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Surveillance of Vaccination Coverage among Adult Populations - United States, 2015. 成人疫苗接种覆盖率监测——美国,2015年
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-05-05 DOI: 10.15585/mmwr.ss6611a1
Walter W Williams, Peng-Jun Lu, Alissa O'Halloran, David K Kim, Lisa A Grohskopf, Tamara Pilishvili, Tami H Skoff, Noele P Nelson, Rafael Harpaz, Lauri E Markowitz, Alfonso Rodriguez-Lainz, Amy Parker Fiebelkorn

Problem/condition: Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low.

Period covered: August 2014-June 2015 (for influenza vaccination) and January-December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination).

Description of system: The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors.

Results: Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013-14 season to 44.8%), pneumococcal vaccine among adults aged 19-64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19-64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19-64 years at increased risk), Td vaccine (adults aged ≥19 years, 19-64 years, and 50-64 years), Tdap vaccine (adults aged ≥19 years and 19-64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19-49 years, and among travelers), herpes zoster vaccine (adult

问题/状况:总体而言,可由疫苗预防的疾病引起的疾病在成人中的发病率高于儿童。建议成年人根据他们的年龄、潜在的医疗状况、生活方式、之前的疫苗接种和其他考虑因素接种疫苗。CDC的最新疫苗接种建议每年在美国成人免疫计划中公布。尽管长期以来建议使用许多疫苗,但美国成年人的疫苗接种覆盖率很低。涵盖期间:2014年8月至2015年6月(流感疫苗)和2015年1月至12月(肺炎球菌、破伤风和白喉[Td]、破伤风和白喉合并无细胞百日咳[Tdap]、甲型肝炎、乙型肝炎、带状疱疹和人乳头瘤病毒[HPV]疫苗)。系统描述:全国健康访谈调查(NHIS)是一个连续的,横断面的美国非机构平民人口的全国家庭调查。全年在家庭概率样本中进行面对面访谈,并每年汇编和发布NHIS数据。调查的目的是监测美国人口的健康状况,并提供健康指标、医疗保健使用和获取以及健康相关行为的估计。结果:与2014年NHIS的数据相比,≥19岁成人的流感疫苗接种覆盖率增加(与2013-14季节相比增加1.6个百分点至44.8%),肺炎球菌疫苗在肺炎球菌疾病风险增加的19-64岁成人中的接种覆盖率增加(增加2.8个百分点至23.0%),Tdap疫苗在≥19岁成人和19-64岁成人中的接种覆盖率分别增加3.1个百分点和3.3个百分点至23.1%和24.7%。≥60岁和≥65岁成人接种带状疱疹疫苗(分别增加2.7个百分点和3.2个百分点,达到30.6%和34.2%),≥19岁卫生保健人员(HCP)接种乙肝疫苗(增加4.1个百分点,达到64.7%)。2015年带状疱疹疫苗接种覆盖率达到了“健康人2020”目标的30%。除了这些适度改善之外,2015年成人疫苗接种覆盖率与2014年的估计数字相似。所有七种疫苗的覆盖率存在种族/族裔差异,与大多数其他群体相比,白人的覆盖率普遍较高。无健康保险的成年人报告接种了流感疫苗(所有年龄组)、肺炎球菌疫苗(19-64岁风险增加的成年人)、Td疫苗(年龄≥19岁、19-64岁和50-64岁的成年人)、百日咳疫苗(年龄≥19岁和19-64岁的成年人)、甲型肝炎疫苗(年龄≥19岁的成年人和旅行者)、乙型肝炎疫苗(年龄≥19岁、19-49岁的成年人和旅行者)、带状疱疹疫苗(年龄≥60岁的成年人)。19-26岁的男性和女性接种HPV疫苗的频率低于有健康保险的人。无论是否有健康保险,报告有常规医疗场所的成年人通常比没有此类场所的成年人更常报告接受推荐的疫苗接种。无论是否有健康保险,在过去一年中与医生接触过一次或多次的成年人中,疫苗接种覆盖率高于在过去一年中没有看过医生的成年人。即使在过去一年内有医疗保险并与医生接触≥10次的成年人中(取决于疫苗),18.2%-85.6%的人也报告没有接种推荐给所有人或有特定适应症的人的疫苗。总体而言,美国出生的成年人的疫苗接种覆盖率高于外国出生的成年人,只有少数例外(流感疫苗接种[19-49岁和50-64岁的成年人],甲型肝炎疫苗接种[年龄≥19岁的成年人],乙型肝炎疫苗接种[年龄≥19岁的糖尿病或慢性肝病成年人])。解释:成人所有疫苗的覆盖率仍然很低,但流感(成人≥19岁)、肺炎球菌(成人19-64岁风险增加)、百白破(成人≥19岁和成人19-64岁)、带状疱疹(成人≥60岁和≥65岁)和乙型肝炎(HCP年龄≥19岁)的疫苗接种覆盖率略有增加;其他疫苗和有接种指征的人群的覆盖率没有提高。实现了2020年30%健康人接种带状疱疹疫苗的目标。对于常规推荐的成人疫苗,种族/民族差异仍然存在。错过接种疫苗的机会仍然存在。虽然拥有健康保险和通常的保健地点与较高的疫苗接种覆盖率有关,但仅凭这些因素与最佳的成人疫苗接种覆盖率无关。
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引用次数: 391
Diabetes Self-Management Education Programs in Nonmetropolitan Counties - United States, 2016. 糖尿病自我管理教育计划在非大都市县-美国,2016年。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-04-28 DOI: 10.15585/mmwr.ss6610a1
Stephanie A Rutledge, Svetlana Masalovich, Rachel J Blacher, Magon M Saunders
<p><strong>Problem/condition: </strong>Diabetes self-management education (DSME) is a clinical practice intended to improve preventive practices and behaviors with a focus on decision-making, problem-solving, and self-care. The distribution and correlates of established DSME programs in nonmetropolitan counties across the United States have not been previously described, nor have the characteristics of the nonmetropolitan counties with DSME programs.</p><p><strong>Reporting period: </strong>July 2016.</p><p><strong>Description of systems: </strong>DSME programs recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators (i.e., active programs) as of July 2016 were shared with CDC by both organizations. The U.S. Census Bureau's census geocoder was used to identify the county of each DSME program site using documented addresses. County characteristic data originated from the U.S. Census Bureau, compiled by the U.S. Department of Agriculture's Economic Research Service into the 2013 Atlas of Rural and Small-Town America data set. County levels of diagnosed diabetes prevalence and incidence, as well as the number of persons with diagnosed diabetes, were previously estimated by CDC. This report defined nonmetropolitan counties using the rural-urban continuum code from the 2013 Atlas of Rural and Small-Town America data set. This code included six nonmetropolitan categories of 1,976 urban and rural counties (62% of counties) adjacent to and nonadjacent to metropolitan counties.