Leading Health Indicators: Data Trends and Disparities
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Transcript of Leading Health Indicators: Data Trends and Disparities
Leading Health Indicators: Data Trends and Disparities
Richard J. Klein, MPHSuzanne E. Proctor, MSPH
National Center for Health StatisticsCenters for Disease Control and Prevention
Physical ActivityModerate physical activity in adultsVigorous physical activity in adolescents Overweight and ObesityObesity in adults Overweight/obesity in children/adolescents
Tobacco Use Cigarette smoking by adults Cigarette smoking by adolescents
Substance Abuse Alcohol and illicit drug use by adolescentsIllicit drug use by adults Binge drinking by adults
Responsible Sexual Behavior Abstinence or condom use by adolescents Condom use by adults Gonorrhea infections*
Mental HealthTreatment of adults with recognized depressionSuicides*
Injury and ViolenceDeaths from motor vehicle crashes Homicides
Environmental QualityOzone pollution exposureEnvironmental tobacco smoke exposureChildren exposed to tobacco smoke at home*Pediatric asthma hospitalizations*
ImmunizationFully immunized children aged 19-35 monthsInfluenza vaccination in high-risk adults Pneumococcal vaccination in high-risk adults
Access to CarePersons with health insuranceSource of ongoing care Early prenatal care * Supplemental measure
Leading Health Indicators and Measures
Data sources for the LHI measures
Same national and State source: Number of measures
National Vital Statistics System 4National Household Survey on Drug Abuse 4Youth Risk Behavior Surveillance System 3Aerometric Information Retrieval System 1Healthcare Cost and Utilization Project 1National Immunization Survey 1 STD Surveillance System 1
Behavioral Risk Factor Surveillance System (State) and different national source:
National Health Interview Survey 7National Health and Nutrition Examination Survey 2National Survey of Family Growth 1
National data source only:
National Health and Nutrition Examination Survey 1
Physical Activity
Adults and adolescents engaging in physical activity
* Adolescents: Students in grades 9 to 12 participating in activity that makes them sweat and breathe hard (at least 20 minutes, 3 or more days per week).
** Adults: Persons aged 18 years and over participating in moderate activity (at least 30 minutes, 5 days per week) and/or vigorous activity
(at least 20 minutes, 3 days per week). Data for adults are age-adjusted to the 2000 standard population. Data for 2001 are preliminary.
Sources: National Health Interview Survey, CDC, NCHS (adults) and Youth Risk Behavior Surveillance System, CDC, NCCDPHP (adolescents).
0
20
40
60
80
100
1993 1995 1997 1999 2001
2010 target
Adolescents*
2010 target
Adults**
Per
cen
t
Adults engaging in physical activity, by gender and education, 2000
Female
Male
Some college
High school graduate
Grades 9-11
Less than 9th grade
College graduate
All adults
42
32
27
19
14
35
28
32
0 10 20 30 40 50
Age-adjusted percent
2010 target
I 95% Confidence Interval.
Notes: Physical activity is defined as moderate activity (at least 30 minutes, 5 days per week) and/or vigorous activity (at least 20 minutes, 3 days per week).
Gender data are for persons 18 years and over. Education data are for persons 25 and over. Data are age adjusted to the 2000 standard population.
Source: National Health Interview Survey, CDC, NCHS.
Summary
Physical activity remained steady during the past decade
Males are significantly more likely to exercise than females
Adults with more education are more likely to exercise
Adolescents living in the South are the least likely to exercise
Overweight and Obesity
Obesity in adults aged 20 years and over,by race/ethnicity
All adults Mexican American*
Black, notHispanic
White, notHispanic
23
31 30
34
22
29 2934
0
10
20
30
40
50
1988 - 1994 1999 - 2000
Ag
e-a
dju
ste
d p
erce
nt
I 95% Confidence Interval
* Can be of any race.
Notes: Obesity is defined as Body Mass Index (BMI) > 30. Data are age-adjusted to the 2000 standard population.
