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Unformatted text preview: Copyright information Permission has been obtained from the copyright holders to reproduce certain quoted material in this report. Further reproduction of this material is prohibited without specific permission of the copyright holder. All other material contained in this report is in the public domain and may be used and reprinted without special permission; citation as to source, however, is appreciated. Suggested citation National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017. Library of Congress Catalog Number 76–641496 For sale by Superintendent of Documents U.S. Government Printing Office Washington, DC 20402 U.S. Department of Health and Human Services Thomas E. Price, M.D. Secretary Centers for Disease Control and Prevention Anne Schuchat, M.D. (RADM, U.S. Public Health Service) Acting Director National Center for Health Statistics Charles J. Rothwell, M.S., M.B.A. Director Preface Health, United States, 2016 is the 40th report on the health status of the nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). The Health, United States series presents an annual overview of national trends in health statistics. The report contains a Chartbook that assesses the nation's health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization and access, health risk factors, prevention, health insurance, and personal health care expenditures. This year's Chartbook focuses on long-term trends in health. The report also contains 114 Trend Tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. A companion report—Health, United States: In Brief—features information extracted from the full report. The complete report and related data products are available on the Health, United States website at: . The 2016 Edition Health, United States, 2016 contains a summary At a Glance table that displays recent data on selected indicators of health and their determinants, cross-referenced to tables in the report. This is followed by a Highlights section, which focuses on both long-term trends and current data on topics of public health interest and illustrates the breadth of material included in Health, United States. The other major sections are a Chartbook, detailed Trend Tables, two Appendixes, and an Index. The major sections of the 2016 report are described below. Chartbook The 2016 Chartbook contains 27 figures on long-term trends in health. As Health, United States enters its 40th year of reporting on the health of the nation, this year’s Chartbook focuses on trends in health and health care since 1975. Examining long-term trends in health informs the development and implementation of effective health policies and programs. The Chartbook has been grouped into five sections. The first section (Figures 1–5) presents an overview of the demographic and socioeconomic factors that have influenced the health of the nation over the last 40 years. The second section (Figures 6–14) focuses on health status and determinants: life expectancy, infant mortality, iii Preface leading causes of death, birth rates, cigarette smoking, obesity, untreated dental caries, diabetes prevalence, and uncontrolled hypertension. The third section (Figures 15–19) presents trends in health care utilization: use of prescription drugs, health care and emergency department visits, overnight hospital stays, and cancer screening tests. The fourth section (Figures 20–22) focuses on changes in health care resources: hospitals, primary and specialist physicians, and nursing homes. The fifth section (Figures 23–27) describes trends in health care expenditures: personal health care expenditures, mental health and substance use expenditures, Medicare managed care enrollment by state, and health insurance coverage. Trend Tables The Chartbook is followed by 114 detailed Trend Tables that highlight major trends in health statistics. Comparability across editions of Health, United States is fostered by including similar Trend Tables in each volume, and timeliness is maintained by improving the content of tables to reflect key topics in public health. An important criterion used in selecting these tables is the availability of comparable national data over a period of several years. Appendixes Appendix I. Data Sources describes each data source used in Health, United States, 2016 and provides references for further information about the sources. Data sources are listed alphabetically within two broad categories: Government Sources, and Private and Global Sources. Appendix II. Definitions and Methods is an alphabetical listing of selected terms used in Health, United States, 2016. It also contains information on the statistical methodologies used in the report. Index The Index to the Trend Tables and Chartbook figures is a useful tool for locating data by