</p><p><strong>Results: </strong>In 2016, a total of 1,065 DSME programs were located in 38% of the 1,976 nonmetropolitan counties; 62% of nonmetropolitan counties did not have a DSME program. The total number of DSME programs for nonmetropolitan counties with at least one DSME program ranged from 1 to 8, with an average of 1.4 programs. After adjusting for county-level characteristics, the odds of a nonmetropolitan county having at least one DSME program increased as the percentage insured increased (adjusted odds ratio [AOR] = 1.10, 95% confidence interval [CI] = 1.08-1.13), the percentage with a high school education or less decreased (AOR = 1.06, 95% CI = 1.04-1.07), the unemployment rate decreased (AOR = 1.19, 95% CI = 1.11-1.23), and the natural logarithm of the number of persons with diabetes increased (AOR = 3.63, 95% CI = 3.15-4.19).</p><p><strong>Interpretation: </strong>In 2016, there were few DMSE programs in nonmetropolitan, socially disadvantaged counties in the United States. The number of persons with diabetes, percentage insured, percentage with a high school education or less, and the percentage unemployed were significantly associated with whether a DSME program was located in a nonmetropolitan county.</p><p><strong>Public health action: </strong>Monitoring the distribution of DSME programs at the county level provides insight needed to strategically address rural disparities in diabetes care and outcomes. The
问题/状况:糖尿病自我管理教育(DSME)是一种临床实践,旨在改善预防措施和行为,重点是决策,解决问题和自我保健。在美国非大都市县建立的DSME项目的分布和相关关系以前没有被描述过,也没有非大都市县的DSME项目的特征。报告期:2016年7月。系统描述:截至2016年7月,由美国糖尿病协会认可或由美国糖尿病教育者协会认可的DSME项目(即活跃项目)由两个组织与CDC共享。使用美国人口普查局的人口普查地理编码来确定每个DSME项目站点使用记录地址的县。县特征数据来自美国人口普查局,由美国农业部经济研究局汇编成2013年美国农村和小城镇地图集。各县诊断出的糖尿病患病率和发病率水平,以及诊断出糖尿病的人数,以前是由疾病预防控制中心估计的。本报告使用2013年美国农村和小城镇地图集中的农村-城市连续体代码定义了非大都市县。该代码包括六个非大都市类别,1976个城市和农村县(62%的县)与大都市县相邻或不相邻。结果:2016年,共有1,065个DSME项目位于1976个非大都市县的38%;62%的非大都市县没有DSME项目。非大都市县至少有一个DSME项目的DSME项目总数在1 ~ 8个之间,平均1.4个项目。在调整了县级特点,nonmetropolitan县有至少一个的几率DSME程序增加投保比例增加(调整优势比(AOR) = 1.10, 95%可信区间[CI] = 1.08 - -1.13),高中教育或更少的比例降低(优势比= 1.06,95% CI = 1.04 - -1.07),失业率下降(优势比= 1.19,95% CI = 1.11 - -1.23),和自然对数患有糖尿病的人的数量增加(优势比= 3.63,95% ci = 3.15-4.19)。解读:2016年,美国非大都市、社会弱势县的DMSE项目很少。糖尿病患者的数量、参保比例、高中以下教育程度的比例和失业比例与DSME项目是否位于非大都市县有显著关联。公共卫生行动:监测DSME项目在县一级的分布,为战略性地解决农村糖尿病护理和结果的差异提供了必要的见解。这些发现提供了必要的信息,以评估DSME项目的可用性,并探索以证据为基础的战略和创新技术,在服务不足的农村社区提供DSME项目。
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引用次数: 40
Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2-8 Years in Rural and Urban Areas - United States, 2011-2012. 与农村和城市地区2-8岁儿童的精神、行为和发育障碍相关的卫生保健、家庭和社区因素的差异——美国,2011-2012
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-03-17 DOI: 10.15585/mmwr.ss6608a1
Lara R Robinson, Joseph R Holbrook, Rebecca H Bitsko, Sophie A Hartwig, Jennifer W Kaminski, Reem M Ghandour, Georgina Peacock, Akilah Heggs, Coleen A Boyle
<p><strong>Problem/condition: </strong>Mental, behavioral, and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors, and less access to health resources.</p><p><strong>Reporting period: </strong>2011-2012.</p><p><strong>Description of system: </strong>The National Survey of Children's Health (NSCH) is a cross-sectional, random-digit-dial telephone survey of parents or guardians that collects information on noninstitutionalized children aged <18 years in the United States. Interviews included indicators of health and well-being, health care access, and family and community characteristics. Using data from the 2011-2012 NSCH, this report examines variations in health care, family, and community factors among children aged 2-8 years with and without MBDDs in rural and urban settings. Restricting the data to U.S. children aged 2-8 years with valid responses for child age and sex, each MBDD, and zip code resulted in an analytic sample of 34,535 children; MBDD diagnosis was determined by parent report and was not validated with health care providers or medical records.</p><p><strong>Results: </strong>A higher percentage of all children in small rural and large rural areas compared with all children in urban areas had parents who reported experiencing financial difficulties (i.e., difficulties meeting basic needs such as food and housing). Children in all rural areas more often lacked amenities and lived in a neighborhood in poor condition. However, a lower percentage of children in small rural and isolated areas had parents who reported living in an unsafe neighborhood, and children in isolated areas less often lived in a neighborhood lacking social support, less often lacked a medical home, and less often had a parent with fair or poor mental health. Across rural subtypes, approximately one in six young children had a parent-reported MBDD diagnosis. A higher prevalence was found among children in small rural areas (18.6%) than in urban areas (15.2%). In urban and the majority of rural subtypes, children with an MBDD more often lacked a medical home, had a parent with poor mental health, lived in families with financial difficulties, and lived in a neighborhood lacking physical and social resources than children without an MBDD within each of those community types. Only in urban areas did a higher percentage of children with MBDDs lack health insurance than children without MBDDs. After adjusting for race/ethnicity and poverty among children with MBDDs, those in rural areas more often had a parent with poor mental health and lived in resource-low neighborhoods than those in urban areas.</p><p><strong>Interpretation: </strong>Certain health care, family, and community disparities were more often reported among children with MBDDS than among children with
