DR GINDI: Thank you everyone for joining us via Skype and via phone.
Just another reminder, if you have accidentally unmuted your microphone, please go ahead and
mute it again.
We want to make sure that everyone can hear and can understand and get their questions
answered.
It is my pleasure to be here today to talk with you about Health United States 2018,
the annual report and year round resource.
Just to give you a quick idea of what we will be talking about today,
I will briefly go over the Health United States report,
sections of the report in case you are not familiar with it.
Although there are many topics covered in Health U.S.,
I will be looking just at some themes from the report today.
We will be exploring just a couple of themes today
but just so you know there are many subjects available in the report.
I will also be going over how Health U.S. can be a resource for you throughout the year
and we will be looking at a suite of products that you can use for your own research on
your own work
and finally, after a question and answer session where you can ask us some questions,
I will be turning to provide feedback about how you use the health United States
A quick overview of the National Center for Health Statistics, we are one of the 13 federal
statistical agencies.
We are the nations critical health statistics agency.
Our mission as part of our role as a health statistical agency is to provide accurate,
timely, relevant information
to help identify and address health issues.
As a statistical agency, we often are not able to answer the why questions,
why is it something happened
but we are an authoritative source of what is happening.
Our reports and publications have to be objective and statistically valid.
We have many report types you might be familiar with
data briefs, which are shorter report that often are looking at a single question and
a single point in time
as long as longer series reports which are filled with analytic and mythological detail.
Health United States is the flagship report of the National Center for Health Statistics.
NCHS has several different data collection programs that you may be familiar with and
each of these are featured at one point or another in the Health United States program
The National Vital Statistics System is a source for all things birth and death statistics
and we will see it featured from this particular data collection system in Health U.S. in a
little bit.
The National Health Interview Survey is a large on-going in-person household based survey
that collects information on health behaviors, health conditions and healthcare utilization.
The National Health and Nutrition Examination Survey, also called NHANES,
is a nationwide nationally representative objective measurement survey
focusing on the ability to collect measurements such as blood pressure, cholesterol,
and one of the premier sources on nutrition information in the country.
The National Health Care Survey is actually a whole family of surveys, of establishment
surveys,
that look at utilization among hospitals, ambulatory care centers, physician offices,
as long as long-term care facilities.
The National Survey of Family Growth is a nationally representative survey that focuses
on the health behaviors that are key to family coordination and growth.
In addition to the major data collection programs,
NCHS fulfills its mission by connecting additional targeted surveys
as well as through its data linkage program where selected surveys are linked to other
administrative data sources
such as the Center for Medicare and Medicaid services.
Health United States has a report mandate.
We are mandated to report from the Secretary of Health and Human Services to the President
and Congress
and we have been published by the National Center for Health Statistics 1975.
The legislative mandate tells us to have a report that covers for major subject areas.
Health status and determinants, Healthcare utilization,
healthcare resources and healthcare expenditures.
We have one overarching large report goal which is to educate the public and policy
makers on key health topics
with three major ways that we try to achieve that goal.
The first is really in bringing together health information from multiple data sources,
thinking about all those different NCHS data collection systems that I just showed you.
Certainly, each of these are featured in the Health United States report.
We also bring together health information from other CDC sources,
other sources from outside of health and human services
and even some private data sources.
Another key focus of Health United States is the focus on trends over time.
It is not enough to bring you the latest content,
the latest health content that can help in your research or your understanding of policies,
we also want to provide context.
What are the patterns,
how are these health indicators changing during the years.
Finally, another key feature of the Health United States report is that this report
examines health disparities between important population subgroups.
We have a long history in Health United States in being able
to be a useful report in understanding differences
not only by race and origin but also across income groups,
regions as well as other geographies.
Thinking specifically about the Health United States 2018 annual report,
we have not just the omnibus large big book you might be familiar with if you are a consistent
Health U.S. user
but also a whole suite of products.
The first main section is the chart book on the health of Americans
This chart book this year features 20 figures along with analytic texts.
Most of these figures deal with data between 2007 and 2017.
Obviously in cases where the data are collected as recently as 2007,
we will start at a more recent year. We do go through 2017.
I wanted to acknowledge that these data in some cases can be older.
