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Disease Surveillance Among U.S.-Bound Immigrants and Refugees - Electronic Disease Notification System, United States, 2014-2019. 美国入境移民和难民的疾病监测-电子疾病通报系统，2014-2019。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2022-01-21 DOI: 10.15585/mmwr.ss7102a1
Christina R Phares, Yecai Liu, Zanju Wang, Drew L Posey, Deborah Lee, Emily S Jentes, Michelle Weinberg, Tarissa Mitchell, William Stauffer, Julie L Self, Nina Marano
<p><strong>Problem/condition: </strong>Each year, approximately 500,000 immigrants and tens of thousands of refugees (range: 12,000-85,000 during 2001-2020) move to the United States. While still abroad, immigrants, refugees, and others who apply for admission to live permanently in the United States must undergo a medical examination. This examination identifies persons with class A or B conditions. Applicants with class A conditions are inadmissible. Infectious conditions that cause an applicant to be inadmissible include infectious tuberculosis (TB) disease (class A TB), infectious syphilis, gonorrhea, and infectious Hansen's disease. Applicants with class B conditions are admissible but might require treatment or follow-up. Class B TB includes persons who completed successful treatment overseas for TB disease (class B0), those with signs or symptoms suggestive of TB but whose overseas laboratory tests and clinical examinations ruled out current infectious TB disease (class B1), those with a diagnosis of latent TB infection (LTBI) (class B2), and the close contacts of persons known to have TB disease (class B3). Voluntary public health interventions might also be offered during the overseas examination. After arriving in the United States, a follow-up TB examination is recommended for persons with class B TB.</p><p><strong>Period covered: </strong>This report summarizes health information that was reported to CDC's Electronic Disease Notification (EDN) system for refugees, immigrants, and eligible others who arrived in the United States during 2014-2019. Eligible others are persons who although not classified as refugees (e.g., certain parolees, special immigrant visa holders, and follow-to-join asylees) are eligible for the same services and benefits as refugees.</p><p><strong>Description of system: </strong>The EDN system has both surveillance and programmatic components. The surveillance component is a centralized database that collects 1) health-related data from the overseas medical examination for immigrants with class A or B conditions and for all refugees and eligible others and 2) TB-related data from the postarrival TB examination. The programmatic component is a reporting system that sends arrival notifications to state and local health agencies in the jurisdiction where newly arriving persons have reported intending to live and provides state and local health agencies and other authorized users with medical data from overseas examinations.</p><p><strong>Results: </strong>During 2014-2019, approximately 3.5 million persons moved to the United States from abroad, including 3.2 million immigrants, 313,890 refugees, and 95,993 eligible others. Among these, the overseas examination identified 139,683 persons (3,903 per 100,000 persons examined) with class B TB, 54 with primary or secondary syphilis (30 per 100,000 persons tested), 761 with latent syphilis (415 per 100,000 persons tested), and, after laboratory testing for gonorrhea was
问题/状况:每年大约有50万移民和成千上万的难民(2001-2020年期间范围:12,000-85,000)移居美国。在国外时，移民、难民和其他申请在美国永久居住的人必须接受体检。该检查可识别A类或B类情况的人员。具有A类条件的申请人不予受理。导致申请人不能入境的传染性疾病包括传染性结核病(A类结核病)、传染性梅毒、淋病和传染性汉森病。患有B类疾病的申请人可以申请，但可能需要治疗或随访。乙类结核病包括在海外成功治疗结核病(B0类)的人、有结核病迹象或症状但其海外实验室检查和临床检查排除目前传染性结核病(B1类)的人、诊断为潜伏性结核病(LTBI)的人(B2类)，以及已知结核病患者的密切接触者(B3类)。在海外检查期间也可提供自愿的公共卫生干预措施。到达美国后，建议对B类结核病患者进行后续结核病检查。所涵盖期间:本报告总结了2014-2019年期间抵达美国的难民、移民和符合条件的其他人向疾病预防控制中心电子疾病通报(EDN)系统报告的健康信息。合格的其他人是指虽然不被列为难民的人(例如，某些假释犯、特别移民签证持有人和随后加入的庇护者)有资格获得与难民相同的服务和福利。系统描述:EDN系统具有监控和编程两部分。监测部分是一个集中数据库，收集1)来自a类或B类移民以及所有难民和符合条件的其他人的海外体检的健康相关数据，以及2)来自赛后结核病检查的结核病相关数据。方案组成部分是一个报告系统，向新抵达人员报告打算居住的辖区内的州和地方卫生机构发送抵达通知，并向州和地方卫生机构及其他授权用户提供海外检查的医疗数据。结果:2014-2019年期间，约有350万人从国外移居美国，其中包括320万移民，313,890名难民和95,993名符合条件的人。其中，境外检查发现B类结核病139683人(每10万人检查3903人)，原发性或继发性梅毒54人(每10万人检查30人)，潜伏性梅毒761人(每10万人检查415人)，2016年增加淋病实验室检测后，淋病共131人(每10万人检查374人)。向难民提供了额外的自愿干预措施，包括疫苗接种和寄生虫推定治疗。到2019年，含麻疹疫苗的第一剂和第二剂覆盖率分别为96%和80%。在建议进行假定治疗的难民人群中，根据具体方案，高达96%的难民得到了治疗并接受了治疗。对于在海外被确认患有B类结核病的139,683人，EDN向适当的州或地方卫生机构发送了抵达通知和海外医疗数据，以便于回国后进行结核病检查。在海外确诊为B0类结核病(6586例)或B1类结核病(94533例)的101119人中，共有67432人(67%)向EDN报告了完整的术后检查。在35,814名2-14岁的海外确诊为B2级结核病的儿童中，20,758(58%)向EDN报告了完整的比赛后检查。(在海外体检期间，成人不接受常规的结核分枝杆菌免疫反应测试。)在向EDN报告进行了完整的术后检查的儿童中，B0或B1类结核病患者在抵达后一年内诊断为结核培养阳性的人数为464人(每10万人检查688例)，B2类结核病儿童为11人(每10万人检查53例)。解读:2014-2019年，境外体检系统共防控传染性结核病6586例、梅毒815例、淋病131例。当该检查用于提供公共卫生干预措施时，大多数难民(高达96%)接受干预措施。对88190人完成了比赛后随访检查，确定了475例结核培养阳性病例，这是进一步限制结核病在美国传播的重要机会，方法是确定并在必要时为LTBI患者提供预防性护理或为疾病患者提供治疗。 公共卫生行动:联邦，州和地方卫生部门和机构应继续使用EDN数据来监测，评估和改进针对美国或最近抵达的移民，难民和符合条件的其他人的健康相关计划和政策。应考虑在海外体检期间可提供的其他公共卫生干预措施(例如LTBI治疗)。最后，对于B类结核病患者，应采取措施确定并消除完成比赛后检查的障碍，以降低结核病和社区传播的风险，同时采取措施鼓励报告完成的检查，以便更好地进行数据驱动的决策。
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引用次数: 4
Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years - United States, 2015-2019. ≥18岁成年人的自杀念头和行为-美国，2015-2019
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2022-01-07 DOI: 10.15585/mmwr.ss7101a1
Asha Z Ivey-Stephenson, Alex E Crosby, Jennifer M Hoenig, Shiromani Gyawali, Eunice Park-Lee, Sarra L Hedden

Problem/condition: Suicidal thoughts and behaviors are important public health concerns in the United States. In 2019, suicide was the 10th leading cause of death among persons aged ≥18 years (adults); in that year, 45,861 adults died as a result of suicide, and an estimated 381,295 adults visited hospital emergency departments for nonfatal, self-inflicted injuries. Regional- and state-level data on self-inflicted injuries are needed to help localities establish priorities and evaluate the effectiveness of suicide prevention strategies.