问题/状况:精神、行为和发育障碍(mbdd)始于儿童早期,往往影响终身健康和福祉。生活在农村地区的人报告的与健康有关的差距比城市地区的人更大,包括健康状况较差、健康风险行为较多、获得卫生资源的机会较少。报告期:2011-2012年。系统描述:全国儿童健康调查(NSCH)是一项针对父母或监护人的横断面随机数字拨号电话调查,收集非机构儿童的年龄信息。结果:与城市地区的所有儿童相比,小农村地区和大农村地区的所有儿童中有更高比例的父母报告有经济困难(即难以满足食物和住房等基本需求)。所有农村地区的儿童往往缺乏便利设施,生活在条件恶劣的社区。然而,在小农村和偏远地区,父母报告生活在不安全社区的儿童比例较低,而偏远地区的儿童较少生活在缺乏社会支持的社区,较少缺乏医疗之家,较少父母心理健康状况一般或较差。在农村亚型中,大约六分之一的幼儿有父母报告的MBDD诊断。小农村地区儿童的患病率(18.6%)高于城市地区(15.2%)。在城市和大多数农村亚型中,与没有MBDD的儿童相比,患有MBDD的儿童往往缺乏医疗之家,父母精神健康状况不佳,生活在经济困难的家庭中,生活在缺乏物质和社会资源的社区。只有在城市地区,mbdd儿童缺乏医疗保险的比例高于无mbdd儿童。在对mbdd儿童的种族/民族和贫困进行调整后,农村地区的儿童比城市地区的儿童更经常有一个心理健康状况不佳的父母,并且生活在资源匮乏的社区。解释:在农村和城市地区,有mbdd的儿童比无mbdd的儿童更常报告某些医疗保健、家庭和社区差异。公共卫生行动:可采用涉及卫生保健、家庭和社区服务及系统的合作来解决为mbdd儿童提供的零散服务和支持问题,无论他们生活在城市还是农村地区。然而,解决保健、家庭和社区因素方面的差异以及利用农村地区儿童的社区优势,为促进农村社区儿童的健康提供了机会。
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引用次数: 96
Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. 创伤性脑损伤相关的急诊就诊、住院和死亡人数 - 美国,2007 年和 2013 年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-03-17 DOI: 10.15585/mmwr.ss6609a1
Christopher A Taylor, Jeneita M Bell, Matthew J Breiding, Likang Xu
<p><strong>Problem/condition: </strong>Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007.</p><p><strong>Reporting period: </strong>2007 and 2013.</p><p><strong>Description of system: </strong>State-based administrative health care data were used to calculate estimates of TBI-related ED visits and hospitalizations by principal mechanism of injury, age group, sex, and injury intent. Categories of injury intent included unintentional (motor-vehicle crashes, falls, being struck by or against an object, mechanism unspecified), intentional (self-harm and assault/homicide), and undetermined intent. These health records come from the Healthcare Cost and Utilization Project's National Emergency Department Sample and National Inpatient Sample. TBI-related death analyses used CDC multiple-cause-of-death public-use data files, which contain death certificate data from all 50 states and the District of Columbia.</p><p><strong>Results: </strong>In 2013, a total of approximately 2.8 million TBI-related ED visits, hospitalizations, and deaths (TBI-EDHDs) occurred in the United States. This consisted of approximately 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths. TBIs were diagnosed in nearly 2.8 million (1.9%) of the approximately 149 million total injury- and noninjury-related EDHDs that occurred in the United States during 2013. Rates of TBI-EDHDs varied by age, with the highest rates observed among persons aged ≥75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7). Overall, males had higher age-adjusted rates of TBI-EDHDs (959.0) compared with females (810.8) and the most common principal mechanisms of injury for all age groups included falls (413.2, age-adjusted), being struck by or against an object (142.1, age-adjusted), and motor-vehicle crashes (121.7, age-adjusted). The age-adjusted rate of ED visits was higher in 2013 (787.1) versus 2007 (534.4), with fall-related TBIs among persons aged ≥75 years accounting for 17.9% of the increase in the number of TBI-related ED visits. The number and rate of TBI-related hospitalizations also increased among persons aged ≥75 years (from 356.9 in 2007 to 454.4 in 2013), primarily because of falls. Whereas motor-vehicle crashes were the leading cause of TBI-related deaths in 2007 in both number and rate, in 2013, intentional self-harm was the leading cause in number and rate. The overall age-adjusted rate of TBI-related deaths for all ages decreased from 17.9 in 2007 to 17.0 in 2013; however, age-adjusted TBI-related death rates attributable to