One of the reasons for that is, again,
thinking about the very large collection of data collection systems that we are working
with,
each of these data collect and system the public use files and estimates become available
at different points during the year.
We do have to make a cut off point as we pull the data together for publication.
So for the Health U.S. 2018, the most recent year for many of these figures is 2017.
We also have the highlights in the chart book and usually these highlights are shorter snippets
drawn specifically from the analytic text.
They often focus on the most recent years data which in many cases is 2017,
or on simple comparisons. Perhaps an increase overtime or a decrease or simple comparisons
between subgroups that were analyzed in the figures.
In addition to the start but, we also have supplementary online only trend tables
for those users who might be interested in obtaining more detail than they were able
to see in the chart book.
In some cases these are dealing with a longer term trends, especially looking at our vital
statistics data collection,
these estimates go back to the 1950s and 1960s
and other cases where perhaps we were only presenting a figure by sex or by age group,
it is an opportunity for users to look at these estimates among more detailed population
groups.
Not just by sex and age group, but also race and Hispanic origin or income or geography.
The appendices are bit of the unsung hero of the Health U.S. annual report,
they are a very important part of being able to obtain details and descriptions of the
data sources and methodology.
If you are interested in looking more into NCHS microdata and want to understand more
about how a key indicator was constructed
or understanding how the questions have changed over time,
the appendices are an excellent source for that kind of information.
A little bit newer for the Health U.S. program, we are the working on more social media friendly
visuals.
These include some shareable images to help communicate the highlights as well as more
visually friendly,
visually focused spotlight infographics that are available on our website.
Today, we will be going through just a few of these themes from the Health U.S. 2018
annual report
and again noting that there are many subjects that are covered in the report
but I will be showcasing today data from 10 charts and tables illustrating the following
kind of trends.
Decreases in life expectancy the impact of changing mortality rates,
changes of health care access utilization among adults and children, and finally,
continuing disparities between demographic and geographic groups.
I will start with life expectancy and mortality drawing specifically from four charts and
tables on
life expectancy, drug overdose death rates, suicide rate and heart disease death rates.
Life expectancy at birth in the U.S. has been increasing or remaining the same every year
between 1994 and 2014.
It has been in decline for two of the past three years.
Life expectancy at birth is one of the fundamental measures of population health
and allows us to compare the health and longevity of the population,
not only across time to be able to see whether we are improving the health of the population,
but also internationally.
What we have seen is in the past few years, since 2015, we have seen significant decreases
in life expectancy among men
while life expectancy at birth has actually remained stable among women.
One of the key features of life expectancy at birth is that changes in the mortality
rates, especially at younger ages,
can have significant impact on the ultimate life expectancy.
One of the key health areas that has impacted the life expectancy at birth in this country,
the decrease, specifically focusing on the decreases in life expectancy, is the increased
death rate for drug overdose.
We have seen drug overdose increase substantially between 2007 and 2017 with increases from
11.9 to 21.7 deaths per 100,000.
When we break those drugoverdose death rates out by sex and also by age group,
what you can see is that we are seeing significant increases among males, particularly
and especially among males and younger age groups and again,
noting that increases in mortality rates, especially among those younger age groups,
are going to be seen as decreases in average life expectancy.
Another topic that has gotten a lot of attention as being a key player in the decreases in
life expectancy are suicide rates.
One of the things we are able to show this year in our trend table is the death rate
for suicide
and for the first time being able to break out the 10 to 14-year-old age group going
all the way back to 1950.
Here in this trend table, you can see the increases in the suicide rate for many of
the age groups.
Now the increases in the mortality rates for the younger age groups are certainly a component
of the decreasing life expectancy
but another important component is the fact that we have seen areas where there has been
traditionally a decline
in the mortality rate so an improvement in health and longevity, actually stabilizing.
This is a figure from the chart book showing mortality rates from the two leading causes
of death in the U.S., heart disease and cancer in decline from 2007.
Specifically, the rate of decrease for heart to decrease disease has slowed from 2011 to
2017.
Where the increases in mortality rate due to heart disease may be offsetting the increases
in mortality in other areas,
we are starting to see the impacts on life expectancy.
Shifting gears a little bit to one of our other key focus areas, I will also talk about
access and utilization.
