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  • 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.