问题/条件:创伤性脑损伤(TBI)会造成短期和长期的不良临床后果,包括死亡和残疾。创伤性脑损伤可由多种主要机制引起,包括机动车碰撞、跌倒和攻击。本报告介绍了 2013 年与创伤性脑损伤相关的急诊就诊、住院和死亡的估计发生率,并与 2007 年的类似估计发生率进行了比较:使用基于州的行政医疗保健数据,按主要伤害机制、年龄组、性别和伤害意图计算与创伤性脑损伤相关的急诊室就诊和住院估计数。伤害意图类别包括无意伤害(机动车碰撞、跌倒、被物体击中或撞击、机制不明)、故意伤害(自残和攻击/他杀)以及意图不明。这些健康记录来自 "医疗成本与利用项目"(Healthcare Cost and Utilization Project)的 "全国急诊科样本 "和 "全国住院病人样本"。与创伤性脑损伤相关的死亡分析使用了疾病预防控制中心的多死因公共使用数据文件,其中包含来自美国 50 个州和哥伦比亚特区的死亡证明数据:2013年,美国共发生了约280万例与创伤性脑损伤相关的急诊就诊、住院和死亡病例(TBI-EDHDs)。其中包括约 250 万次与创伤性脑损伤相关的急诊就诊、约 28.2 万次与创伤性脑损伤相关的住院治疗以及约 5.6 万次与创伤性脑损伤相关的死亡。2013年期间,美国共发生了约1.49亿例与伤害和非伤害相关的急诊HD,其中近280万例(1.9%)被诊断为创伤性脑损伤。创伤性脑损伤-EDHD发病率因年龄而异,年龄≥75岁(每10万人中有2232.2人)、0-4岁(1591.5人)和15-24岁(1080.7人)的发病率最高。总体而言,与女性(810.8)相比,男性的创伤性脑损伤-急诊HD年龄调整率更高(959.0),所有年龄组最常见的主要受伤机制包括跌倒(413.2,年龄调整)、被物体击中或撞击(142.1,年龄调整)和机动车碰撞(121.7,年龄调整)。2013年(787.1人次)与2007年(534.4人次)相比,经年龄调整后的急诊室就诊率有所上升,其中≥75岁人群中与跌倒相关的创伤性脑损伤占创伤性脑损伤相关急诊室就诊人数增长的17.9%。与创伤性脑损伤相关的住院人数和住院率在年龄≥75 岁的人群中也有所增加(从 2007 年的 356.9 人增至 2013 年的 454.4 人),主要原因是跌倒。2007 年,机动车撞伤是造成创伤性脑损伤相关死亡的主要原因,无论是在人数还是在死亡率上都是如此,而在 2013 年,故意自残是造成创伤性脑损伤相关死亡的主要原因,无论是在人数还是在死亡率上都是如此。经年龄调整后,所有年龄段与创伤性脑损伤相关的总体死亡率从2007年的17.9下降到2013年的17.0;然而,经年龄调整后,与跌倒相关的创伤性脑损伤死亡率从2007年的3.8上升到2013年的4.5,其中主要是老年人。尽管机动车撞车导致的与创伤性脑损伤相关的年龄调整后死亡率从 2007 年的 5.0 降至 2013 年的 3.4,但机动车撞车导致的与创伤性脑损伤相关的年龄调整后急诊就诊率却从 2007 年的 83.8 上升至 2013 年的 99.5。机动车撞伤导致的与创伤性脑损伤相关的年龄调整后住院率从2007年的23.5降至2013年的18.8:在预防机动车撞车事故方面取得了进展,因此从 2007 年到 2013 年,与创伤性脑损伤相关的住院人数和死亡人数均有所下降。然而,在同一时期,老年人跌倒导致的创伤性脑损伤的数量和比例却大幅上升。虽然公众对青少年运动相关脑震荡的关注度很高,但本报告的研究结果表明,老年人跌倒导致的创伤性脑损伤(其中许多导致住院和死亡)应受到公共卫生的关注:公共卫生行动:老年人跌倒导致的创伤性脑损伤数量的增加表明,迫切需要加强对老年人群的跌倒预防工作。已确定了多种有效的干预措施,疾病预防控制中心已制定了 STEADI 计划(制止老年人意外死亡和伤害),作为一项综合战略,该战略结合了经验支持的临床指南和经过科学检验的干预措施,帮助初级保健提供者通过识别可改变的风险因素和实施有效的干预措施(如运动、药物管理和维生素 D 补充)来应对患者的跌倒风险。
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引用次数: 0
Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64 Years - Behavioral Risk Factor Surveillance System, United States, 2014. 18-64岁成年人医疗保健获取和医疗服务使用的监测-行为风险因素监测系统,美国,2014。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-02-24 DOI: 10.15585/mmwr.ss6607a1
Catherine A Okoro, Guixiang Zhao, Jared B Fox, Paul I Eke, Kurt J Greenlund, Machell Town
<p><strong>Problem/condition: </strong>As a result of the 2010 Patient Protection and Affordable Care Act, millions of U.S. adults attained health insurance coverage. However, millions of adults remain uninsured or underinsured. Compared with adults without barriers to health care, adults who lack health insurance coverage, have coverage gaps, or skip or delay care because of limited personal finances might face increased risk for poor physical and mental health and premature mortality.</p><p><strong>Period covered: </strong>2014.</p><p><strong>Description of system: </strong>The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18-64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module.</p><p><strong>Results: </strong>In 2014, health insurance coverage and other health care access measures varied substantially by state, state Medicaid expansion status, expanded geographic region (i.e., states categorized geographically into nine regions), and FPL category. The following proportions refer to the range of estimated prevalence for health insurance and other health care access measures by examined geographical unit (unless otherwise specified), as reported by respondents. Among adults with health insurance coverage, the range was 70.8%-94.5% for states, 78.8%-94.5% for Medicaid expansion states, 70.8%-89.1% for nonexpansion states, 73.3%-91.0% for expanded geographic regions, and 64.2%-95.8% for FPL categories. Among adults who had a usual source of health care, the range was 57.2%-86.6% for states, 57.2%-86.6% for Medicaid expansion states, 61.8%-83.9% for nonexpansion states, 64.4%-83.6% for expanded geographic regions, and 61.0%-81.6% for FPL categories. Among adu
问题/状况:根据2010年的《患者保护和平价医疗法案》,数百万美国成年人获得了医疗保险。然而,数以百万计的成年人仍然没有保险或保险不足。与没有保健障碍的成年人相比,缺乏健康保险、存在保险缺口或因个人财务有限而跳过或延迟护理的成年人可能面临更大的身心健康状况不佳和过早死亡的风险。涵盖时间:2014年。系统描述:行为风险因素监测系统(BRFSS)是一项正在进行的、基于州的、固定电话和移动电话的调查,调查对象是居住在美国的年龄≥18岁的非机构成年人。数据是从各州、哥伦比亚特区和参与调查的美国领土收集的,包括健康风险行为、慢性健康状况、医疗保健获取和临床预防服务(CPS)的使用。2014年BRFSS中纳入了一个可选的医疗保健获取模块。本报告总结了2014年所有50个州和哥伦比亚特区的BRFSS数据,这些数据是由美国预防服务工作组或免疫实践咨询委员会在工作年龄成年人(18-64岁)中推荐的医疗保健获取和使用选定的CPS,按州、州医疗补助扩张状况、扩大的地理区域和联邦贫困水平(FPL)划分的。本报告还分析了访谈时医疗保险的基本类型、前12个月医疗保险的连续性以及其他获得医疗保健的措施(即由于费用而未得到满足的医疗保健需求、由于费用而未得到满足的处方需求、医疗债务[随着时间的推移而支付的医疗账单]、前一年的医疗就诊次数)。以及对获得的医疗保健的满意度),其中包括来自BRFSS可选医疗保健访问模块的问题。结果:2014年,健康保险覆盖范围和其他医疗保健获取措施因州、州医疗补助扩张状况、扩大的地理区域(即各州在地理上分为9个区域)和FPL类别而有很大差异。以下比例是指按调查的地理单位(除非另有说明)分列的健康保险和其他保健措施的估计普及率范围,如答复者所报告。在拥有医疗保险的成年人中,各州的范围为70.8%-94.5%,扩大医疗补助的州为78.8%-94.5%,未扩大医疗补助的州为70.8%-89.1%,扩大地理区域为73.3%-91.0%,FPL类别为64.2%-95.8%。在拥有常规医疗保健来源的成年人中,各州的范围为57.2%-86.6%,医疗补助扩张州为57.2%-86.6%,非医疗补助扩张州为61.8%-83.9%,扩大地理区域为64.4%-83.6%,FPL类别为61.0%-81.6%。在接受常规检查的成年人中,各州的范围为52.1%-75.5%,医疗补助扩大的州为56.0%-75.5%,未扩大的州为52.1%-71.1%,扩大的地理区域为56.8%-70.2%,FPL类别为59.9%-69.2%。在因成本而未满足医疗保健需求的成年人中,各州的范围为8.0%-23.1%,医疗补助扩张州为8.0%-21.9%,非医疗补助扩张州为11.9%-23.1%,扩大地理区域为11.6%-20.3%,FPL类别为5.3%-32.9%。癌症筛查、流感疫苗接种和曾经接受过人类免疫缺陷病毒检测的估计流行率也因州、州医疗补助扩张状况、扩大的地理区域和FPL类别而异。保险覆盖率的普及程度在种族/族裔群体中相差约25个百分点(范围:西班牙裔为63.9%,非西班牙裔亚裔为88.4%),在FPL类别中相差约32个百分点(范围:家庭收入为FPL 400%的成年人为64.2%)。在种族/族裔群体中,因成本而未得到满足的卫生保健需求的普遍程度相差近14个百分点(范围:非西班牙裔亚洲人11.3%,西班牙裔美国人25.0%),在残疾和非残疾成年人中相差约17个百分点(30.8%对13.7%),按FPL类别划分相差约28个百分点(范围:家庭收入为FPL 400%的成年人5.3%,家庭收入为FPL 400%的成年人32.9%)。本报告首次提出了18-64岁成人中基于人群的卫生保健获取和使用CPS的估计。本报告的调查结果表明,健康保险的覆盖面存在很大差异;其他获得保健服务的措施;以及各州使用CPS的情况、各州医疗补助扩张状况、扩大的地理区域和FPL类别。2014年,在生活在贫困线以下的成年人中,健康保险覆盖率、拥有常规护理来源、进行例行检查以及没有因费用而无法满足医疗保健需求的比例较高。