I will be focusing specifically on charts and tables that look at insurance status among
adults and children,
the nonreceipt of prescriptive drugs due to cost, prescription drug use overall and childhood
vaccination.
The percentage of the adults age 18 to 64 who are uninsured was down to 13.3% in 2018,
6.3 percentage points lower than 2007.
This decrease in the uninsured rate was complimented by increases in coverage in terms of both
private coverage
as well as Medicaid and other public coverage.
One thing to note that while the data from the chart book were preliminary at the time
of collacting this data,
the final 2018 estimates are available through the NHIS early release program at the URL
on your screen.
Insurance impacts many parts of our healthcare utilization and health outcomes.
In particular focusing here on information from one of our long-term trend tables,
we can see that in 2017, the percentage of adult age 18 to 64 who delayed or did not
get needed prescription drugs due to cost
actually differed by insurance coverage status.
Among adults who reported private health insurance, just under 4% said that they delayed or
did not get the prescription drug they needed to due to cost.
That rose when we are looking at adults who had Medicaid or public coverage to 9.4% and
among adults age 18 to 64 years who are uninsured,
almost 17% said they had delayed or did not get prescription drugs due to cost.
If we look at how may people this impacts, what is the burden of this issue?
We can also look at how many people report taking prescription drugs.
This shifts us to a different data source. This is from NHANES and this data is from
2015 and 2016
but here we see that 1 in 8 people, 12.5 percent, used five or more prescriptive drugs in the
last 30 days
and if we actually look at the chart book text, we can see that it is actually just
under half,
48% of people report taking at least one prescription drug in the last 30 days.
Looking at children, we can also see that the percentage of children under age 18 who
had no health insurance
decreased 3.8 percentage points to 5.2% in 2018 and similarly, we then saw increases
in both the proportion
with private coverage as well Medicaid or other public coverage.
What kind of health insurance you have matters for utilization among children.
What we see in the National Immunization Survey is that childhood vaccinations differ by these
different insurance categorizes
among children who had a private coverage, private health insurance coverage, who were
aged 19-35 months, we found that three quarters
of those with private coverage had completed the recommended seven vaccine theories.
Among children who had Medicaid, 66.5% completed the seven vaccine series.
Among children who are uninsured, 48.5% completed the vaccine theories.
And taking us to the last of the three themes we are looking at today, let's look at continuing
disparities.
As I mentioned before, most of the trend tables that we have are able to look at these key
health indicators by a
number of different demographic and geographic subgroups.
I am looking at two today.
I am looking at teen births among females aged 15-19 years and vaccination coverage
among children 19 to 35 months.
One thing we note from the chart book is the birth rate among teenagers aged 15 to 19 fell
by more than one half
41.5 per 1,000 females in 2007 to 18.8 live births per 1,000 females in 2017.
This is a record low for the United States.
However, throughout that period, the disparity by race and Hispanic origin persisted.
I think it is important for us to be able to recognize that even in a place of public
health success
that we still have to examine the disparities that may exist.
Again, I think it is important to note that the 2018 teen birthrates are available at
the URL on your screen.
Not only can we look at disparities by racial and Hispanic origin but also by region and
by different geographic variables.
One geographic variable that is definitely of interest to many is urban and rural disparities.
In this particular analysis, we found that children who were living outside of metropolitan
statistical areas,
that is children who are living in more rural environments were less likely to have received
the complete combined vaccination series
than those living in metropolitan statistical area principal cities. They are in the more
urban areas.
That brings us to the conclusion of the three themes that we are exploring for the Health
U.S. 2018 report
and I hope you will go into the report and find and access the data that you were looking
for to tell the stories that you need to tell through data
but I also want to encourage you to continue to use Health U.S. as a year round resource.
We think of Health U.S. as being a spectrum of products, not only the single chart book
but really being able to appeal to a number of different kinds of users.
The casual user who might be interested in quick statistics perhaps for a paper or to
guide them along a research path.
More sophisticated users who might be more interested in assessing patterns, whether
that is over time or whether those are statistical comparisons between subgroups
and then finally an in depth user might be interested in putting together their own analyses
using our trend tables
or interested in working with NCHS microdata, the public use files from the NCHS data collection
systems
and want to understand how we have put together our key health indicators.