Period covered: 2015-2019.

Description of system: The National Survey on Drug Use and Health (NSDUH) is an annual survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects data on the use of illicit drugs, alcohol, and tobacco; initiation of substance use; substance use disorders and treatment; health care; and mental health. This report summarizes data on responses to questions concerning suicidal thoughts and behaviors contained in the mental health section among sampled persons aged ≥18 years in all 50 states and the District of Columbia. This report summarizes 2015-2019 NSDUH data collected from 254,767 respondents regarding national-, regional-, and state-level prevalence of suicidal thoughts, planning, and attempts by age group, sex, race and ethnicity, region, state, education, marital status, poverty level, and health insurance status.

Results: Prevalence estimates of suicidal thoughts and behaviors varied by sociodemographic factors, region, and state. During 2015-2019, an estimated 10.6 million (annual average) adults in the United States (4.3% of the adult population) reported having had suicidal thoughts during the preceding year. The prevalence of having had suicidal thoughts ranged from 4.0% in the Northeast and South to 4.8% in the West and from 3.3% in New Jersey to 6.9% in Utah. An estimated 3.1 million adults (1.3% of the adult population) had made a suicide plan in the past year. The prevalence of having made suicide plans ranged from 1.0% in the Northeast to 1.4% in the Midwest and West and from 0.8% in Connecticut and New Jersey to 2.4% in Alaska. An estimated 1.4 million adults (0.6% of the adult population) had made a suicide attempt in the past year. The prevalence of suicide attempts ranged from 0.5% in the Northeast to 0.6% in the Midwest, South, and West and from 0.3% in Connecticut to 0.9% in West Virginia. Past-year prevalence of suicidal thoughts, suicide planning, and suicide attempts was higher among females than among males, higher among adults aged 18-39 years than among those aged ≥40 years, higher among noncollege graduates than college graduates, and higher among adults who had never been married than among those who were married, separated, divorced, or widowed. Prevalence was also higher among those living in poverty than among

问题/状况:自杀的想法和行为是美国重要的公共卫生问题。2019年，自杀是18岁以上人群(成年人)的第十大死因;在那一年，有45861名成年人死于自杀，估计有381295名成年人因非致命的自我伤害而去医院急诊室就诊。需要地区和州一级的自我伤害数据，以帮助地方确定优先事项并评估自杀预防策略的有效性。涵盖时间:2015-2019年。系统描述:全国药物使用和健康调查(NSDUH)是一项针对年龄≥12岁的非机构美国平民代表性样本的年度调查。NSDUH收集关于使用非法药物、酒精和烟草的数据;开始使用药物;物质使用障碍及其治疗;卫生保健;还有心理健康。本报告总结了在所有50个州和哥伦比亚特区抽样的年龄≥18岁的人对精神卫生部分所载自杀念头和行为问题的回答数据。本报告总结了2015-2019年NSDUH从254,767名受访者中收集的关于国家、地区和州一级自杀念头、计划和企图的流行情况的数据，这些数据按年龄、性别、种族和民族、地区、州、教育、婚姻状况、贫困水平和健康保险状况进行了分类。结果:自杀想法和行为的患病率估计因社会人口因素、地区和州而异。在2015-2019年期间，美国估计有1060万(年平均)成年人(占成年人口的4.3%)报告在前一年有过自杀念头。有过自杀念头的患病率从东北部和南部的4.0%到西部的4.8%，从新泽西州的3.3%到犹他州的6.9%不等。估计有310万成年人(占成年人口的1.3%)在过去一年有过自杀计划。制定过自杀计划的患病率从东北部的1.0%到中西部和西部的1.4%，从康涅狄格州和新泽西州的0.8%到阿拉斯加的2.4%不等。在过去一年中，估计有140万成年人(占成年人口的0.6%)曾试图自杀。自杀企图的流行率从东北部的0.5%到中西部、南部和西部的0.6%，从康涅狄格州的0.3%到西弗吉尼亚州的0.9%不等。过去一年自杀念头、自杀计划和自杀企图的患病率在女性中高于男性，在18-39岁的成年人中高于≥40岁的成年人，在非大学毕业生中高于大学毕业生，在从未结婚的成年人中高于已婚、分居、离婚或丧偶的成年人。贫困者的患病率也高于家庭收入达到或高于联邦贫困线的人，享受医疗补助或儿童健康保险计划的人的患病率高于有其他类型健康保险或没有健康保险的人。解释:本报告的调查结果突出了2015-2019年全国、地区和州各级在调查前12个月内成人自杀念头、自杀计划和自杀未遂流行率的差异。自杀想法和行为的地域差异因社会人口学特征而异，可能归因于人口的社会人口学构成、选择性迁移或当地文化环境。这些发现强调了持续监测的重要性，以收集当地相关数据作为预防和干预战略的基础。公共卫生行动:了解自杀的模式和风险因素对于设计、实施和评估预防自杀的公共卫生计划和政策至关重要，这些计划和政策可以降低与自杀想法和行为相关的发病率和死亡率。州卫生部门和联邦机构可以使用本报告的结果来评估在实现国家和州预防自杀的卫生目标方面取得的进展。策略可能包括识别和支持处于危险中的人，促进连通性，以及创造保护性环境。
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引用次数: 124
Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. 4 岁儿童自闭症谱系障碍的早期识别 - 自闭症和发育障碍监测网络，11 个站点，美国，2018 年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-12-03 DOI: 10.15585/mmwr.ss7010a1