{"title":"Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64 Years - Behavioral Risk Factor Surveillance System, United States, 2014.","authors":"Catherine A Okoro, Guixiang Zhao, Jared B Fox, Paul I Eke, Kurt J Greenlund, Machell Town","doi":"10.15585/mmwr.ss6607a1","DOIUrl":"10.15585/mmwr.ss6607a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;As a result of the 2010 Patient Protection and Affordable Care Act, millions of U.S. adults attained health insurance coverage. However, millions of adults remain uninsured or underinsured. Compared with adults without barriers to health care, adults who lack health insurance coverage, have coverage gaps, or skip or delay care because of limited personal finances might face increased risk for poor physical and mental health and premature mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18-64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2014, health insurance coverage and other health care access measures varied substantially by state, state Medicaid expansion status, expanded geographic region (i.e., states categorized geographically into nine regions), and FPL category. The following proportions refer to the range of estimated prevalence for health insurance and other health care access measures by examined geographical unit (unless otherwise specified), as reported by respondents. Among adults with health insurance coverage, the range was 70.8%-94.5% for states, 78.8%-94.5% for Medicaid expansion states, 70.8%-89.1% for nonexpansion states, 73.3%-91.0% for expanded geographic regions, and 64.2%-95.8% for FPL categories. Among adults who had a usual source of health care, the range was 57.2%-86.6% for states, 57.2%-86.6% for Medicaid expansion states, 61.8%-83.9% for nonexpansion states, 64.4%-83.6% for expanded geographic regions, and 61.0%-81.6% for FPL categories. Among adu","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 7","pages":"1-42"},"PeriodicalIF":24.9,"publicationDate":"2017-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34759224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 86
Health-Related Behaviors by Urban-Rural County Classification — United States, 2013 健康相关行为的城乡县分类-美国,2013
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-02-03 DOI: 10.15585/mmwr.ss6605a1
Kevin A. Matthews, J. Croft, Yong Liu, Hua Lu, D. Kanny, A. Wheaton, T. Cunningham, L. Khan, R. Caraballo, J. Holt, P. Eke, W. Giles
Problem/Condition Persons living in rural areas are recognized as a health disparity population because the prevalence of disease and rate of premature death are higher than for the overall population of the United States. Surveillance data about health-related behaviors are rarely reported by urban-rural status, which makes comparisons difficult among persons living in metropolitan and nonmetropolitan counties. Reporting Period 2013. Description of System The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. BRFSS data were analyzed for 398,208 adults aged ≥18 years to estimate the prevalence of five self-reported health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations) by urban-rural status. For this report, rural is defined as the noncore counties described in the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Results Approximately one third of U.S. adults practice at least four of these five behaviors. Compared with adults living in the four types of metropolitan counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan), adults living in the two types of nonmetropolitan counties (micropolitan and noncore) did not differ in the prevalence of sufficient sleep; had higher prevalence of nondrinking or moderate drinking; and had lower prevalence of current nonsmoking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations. The overall age-adjusted prevalence of reporting at least four of the five health-related behaviors was 30.4%. The prevalence among the estimated 13.3 million adults living in noncore counties was lower (27.0%) than among those in micropolitan counties (28.8%), small metropolitan counties (29.5%), medium metropolitan counties (30.5%), large fringe metropolitan counties (30.2%), and large metropolitan centers (31.7%). Interpretation This is the first report of the prevalence of these five health-related behaviors for the six urban-rural categories. Nonmetropolitan counties have lower prevalence of three and clustering of at least four health-related behaviors that are associated with the leading chronic disease causes of death. Prevalence of sufficient sleep was consistently low and did not differ by urban-rural status. Public Health Action Chronic disease prevention efforts focus on improving the communities, schools, worksites, and health systems in which persons live, learn, work, and play. Eviden