topic. Tables and figures are cross-referenced by such topics as child and adolescent health; older population aged 65 and over; women's health; men's health; state data; American Indian or Alaska Native, Asian, black or African American, Hispanic-origin, and white populations; education; injury; disability; and metropolitan and nonmetropolitan data. Many of the Index topics are also available as conveniently grouped data packages on the Health, United States website at: . Health, United States, 2016 Data Considerations Racial and Ethnic Data Many tables in Health, United States present data according to race and Hispanic origin, consistent with a departmentwide emphasis on ensuring that health data on racial and ethnic minority populations are presented whenever possible. Trend data on race and ethnicity are presented in the greatest detail possible after taking into account the quality of the data, the amount of missing data, and the number of observations. These issues significantly affect the availability of reportable data for certain populations, such as the Native Hawaiian or Other Pacific Islander populations and the American Indian or Alaska Native populations. Standards for the classification of federal data on race and ethnicity are described in an appendix. (See Appendix II, Race.) Education and Income Data Many Trend Tables in Health, United States present data according to socioeconomic status, using education and family income as proxy measures. Education and income data are generally obtained directly from survey respondents and are not usually available from recordsbased data collection systems. (See Appendix II, Education; Family income; Poverty.) Disability Data Disability can include the presence of physical or mental impairments that limit a person's ability to perform an important activity and affect the use of or need for support, accommodation, or intervention to improve functioning. Information on disability in the U.S. population is critical to health planning and policy. Disability may be measured based on a specific disability or a composite measure designed to identify persons with any of a variety of disabilities. Health, United States includes data from the National Health Interview Survey to examine specific types of disability and to create composite disability measures consistent with two of the conceptual components that have been identified in disability models and legislation: basic actions difficulty and complex activity limitation. Basic actions difficulty captures limitations or difficulties in movement and sensory, emotional, or mental functioning that are associated with a health problem. Complex activity limitation describes limitations or restrictions in a person's ability to participate fully in social role activities such as working or maintaining a household. Health, United States, 2016 includes the following disability-related information: basic actions difficulty and complex activity limitation (Table 42), vision and hearing limitations for adults (Tables 43 and 44), and disability-related information for Medicare enrollees (Table 108), Medicaid recipients (Table 109), and veterans with service-connected disabilities (Table 111). For more iv Preface information on disability statistics, see Altman and Bernstein (1) and Brault (2). Statistical Significance All statements in the text describing differences, or lack thereof, in estimates indicate that statistical testing was performed. Differences between two point estimates were determined to be statistically significant at the 0.05 level using two-sided significance tests (z-tests) without correction for multiple comparisons. Data tables include point estimates and standard errors for users who would like to perform additional statistical tests. In the text, the standard terminology used when a difference between two point estimates was tested is, "Between (estimate 1) and (estimate 2)." For example, the statement "Between 2014 and 2015" indicates that the difference between the point estimate for 2014 and that for 2015 was tested for statistical significance. The statistical significance of a time trend was assessed using weighted least squares regression applied to data for all years in the time period. (For a description of the trend testing technique, see the Technical Notes that follow the Chartbook.) The terminology used in the text to indicate testing of a trend is "During (time period 1)–(time period 2)." For example, the statement "During 2005–2015" indicates that a statistical test of trend was conducted that included estimates for all 11 years in the time period. Because statistically significant differences or trends are partly a function of sample size (i.e., the larger the sample, the smaller the change that can be detected), statistically significant differences or trends do not necessarily