Abstract
The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, published a comprehensive report on the history and operations of the US National Vital Statistics System (NVSS). A new NCHS report examines the prevalence of depression among adults. Another new report looks at the frequency of significant head injuries among children.
US National Vital Statistics System History Documented
The NVSS produces the nation’s official birth and death statistics and is the source of such key indicators of the nation’s health as life expectancy, leading causes of death, infant mortality rates, fertility rates, and teen birth rates. It is one of the longest-operating federal and state cooperative data systems. The decentralized system is coordinated by NCHS and governed by a series of cooperative agreements between NCHS and 57 registration areas: the 50 states, the District of Columbia, New York City, and 5 territories (Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas). A new report, “The U.S. National Vital Statistics System: Transitioning Into the 21st Century, 1990-2017,” 1 describes the recent developments in the system and provides useful information for interpreting and using national vital statistics.
The NVSS has instituted many important changes during the past few decades. Some changes resulted from rapidly changing technology (eg, use of electronic birth and death records and automated systems for transmitting records through all stages of processing). Other changes resulted from societal changes, such as the development of new cause-of-death codes to classify deaths related to terrorism. One major development in the system has been an emphasis on speeding up the availability of data and improving access to data so that they can be used for policy and programmatic applications.
The report updates previous histories of the system and is organized by general topic, with an emphasis on the developments that affected each data subject. A detailed timeline guides the reader to major changes in the system, reasons for those changes, and their effect on the data. A series of appendices provides additional background and context.
Prevalence of Depression
A new report, “Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016,” 2 provides the most recent national estimates of depression among adults. Data were collected in the National Health and Nutrition Examination Survey, a nationwide survey consisting of standardized examinations, interviews, and laboratory testing with a sample of the nation’s civilian, noninstitutionalized population. The prevalence of depression is based on scores from the Patient Health Questionnaire-9, a symptom-screening questionnaire that allows for criteria-based diagnoses of depressive disorders. 3
Results from the Patient Health Questionnaire-9 found that rates of depression differed by age, sex, education, income, and health behaviors. During 2013-2016, 8.1% of Americans aged ≥20 reported being depressed during a given 2-week period. Overall, women were almost twice as likely as men (10.4% vs 5.5%) to report being depressed, and this difference by sex was observed in each age group. Non-Hispanic Asian people had the lowest prevalence of depression (3.1%) compared with other racial/ethnic groups, including Hispanic (8.2%), non-Hispanic white (7.9%), and non-Hispanic black (9.2%) people. This pattern prevailed for both men and women.
The prevalence of depression among adults decreased as family income levels increased. Overall, 15.8% of adults from families living below the federal poverty level reported being depressed compared with 3.5% of adults from families living at ≥400% of the federal poverty level. Men at the highest income level reported the lowest rate of depression (2.3%), and women at the lowest income level reported the highest rate of depression (19.8%). The survey found that approximately half (50.2%) of those with depression reported difficulties with work, home, or social activities.
The National Health and Nutrition Examination Survey also collected data on the prevalence of depression in earlier survey periods, and trend data indicated that the prevalence of adults with depression did not change significantly from 2007-2008 to 2015-2016. Among men, the prevalence of depression was 5.7% in 2007-2008 and 5.4% in 2015-2016. The comparable figures for women were 10.4% in 2007-2008 and 9.3% in 2015-2016.
Significant Head Injuries Among Children
The National Health Interview Survey is a large-scale, general-purpose health survey that collects data through household interviews with a sample of the nation’s civilian, noninstitutionalized population. In the 2016 National Health Interview Survey, parents or guardians answered questions about whether their children had ever had a significant head injury or concussion. Previous studies of head injuries used data obtained from the health care system on injuries that were medically attended. A new report, “Parental Report of Significant Head Injuries in Children Aged 3-17 Years: United States, 2016,” 4 presents estimates of parent-reported lifetime significant head injuries among children aged 3-17 years, providing information about head injuries not limited to those that were medically attended.
In 2016, 7.0% of children aged 3-17 years had ever had a significant head injury based on data reported by parents or guardians. Overall, boys were more likely than girls to have ever had a significant head injury. The percentage of children who had ever had a significant head injury increased with age and was nearly 3 times higher among teenagers aged 15-17 (11.7%) than among children aged 3-5 (4.0%). Among teenagers aged 15-17, boys (14.1%) were more likely than girls (9.2%) to have ever had a significant head injury. The report noted significant differences by race/ethnicity. For both boys and girls, non-Hispanic white children had a higher percentage of lifetime significant head injuries than non-Hispanic black and non-Hispanic other children.
Girls whose parents had >high school education (6.4%) were more likely than girls whose parents had ≤high school diploma or general educational development (4.0%) to have ever had a significant head injury. The prevalence of significant head injuries among boys did not differ by parents’ education. The survey found that most (81.3%) children who had ever had a significant head injury had only 1 in their lifetime.