问题/状况生活在农村地区的人被认为是健康差距人口,因为他们的疾病流行率和过早死亡率高于美国总人口。有关健康行为的监测数据很少按城乡状况报告,这使得难以对居住在大都市县和非大都市县的人进行比较。2013年报告期。行为风险因素监测系统(BRFSS)是一项正在进行的、基于州的、随机数字拨号的固定电话和移动电话调查,调查对象是居住在美国的年龄≥18岁的非机构成年人。BRFSS收集与死亡和残疾的主要原因有关的健康风险行为、慢性疾病和病症、获得保健和使用预防性保健服务的数据。对398,208名年龄≥18岁的成年人的BRFSS数据进行分析,以估计五种自我报告的健康相关行为(充足睡眠、目前不吸烟、不饮酒或适度饮酒、维持正常体重和满足有氧休闲时间体力活动建议)在城乡状况中的流行程度。在本报告中,农村被定义为2013年国家卫生统计中心城乡分类方案中描述的非核心县。结果:大约三分之一的美国成年人至少有这五种行为中的四种。与四种类型的都市县(大中心都市、大边缘都市、中等都市和小都市)的成年人相比,两种类型的非都市县(小都市和非核心)的成年人在充足睡眠的患病率上没有差异;不饮酒或适度饮酒的患病率较高;目前不吸烟、保持正常体重、满足休闲时间有氧运动建议的人群患病率较低。报告五种健康相关行为中至少四种的总体年龄调整患病率为30.4%。居住在非核心县的1330万成年人的患病率(27.0%)低于小都市县(28.8%)、小都市县(29.5%)、中等都市县(30.5%)、大边缘都市县(30.2%)和大都市中心县(31.7%)。这是首次报道城乡六类人群中这五种健康相关行为的流行情况。非大都市县的三种和至少四种与主要慢性疾病死亡原因相关的健康相关行为的发病率较低。睡眠充足的患病率一直很低,城乡状况没有差异。慢性病预防工作的重点是改善人们生活、学习、工作和娱乐的社区、学校、工地和卫生系统。改善美国人群健康相关行为的循证策略可用于实现以下五种自我报告的健康相关行为(充足睡眠、当前不吸烟、不饮酒或适度饮酒、保持正常体重和满足有氧休闲时间体力活动建议)的健康人2020目标。这些发现表明,需要不断提高公众意识和公众教育,特别是在这些与健康有关的行为流行率最低的农村县。
{"title":"Health-Related Behaviors by Urban-Rural County Classification — United States, 2013","authors":"Kevin A. Matthews, J. Croft, Yong Liu, Hua Lu, D. Kanny, A. Wheaton, T. Cunningham, L. Khan, R. Caraballo, J. Holt, P. Eke, W. Giles","doi":"10.15585/mmwr.ss6605a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6605a1","url":null,"abstract":"Problem/Condition Persons living in rural areas are recognized as a health disparity population because the prevalence of disease and rate of premature death are higher than for the overall population of the United States. Surveillance data about health-related behaviors are rarely reported by urban-rural status, which makes comparisons difficult among persons living in metropolitan and nonmetropolitan counties. Reporting Period 2013. Description of System The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. BRFSS data were analyzed for 398,208 adults aged ≥18 years to estimate the prevalence of five self-reported health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations) by urban-rural status. For this report, rural is defined as the noncore counties described in the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Results Approximately one third of U.S. adults practice at least four of these five behaviors. Compared with adults living in the four types of metropolitan counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan), adults living in the two types of nonmetropolitan counties (micropolitan and noncore) did not differ in the prevalence of sufficient sleep; had higher prevalence of nondrinking or moderate drinking; and had lower prevalence of current nonsmoking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations. The overall age-adjusted prevalence of reporting at least four of the five health-related behaviors was 30.4%. The prevalence among the estimated 13.3 million adults living in noncore counties was lower (27.0%) than among those in micropolitan counties (28.8%), small metropolitan counties (29.5%), medium metropolitan counties (30.5%), large fringe metropolitan counties (30.2%), and large metropolitan centers (31.7%). Interpretation This is the first report of the prevalence of these five health-related behaviors for the six urban-rural categories. Nonmetropolitan counties have lower prevalence of three and clustering of at least four health-related behaviors that are associated with the leading chronic disease causes of death. Prevalence of sufficient sleep was consistently low and did not differ by urban-rural status. Public Health Action Chronic disease prevention efforts focus on improving the communities, schools, worksites, and health systems in which persons live, learn, work, and play. Eviden","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"25 1","pages":"1 - 8"},"PeriodicalIF":24.9,"publicationDate":"2017-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81230000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 239
Surveillance for Cancer Incidence and Mortality — United States, 2013 癌症发病率和死亡率监测-美国,2013
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-27 DOI: 10.15585/mmwr.ss6604a1
Simple D. Singh, S. Henley, A. B. Ryerson
This report provides, in tabular and graphic form, official federal statistics on cancer incidence and mortality for 2013 and trends for 1999-2013 as reported by CDC and the National Cancer Institute (NCI). Data in this report come from the United States Cancer Statistics (USCS) system (1), which includes cancer incidence data from population-based cancer registries that participate in CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results (SEER) program reported as of November 2015 and cancer mortality data from death certificate information reported to state vital statistics offices as of June 2015 and compiled into a national file for the entire United States by CDC's National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS).