Kelly A Shaw, Matthew J Maenner, Amanda V Bakian, Deborah A Bilder, Maureen S Durkin, Sarah M Furnier, Michelle M Hughes, Mary Patrick, Karen Pierce, Angelica Salinas, Josephine Shenouda, Alison Vehorn, Zachary Warren, Walter Zahorodny, John N Constantino, Monica DiRienzo, Amy Esler, Robert T Fitzgerald, Andrea Grzybowski, Allison Hudson, Margaret H Spivey, Akilah Ali, Jennifer G Andrews, Thaer Baroud, Johanna Gutierrez, Libby Hallas, Jennifer Hall-Lande, Amy Hewitt, Li-Ching Lee, Maya Lopez, Kristen Clancy Mancilla, Dedria McArthur, Sydney Pettygrove, Jenny N Poynter, Yvette D Schwenk, Anita Washington, Susan Williams, Mary E Cogswell
<p><strong>Problem/condition: </strong>Autism spectrum disorder (ASD).</p><p><strong>Period covered: </strong>2018.</p><p><strong>Description of system: </strong>The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD.</p><p><strong>Results: </strong>For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23
问题/条件：自闭症谱系障碍 (ASD).覆盖时期：2018.系统描述：自闭症和发育障碍监测网络是一项积极的监测计划，旨在估算自闭症谱系障碍（ASD）的患病率，并监测 4 至 8 岁儿童中自闭症谱系障碍的识别时间。本报告重点关注 2018 年 4 岁的儿童，这些儿童出生于 2014 年，其父母或监护人在 2018 年的任何时间居住在 11 个站点（亚利桑那州、阿肯色州、加利福尼亚州、佐治亚州、马里兰州、明尼苏达州、密苏里州、新泽西州、田纳西州、犹他州和威斯康星州）之一的监测区域内。如果儿童曾在评估中获得 1) ASD 诊断声明（诊断），2) ASD 特殊教育分类（资格），或 3) ASD 国际疾病分类 (ICD) 代码，则被归类为 ASD 患儿。此外，还对 4 岁儿童中的疑似 ASD 进行了追踪。不符合 ASD 病例定义的儿童，如果其记录中包含合格专业人员的声明，表示怀疑患有 ASD，则被归类为疑似 ASD：2018 年，4 岁儿童中 ASD 的总体患病率为千分之 17.0（59 分之一）。流行率从犹他州的千分之 9.1 到加利福尼亚州的千分之 41.6 不等。在每个地区，男孩的患病率都高于女孩，男女患病率之比为 3.4。在 4 岁儿童中，非西班牙裔白人（White）儿童的 ASD 患病率（12.9‰）低于非西班牙裔黑人（Black）儿童（16.6‰）、西班牙裔儿童（21.1‰）和亚裔/太平洋岛民（A/PI）儿童（22.7‰）。在患有 ASD 且有智力信息的 4 岁儿童中，52% 的儿童符合并发智力残疾的监测病例定义（智商≤70 或评估中记录的检查者关于智力残疾的声明）。在患有 ASD 的 4 岁儿童中，72% 在≤36 个月时进行了首次评估。按人口普查区家庭收入中位数（MHI）三等分法进行分层，家庭收入中位数低的三等分法（72%）在 36 个月时接受评估的 ASD 和智障儿童比例低于家庭收入中位数高的三等分法（84%）。4 岁儿童在 48 个月前被诊断为 ASD 或符合 ASD 诊断条件的累计发生率（2014 年出生的儿童中每 1,000 人中有 13.6 人）是 8 岁儿童（2010 年出生的儿童中每 1,000 人中有 8.9 人）的 1.5 倍。在所有 MHI 分层中，ASD 诊断或 48 个月前获得资格的累计发生率越高，MHI 越低。每 1,000 名 4 岁儿童中有 2.6 名疑似 ASD 患儿，这意味着每 6 名 ASD 患儿中就有 1 名疑似 ASD 患儿。自闭症和疑似自闭症的合计患病率（每1000名4岁儿童中有19.7名）低于8岁儿童的自闭症患病率（每1000名8岁儿童中有23.0名）：2018年，ASD患病率历来较低的群体（非白人和低MHI）在4岁儿童中的患病率和累计发病率较高，这表明这些群体在识别ASD方面取得了进展。然而，在低 MHI 三元组中，36 个月前接受评估的 ASD 和智障儿童比例低于高 MHI 组，表明在及时评估方面存在差异。与 8 岁儿童相比，4 岁儿童在 48 个月前被诊断或符合条件的累计发生率更高，这表明在早期识别 ASD 方面有所改进。4 岁儿童的总体发病率低于 8 岁儿童，即使将 4 岁前怀疑患有 ASD 的儿童的发病率计算在内也是如此。这一结果表明，许多在 4 岁之后被发现的儿童在 48 个月之前并没有疑似 ASD 的记录：与 2010 年出生的儿童相比，2014 年出生的儿童更有可能在 48 个月大之前被确认患有 ASD，这表明早期确认的可能性增加了。然而，4 岁儿童的 ASD 识别率因地区而异，这表明有机会对促进早期识别的发育筛查和诊断方法进行研究。与 8 岁儿童相比，4 岁儿童更有可能同时患有智力障碍，这表明在认知障碍以外的发育问题的早期识别和评估方面仍需改进。改善对自闭症的早期识别，可以使儿童更早地接受循证干预，并有可能改善发育结果。
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引用次数: 0
Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. 8岁儿童自闭症谱系障碍的流行与特征——自闭症与发育障碍监测网络，11个站点，美国，2018。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-12-03 DOI: 10.15585/mmwr.ss7011a1
Matthew J Maenner, Kelly A Shaw, Amanda V Bakian, Deborah A Bilder, Maureen S Durkin, Amy Esler, Sarah M Furnier, Libby Hallas, Jennifer Hall-Lande, Allison Hudson, Michelle M Hughes, Mary Patrick, Karen Pierce, Jenny N Poynter, Angelica Salinas, Josephine Shenouda, Alison Vehorn, Zachary Warren, John N Constantino, Monica DiRienzo, Robert T Fitzgerald, Andrea Grzybowski, Margaret H Spivey, Sydney Pettygrove, Walter Zahorodny, Akilah Ali, Jennifer G Andrews, Thaer Baroud, Johanna Gutierrez, Amy Hewitt, Li-Ching Lee, Maya Lopez, Kristen Clancy Mancilla, Dedria McArthur, Yvette D Schwenk, Anita Washington, Susan Williams, Mary E Cogswell

Problem/condition: Autism spectrum disorder (ASD).

Period covered: 2018.

Description of system: The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code.

Results: For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months).

