical activity. We should keep in mind though, that the National Health Interview Survey (NHIS) only collects information on leisure-time physical activity, so our study was not able to look at occupational physical activity.


Q:  What made you decide to conduct this study on physical activity among Americans?

DB/TC:  One motivation for conducting this study was that we wanted to look at state-by-state percentages.  This new report is a continuation of a previous report (https://www.cdc.gov/nchs/data/nhsr/nhsr094.pdf) that looked at occupational differences among employed adults who met federal physical activity guidelines during their leisure-time physical activity. That report focused on individuals, not states, and excluded adults who were not working. While doing that analysis, we saw that there was considerable regional variation in the outcome.  We wanted to expand that earlier research to include all adults in this same age group (working as well as nonworking), and to consider differences in meeting the guidelines by state because we had already seen this regional variation.


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

DB/TC:  We did observe some differences between men and women, as well as by work status, but we didn’t distinguish between many demographic groups since this was a state-level analysis. Men had higher percentages of meeting the guidelines through leisure-time physical activity than women overall — and within most, but not all, states. This was also true when we compared working and nonworking men and women overall and within most states.


Q:  Why do you think there is such a vast difference among the states in the percentage of adults who meet the guidelines for physical activity through their leisure-time physical activity?

DB/TC:  There are likely many factors that play a role in these state differences, as researchers are likely to suggest. We looked at just two: occupational distributions among working adults (and among working men and women), and at percentages of illness and disability among nonworking adults (and among nonworking men and women). States with higher percentages of professionals and managers — relative to production workers –generally had higher percentages of working adults meeting the federal guidelines for physical activity during their leisure time than states with more production workers and fewer professionals and managers. Similarly, states with higher percentages of nonworking adults in fair or poor health or with a disability had lower percentages of meeting the guidelines during their leisure time than states with fewer nonworking adults in fair or poor health or with a disability. Indeed, many factors are likely involved. And we only considered leisure-time physical activity in our study. Our survey doesn’t collect information on physical activity performed while at work or when commuting.


Q:  What sort of trend data do you have on this topic that will help us see how physical activity for Americans has evolved over time?

DB/TC:  There is some trend data available through various sources. The Centers for Disease Control and Prevention (CDC) has published several reports on this topic; the 2014 report is available at https://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf, and a 2010 report is available at https://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf. CDC also has mini-reports available for each state that take into account state-specific data; these are available at  https://www.cdc.gov/physicalactivity/resources/state-action-guides.html.

Also, the National Center for Health Statistics (NCHS) reports Key Health Indicators based on the National Health Interview Survey (NHIS), including person-level estimates of adults aged 18 and over who meet the 2008 federal physical activity guidelines for both aerobic and muscle-strengthening activities during leisure-time physical activity. Please see tables 7.5 through 7.8 in https://www.cdc.gov/nchs/nhis/releases/released201806.htm#7A.


Q:  Is this the most recent data you have on this topic?

DB/TC:  While we do have newer data files, those data were not available when we were carrying out our analysis. So our current report is based on 2010-2015 National Health Interview Survey (NHIS) data. However, the most recent Key Health Indicators report at the website immediately above includes results from the 2016 and 2017 National Health Interview Survey.


Q: How many people were surveyed for this report?

DB/TC:  The National Health Interview Survey, or NHIS, is a national, in-person survey conducted annually. Roughly 35,000 U.S. adults respond to the “Sample Adult” interview in any given survey year, and all of them are asked a series of questions about how often, how long, and how vigorously they spend leisure time doing exercise. This report looks at state-level variation in meeting the 2008 federal guidelines for physical activity through leisure-time physical activity among adults aged 18-64 using the 2010-2015 NHIS. The 2008 physical activity guidelines recommend muscle-strengthening activities at least twice weekly, with either moderate-intensity aerobic physical activity for at least 150 minutes per week, vigorous-intensity aerobic physical activity for at least 75 minutes per week, or an equivalent combination. For those of our readers interested in the specific sample sizes used in this analysis, here are the numbers:

Sample adults aged 18-64 years who met the guidelines for both muscle-strengthening and aerobic activities through leisure physical activity (n = 32,942) are the focus of the study. Sample adults meeting only one guideline (n = 48,810) or neither guideline (n = 70,402) are not shown separately, but are included in the denominators. Percentage estimates are based on pooled data from the 2010–2015 NHIS for all 50 states and the District of Columbia.