本报告以表格和图形形式提供了2013年癌症发病率和死亡率的官方联邦统计数据,以及由疾病预防控制中心和国家癌症研究所(NCI)报告的1999-2013年趋势。本报告中的数据来自美国癌症统计(USCS)系统(1),其中包括参与CDC国家癌症登记计划(NPCR)和NCI监测、流行病学、截至2015年6月,死亡证明信息中的癌症死亡率数据报告给州生命统计办公室,并由疾病预防控制中心的国家卫生统计中心(NCHS)国家生命统计系统(NVSS)汇编成整个美国的国家档案。
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引用次数: 21
Childhood Blood Lead Levels in Children Aged <5 Years — United States, 2009–2014 美国2009-2014年5岁以下儿童血铅水平
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-20 DOI: 10.15585/mmwr.ss6603a1
J. Raymond, M. Brown
This report provides data concerning childhood blood lead levels (BLLs) in the United States during 2009-2014. These data were collected and compiled from raw data extracts sent by state and local health departments to CDC's Childhood Blood Lead Surveillance (CBLS) system. These raw data extracts have been de-identified and coded into a format specifically for childhood blood lead reporting. The numbers of children aged <5 years for 2014 are reported with newly confirmed BLLs ≥10 µg/dL by month (Table 1) and geographic location (Table 2). The incidence of BLLs ≥10 µg/dL is reported by age group for 2009-2014 (Table 3). The numbers of children aged <5 years are reported by the prevalence of BLLs 5-9 µg/dL by age group and sample type during 2009-2014 (Tables 4 and 5). For the period 2009-2014, the numbers of children newly confirmed with BLLs ≥70 µg/dL are summarized (Figure 1) as well as the percentage of children with BLLs ≥5 µg/dL (Figure 2).
本报告提供了2009-2014年美国儿童血铅水平(BLLs)的数据。这些数据是从州和地方卫生部门发送给疾病预防控制中心儿童血铅监测(CBLS)系统的原始数据摘录中收集和汇编的。这些原始数据摘录已被去识别并编码为专门用于儿童血铅报告的格式。报告了2014年5岁以下儿童的数量,新确诊的bll≥10µg/dL按月(表1)和地理位置(表2)。2009-2014年,bll≥10µg/dL的发病率按年龄组报告(表3)。2009-2014年,<5岁儿童的数量按年龄组和样本类型按bll 5-9µg/dL的患病率报告(表4和5)。总结了新确诊的bll≥70µg/dL的儿童人数(图1)以及bll≥5µg/dL的儿童百分比(图2)。
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引用次数: 56
National Estimates of Marijuana Use and Related Indicators - National Survey on Drug Use and Health, United States, 2002-2014. 全国大麻使用估算及相关指标——2002-2014年美国全国毒品使用和健康调查。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-09-02 DOI: 10.15585/mmwr.ss6511a1
Alejandro Azofeifa, Margaret E Mattson, Gillian Schauer, Tim McAfee, Althea Grant, Rob Lyerla
<p><strong>Problem/condition: </strong>In the United States, marijuana is the most commonly used illicit drug. In 2013, 7.5% (19.8 million) of the U.S. population aged ≥12 years reported using marijuana during the preceding month. Because of certain state-level policies that have legalized marijuana for medical or recreational use, population-based data on marijuana use and other related indicators are needed to help monitor behavioral health changes in the United States.</p><p><strong>Period covered: </strong>2002-2014.</p><p><strong>Description of system: </strong>The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects information about the use of illicit drugs, alcohol, and tobacco; initiation of substance use; frequency of substance use; substance dependence and abuse; perception of substance harm risk or no risk; and other related behavioral health indicators. This report describes national trends for selected marijuana use and related indicators, including prevalence of marijuana use; initiation; perception of harm risk, approval, and attitudes; perception of availability and mode of acquisition; dependence and abuse; and perception of legal penalty for marijuana possession.</p><p><strong>Results: </strong>In 2014, a total of 2.5 million persons aged ≥12 years had used marijuana for the first time during the preceding 12 months, an average of approximately 7,000 new users each day. During 2002-2014, the prevalence of marijuana use during the past month, past year, and daily or almost daily increased among persons aged ≥18 years, but not among those aged 12-17 years. Among persons aged ≥12 years, the prevalence of perceived great risk from smoking marijuana once or twice a week and once a month decreased and the prevalence of perceived no risk increased. The prevalence of past year marijuana dependence and abuse decreased, except among persons aged ≥26 years. Among persons aged ≥12 years, the percentage reporting that marijuana was fairly easy or very easy to obtain increased. The percentage of persons aged ≥12 reporting the mode of acquisition of marijuana was buying it and growing it increased versus getting it for free and sharing it. The percentage of persons aged ≥12 years reporting that the perceived maximum legal penalty for the possession of an ounce or less of marijuana in their state is a fine and no penalty increased versus probation, community service, possible prison sentence, and mandatory prison sentence.</p><p><strong>Interpretation: </strong>Since 2002, marijuana use in the United States has increased among persons aged ≥18 years, but not among those aged 12-17 years. A decrease in the perception of great risk from smoking marijuana combined with increases in the perception of availability (i.e., fairly easy or very easy to obtain marijuana) and fewer punitive legal penalties (e.g.,