Interpretation: In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overa

问题/状况:自闭症谱系障碍(ASD)。涵盖时间:2018年。系统描述:自闭症和发育障碍监测(ADDM)网络对ASD进行主动监测。本报告重点研究了2018年父母或监护人居住在美国11个ADDM网络站点(亚利桑那州、阿肯色州、加利福尼亚州、佐治亚州、马里兰州、明尼苏达州、密苏里州、新泽西州、田纳西州、犹他州和威斯康星州)的8岁儿童ASD的患病率和特征。为了确定8岁儿童的ASD, ADDM网络工作人员回顾并提取了社区医疗和教育服务提供者的发展评估和记录。2018年，如果儿童的记录记录了1)评估(诊断)中的ASD诊断声明，2)ASD的特殊教育分类(资格)，或3)ASD国际疾病分类(ICD)代码，则儿童符合病例定义。结果:2018年，在所有11个ADDM站点中，每1000名8岁儿童的ASD患病率从密苏里州的16.5到加利福尼亚州的38.9不等。8岁儿童的总体ASD患病率为23.0 / 1000(1 / 44)，男孩的患病率是女孩的4.2倍。除了美洲印第安人/阿拉斯加土著儿童的ASD患病率高于非西班牙裔白人(白人)儿童(每1000名8岁儿童中有29.0人对21.2人)外，不同种族和民族的总体ASD患病率相似。在多个地区，西班牙裔儿童的ASD患病率低于白人儿童(亚利桑那州、阿肯色州、佐治亚州和犹他州)和非西班牙裔黑人儿童(佐治亚州和明尼苏达州)。ASD患病率与社区家庭收入中位数之间的关系因地区而异。在5058名符合ASD病例定义的儿童中，75.8%的儿童在评估中有ASD的诊断声明，18.8%的儿童有ASD特殊教育分类或资格，但没有ASD诊断声明，5.4%的儿童只有ASD ICD代码。每1000名8岁儿童的ASD患病率仅基于记录在案的ASD诊断声明，总体为17.4(范围:马里兰州为11.2，加利福尼亚州为29.9)。最早已知的ASD诊断的中位年龄从加州的36个月到明尼苏达州的63个月不等。在3007名有认知能力数据的ASD患儿中，35.2%的患儿智商(IQ)得分≤70。IQ分数≤70的自闭症儿童在黑人、西班牙裔和白人儿童中的比例分别为49.8%、33.1%和29.7%。总体而言，智商得分≤70的ASD儿童比智商得分>70的ASD儿童诊断ASD的中位年龄更早(44个月对53个月)。解读:2018年，估计每44名8岁儿童中就有1名患有ASD，不同地区的患病率和确诊年龄中位数差异很大。尽管整体的自闭症患病率在种族和民族上是相似的，但在某些地方，西班牙裔儿童比白人或黑人儿童更不容易被确诊为患有自闭症。与白人和西班牙裔儿童相比，黑人儿童被归类为智力残疾的比例更高，这与之前的研究结果一致。公共卫生行动:在不同种族、民族和地理特征的儿童中，ASD患病率和社区ASD识别实践的差异突出了研究这种差异的原因和提供公平获得发展评估和服务的策略的重要性。这些发现还强调需要加强诊断、治疗和支持服务的基础设施，以满足所有儿童的需求。
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引用次数: 763
Abortion Surveillance - United States, 2019. 堕胎监测-美国，2019年。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-11-26 DOI: 10.15585/mmwr.ss7009a1
Katherine Kortsmit, Michele G Mandel, Jennifer A Reeves, Elizabeth Clark, H Pamela Pagano, Antoinette Nguyen, Emily E Petersen, Maura K Whiteman
<p><strong>Problem/condition: </strong>CDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States.</p><p><strong>Period covered: </strong>2019.</p><p><strong>Description of system: </strong>Each year, CDC requests abortion data from the central health agencies for 50 states, the District of Columbia, and New York City. For 2019, 49 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 48 reporting areas provided data each year during 2010-2019. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2018 were assessed as part of CDC's Pregnancy Mortality Surveillance System (PMSS).</p><p><strong>Results: </strong>A total of 629,898 abortions for 2019 were reported to CDC from 49 reporting areas. Among 48 reporting areas with data each year during 2010-2019, in 2019, a total of 625,346 abortions were reported, the abortion rate was 11.4 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 195 abortions per 1,000 live births. From 2018 to 2019, the total number of abortions increased 2% (from 614,820 total abortions), the abortion rate increased 0.9% (from 11.3 abortions per 1,000 women aged 15-44 years), and the abortion ratio increased 3% (from 189 abortions per 1,000 live births). From 2010 to 2019, the total number of reported abortions, abortion rate, and abortion ratio decreased 18% (from 762,755), 21% (from 14.4 abortions per 1,000 women aged 15-44 years), and 13% (from 225 abortions per 1,000 live births), respectively. In 2019, women in their 20s accounted for more than half of abortions (56.9%). Women aged 20-24 and 25-29 years accounted for the highest percentages of abortions (27.6% and 29.3%, respectively) and had the highest abortion rates (19.0 and 18.6 abortions per 1,000 women aged 20-24 and 25-29 years, respectively). By contrast, adolescents aged <15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.7%, respectively) and had the lowest abortion rates (0.4 and 2.7 abortions per 1,000 women aged <15 and ≥40 years, respectively). However, abortion ratios in 2019 were highest among adolescents (aged ≤19 years) and lowest among women aged 25-39 years. Abortion rates decreased from 2010 to 2019 for all women, regardless of age. The decrease in abortion rate was highest among adolescents compared with any other age group. From 2018 to 2019, abortion rates decreased or did not change among women aged ≤24 years; however, the abortion rate increased among those aged ≥25 years. Abortion ratios also decreased or did not change from 2010 to 2019 for all age groups, except adolescents aged <15 years. The decrease in abortion ratio was highest among women aged ≥40 years compared with
问题/状况:疾病预防控制中心进行堕胎监测，记录美国获得合法人工流产的妇女人数和特点以及与堕胎有关的死亡人数。涵盖时间:2019年。系统描述:每年，疾病预防控制中心要求50个州、哥伦比亚特区和纽约市的中央卫生机构提供堕胎数据。2019年，49个报告地区自愿向疾病预防控制中心提供了人工流产汇总数据。其中，有48个报告领域在2010-2019年期间每年提供数据。人口普查和出生数据分别用于计算堕胎率(每1,000名15-44岁妇女的堕胎次数)和比率(每1,000名活产的堕胎次数)。作为疾病预防控制中心妊娠死亡率监测系统(PMSS)的一部分，对2018年的堕胎相关死亡进行了评估。结果:2019年49个报告地区共向疾病预防控制中心报告流产629898例。在2010-2019年每年有数据的48个报告地区中，2019年共报告堕胎625346例，堕胎率为每千名15-44岁妇女11.4例堕胎，堕胎率为每千名活产195例堕胎。从2018年到2019年，堕胎总数增加了2%(从614820例堕胎总数)，堕胎率增加了0.9%(从每1000名15-44岁妇女中有11.3例堕胎)，堕胎率增加了3%(从每1000名活产妇女中有189例堕胎)。从2010年到2019年，报告的堕胎总数、堕胎率和堕胎率分别下降了18%(从762,755例下降)、21%(从每1,000名15-44岁妇女14.4例堕胎下降)和13%(从每1,000名活产妇女225例堕胎下降)。2019年，20多岁的女性占堕胎人数的一半以上(56.9%)。20-24岁和25-29岁妇女的堕胎比例最高(分别为27.6%和29.3%)，堕胎率最高(每1000名20-24岁和25-29岁妇女的堕胎率分别为19.0和18.6)。相比之下，13周妊娠期青少年的妊娠率一直很低(≤9.0%)。2019年流产比例最高的是≤13周手术流产(49.0%)，其次是≤9周早期药物流产(42.3%)、>13周手术流产(7.2%)、>9周药物流产(1.4%);(解释:在2010-2019年连续报告数据的48个地区中，2010-2019年报告的堕胎总数、发生率和比例总体下降;然而，从2018年到2019年，所有指标均增长了1%-3%。公共卫生行动:堕胎监测可用于帮助评估旨在促进公平获得以患者为中心的优质避孕服务的计划，以减少美国的意外怀孕。
