National health statistics reports最新文献

Background: Since 1972, low-density lipoprotein cholesterol (LDL-C) has been calculated by the Friedewald equation, which estimates very low-density lipoprotein cholesterol as triglycerides divided by 5 and is accurate only for triglycerides <400 mg/dL. The Martin equation, published in 2013 (for triglycerides <400 mg/dL), replaced 5 with a factor varying over an array of non-high-density lipoprotein cholesterol and triglyceride levels. This array was extended in 2021 for triglycerides 400-<800 mg/dL. In 2020, the Sampson equation, accurate for triglycerides <800 mg/dL, was developed using multiple least squares regression. This report compares LDL-C as calculated by the Friedewald, Martin, and Sampson equations in a nationally representative sample of adults with triglycerides <400 mg/dL across the distribution of clinical cut points for LDL-C (<70 mg/dL, 70-<100 mg/dL, 100-<160 mg/dL, 160-<190 mg/dL, and ≥190 mg/dL) to assess the impact of equation choice on national estimates.

Methods: Using data on 4,461 adults in the 2015-2018 National Health and Nutrition Examination Survey, classification agreement into the LDL-C categories used for clinical management across the three equations was assessed using kappa statistics for men and women overall and by demographic subgroups. A sensitivity analysis assessed classification agreement between the Martin and Sampson equations for adults with triglycerides <800 mg/dL.

Results: During 2015-2018, 9.8%-10.0% of adults age 20 and older had LDL-C levels <70 mg/dL (Friedewald: 10.0%, Martin: 9.8%, Sampson: 9.8%). Less than 3% had LDL-C >190 mg/dL (Friedewald: 2.3%, Martin: 2.4%, Sampson: 2.6%). Very good agreement between the equations was seen in all subgroups (kappa >0.8).

Conclusions: The three equations for LDL-C produce similar U.S. population-level percent distributions for adults age 20 and older across LDL-C categories.

Objective: This report examines selected measures of healthcare use among teenagers ages 12-17 by parent- or self-report. Agreement between parent-reported and teen self-reported data is also evaluated.

Methods: The percentage of teenagers with doctor visits, wellness visits, having a usual place of care, having a personal doctor or nurse, and having time alone with a doctor were estimated using teen-reported data from the National Health Interview Survey-Teen collected from July 2021 through December 2023. These estimates were compared with parent-reported estimates from the same time period using data from the National Health Interview Survey. Cohen's kappa and prevalence-adjusted, bias-adjusted kappa (PABAK) values were used to evaluate agreement between parent and teen responses.

Results: Across all measures, parents reported higher healthcare use for their teenagers than teenagers reported for themselves (for example, 91.4% of parents reported a doctor's visit in the last 12 months compared with 83.0% of teenagers). Cohen's kappa values across measures showed fair to slight agreement, with PABAK values showing slightly higher agreement, ranging from slight to substantial. Percentage agreement patterns were most often driven by both parent and teenager affirming healthcare use indicators, except for having time alone with a doctor, which was driven slightly more by the parent and teenager both reporting the teenager had not received this service. Disagreement patterns were driven by parents affirming services the teenager did not; disagreement was highest for having a personal doctor or nurse and time alone with a doctor.

Objectives: This report presents national estimates of difficulties in functioning for children ages 2-17.

Methods: 2021-2023 National Health Interview Survey (NHIS) data were used to assess difficulties in functioning among children. NHIS has included the Child Functioning Module, developed jointly by UNICEF and the Washington Group on Disability Statistics, since 2019. The module's questions ask about difficulties in the following functional domains: seeing, hearing, walking, communication, behavior, and learning (for all children ages 2-17); fine motor and playing (for children ages 2-4); and self-care, remembering, concentrating, coping with change, relationships, and affect (anxiety and depression) (for children ages 5-17). Prevalence estimates were calculated for different levels of difficulty (a lot of difficulty, some difficulty, or no difficulty) and are presented for overall functioning, by individual functional domain, and by number of functional domains where difficulties were reported. Differences in functioning by age, sex, race and Hispanic origin, urbanization level, and family income are also presented.

