Abstract
The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, released the midcourse review of the Healthy People 2020 program, a nationwide program in disease prevention and health promotion. A new report examines patterns of physician visits for attention-deficit/hyperactivity disorder (ADHD) and finds that boys make more visits than girls. NCHS releases final 2015 data on mortality and reports on vaccination coverage among adults with diagnosed diabetes. A new index of upcoming NCHS reports, NCHS data files, and data resources to be released in 2017 is available on the NCHS website.
Healthy People 2020 Progress Assessed
Healthy People was developed by the US Department of Health and Human Services to guide, direct, and evaluate the nation’s health promotion efforts, with goals and objectives for improving the health of all Americans. Healthy People 2020 is the fourth and current version of the Healthy People initiative.
Healthy People 2020 Midcourse Review 1 provides an overview of progress toward meeting targets halfway through the 10-year initiative. The 820-page report provides detailed information on progress and data on health disparities, as available, for 1271 objectives in 42 topic areas. A total of 1055 of the 1271 objectives (83.0%) were measurable through 2015; baseline data years ranged from 1991 to 2004 because of variations in data sources and availability. Similarly, subsequent baseline data years available for calculations of midcourse progress ranged from 2005 to 2010.
Of the 1055 measurable objectives, 226 (21.4%) objectives had met or exceeded their 2020 targets, 198 (18.8%) were improving, 285 (27.0%) showed little or no change, and 119 (11.3%) were getting worse. Of the measureable objectives, 193 (18.3%) had baseline data only and lacked updated information to assess progress. Only 34 objectives (3.2%) were considered informational and did not have targets set by the time of this report.
Data on progress were grouped by topic area and population group. By topic area, progress was made in the areas of adolescent health; cancer; chronic kidney disease; heart disease and stroke; human immunodeficiency virus; immunization and infectious diseases; maternal, infant, and child health; occupational safety and health; oral health; and sexually transmitted diseases. The report showed no progress or a move away from goals in the following areas: access to health services; arthritis, osteoporosis, and chronic back conditions; diabetes; early and middle childhood health; family planning; injury and violence prevention; mental health and mental disorders; older adult health; respiratory diseases; and substance abuse.
Rates of Physician Visits for ADHD
The National Ambulatory Medical Care Survey produces annual statistics on visits to office-based private physicians. Data are analyzed by physician characteristics, patient characteristics, and patient symptoms, diagnoses, and treatments. A recent report, Physician Office Visits for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents Aged 4-17 Years: United States, 2012-2013, presents data on visits for ADHD, one of the most commonly diagnosed neurobehavioral disorders of childhood. 2
During 2012-2013, children aged 4-17 with a primary diagnosis of ADHD made an estimated annual average of 6.1 million physician office visits (105 visits per 1000 children). The annual ADHD visit rate was more than twice as high for boys (147 per 1000 boys) than for girls (62 per 1000 girls). Central nervous system stimulant medications were provided, prescribed, or continued at about 80% of ADHD visits among children. Among ADHD visits by children, 29% included a diagnostic code for an additional mental health disorder, including episodic mood disorder (7%); anxiety, dissociative, and somatoform disorder (7%); and disturbance of emotions specific to childhood and adolescence (4%). The report includes data on visits by physician specialty: 48% of visits were with pediatricians, 36% were with psychiatrists, and 12% were with general and family practitioners.
2015 Mortality Data
A new NCHS report, Mortality in the United States, 2015, 3 presents 2015 US final mortality data on deaths and death rates by demographic and medical characteristics, including mortality patterns by sex, race/ethnicity, and cause of death. The report compares 2015 data with 2014 data on life expectancy estimates, age-adjusted death rates by race/ethnicity and sex, 10 leading causes of death, and 10 leading causes of infant death. Data from death certificates filed in all 50 states and the District of Columbia were compiled into national data through the National Vital Statistics System.
Key findings show that the life expectancy at birth for the total US population in 2015 was 78.8 years—down 0.1 year from 78.9 years in 2014. For men, life expectancy decreased slightly from 76.5 years in 2014 to 76.3 years in 2015. For women, life expectancy decreased from 81.3 years in 2014 to 81.2 years in 2015. Life expectancy for women was consistently higher than it was for men. In 2015, the difference in life expectancy between women and men increased 0.1 year, from 4.8 years in 2014 to 4.9 years in 2015. In 2014 and 2015, life expectancy at age 65 for the total population was 19.4 years. In 2014 and 2015, life expectancy at age 65 was 20.6 years for women and 18.0 years for men. The difference in life expectancy at age 65 between women and men remained at 2.6 years in 2015.
In 2015, 2 712 630 resident deaths were registered in the United States—86 212 more deaths than in 2014. From 2014 to 2015, the age-adjusted death rate per 100 000 population increased 1.2%, from 724.6 in 2014 to 733.1 in 2015. Age-adjusted death rates increased from 2014 to 2015 for non-Hispanic black men (0.9%), non-Hispanic white men (1.0%), and non-Hispanic white women (1.6%). Age-adjusted death rates did not change substantially for non-Hispanic black women, Hispanic men, or Hispanic women from 2014 to 2015. In 2015, the 10 leading causes of death remained unchanged from 2014 (heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease, and suicide). The 10 leading causes accounted for 74.2% of all deaths in the United States in 2015.