{"title":"Abortion Surveillance - United States, 2019.","authors":"Katherine Kortsmit,&nbsp;Michele G Mandel,&nbsp;Jennifer A Reeves,&nbsp;Elizabeth Clark,&nbsp;H Pamela Pagano,&nbsp;Antoinette Nguyen,&nbsp;Emily E Petersen,&nbsp;Maura K Whiteman","doi":"10.15585/mmwr.ss7009a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss7009a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;CDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;Each year, CDC requests abortion data from the central health agencies for 50 states, the District of Columbia, and New York City. For 2019, 49 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 48 reporting areas provided data each year during 2010-2019. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2018 were assessed as part of CDC's Pregnancy Mortality Surveillance System (PMSS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 629,898 abortions for 2019 were reported to CDC from 49 reporting areas. Among 48 reporting areas with data each year during 2010-2019, in 2019, a total of 625,346 abortions were reported, the abortion rate was 11.4 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 195 abortions per 1,000 live births. From 2018 to 2019, the total number of abortions increased 2% (from 614,820 total abortions), the abortion rate increased 0.9% (from 11.3 abortions per 1,000 women aged 15-44 years), and the abortion ratio increased 3% (from 189 abortions per 1,000 live births). From 2010 to 2019, the total number of reported abortions, abortion rate, and abortion ratio decreased 18% (from 762,755), 21% (from 14.4 abortions per 1,000 women aged 15-44 years), and 13% (from 225 abortions per 1,000 live births), respectively. In 2019, women in their 20s accounted for more than half of abortions (56.9%). Women aged 20-24 and 25-29 years accounted for the highest percentages of abortions (27.6% and 29.3%, respectively) and had the highest abortion rates (19.0 and 18.6 abortions per 1,000 women aged 20-24 and 25-29 years, respectively). By contrast, adolescents aged &lt;15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.7%, respectively) and had the lowest abortion rates (0.4 and 2.7 abortions per 1,000 women aged &lt;15 and ≥40 years, respectively). However, abortion ratios in 2019 were highest among adolescents (aged ≤19 years) and lowest among women aged 25-39 years. Abortion rates decreased from 2010 to 2019 for all women, regardless of age. The decrease in abortion rate was highest among adolescents compared with any other age group. From 2018 to 2019, abortion rates decreased or did not change among women aged ≤24 years; however, the abortion rate increased among those aged ≥25 years. Abortion ratios also decreased or did not change from 2010 to 2019 for all age groups, except adolescents aged &lt;15 years. The decrease in abortion ratio was highest among women aged ≥40 years compared with","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"70 9","pages":"1-29"},"PeriodicalIF":24.9,"publicationDate":"2021-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39654650","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: 82
Homicides of American Indians/Alaska Natives - National Violent Death Reporting System, United States, 2003-2018. 美国印第安人/阿拉斯加原住民的凶杀案--美国全国暴力死亡报告系统，2003-2018 年。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-11-19 DOI: 10.15585/mmwr.ss7008a1
Emiko Petrosky, Laura M Mercer Kollar, Megan C Kearns, Sharon G Smith, Carter J Betz, Katherine A Fowler, Delight E Satter
<p><strong>Problem/condition: </strong>Homicide is a leading cause of death for American Indians/Alaska Natives (AI/ANs). Intimate partner violence (IPV) contributes to many homicides, particularly among AI/AN females. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on AI/AN homicides. Results include victim and suspect sex, age group, and race/ethnicity; method of injury; type of location where the homicide occurred; precipitating circumstances (i.e., events that contributed to the homicide); and other selected characteristics.</p><p><strong>Period covered: </strong>2003-2018.</p><p><strong>Description of system: </strong>NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports and links related deaths (e.g., multiple homicides and homicide followed by suicide) into a single incident. This report includes data on AI/AN homicides that were collected from 34 states (Alabama, Alaska, Arizona, California, Colorado, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Virginia, Washington, and Wisconsin) and the District of Columbia.