Results: In 2021-2023, about one-quarter (24.9%) of children ages 2-4 experienced difficulties in functioning (4.1% experienced a lot of difficulty in one or more domains and 20.8% experienced some difficulty). Among children ages 5-17, just over one-half (50.8%) experienced functioning difficulties (13.0% experienced a lot of difficulty and 37.8% experienced some difficulty). The prevalence of functioning difficulties varied by sex, with boys being more likely than girls to experience a lot of difficulty in at least one domain, but differences across other characteristics varied. Functioning difficulties were most prevalent in the domains of communication, learning, behavior, and playing among children ages 2-4. For those ages 5-17, the most prevalent domains were anxiety, accepting change, behavior, depression, and making friends. Among children who experienced functioning difficulties, most had difficulty in only one functional domain.

Introduction: Personal care aides (aides) are a key part of the long-term care infrastructure and provide hands-on care and support with essential activities of daily living to older and disabled Americans. This report presents the number of aides employed in adult day services centers (ADSC) and residential care communities (RCC), the hours they spend with their service users, and their training and benefits.

Methods: Data are from the ADSC and RCC provider components of the 2022 National Post-acute and Long-term Care Study, conducted biennially by the National Center for Health Statistics. The study includes several questions on staffing, including about the number of registered nurses (RNs), licensed practical nurses (LPNs) or licensed vocational nurses (LVNs), and aides employed directly by ADSCs and RCCs. Full-time equivalent (FTE) staff is based on the number of full-time and part-time employees. A measure of hours per user (participant or resident) per day was used to compare staffing levels in the two settings relative to the number of users. Responses to questions on number of hours of training required and types of training and benefits offered to aides were used to compare in and across ADSC and RCC settings.

Results: Of the 15,600 nursing (RN, LPN or LVN, and aide) FTEs employed in ADSCs and 452,000 employed in RCCs, the majority were aides (63.2% and 76.0%, respectively). Both settings often employed at least one aide (56.2% and 75.6%). The average total of all nursing staffing hours per participant or resident per day was 1 hour and 34 minutes for ADSCs and 4 hours and 25 minutes for RCCs. A lower percentage of ADSCs than RCCs offered training in dementia care (50.8% and 72.3%) and end-of-life issues (19.7% and 58.4%).

Objective: This report presents national estimates of visits to health centers in the United States in 2023. Estimates are presented for selected characteristics and compared by age, sex, and race and ethnicity.

Methods: Estimates were calculated from the 2023 National Ambulatory Medical Care Survey Health Center Component. Data were collected from federally qualified health centers (FQHCs) and health center program look-alikes, which meet federal requirements but do not receive federal funding. Data were weighted to produce nationally representative estimates of visits to health centers in all 50 U.S. states and the District of Columbia.

Results: During 2023, an estimated 119.9 million visits were made to health centers in the United States, an overall rate of 363.2 visits per 1,000 people. The visit rate among females (450.5) was higher than for males (272.4). Visit rates were highest for Hispanic people (767.7) compared with White non-Hispanic (subsequently, White) (167.1), Black non-Hispanic (subsequently, Black) (391.5), and non-Hispanic people of other races (192.4). Differences in visit rates by age were not statistically significant. Diseases accounted for about one-half of health center visits (53.8%), and symptoms and signs accounted for 22.0% of visits. Examinations (12.7%) and screenings (10.2%) were also frequent reasons for health center visits. Endocrine diseases represented the most frequently mentioned disease category at health center visits (24.5%), overall and among adults age 45 and older. For visits by adults ages 18-44, mental health disorders represented the most common disease category (20.3%). Among visits by children and adolescents age 17 and younger, respiratory diseases (14.8%) and mental health disorders (12.9%) were the most common disease categories.