Source: National Health and Nutrition Examination Survey, CDC, NCHS.
2010 target
Overweight in youth aged 6-19 years, by race/ethnicity
All youth Mexican American*
Black, notHispanic
White, notHispanic
11
15 14
22
10 12
15
24
0
10
20
30
40
1988 – 1994 1999 - 2000
Per
cen
t
I 95% Confidence Interval
* Can be of any race.
Note: Overweight is defined as at or above the age- and gender-specific 95th percentile of BMI. Confidence intervals for 1988-1994 are estimated.
Source: National Health and Nutrition Examination Survey, CDC, NCHS.
2010 target
Obesity in adults, 1999
18.721.5
30.5
0
5
10
15
20
25
30
35
Age-adjusted percent
BRFSS NHIS NHANES*
* NHANES data are for 1999-2000.
I 95% Confidence Interval.
Notes: Obesity is defined as Body Mass Index (BMI) > 30. Data are for persons 20 years and over. Data are age adjusted to the 2000 standard population.
Sources: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP; National Health Interview Survey (NHIS),CDC, NCHS; National Health and Nutrition Examination
Survey (NHANES),CDC, NCHS.
Mode of administration affects estimate of obesity obtained from different surveys
Self-reported data underestimate the measured prevalence of obesity Telephone
survey
In-personinterview
In-personexamination
Summary
Overweight/obesity is increasing for all ages
The increase is observed for all race/ethnic groups
Adult females are more likely to be obese than adult males
Overweight/obesity is highest among Black and Mexican-Americans
Tobacco Use
Cigarette smoking by adults and adolescents
0
10
20
30
40
1991 1993 1995 1997 1999 2001
2010 target
Adolescents*
2010 target
Adults**
* Adolescents: Students in grades 9 to 12 who reported smoking cigarettes on 1 or more of the 30 days preceding the survey.
** Adults: Persons aged 18 years and over who have smoked at least 100 cigarettes in lifetime and who now smoke every day or some days. Data are age-adjusted to the 2000 standard population. Data for 2001 are preliminary.
Sources: National Health Interview Survey, CDC, NCHS (adults). Youth Risk Behavior Surveillance System, CDC, NCCDPHP (adolescents, all years except 2000) and National Youth Tobacco Survey, CDC, OSH (adolescents, 2000).
Per
cen
t
Cigarette smoking by adults 18 years and over,by race/ethnicity and gender, 2000
All ad
ults
Hispan
ic*
Black
,
not His
panic W
hite,
not His
panic
23
33
15
2325
1821
25
0
10
20
30
40
50
Ag
e-a
dju
ste
d p
erce
nt
2010 target
I 95% Confidence Interval.
Notes: Smoking is defined as having at least 100 cigarettes in lifetime and now smoking every day or some days.
Data are age-adjusted to the 2000 standard population.
Source: National Health Interview Survey, CDC, NCHS.
* Can be of any race
Asian
or
Pacifi
c Is
lander
Femal
eM
ale
Amer
ican
India
n
or Ala
ska
Nativ
e
Cigarette smoking by adolescents in grades 9 to 12, 2001
Notes: Smoking is defined as having cigarettes on 1 or more of the 30 days preceding the survey.
Data are for all reporting States (weighted and unweighted data included).
Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP.
29.8 – 38.5 25.3 – 29.7 8.3 – 25.2 No data
Percent N
(14)(15)(15) (7)
Summary
Adult cigarette smoking has changed little during the past decade
American Indian and Alaska Native adults are the most likely to smoke
Adolescent cigarette smoking is on the decline
White adolescents are the most likely to smoke
Substance Abuse
Binge drinking by adults 18 years and over, by race/ethnicity, 2000
24.6
18.9
22.2
19.7
12.5
28.3
30.5
13.9
21.8
0 5 10 15 20 25 30 35 40
Percent* Can be of any race.
Note: Binge drinking is defined as having 5 or more drinks at once in the 30 days prior to the survey.