To help you understand a little bit more about what I mean, I am going to use functional
limitation as an example indicator
to help step through these different parts of Health U.S..
Before we get started, lets define what I mean by functional limitation.
For those of you who are not familiar, the Washington Group on disability statistics
was first formed by the UN statistical commission in 2001
to help create tools that allow for the collection of internationally accurate comparable statistics
on individuals living with functional limitations.
These standard questions were able to be added to international censuses and surveys.
This short set of questions assesses functioning in six different domains.
Vision, hearing, mobility, upper body functioning, communication and cognition.
Some of the features of the Washington group short set on function that we use in our analysis
are
the ability to first look at either a composite or domain specific kind of limitation
where we can either talk about people who have functional limitations or people with
limitations in the area of vision
and we can also look at not only at a yes, no, black, white sense of limitations
but also be able to look at the continuum of difficulty levels.
Questions on functional limitation were first added to the sampule adult section on the
National Health Interview Survey in 2010.
We can start off where our in depth user might start, taking a look at the appendix.
The appendix is a place you can go to understand what the questions look like on a survey,
how the data was collected as well as how the questions may have changed over time.
This is just a start of the functional limitation entry.
The casual user might just be interested in a quick highlight.
What is the percentage of people who have functional limitation in the most recent time
period that was available in the book.
We can see that in 2017, the percentage of adults who were aged 18 to 64 who reported
having difficulty functioning was a 33.7%,
which can be further decomposed along that continuum of limitation.
Our more sophisticated user might be interested in looking at the figure in the chart book
as well as the analytic text to get a sense of
how these patterns have been changing over time.
To be able to see specifically, for example, that the proportion of adults aged 18 to 64
who had a lot of difficulty or cannot do at all in at least one domain
increased by 0.3 percentage point between 2010 and 2014.
Finally, the in depth user might be interested in looking at the trend tables.
For those of you who are used to the paper version of the health U.S. book
who might want to look at the index as a way to find their topic of interest, the data
fighter is also an electronic index.
You can go to the subjects and select from the drop-down menus.
In this case, we'll look at functional limitations.
You can see that we look at both of the figures in the chart book as well as more detailed
trend tables.
Here I've pulled up the trend table in Excel, we are looking at across multiple years and
that we are able to look at multiple
ways of decomposing this indicator, both in the number of millions of people reporting
specific levels of difficulty, total age adjusted estimates.
You may have decided to pull together a different graphic but what I pulled together in just
a few minutes using that Excel table is a bar chart
looking at the percentage of adults aged 18 and older between 2010 and 2017 who reported
these different levels of difficulty
One of the things that was appealing about using Excel to do this is that I have actually
chosen to look a completely different population
than was chosen for the chart book.
I am looking here at 18 and older instead of 18 to 64 and 65 and older populations
So if you were interested in looking at functional limitations or another key health indicators
by sex, by race and Hispanic origin, or by income,
the trend tables are another way to do that.
At this point, you would agree with me that you have these two main takeaways from our
conversation thus far.
The first is that Health U.S. 2018 is an annual report on the nation's health that can provide
key content and context.
The specific examples we talked through were on life expectancy, access and utilization,
as well as disparities.
Of course, I do want to do leave you with the fact that Health U.S. 2018 can be a year-round
resource.
You can use this to quickly research health topics and we hope that the suite of products
are accessible to casual, sophisticated,
as well as in-depth users
And here I will answer your questions.
JEFF: Yes, If you would like to ask a question, we recommend using the chat feature.
We had one question about whether there is any 2018 data in the report so we will have
Dr. Gindi respond to that.
Dr. GINDI: Thanks, Jeff. Yes, there is some 2018 data in the report.
You can find 2018 data specifically in the health insurance chart and tables because
that data was available,
the data was available in a preliminary way at the point we were collating the data for
this report.
2018 data are also available for the tobacco use because those data were available at the
time.
Otherwise, for the most part, our more recent are going to be from 2017.
JEFF: There is a second question about some of the trend tables, that aren't in this most
recent version. In particular the table on the trend of homicide in the U.S.
DR GINDI: Absolutely, thanks for that.
That is something that I think people who have been longer term users of the Health
U.S. report will notice that
their tables they are used to do it not to get updated this year.