</p><p><strong>Results: </strong>NVDRS collected data on 2,226 homicides of AI/ANs in 34 states and the District of Columbia during 2003-2018. The age-adjusted AI/AN homicide rate was 8.0 per 100,000 population. The homicide rate was three times higher in AI/AN males than females (12.0 versus 3.9), and the median age of AI/AN victims was 32 years (interquartile range: 23-44 years). Approximately half of AI/AN homicide victims lived or were killed in metropolitan areas (48.2% and 52.7%, respectively). A firearm was used in nearly half (48.4%) of homicides and in a higher percentage of homicides of AI/AN males than females (51.5% versus 39.1%). More AI/AN females than males were killed in a house or apartment (61.8% versus 53.7%) or in their own home (47.7% versus 29.0%). Suspects were identified in 82.8% of AI/AN homicides. Most suspects were male (80.1%), and nearly one third (32.1%) of suspects were AI/ANs. For AI/AN male victims, the suspect was most often an acquaintance or friend (26.3%), a person known to the victim but the exact nature of the relationship was unclear (12.3%), or a relative (excluding intimate partners) (10.5%). For AI/AN female victims, the suspect was most often a current or former intimate partner (38.4%), an acquaintance or friend (11.5%), or a person known to the victim but the exact nature of the relationship was unclear (7.9%). A crime precipitated 24.6% of AI/AN homicides (i.e., the homicide occurred as the result of another serious crime). More AI/AN males were victims of homicides due to an argument or conflict than females (54.7% versus 37.3%), whereas more
问题/条件：杀人是美国印第安人/阿拉斯加原住民（AI/ANs）的主要死因。亲密伴侣暴力 (IPV) 是许多凶杀案的诱因，尤其是在美国印第安人/阿拉斯加原住民女性中。本报告总结了疾病预防控制中心全国暴力死亡报告系统（NVDRS）中有关美国印第安人/阿拉斯加原住民凶杀案的数据。结果包括受害者和嫌疑人的性别、年龄组和种族/民族；伤害方式；凶杀案发生地的类型；诱发因素（即导致凶杀案发生的事件）；以及其他选定特征：NVDRS 收集从死亡证明、验尸官/法医报告和执法报告中获得的有关暴力死亡的数据，并将相关死亡（如多起凶杀和凶杀后自杀）联系到一个事件中。明尼苏达州、密苏里州、内布拉斯加州、内华达州、新泽西州、新墨西哥州、纽约州、北卡罗来纳州、俄亥俄州、俄克拉荷马州、俄勒冈州、宾夕法尼亚州、罗得岛州、南卡罗来纳州、犹他州、弗吉尼亚州、华盛顿州和威斯康星州）以及哥伦比亚特区。结果：NVDRS 收集了 2003-2018 年间 34 个州和哥伦比亚特区的 2,226 起针对亚裔美国人/印第安人的凶杀案数据。经年龄调整后，每 100,000 人口中的亚裔美国人/非裔杀人案发生率为 8.0。亚裔美国人/非裔男性的杀人案发生率是女性的三倍（12.0 对 3.9），亚裔美国人/非裔受害者的中位年龄为 32 岁（四分位间范围：23-44 岁）。约有一半的阿拉斯加原住民/印第安人凶杀案受害者生活或遇害于大都市地区（分别为 48.2% 和 52.7%）。近一半（48.4%）的凶杀案中使用了枪支，在针对亚裔美国人/印第安人男性的凶杀案中，使用枪支的比例高于女性（51.5% 对 39.1%）。在住宅或公寓（61.8% 对 53.7%）或自己家中（47.7% 对 29.0%）遇害的亚裔/非裔女性多于男性。在 82.8%的亚裔美国人/非裔美国人凶杀案中，犯罪嫌疑人的身份得到确认。大多数嫌疑人为男性（80.1%），近三分之一（32.1%）的嫌疑人为阿拉斯加原住民/印第安人。对于亚裔美国人/印第安人男性受害者而言，犯罪嫌疑人通常是熟人或朋友（26.3%）、受害者认识但关系性质不明确的人（12.3%）或亲属（不包括亲密伴侣）（10.5%）。对于阿拉斯加原住民/印第安人女性受害者而言，犯罪嫌疑人通常是现任或前任亲密伴侣（38.4%）、熟人或朋友（11.5%），或者是受害者认识但关系性质不明确的人（7.9%）。在 24.6%的亚裔美国人/非裔美国人凶杀案中，犯罪是诱因（即凶杀案的发生是另一起严重犯罪的结果）。在因争吵或冲突导致的凶杀案中，亚裔美国人男性受害者多于女性受害者（54.7%对 37.3%），而在因 IPV 导致的凶杀案中，亚裔美国人女性受害者多于男性受害者（45.0%对 12.1%）。在与 IPV 相关的凶杀案中，87.2%的阿拉斯加原住民/印第安人女性受害者是被现任或前任亲密伴侣杀害的，而大约一半（51.5%）的阿拉斯加原住民/印第安人男性受害者是间接受害者（即在与 IPV 相关的事件中被杀害的受害者本身并非亲密伴侣）：本报告详细总结了 2003-2018 年期间 NVDRS 有关亚裔美国人/印第安人凶杀案的数据。人际冲突是一种主要情况，在所有亚裔美国人/印第安人凶杀案中，近一半的凶杀案是由争吵引发的，而对于女性受害者而言，45.0%的凶杀案是由 IPV 引发的：NVDRS 提供了有关亚裔美国人/印第安人凶杀案的重要持续数据，可用于确定有效的早期干预策略以预防这些死亡。在可能的情况下，暴力预防工作应包括社区开发、文化相关和基于证据的策略。这些努力应纳入传统的本地知识和解决方案，实施并在可能的情况下调整基于证据的 IPV 和其他暴力预防战略，并考虑历史和更大的社会因素的影响，这些因素增加了在 AI/AN 社区发生暴力的可能性。
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引用次数: 5
Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018. 在性传播疾病诊所寻求治疗的人的人口统计、行为和临床特征- 14个站点，性病监测网络，美国，2010-2018。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-11-05 DOI: 10.15585/mmwr.ss7007a1
Eloisa Llata, Kendra M Cuffe, Viani Picchetti, Jimmy R Braxton, Elizabeth A Torrone
<p><strong>Problem: </strong>Sexually transmitted diseases (STDs) are a major cause of morbidity in the United States, with an estimated $15.9 billion in lifetime direct medical costs. Although the majority of STDs are diagnosed in the private sector, publicly funded STD clinics have an important role in providing comprehensive sexual health care services, including STD and HIV screening, for a broad range of patients. In certain cases, STD clinics often are the only source of sexual health care for patients, particularly among gay, bisexual, and other men who have sex with men (MSM).</p><p><strong>Period covered: </strong>2010-2018.</p><p><strong>Description of the system: </strong>The STD Surveillance Network (SSuN) is an ongoing sentinel surveillance system for monitoring clinical information among patients attending STD clinics. SSuN is a collaboration of competitively selected state and city health departments that conduct facility-based sentinel surveillance in STD clinics. Information routinely collected through the course of patient encounters is obtained for all patients seeking care in the participating STD clinics. This information includes demographic, behavioral, and clinical characteristics (e.g., STD and HIV tests performed and STD and HIV diagnoses). This report presents 2010-2018 SSuN data from 14 STD clinics in five cities (Baltimore, Maryland; New York City, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) to describe the patient populations seeking care in these STD clinics. Estimated numbers and percentages of patients receiving selected STD-related health services were calculated for each year by using an inverse variance weighted random-effects model, adjusting for heterogeneity among SSuN jurisdictions. Trends in receipt of selected STD-related health services were examined and included HIV screening after an acute STD diagnosis among persons not previously known to have HIV infection, annual chlamydia screening among adolescent and young females, and extragenital chlamydia and gonorrhea screening among MSM.</p><p><strong>Results: </strong>During 2010-2018, the total number of annual visits made in the 14 participating STD clinics decreased 29.8% (from 145,728 to 102,275 visits), and the total number of unique patients examined in the clinics decreased 35.1% (from 94,281 to 61,172 patients). Decreases in the number of unique patients occurred both among men who have sex with women only (42.4%; from 37,842 in 2010 to 21,781 in 2018) and among females (51.4%; from 36,485 in 2010 to 17,721 in 2018). The decreases in the number of female patients were observed across all age groups, although they were more pronounced among females aged ≤24 years (66.4%; from 17,721 in 2010 to 5,962 in 2018). In contrast, the number of patients identified as MSM increased 44.0% (from 12,859 in 2010 to 18,512 in 2018), with the greatest increase among MSM aged ≥25 years (58.6%; from 9,918 in 2010 to 15,73