Source: National Household Survey on Drug Abuse, SAMHSA.
2010 target
Asian only
American Indian/Alaska Native only
Black only
White only
Female
Male
More than one race
All adults
Hispanic*
Illicit drug use in the past month byadolescents aged 12-17 years, 1999
Note: Illicit drug use is defined as using at least one of the following substances in the past month: marijuana or hashish, cocaine, inhalants, hallucinogens, heroin, or any nonmedical use of analgesics, tranquilizers, stimulants, or sedatives.Source: National Household Survey on Drug Abuse, SAMHSA.
10.8 – 16.5 9.4 – 10.7 7.4 – 9.2
Percent N
(17)(17)(17)
Summary
Alcohol abuse is increasing among adults and decreasing among adolescents
Drug use among has remained steady for both groups
Adult males are more than twice as likely to binge drink than adult females
American Indian/Alaska Native adults are the most likely to binge drink
Responsible Sexual Behavior
Responsible sexual behavior by adolescents in grades 9 - 12
Per
cen
t
0
20
40
60
80
100
1991 1993 1995 1997 1999 2001
Abstain or use condoms
Used condom at last intercourse
Never had intercourse
No intercourse in past 3 months
Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP.
Gonorrhea incidence, by age and race/ethnicity, 2000
* Can be of any raceSource: Sexually Transmitted Diseases Surveillance System, CDC, NCHSTP.
SupplementalMeasure
28
827
30
114
80
230
78
563
132
0 100 200 300 400 500 600 700 800 900
New cases per 100,000 population
2010 target = 19
Black, not Hispanic
Asian or Pacific Islander
American Indian/Alaska Native
35-44 years
15-24 years
25-34 years
All persons
White, not Hispanic
Hispanic*
Summary
Adolescents abstaining from sexual intercourse or using condoms is increasing
Nearly 3 times as many adolescents have never had intercourse as those who have
No significant differences in responsible sexual behavior among adolescent race/ethnic groups
Responsible sexual behavior decreases with each grade
Mental Health
Suicide rates, by race/ethnicity, 2000
All per
sons
Amer
ican
India
n or
Alask
a Nat
ive
Asian
or
Pacifi
c Is
lander
10.6
12.0
5.8 5.8
12.1
6.1
0
5
10
15
2010 target
* Can be of any race.Note: Data are age adjusted to the 2000 standard population.
Source: National Vital Statistics System - Mortality, CDC, NCHS.
Hispan
ic*
Black
,
not His
panic
White
,
not His
panic
Ag
e-a
dju
ste
d r
ate
per
10
0,0
00
stan
dar
d p
op
ula
tio
n
SupplementalMeasure
Suicide rates, 2000
Note: Rates are age adjusted to the 2000 standard population.
Source: National Vital Statistics System - Mortality, CDC, NCHS
13.0 – 21.7 10.7 – 12.9 4.4 – 10.6
Age-adjusted rate per 100,000 N
(17)(17)(17)
Summary
Whites and American Indians/Alaska Natives are twice as likely to commit suicide as other groups
Males are almost 5 times as likely to commit suicide than females
Suicide rates are highest in Western States
Injury and Violence
0
5
10
15
20
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Motor vehicle crash deaths
Motor vehicle crash deaths and homicides
Homicides
Note: Data are age adjusted to the 2000 standard population.
Source: National Vital Statistics System - Mortality, CDC, NCHS.
Ag
e-a
dju
ste
d r
ate
per
10
0,0
00
stan
dar
d p
op
ula
tio
n
2010 target
2010 target
Homicide rates, 2000*
* Data for ME, NH, and SD are for 1999.
** Data are suppressed. Too few homicides occurred in ND, VT, and WY to report reliable rates.
Note: Rates are age adjusted to the 2000 standard population.
