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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.