问题:性传播疾病(STDs)是美国发病率的主要原因，据估计终生直接医疗费用为159亿美元。虽然大多数性传播疾病是在私营部门诊断出来的，但公共资助的性传播疾病诊所在为广大患者提供全面的性保健服务，包括性传播疾病和艾滋病毒筛查方面发挥着重要作用。在某些情况下，性病诊所通常是患者，特别是同性恋、双性恋和其他男男性行为者(MSM)的唯一性保健来源。涵盖时间:2010-2018年。系统描述:性病监测网络(SSuN)是一个持续的哨点监测系统，用于监测在性病诊所就诊的患者的临床信息。SSuN是竞争性选择的州和城市卫生部门的合作，在性病诊所进行以设施为基础的哨点监测。通过患者接触过程中例行收集的信息是所有在参与性病诊所寻求治疗的患者的信息。这些信息包括人口统计、行为和临床特征(例如，进行的性病和艾滋病毒检测以及性病和艾滋病毒诊断)。本报告介绍了2010-2018年来自五个城市(马里兰州巴尔的摩;纽约市，纽约;宾夕法尼亚州费城;加州旧金山;和西雅图，华盛顿)来描述在这些性病诊所寻求治疗的患者群体。使用逆方差加权随机效应模型计算每年接受选定性传播疾病相关卫生服务的患者的估计人数和百分比，并对SSuN辖区之间的异质性进行调整。对接受某些与性传播疾病有关的保健服务的趋势进行了检查，其中包括对以前不知道感染艾滋病毒的人进行急性性传播疾病诊断后的艾滋病毒筛查，对青少年和年轻女性进行年度衣原体筛查，以及对男男性行为者进行生殖器外衣原体和淋病筛查。结果:2010-2018年，参与研究的14家性病诊所的年总访问量减少了29.8%(从145,728次减少到102,275次)，诊所检查的独特患者总数减少了35.1%(从94281例减少到61,172例)。仅与女性发生性行为的男性患者数量减少(42.4%;从2010年的37842人增加到2018年的21781人)，女性占51.4%;从2010年的36,485人到2018年的17,721人)。在所有年龄组中均观察到女性患者数量的减少，但在≤24岁的女性中更为明显(66.4%;从2010年的17721人到2018年的5962人)。相比之下，被确定为MSM的患者人数增加了44.0%(从2010年的12859人增加到2018年的18512人)，其中年龄≥25岁的MSM人数增加最多(58.6%;从2010年的9918人增加到2018年的15733人)。在诊断出急性性病(定义为衣原体、淋病或原发性或继发性梅毒)的就诊期间，在性病诊断后约14天内进行艾滋病毒检测的就诊比例从2010年的58.2%增加到2018年的70.2%。在接受检测的患者中，发现了1,672例艾滋病毒感染，其中84.0%为男男性行为者。在15-24岁的女性中，在任何日历年进行衣原体筛查的百分比从2010年的88.6%上升到2018年的90.6%。然而，由于在研究期间，15-24岁的女性在这些诊所就诊的人数减少，接受衣原体检测的青少年和年轻女性的原始数量从2010年的14249人减少到2018年的4507人。在2010-2018年期间，同年首次衣原体诊断阳性后重新检测的女性百分比从11.4%到13.3%不等。2010-2018年期间，直肠衣原体和直肠淋病检测的男男性行为者比例增加(分别从54.7%增加到57.8%和从55.0%增加到58.4%)。在同一时期，诊断为直肠衣原体的男男性行为者比例(从2010年的15.5%增加到2018年的17.7%)和直肠淋病(从2010年的13.3%增加到2018年的17.1%)有所增加。与咽衣原体相比，咽淋病筛查更为常见(从2010年的69.5%上升到2018年的74.6%)，在研究期间，阳性比例翻了一番(从2010年的7.3%上升到2018年的14.8%)。咽部衣原体检测也有所增加(从2010年的50.3%上升到2018年的72.9%)，同时阳性检测也有所下降(从2010年的4.2%下降到2018年的2.6%)。解释:2010-2018年期间，参加SSuN的性病诊所患者的人口组成发生了变化。了解性病患者的人口统计趋势和所提供的服务有助于确定性病控制工作中可解决的差距，并指导公共卫生行动。总体而言，在研究期间，较少的女性，特别是15-24岁的女性，在这些性病诊所接受治疗。 在青少年和年轻女性中，未经治疗的性传播疾病会导致严重的后果，包括盆腔炎和不孕症。需要作出更多努力，监测青少年和年轻女性在何处就医，并确保她们得到与性传播疾病有关的优质保健服务，特别是考虑到报告的女性性传播疾病病例有所增加。参加性病诊所的男男性行为者人数的增加，为向这一人群提供性病和艾滋病毒预防服务提供了一个独特的机会。虽然很大比例的性病病例是在性病诊所之外诊断出来的，但公共资助的性病诊所是性病相关卫生服务的重要安全网提供者，并为面临性病和艾滋病毒感染后果风险的患者群体提供至关重要的性病相关卫生服务。公共卫生行动:与性传播疾病有关的卫生服务是预防性传播疾病和艾滋病毒传播和感染或与性传播疾病有关的后遗症的有效战略。确保所有人获得高质量的艾滋病毒和性传播疾病预防和治疗服务，对于采取有效的公共卫生办法减少性传播疾病至关重要。性传播疾病诊所为预防性传播疾病相关发病率提供了至关重要的安全网服务，包括及时发现和治疗衣原体、淋病和梅毒等可治愈的性传播疾病。参加SSuN的性病诊所的男男性行为者人数增加，为患者提供了更多机会，使他们能够获得高影响的艾滋病毒预防服务(例如，接触前预防)，而且这些诊所的定位是促进艾滋病毒感染者开始或恢复治疗。
{"title":"Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.","authors":"Eloisa Llata,&nbsp;Kendra M Cuffe,&nbsp;Viani Picchetti,&nbsp;Jimmy R Braxton,&nbsp;Elizabeth A Torrone","doi":"10.15585/mmwr.ss7007a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss7007a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem: &lt;/strong&gt;Sexually transmitted diseases (STDs) are a major cause of morbidity in the United States, with an estimated $15.9 billion in lifetime direct medical costs. Although the majority of STDs are diagnosed in the private sector, publicly funded STD clinics have an important role in providing comprehensive sexual health care services, including STD and HIV screening, for a broad range of patients. In certain cases, STD clinics often are the only source of sexual health care for patients, particularly among gay, bisexual, and other men who have sex with men (MSM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2010-2018.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of the system: &lt;/strong&gt;The STD Surveillance Network (SSuN) is an ongoing sentinel surveillance system for monitoring clinical information among patients attending STD clinics. SSuN is a collaboration of competitively selected state and city health departments that conduct facility-based sentinel surveillance in STD clinics. Information routinely collected through the course of patient encounters is obtained for all patients seeking care in the participating STD clinics. This information includes demographic, behavioral, and clinical characteristics (e.g., STD and HIV tests performed and STD and HIV diagnoses). This report presents 2010-2018 SSuN data from 14 STD clinics in five cities (Baltimore, Maryland; New York City, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) to describe the patient populations seeking care in these STD clinics. Estimated numbers and percentages of patients receiving selected STD-related health services were calculated for each year by using an inverse variance weighted random-effects model, adjusting for heterogeneity among SSuN jurisdictions. Trends in receipt of selected STD-related health services