From 2014 to 2015, age-adjusted death rates increased for 8 of 10 leading causes of death: 0.9% for heart disease, 2.7% for chronic lower respiratory diseases, 6.7% for unintentional injuries, 3.0% for stroke, 15.7% for Alzheimer disease, 1.9% for diabetes, 1.5% for kidney disease, and 2.3% for suicide. The rate decreased by 1.7% for cancer, and the rate for influenza and pneumonia remained virtually the same.
The infant mortality rate per 100 000 live births increased from 582.1 infant deaths in 2014 to 589.5 infant deaths in 2015, although the change was not significant. The 10 leading causes of infant death in 2015 accounted for 68.6% of all infant deaths in the United States. The leading causes in 2015 were the same as in 2014: congenital malformations, low birth weight, sudden infant death syndrome, maternal complications, unintentional injuries, cord and placental complications, bacterial sepsis of newborn, respiratory distress of newborn, diseases of the circulatory system, and neonatal hemorrhage. The infant mortality rate per 100 000 live births for unintentional injuries increased 11.3%, from 29.1 infant deaths in 2014 to 32.4 infant deaths in 2015. Mortality rates for other leading causes of infant death did not change substantially.
Immunization Rates Among Adults With Diabetes
One in 10 US adults aged ≥18 has been diagnosed with diabetes, and people with diabetes are at an increased risk for complications from vaccine-preventable diseases. Several vaccines are recommended for adults with diabetes, including annual vaccination for influenza and at least a 1-time dose of pneumococcal conjugate vaccine (PCV), regardless of age; a shingles vaccine starting at age 60; and a hepatitis B vaccine soon after diabetes diagnosis among those aged 19-59. A new report, Vaccination Coverage Among Adults With Diagnosed Diabetes: United States, 2015, 4 describes the receipt of these vaccinations among adults with diabetes by sex, age, race/ethnicity, and poverty status. Data came from the National Health Interview Survey, a large-scale general purpose health survey of a sample of the nation’s noninstitutionalized civilian population.
Among adults aged ≥18 with diagnosed diabetes, 61.6% had an influenza vaccine in the past year. The influenza vaccination rate increased with age: 41.4% of those aged 18-44, 51.0% of those aged 45-59, 69.1% of those aged 60-74, and 74.5% of those aged ≥75 were vaccinated for influenza in the past year. Influenza vaccination rates were highest for non-Hispanic Asian (71.1%) and non-Hispanic white (65.3%) adults as compared with Hispanic (53.9%) and non-Hispanic black (51.1%) adults. Influenza vaccination increased with income status: 50.9% of poor adults with diagnosed diabetes had an influenza vaccine in the past year, compared with 57.8% of near-poor and 65.9% of not-poor adults with diagnosed diabetes. Poor adults are defined as having family incomes below the federal poverty level; near-poor adults have family incomes 100% to <200% of the federal poverty level; and not-poor adults have family incomes ≥200% of the federal poverty level. Income is based on reported or imputed family income.
More than half (52.6%) of adults with diagnosed diabetes received PCV. The percentage of adults who ever had PCV increased with age: 27.5% of those aged 18-44, 38.4% of those aged 45-59, 60.0% of those aged 60-74, and 74.2% of those aged ≥75 had PCV at some point in the past. Most (60.1%) non-Hispanic white adults with diagnosed diabetes had PCV at some point in the past, compared with 36.8% of Hispanic, 40.8% of non-Hispanic black, and 44.3% of non-Hispanic Asian adults with diagnosed diabetes. The percentage of adults who had PCV increased with income status. Fewer than half (42.2%) of those who were poor, 51.5% of those who were near poor, and 55.7% of those who were not poor had ever had PCV.
More than one-quarter (27.2%) of adults aged ≥60 with diagnosed diabetes ever had a shingles vaccine. Nearly one-third (31.7%) of adults aged ≥75, compared with 25.2% of adults aged 60-74, had a shingles vaccine. Among adults aged ≥60, non-Hispanic white adults (32.0%) were 2.5 times as likely as non-Hispanic black adults (13.0%) and 1.7 times as likely as Hispanic adults (18.3%) to have had a shingles vaccine. The percentage of adults aged ≥60 with diagnosed diabetes who ever had a shingles vaccine increased with income status: 16.1% of those who were poor, 20.0% of those who were near poor, and 31.9% of those who were not poor had ever had a shingles vaccine.
Fewer than one-fifth (17.1%) of adults with diagnosed diabetes had the 3-dose vaccination schedule for hepatitis B, and having had the hepatitis B vaccination decreased by age: 30.2% of those aged 18-44, 21.9% of those aged 45-59, 14.8% of those aged 60-74, and 7.0% of those aged ≥75 had the 3-dose vaccination schedule for hepatitis B. Coverage of the 3-dose vaccination schedule for hepatitis B increased with income: 13.6% of poor, 14.3% of near-poor, and 19.1% of not-poor adults had the 3-dose vaccination schedule for hepatitis B at some point in the past.
NCHS Annual Index of Statistical Products and Reports
A new index of NCHS reports, data files, and statistical products to be released in 2017 is available on the NCHS website. 5 The listing indexes and allows readers to search by month of release, keywords, data sources, and release type. Release type includes the NCHS publication series, public use data files, and web tables.