 


QuickStats: Percentage of Adults Aged 18 Years or Older With or Without Psychological Distress† Who Were Current Smokers, by Age Group and Level of Distress — National Health Interview Survey, 2014–2016

June 18, 2018

During 2014–2016, 37.2% of adults aged 18 years or older with serious psychological distress were current smokers, followed by 27.6% of those with mild to moderate psychological distress and 14% of those with no psychological distress.

Among adults aged 18–44 and 45–64 years, the percentage of adults who were current smokers increased with the level of psychological distress.

Among adults aged 65 years or older, the percentage who were current smokers was less among adults with no psychological distress than among adults with mild to moderate or serious psychological distress.

Source: National Health Interview Survey, 2014–2016. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6723a6.htm


Describing the Increase in Preterm Births in the United States, 2014–2016

June 13, 2018

Questions for Joyce Martin, Statistician, and Lead Author of “Describing the Increase in Preterm Births in the United States, 2014–2016

Q: What did you think was the most interesting finding in your report?

JM: Two things – that the rate has increased for three straight years following several years of decline, and that the increase generally occurred among babies born late preterm.


Q: Why are total preterm birth rates increasing?

JM: The reasons for the rise are not well understood, but appear to be largely among births occurring at the highest end of the preterm/late range, that is, at 36 weeks.  That said, it is important to note that early preterm births, those at the greatest risk of poor outcome increased among non-Hispanic black births.


Q: Why did you decide to examine preterm birth rates?

JM: The preterm birth rate is a basic indicator of the maternal and infant health of a nation and, accordingly, changes in the preterm rate have important implications for the public health. Babies born prior to 37 weeks of gestation are more likely to die within the first year of life and more likely to suffer life-long morbidities than those born later in pregnancy.


Q: How did preterm birth rates vary among U.S. states from 2014-2016?

JM: Preterm rates rose significantly in 23 states and the District of Columbia and non-significant increased were seen in an additional 22 states.  In short, rates are trending upward for the vast majority of states.


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

JM: The incidence of infants born too soon is on the rise in the US, appears to be largely among late preterm births and the rise does not appear to be limited to any specific maternal race, age or geographic group.


QuickStats: Homicide and Suicide† Death Rates for Persons Aged 15–19 Years — National Vital Statistics System, United States, 1999–201

June 8, 2018

In 1999, the homicide death rate for persons aged 15–19 years (10.4 per 100,000) was higher than the suicide rate (8.0). By 2010–2011, the homicide and suicide rates had converged.

After 2011, the suicide rate increased to 10.0 in 2016; the homicide rate declined through 2013 but then increased to 8.6 in 2016.

Source: National Vital Statistics System. 1999–2016. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a7.htm


Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

June 6, 2018

Donald Cherry, M.S., Health Statistician

Questions for Donald Cherry, M.S., Health Statistician, and Lead Author of “Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

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

DC:  Most of the results confirmed what we’ve seen in current research, so there really was not a finding in this study that surprised me. But confirming existing knowledge is an important finding! Specifically, the results examining urban-rural visit differences are exactly in the expected direction; that is, in large metropolitan areas, psychiatrists are more concentrated (as suggested by prior research), and we would expect to see a higher percentage of visits to them for mental health-related issues. Rural areas have less psychiatrists and more primary care physicians (PCPs) (as suggested by prior research), and seeing 54% of mental health-related visits occurring at primary care physician offices suggests that in these rural areas, availability of provider type for outpatient mental health treatment might be limited.