have public health significance (3). Terms such as "similar," "stable," and "no difference" indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between statistics does not necessarily suggest that the difference was tested and found to not be significant. Overall estimates generally have relatively small standard errors, but estimates for certain population subgroups may be based on small numbers and have relatively large standard errors. Although numbers of births and deaths from the Vital Statistics System represent complete counts (except for births in those states where data are based on a 50% sample for selected years) and are not subject to sampling error, the counts are subject to random variation, which means that the number of events that actually occur in a given year may be considered as one of a large series of possible results that could have arisen under the same circumstances. When the number of events is small and the probability of such an event is small, considerable caution must be observed in interpreting the conditions described by the estimates. Estimates that are unreliable because of large standard errors or small numbers of events are noted with an asterisk. The criteria used to designate or suppress unreliable estimates are indicated in the table footnotes. Health, United States, 2016 For NCHS surveys, point estimates and their corresponding variances were calculated using the SUDAAN software package (4), which takes into consideration the complex survey design. Standard errors for other surveys or data sets were computed using the methodology recommended by the programs providing the data, or were provided directly by those programs. Standard errors are available for selected tables in the spreadsheet version on the Health, United States website at: . Accessing Health, United States References 1. Altman B, Bernstein A. Disability and health in the United States, 2001–2005. Hyattsville, MD: NCHS; 2008. 2. Brault MW. Americans with disabilities: 2010. Current population reports, P70–131. Washington, DC: U.S. Census Bureau; 2012. 3. CDC. Youth Risk Behavior Surveillance System (YRBSS). Interpretation of YRBS trend data. Atlanta, GA; 2014. 4. RTI International. SUDAAN (Release 11.0.0) [computer software]; 2012. Health, United States can be accessed in its entirety at: . The website is a userfriendly resource for Health, United States and related products. In addition to the full report, the website contains data conveniently organized and grouped by topic. The Chartbook figures are provided as PowerPoint slides, and the Trend Tables and Chartbook data tables are provided as spreadsheet and PDF files. Many spreadsheet files include additional years of data not shown in the printed report, along with standard errors where available. Visitors to the website can join the Health, United States e-mail list (https:// ) to receive announcements about release dates and notices of updates. Previous editions of Health, United States, and their Chartbooks, can also be accessed from the website. Printed copies of Health, United States can be purchased from the U.S. Government Printing Office at: http:// bookstore.gpo.gov. Questions? If you have questions about Health, United States or related data products, please contact: Office of Information Services Information Dissemination Staff National Center for Health Statistics Centers for Disease Control and Prevention 3311 Toledo Road Hyattsville, MD 20782–2064 Phone: 1–800–CDC–INFO (1–800–232–4636) TTY: 1–888–232–6348 Internet: Online request form: For e-mail updates on NCHS publication releases, subscribe online at: . v Preface Health, United States, 2016 Acknowledgments Overall responsibility for planning and coordinating the content of this volume rested with the National Center for Health Statistics’ (NCHS) Office of Analysis and Epidemiology, under the direction of Julia S. Holmes and Irma E. Arispe. Production of Health, United States, 2016 was managed by Sheila J. Franco, Virginia M. Freid, Julia S. Holmes, and Hashini S. Khajuria. Preparation of the volume, including highlights, trend tables, appendixes, and index, was completed by Shilpa Bengeri, Mary Ann Bush, La-Tonya D. Curl, Anne K. Driscoll, Catherine R. Duran, Sheila J. Franco, Virginia M. Freid, Nancy Han, Hashini S. Khajuria, Ji-Eun Kim, Florence Lee, Xianfen Li, Anita L. Powell, Ilene B. Rosen, and Ashley M. Woodall. Administrative and word processing assistance was provided by Lillie C. Featherstone. Production of the Chartbook was managed by Sheila J. Franco and Virginia M. Freid. Data, analysis, and text for specific charts were provided by Shilpa Bengeri, Mary Ann Bush, La-Tonya D. Curl, Anne K. Driscoll, Catherine R. Duran, Sheila J. Franco, Virginia M. Freid, Nancy Han, Hashini S. Khajuria, Ji-Eun Kim, Florence Lee, Xianfen Li, Diane M. Makuc, and Ashley