Conclusions: Females visited health centers at a higher rate than males. Hispanic and Black people visited health centers at a higher rate than White people. Visit characteristics differed by age.

Objective: This report provides a comprehensive look at enrollment in high-deductible health plans (HDHP), including consumer-directed health plans (CDHP) among privately insured people younger than age 65.

Methods: Data from the 2019 through 2023 National Health Interview Survey were used to examine enrollment in HDHPs and CDHPs among people younger than age 65 with private health insurance. CDHPs are HDHPs with an associated health savings account or health reimbursement account. All estimates are presented by sex, age group, race and Hispanic origin, family income, family educational attainment, level of urbanization, and source of private coverage.

Results: In 2023, among privately insured people younger than age 65, 41.7% were enrolled in an HDHP. Enrollment increased from 40.3% in 2019 to 43.3% in 2021, followed by a decrease to 41.7% in 2023. Among people with employment-based coverage, enrollment in an HDHP increased from 40.2% in 2019 to 43.4% in 2021, followed by a decrease to 41.9% in 2023. For people with directly purchased coverage, enrollment in an HDHP increased from 44.3% in 2019 to 47.0% in 2020, followed by a decrease to 43.1% in 2023. Generally, White non-Hispanic people were the most likely to be enrolled in an HDHP. Black non-Hispanic and Hispanic people were the least likely to be enrolled in an HDHP. Enrollment in an HDHP increased with family income and family educational attainment. In 2023, 19.5% of people younger than age 65 with private health insurance were enrolled in a CDHP. Enrollment characteristics of people with CDHPs mirrored those of people with HDHPs overall. However, children were more likely to be enrolled in an CDHP plan than adults ages 18-64. People with employment-based coverage were nearly four times more likely to be enrolled in a CDHP than their counterparts with directly purchased coverage.

Objective: This report presents national estimates of the percentage of adults age 65 and older who met the federal physical activity guidelines for both aerobic and muscle-strengthening activities during leisure time by sociodemographic and health-related characteristics.

Methods: Data from the 2022 National Health Interview Survey were used to estimate the percentage of adults age 65 and older who met the U.S. Department of Health and Human Services 2018 Federal Physical Activity Guidelines for Americans for both aerobic and muscle-strengthening activities during leisure time. Adults were considered to have met the guidelines if they met both aerobic and muscle-strengthening recommendations. Estimates are presented by age group, sex, race and Hispanic origin, education, family income, urbanization level, respondent-assessed health status, chronic conditions, disability status, severity of depression symptoms, severity of anxiety symptoms, and body mass index.

Results: Overall, 13.9% (age adjusted) of adults age 65 and older met federal physical activity guidelines for both aerobic and muscle-strengthening activities in 2022. Differences were seen by several sociodemographic characteristics. Men (16.9%), White non-Hispanic adults (15.2%), and those living in metropolitan areas (14.7%) were more likely to meet the guidelines. The percentage meeting the federal physical activity guidelines increased with increasing education level and family income and decreased with number of chronic conditions. Older adults who reported poor health status had the lowest percentage meeting the guidelines compared with those reporting good, very good, or excellent health. Older adults without disabilities were three times more likely to meet the federal physical activity guidelines than adults with disabilities (15.9% compared with 5.0%, respectively). Older adults with no depression or anxiety symptoms were more likely to meet the guidelines than those with mild symptoms or moderate or severe symptoms.

Objective: This report examines the prevalence of symptoms of anxiety and depression among adults by sociodemographic and geographic characteristics, and how those may have changed between 2019 and 2022.

Methods: Data from the 2022 National Health Interview Survey were used to examine the prevalence of symptoms of anxiety, using the Generalized Anxiety Disorder scale (GAD-7), and symptoms of depression, using the Patient Health Questionnaire depression scale (PHQ-8).