Also, the results show no difference in a couple of areas. One area where you can see this is in the percent of health-related visits to psychiatrists vs. PCPs when Medicare is the expected source of payment. We see this too, in the rate of visits when the patient age is 65 years and older – which is interesting for its possible implications.  These results together may indicate that older adults, who are also assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


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

DC:  I think the real take-home message of this report is that continued monitoring of the utilization of mental health services is important in identifying the present and future needs of the U.S. adult population. As one might expect, the composite of mental health-related visits occur in psychiatrists’ offices; however, this does not seem to be a phenomenon that is always consistent. Differences in mental health-related visits by physician specialty did vary by age, payment type, and within patient sex. The most interesting difference is in large metropolitan areas where a higher percentage of mental health-related office visits are to psychiatrists compared to primary care physicians (PCPs). In rural areas, an opposite trend is observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas.


Q:  What made you decide to conduct this study on mental health-related doctor’s office visits?

DC:  My background is in psychology, and I’m very interested in mental health issues, so mental-health related doctor’s office visits is a natural topic for me to explore. Having access to the National Ambulatory Medical Care Survey (NAMCS) data has given me the opportunity to examine different research topics. In the past, I have also been privileged to collaborate with prominent researchers in the field who have used NAMCS data. I have specifically been interested in where people are going to get treatment for mental health issues. Data accessibility in NAMCS is especially useful becauses it collects visit details on both primary care physicians and psychiatrists in the same survey sample design.


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

DC:  We did note some differences among different age groups, between sexes, and between rural and urban areas of the United States. When examining age, the mental health-related office visit rate to psychiatrists is higher compared with the rate to primary care physicians among all adults, and among adults in age groups 18–34, 35–49, and 50–64. But there was no significant difference among adults aged 65 and over. Not seeing a difference in rates for the oldest patients is interesting, and some researchers indicate that psychiatrists have a proportionately smaller role in office-based mental health care among older adults — than younger — perhaps due to age-related attitudinal differences toward psychiatric services.

Looking at sex, mental health-related office visit rates to psychiatrists are higher compared with primary care physicians for both men and women, but the visit rate is higher for women compared to men (1,380 vs. 1,111 visits per 10,000 adults).  Within-sex differences were expected given the overall premise of where adults as a group are getting their care. Within-sex differences follow 2016 data presented by The National Institutes of Mental Health that show the prevalence of any mental health illness is higher in women (21.7%) vs. men (14.5%).

Large metropolitan areas experienced a higher percentage of mental health-related office visits to psychiatrists compared to PCPs. In rural areas, an opposite trend was observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas. In medium to small metropolitan areas there was no difference in the percent of visits to either physician specialty, suggesting a possible absence of a supply-demand issue.


Q:  What sort of trend data do you have on this topic that will help us see how mental health-related doctor’s office visits have evolved over time?

DC:  Although we did not examine mental health-related office visits across years for this analysis, we certainly have the ability to examine the same characteristics in future research. An interesting finding in our current report is that mental health-related office visit rates to psychiatrists are higher compared with primary care physician visit rates in all age groups — except for adults aged 65 and over, and as a percentage of visits among all primary expected payment types except Medicare. These results together may indicate that older adults, who are assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


Q:  What information do you have on the differences between or among the different types of physicians that are visited for mental health, e.g. what do patients get at a psychiatrist’s office visit that they may not receive at a primary care physician’s – and vice versa?

DC:  There is information available about the type of care patients receive for mental health from different types of physicians. We do have the ability to determine some components of care which patients receive at mental health-related visits; for example, did the patient receive psychotherapy, health education/counseling, psychotropic medications, etc. However, this topic has been examined before as researchers outside The National Center for Health Statistics (NCHS) have studied care received at psychiatrist vs. PCP offices, so this data brief did not explore these factors extensively. Perhaps in a future NCHS study! The uniqueness of this research in how we define a mental health-related office visit should be recognized – and will be very useful in future studies. By using the patient’s reason for a visit, and not a physician’s diagnosis, we attempt to control that at least the initial reason for the visit was for a mental health issue.