M. Woodall. Publication assistance was provided by CDC/OPHSS/ NCHS/OD/Office of Information Services (OIS) and Office of Information Technology (OIT). Cover design was provided by Sarah Hinkle. Printing was managed by Nathanael Brown (CDC/OD/OADC). Publication production was performed under contract with Karna, LLC. Electronic access through the NCHS website was provided by Shilpa Bengeri, Christine J. Brown (CDC/OPHSS/NCHS/OD/OMO), La-Tonya D. Curl, Virginia M. Freid, Elom L. Lawson, Florence Lee, Anthony Lipphardt, Anita L. Powell, Ilene B. Rosen, Brian Tsai (CDC/ OPHSS/NCHS/OD), and Ashley M. Woodall. Data and technical assistance were provided by staff of the following NCHS organizations: Division of Health Care Statistics: Jill Ashman, Lauren Harris-Kojetin, Pinyao Rui, Susan M. Schappert, Manisha Sengupta, and Victor V. Shigaev; Division of Health and Nutrition Examination Surveys: Namanjeet Ahluwalia, Margaret D. Carroll, Mark S. Eberhardt, Eleanor B. Fleming, Qiuping Gu, Brian K. Kit, Cynthia L. Ogden, and Ryne Paulose-Ram; Division of Health Interview Statistics: Veronica Benson, Debra Blackwell, Barbara Bloom, Robin A. Cohen, Jacqueline Lucas, Tina Norris, Jeannine Schiller, Charlotte Schoenborn, Maria Villarroel, Brian Ward, and Emily Zammitti; Division of Vital Statistics: Robert N. Anderson, Joyce A. Arbertha, Elizabeth Arias, Amy M. Branum, Anjani Chandra, Sally C. Curtin, Kimberly Daniels, Anne K. Driscoll, Elizabeth Gregory, Annie Liu, Joyce A. Martin, T.J. Mathews, Arialdi M. Miniño, Steven J. Steimel, and Margaret Warner; Office of Analysis and Epidemiology: Holly Hedegaard, Deborah D. Ingram, Ellen A. Kramarow, Laura A. Pratt, and Cheryl V. Rose; Office of the Center Director: Juan Albertorio and Francis C. Notzon; and Office of Research and Methodology: Meena Khare. vi Acknowledgments Additional data and technical assistance were provided by the following organizations of the Centers for Disease Control and Prevention (CDC): National Center for Chronic Disease Prevention and Health Promotion: Tara Jatlaoui; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Jim Braxton, Lori Elmore, Anna Satcher Johnson, Sarah Kidd, Jennifer Ludovic, Rodney Presley, Elizabeth Torrone, Hillard Weinstock, and the Surveillance and Data Management Branch; National Center for Immunization and Respiratory Diseases: Laurie D. Elam-Evans, Holly A. Hill, James Singleton, and David Yankey; Office of Public Health Scientific Services, Center for Surveillance, Epidemiology, and Laboratory Services: Ruth Ann Jajosky; by the following organizations within the Department of Health and Human Services: Agency for Healthcare Research and Quality: Kellyn V. Carper and Anne Elixhauser; Centers for Medicare & Medicaid Services: Aaron C. Catlin, Tony Dean, Maria Diacogiannis, Micah B. Hartman, Deborah Kidd, Barbara S. Klees, Jennifer W. Lazio, Anne B. Martin, Debra Reed-Gillette, Joseph F. Regan, Jeffrey S. Silverman, Christopher J. Truffer, and Lekha S. Whittle; National Institutes of Health: Nadia Howlander and Marsha Lopez; Substance Abuse and Mental Health Services Administration: Mitchell Berger, Christopher D. Carroll, Beth Han, and Neil Russell; and by the following governmental and nongovernmental organizations: U.S. Census Bureau: Bernadette Proctor; Bureau of Labor Statistics: Elizabeth A. Ashack, Ryan Farrell, Matt Gunter, Jesus Ranon, and Audrey Watson; Department of Veterans Affairs: Tom Garin and Susan Sullivan; American Association of Colleges of Pharmacy: Nancy T. Nguyen, Danielle A. Taylor, and Jamie N. Taylor; American Association of Colleges of Osteopathic Medicine: Lindsey Jurd; American Association of Colleges of Podiatric Medicine: Moraith G. North; American Dental Association: Adriana R. Menezes and Bradley Munson; Association of American Medical Colleges: Brianna Gunter; Association of Schools and Colleges of Optometry: Joanne C. Zuckerman; Association of Schools & Programs of Public Health: Christine M. Plepys; University of Michigan, Monitoring the Future: Lloyd Johnston and Ginger Maggio; and Cowles Research Group: C. McKeen Cowles. Special Acknowledgment The Health, United States team would like to recognize Virginia (Ginny) M. Freid and Ilene B. Rosen, who recently retired from the National Center for Health Statistics. Ginny contributed to Health, United States for more than 30 years, providing direction and guidance for the report. Her analytical and statistical skills were key to maintaining Health, United States as the gold standard for reporting on health in the United States. Ilene provided meticulous administrative and production support for Health, United States for nearly 10 years, including the critical task of report distribution to key partners and stakeholders. We wish them the very best in their retirement! He...
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