问题/状况:在美国,大麻是最常用的非法毒品。2013年,美国12岁以上人口中有7.5%(1980万)报告在前一个月吸食大麻。由于某些州一级的政策已将大麻用于医疗或娱乐用途合法化,因此需要基于人口的大麻使用数据和其他相关指标来帮助监测美国的行为健康变化。涵盖期间:2002-2014年。系统描述:全国药物使用和健康调查(NSDUH)是一项全国性和州级的调查,调查对象是年龄≥12岁的非机构美国平民人口的代表性样本。NSDUH收集有关使用非法药物、酒精和烟草的信息;开始使用药物;物质使用频率;物质依赖和滥用;感知物质危害风险或无风险;以及其他相关的行为健康指标。本报告描述了选定大麻使用的国家趋势和相关指标,包括大麻使用的流行程度;初始化;对伤害风险的感知、认可和态度;可得性知觉与获取方式;依赖和滥用;以及对持有大麻的法律处罚的认知。结果:2014年,共有250万≥12岁的人在过去的12个月内首次使用大麻,平均每天约有7000名新用户。在2002-2014年期间,≥18岁的人群中,过去一个月、过去一年、每天或几乎每天使用大麻的患病率增加,但在12-17岁的人群中没有增加。在年龄≥12岁的人群中,每周吸食1 - 2次、每月吸食1次大麻的高危人群比例下降,无高危人群比例上升。除年龄≥26岁的人群外,过去一年大麻依赖和滥用的患病率有所下降。在年龄≥12岁的人群中,报告大麻相当容易或非常容易获得的比例增加。报告大麻获取方式为购买和种植的≥12岁人群比例高于免费获取和分享的比例。与缓刑、社区服务、可能的监禁和强制性监禁相比,在他们的州,持有一盎司或更少大麻的最高法律惩罚是罚款,而没有增加惩罚的年龄≥12岁的人的百分比。解释:自2002年以来,美国18岁以上人群的大麻使用量有所增加,但12-17岁人群的大麻使用量没有增加。对吸食大麻的巨大风险认知的下降,加上对可获得性(即相当容易或非常容易获得大麻)认知的增加,以及对个人使用大麻的惩罚性法律处罚(例如,不处罚)的减少,可能是成年人使用大麻增加的原因。公共卫生行动:国家和州一级的数据可以帮助联邦、州和地方公共卫生官员制定有针对性的预防活动,以减少青少年开始使用大麻,防止大麻依赖和滥用,并防止对健康的不利影响。随着州一级关于医用和娱乐大麻使用的法律的变化,可能需要修改国家和州一级的调查,并且可能需要更及时和全面的监测系统来提供这些数据。在年轻人群中使用大麻是一个特别的公共卫生问题,需要改变吸食大麻危害风险的看法。
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引用次数: 348
Surveillance for Violent Deaths - National Violent Death Reporting System, 17 States, 2013. 暴力死亡监测——全国暴力死亡报告系统,17个州,2013。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-08-19 DOI: 10.15585/mmwr.ss6510a1
Bridget H Lyons, Katherine A Fowler, Shane P D Jack, Carter J Betz, Janet M Blair
<p><strong>Problem/condition: </strong>In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 17 U.S. states for 2013. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.</p><p><strong>Reporting period covered: </strong>2013.</p><p><strong>Description of system: </strong>NVDRS collects data from participating states regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 17 states that collected statewide data for 2013 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, North Carolina, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) from a single incident.</p><p><strong>Results: </strong>For 2013, a total of 18,765 fatal incidents involving 19,251 deaths were captured by NVDRS in the 17 states included in this report. The majority (66.2%) of deaths were suicides, followed by homicides (23.2%), deaths of undetermined intent (8.8%), deaths involving legal intervention (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). (The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Suicides occurred at higher rates among males, non-Hispanic whites, American Indian/Alaska Natives, persons aged 45-64 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged 15-44 years; rates were highest among non-Hispanic black males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or were related to intimate partner violence (particularly for females). A known relationship between a homicide victim and a suspected perpetrator was most likely either that of an acquaintance or friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20-24 years and 30-34 years; rates were highest among non-Hispanic black males. Precipitating facto
问题/状况:2013年,美国有超过5.7万人死于与暴力有关的伤害。本报告总结了CDC国家暴力死亡报告系统(NVDRS)关于2013年美国17个州暴力死亡的数据。结果按性别、年龄组、种族/民族、婚姻状况、受伤地点、受伤方法、受伤情况和其他选定的特征报告。报告所涉期间:2013年。系统描述:NVDRS从参与国家收集有关暴力死亡的数据,这些数据来自死亡证明、验尸官/法医报告、执法报告和二手来源(例如,儿童死亡审查小组数据、补充杀人案报告、医院数据和犯罪实验室数据)。本报告包括来自17个州的数据,这些州收集了2013年全州数据(阿拉斯加州、科罗拉多州、佐治亚州、肯塔基州、马里兰州、马萨诸塞州、北卡罗来纳州、新泽西州、新墨西哥州、俄亥俄州、俄克拉荷马州、俄勒冈州、罗德岛州、南卡罗来纳州、犹他州、弗吉尼亚州和威斯康星州)。NVDRS对每个死亡事件的文件进行整理,并将单个事件中相关的死亡(例如,多起凶杀案、一起凶杀后自杀或多起自杀)联系起来。结果:2013年,在本报告所包括的17个州,NVDRS共捕获了18,765起致命事件,涉及19,251人死亡。大多数死亡(66.2%)是自杀,其次是他杀(23.2%)、不明原因死亡(8.8%)、涉及法律干预的死亡(1.2%)(即由执法人员和其他有权使用致命武力的人造成的死亡,不包括合法处决)和非故意枪支死亡(解释:本报告提供了2013年NVDRS数据的详细摘要。公共卫生行动:NVDRS数据用于监测与暴力有关的致命伤害的发生,并协助公共卫生当局制定、实施和评估减少和预防暴力死亡的方案和政策。例如,犹他州暴力死亡报告系统(VDRS)的数据被用于制定支持亲密伴侣凶杀受害者的子女的政策,科罗拉多州VDRS数据被用于开发针对中年男性的基于网络的自杀预防计划,罗德岛州VDRS数据被用于指导工作场所的自杀预防工作。继续发展和扩大NVDRS,使其包括美国所有州、领土和哥伦比亚特区,对减少暴力影响的公共卫生努力至关重要。
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引用次数: 142
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Mmwr Surveillance Summaries
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