Source: National Vital Statistics System - Mortality, CDC, NCHS
7.2 – 36.2 4.0 – 6.4 2.0 – 3.8 DSU**
Age-adjusted rate per 100,000 N
(16)(16)(16) (3)
Summary
Motor vehicle crash deaths and homicides decreased during the past decade
Males and those with less education are more likely to die from both causes
American Indians/Alaska Natives are 2 times as likely to die in a motor vehicle crash as other groups
Blacks are much more likely to die from homicide than other groups
Homicide rates are highest in the South and Southwest
Environmental Quality
Young children exposed to tobacco smoke at home, by race/ethnicity and family income level, 1998
20
2722
11
34
26
14
0
10
20
30
40
50
Per
cen
t
2010 target
I 95% Confidence Interval.
Notes: Data are for children aged 6 years and under. Exposure to tobacco smoke at home is defined as living in a household
where a resident smokes inside the home at least 4 days per week. Data for American Indian or Alaska Natives and
Asian or Pacific Islanders are statistically unreliable and are not shown. Data are age-adjusted to the 2000 standard population.
Source: National Health Interview Survey, CDC, NCHS.
* Can be of any race
All children Hispanic*Black, not
Hispanic
White, not
Hispanic
Near poor Middle/ high
Poor
SupplementalMeasure
Summary
Percent of persons exposed to ozone pollution has not changed significantly during the past 4 years
Asians are the most likely to be exposed to ozone pollution
25 States have already met the Healthy People 2010 target for ozone exposure
Black children and children with low income are the most likely to be exposed to tobacco smoke at home
Immunization
Influenza and pneumococcal vaccination among adults aged 65 and over
0
10
20
30
40
50
60
70
80
90
1989 1991 1993 1995 1997 1999 2001
Notes: Data are age adjusted to the 2000 standard population. Data for 2001 are preliminary.
Source: National Health Interview Survey (NHIS), CDC, NCHS.
* Received within the past 12 months.** Ever received.
2010 target
Influenza*
Pneumococcal**
Ag
e-a
dju
ste
d p
erce
nt
Fully immunized children aged 19 to 35 months, 2001
Notes: Fully immunized children are those receiving at least 4 doses of DTaP, 3 doses of Polio, 1 dose of MMR, 3 doses of
Hib, and 3 doses of Hepatitis B antigens.
Source: National Immunization Survey, CDC, NIP and NCHS.
63 – 71 72 – 77 78 – 82
Age-adjusted percent N
(17)(17)(17)
Summary
Percent of older adults receiving influenza and pneumococcal vaccinations increased during the 1990s but has plateaued in recent years
Blacks are the least likely of any race/ethnic group to receive either vaccination
Vaccination rates for children are lowest in the Southwest and Pacific Northwest
Access to Care
50
60
70
80
90
100
1997 1998 1999 2000 2001
0
Persons under age 65 with health insurance, by race/ethnicity, 2000
Ag
e-a
dju
ste
d p
erce
nt White, not Hispanic
All persons
Black, not Hispanic
Source: National Health Interview Survey, CDC, NCHS.
* Can be of any race.
Hispanic *
Native Hawaiian/Other Pacific Islander
Asian
American Indian or Alaska Native
2010 target
Summary
Health insurance coverage has not increased substantially during the past 4 years
Hispanics are among the least likely to have access to care for all measures
American Indians/Alaska Natives are least likely to have health insurance but most likely to have a usual source of care
Prenatal care in the first trimester is lowest in the Southwest
Resources
Healthy People 2010 Statistical Workshopfor Regional, State, and Local Health Staff
Mortality data Age adjustmentLife tablesHospital discharge statisticsState dataRace and ethnicity classificationMeasuring health disparities
Variability Small area estimationBasic epidemiologic methodsTarget-setting methodsSoftware for statistical analysisData availability via websites
For more information, contact:
Richard J. Klein, MPH [email protected]
Websites
DHHS Healthy People: www.health.gov/healthypeople
NCHS Healthy People: www.cdc.gov/nchs/healthypeople
DATA2010: www.wonder.cdc.gov/data2010