Results: During 2022, about one in five adults age 18 and older experienced any symptoms of anxiety (18.2%) or symptoms of depression (21.4%) in the past 2 weeks. The severity of symptoms differed by sociodemographic and geographic characteristics. The percentages of adults with mild, moderate, or severe symptoms of both anxiety and depression were highest among adults ages 18-29 and decreased with age and were higher among women than men. Asian non-Hispanic adults were least likely to experience moderate and severe symptoms of anxiety and depression compared with the other race and Hispanic-origin groups examined. In addition, the percentage of adults with any symptoms of anxiety and depression was highest among those with less than a high school education and with family incomes less than 100% of the federal poverty level and was higher among those living in rural areas. A significant increase was seen in the percentage of adults with anxiety symptoms (from 15.6% to 18.2%, respectively) and depression symptoms (from 18.5% to 21.4%, respectively) between 2019 and 2022. Increases in symptoms of anxiety and depression were seen throughout the subgroups examined, including adults ages 18-44, Black non-Hispanic and White non-Hispanic adults, adults with a high school education or more, and adults with family incomes of 100% of the federal poverty level or higher, as well as adults from all regions and urbanization levels.

Objective: This report describes care received at health centers in the United States in 2022. Estimates are presented for selected characteristics.

Methods: The data presented in this report are from the 2022 National Ambulatory Medical Care Survey Health Center Component. Data were collected from federally qualified health centers and federally qualified health center look-alikes and weighted to produce nationally representative estimates of visits to health centers from all 50 U.S. states and the District of Columbia.

Results: During 2022, an estimated 89.5 million visits were made by adults to health centers in the United States, an overall rate of 349.4 visits per 1,000 adults. The visit rate among women was higher than for men. Differences in visit rates by age were not significant. Adults who were not married accounted for 48.2% of visits, and adults who were married accounted for 37.6% of visits. More than one-half of health center visits were disease-related (61.4%). Symptoms-related diagnoses accounted for 22.0% of visits. Screenings (12.6%) and examinations (10.2%) were also frequent reasons for health center visits. Social determinants of health were listed as a reason for the visit at 2.0% of health center visits. Endocrine diseases represented the most frequently mentioned disease category (29.1%), overall and among adults age 45 and older. Mental disorders represented the most common disease category among adults ages 18-44.

Conclusions: Women visited health centers at a higher rate than men. In addition, patient and visit characteristics, including marital status and diagnoses, differed by age.

Objective: This report describes differences in the experience of family food insecurity in the past 30 days among working adults ages 18-64 by selected work conditions.

Methods: Using data from the 2021 National Health Interview Survey on working adults ages 18-64, family food insecurity in the past 30 days was examined by selected work conditions, including type of work shift, work schedule inflexibilities, advance notice of work schedule, and monthly change in earnings. Bivariate associations between family food insecurity and each type of work condition were examined, and logistic regression models were used to estimate associations adjusting for age, sex, race and Hispanic origin, nativity status, marital status, presence of children in family, educational attainment, family income as a percentage of the federal poverty level, employed full time, occupation, health status, disability status, rural residence, and region. Model-adjusted prevalence of family food insecurity among working adults by type of work conditions is reported.

Results: In 2021, 4.4% of working adults ages 18-64 lived in families experiencing food insecurity. Differences in family food insecurity by work conditions persisted even after adjusting for potential confounders. After adjustment, those working rotating or other types of shifts were more likely to report family food insecurity (5.7%) compared with day shift workers (4.0%). Workers who reported that it was very difficult or somewhat difficult to change their work schedule were more likely to experience family food insecurity (6.3%) than workers who reported it was very easy or somewhat easy to change their work schedule (3.8%). Food insecurity also varied by monthly change in earnings, from 3.9% among workers whose earnings did not change to 5.5% among workers whose earnings changed at least a moderate amount from month to month.