So in the Health U.S. 2017 report, we had 114 different trend tables covering, I think
it was about 85 different subject.
One of the things we are trying to do, as I mentioned, this is, this report has been
put out by NCHS since 1975.
The report really has not fundamentally changed very much in its structure since that time.
We know that the ways people get their health information and health statistical information
is changing and so we really are trying
to make sure that we can redesign our product in such a way to make the information more
accessible to users.
People are interested in using data for data visualization or other more internal products
the ways they can take information not just where we have given it to them in the chart
but take information for themselves and use it.
While we are starting to get at that through the data finder and through these trend tables,
we are working hard on redesign and actually
to let you know as part of our redesign, we are reaching out to our data users,
we are trying to get feedback from all of you to hear about what you think of Health
U.S., what you are looking for in the product.
To be quite honest, we are also looking to find out who you are.
We know that our report is geared toward policy-makers.
We also know that the report gets used by public health professionals and academics
but we are interested in knowing more about who you are, what you are looking for.
Feel free to look at the link on your screen and to tell us more about how you use Health
U.S..
JEFF: We have another question asking about a specific statistic.
One in eight people use five or more prescription drugs. Whether or not this applies to the
nation or is it broken down by insurance coverage.
That is a good question. Thank you for bringing it up because I did present that right after
a slide that looked at health insurance coverage.
The statistic of 1 and 8 people using president drugs is for the nation as a whole.
But you can actually look for more additional information to break it down by a number of
different subgroups in that data finder.
If you go back to, if you go to the data finder on the Health U.S. website
looking specifically at discussion drug use coverage, then you can look at the trend table
and looked along the rows along the side to look for health insurance coverage.
JEFF: Okay, there was a question about whether in the report there is diabetes rate data.
DR GINDI: We do have diabetes prevalence data, which looks at the percentage of the population.
There is a chart on that. Again, in the same vein of the previous answer,
as you go to the data finder and look for diabetes, you can look for a specific chart
we have available
as well as tables and then, when you look at the diabetes prevalence,
one of the things because of this is from the NHANES survey that does objective measurements,
we are able to base this not just on self-reported diabetes, which is of course an important
indicator as well
but actually looking at the rate of diabetes where we can look at the measurements to see
whether somebody would be classified as having diabetes or not.
We are able to look at total diabetes as well as whether or not someone has already received
the diabetes diagnosis from their physician
as well as the prevalence of undiagnosed diabetes.
JEFF: There is another question here, which you partially addressed, the question is how
often is this updated?
Traditionally it has been an annual report and I guess I will let you expand on that.
DR GINDI: So Health U.S. has traditionally been an annual report. There have been some
years where we have combined two years worth of data collection
in a single report but for the most part this report does come out annually.
Now, we do have some other ways of dealing with updated data.
Some years we have actually looked at trying to update the data throughout the year, when
there are more data available.
Another thing that we have been trying is to use the spotlight infographics.
Again, this is another partner in the suite of products from Health U.S.,
where we are looking at topics that are dealt with in Health United States and using the
most updated data available,
to figure out a slightly different look at that topic.
So for example, our most recent spotlight infographic was on racial and ethnic disparities
in heart disease.
So, we were able to take the most updated data from the National Health Interview Survey
as well as NHANES as well as vital statistics
pulling them altogether and looking at racial and ethnic disparities, using the most recent
data.
JEFF: In the past, there has been a special feature, special topics. There was not one
this time. Is there any plan in the future to incorporate special features?
DR GINDI: Yeah, so there was no special feature this year for the Health U.S. 2018 report.
One of the things that we are trying to do as part of our redesign is actually do some
redesign activities where we are looking at getting
a lot of input from different stakeholders.
One of the things that we did have to make sure that in order to put out any report this
year,
that we were able to pull aside some of the work that had already been done to focus on
redesign and so there was no special feature for 2018.
JEFF: That is all the questions so far. Does anybody else have any other questions?
At this time, if anyone would like to ask a question, I will unmute the mic.
Okay. I think that is about it.
We thank everybody for attending this webinar on health United States.
Again, if you have any questions you think of later or any follow-up, please contact
us at that email address again
paoquery@cdc.gov, thanks very much for joining us today.