were examined and included HIV screening after an acute STD diagnosis among persons not previously known to have HIV infection, annual chlamydia screening among adolescent and young females, and extragenital chlamydia and gonorrhea screening among MSM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During 2010-2018, the total number of annual visits made in the 14 participating STD clinics decreased 29.8% (from 145,728 to 102,275 visits), and the total number of unique patients examined in the clinics decreased 35.1% (from 94,281 to 61,172 patients). Decreases in the number of unique patients occurred both among men who have sex with women only (42.4%; from 37,842 in 2010 to 21,781 in 2018) and among females (51.4%; from 36,485 in 2010 to 17,721 in 2018). The decreases in the number of female patients were observed across all age groups, although they were more pronounced among females aged ≤24 years (66.4%; from 17,721 in 2010 to 5,962 in 2018). In contrast, the number of patients identified as MSM increased 44.0% (from 12,859 in 2010 to 18,512 in 2018), with the greatest increase among MSM aged ≥25 years (58.6%; from 9,918 in 2010 to 15,73","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"70 7","pages":"1-20"},"PeriodicalIF":24.9,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39678673","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: 8
Acute Gastroenteritis on Cruise Ships - Maritime Illness Database and Reporting System, United States, 2006-2019. 游轮上的急性肠胃炎-海洋疾病数据库和报告系统，美国，2006-2019。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-09-24 DOI: 10.15585/mmwr.ss7006a1
Keisha A Jenkins, George H Vaughan, Luis O Rodriguez, Amy Freeland
<p><strong>Problem/condition: </strong>Gastrointestinal illness is common worldwide and can be transmitted by an infected person or contaminated food, water, or environmental surfaces. Outbreaks of gastrointestinal illness commonly occur in crowded living accommodations or communities where persons are physically close. Pathogens that cause gastrointestinal illness outbreaks can spread quickly in closed and semienclosed environments, such as cruise ships. CDC's Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port.</p><p><strong>Period covered: </strong>2006-2019.</p><p><strong>Description of system: </strong>VSP maintains the Maritime Illness Database and Reporting System (MIDRS) for monitoring cases of AGE illness among passengers and crew sailing on cruise ships carrying ≥13 passengers and within 15 days of arrival at U.S. ports from foreign ports of call. Cruise ships under VSP jurisdiction are required to submit a standardized report (24-hour report) of AGE case counts for passengers and crew 24-36 hours before arrival at the first U.S. port after traveling internationally. If the cumulative number of AGE cases increases after submission of the 24-hour report, an updated report must be submitted no less than 4 hours before the ship arrives at the U.S. port. A special report is submitted to MIDRS when vessels are within 15 days of arrival at a U.S. port and cumulative case counts reach 2% of the passenger or crew population during a voyage. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ship's medical staff.</p><p><strong>Results: </strong>During 2006-2019, a total of 37,276 voyage reports from 252 cruise ships were submitted to MIDRS. Of the 252 cruise ships, 80.6% were extra large in size (60,001-120,000 gross registered tons [GRT]), 37.0% and 32.9% had voyages lasting 3-5 days and 8-10 days, respectively, and 53.2% were traveling to a port in the Southeast region of the United States at the time the final MIDRS report was submitted. During 2006-2019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). Incidence rates decreased from 32.5 cases per 100,000 travel days to 16.9 for passengers and from 13.5 to 5.2 for crew. Among passengers, AGE incidence rates increased with increasing ship size and voyage length. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 6-7 days. Geographically, passenger incidence rates were highest among ships underway to ports in California, Alaska, Texas, New York, Florida, and Louisiana. Among passengers, AGE incidence rates were significantly higher on ships anchoring in California (32.1 per 100,0
问题/状况:胃肠道疾病在世界范围内很常见，可通过感染者或受污染的食物、水或环境表面传播。胃肠道疾病的暴发通常发生在拥挤的住所或人们身体距离近的社区。引起胃肠道疾病爆发的病原体可以在封闭和半封闭的环境中迅速传播，例如游轮。美国疾病控制与预防中心的船舶卫生计划(VSP)负责对访问外国港口后进入美国的游轮进行公共卫生检查和监测急性胃肠炎(AGE)疾病。涵盖期间:2006-2019年。系统描述:VSP维护海上疾病数据库和报告系统(MIDRS)，用于监测乘坐≥13名乘客的游轮上的乘客和船员在从外国停靠港抵达美国港口后15天内的AGE疾病病例。在VSP管辖范围内的游轮，必须在国际旅行后抵达美国第一个港口的24-36小时前提交乘客和船员AGE病例计数的标准化报告(24小时报告)。如果在提交24小时报告后，AGE病例累计数量增加，则必须在船舶到达美国港口之前至少4小时提交更新报告。当船舶抵达美国港口后15天内，累计病例数达到航程中乘客或船员总数的2%时，向MIDRS提交一份特别报告。当航行中有3%或以上的乘客或船员向船上医务人员报告AGE症状时，VSP宣布爆发。结果:2006-2019年期间，共有来自252艘游轮的37276份航行报告提交给MIDRS。在252艘游轮中，80.6%为特大型(60,001-120,000总注册吨[GRT])， 37.0%和32.9%的游轮航行时间分别为3-5天和8-10天，53.2%的游轮在提交MIDRS最终报告时前往美国东南部地区的港口。2006-2019年，VSP共收到24小时常规报告18040份(48.4%)，4小时更新报告18606份(49.9%)，特别报告612份(1.6%)(2%和3%的AGE报告)。乘客的发病率从每10万旅行日32.5例下降到16.9例，机组人员从13.5例下降到5.2例。在旅客中，AGE发病率随着船型和航程的增加而增加。对于船员来说，与小型和大型船只以及持续6-7天的航行相比，超大型船只的费率明显更高(每10万旅行日19.8)。从地理上看，前往加利福尼亚、阿拉斯加、德克萨斯、纽约、佛罗里达和路易斯安那州港口的船只的乘客发病率最高。在乘客中，停泊在加州的船舶的AGE发病率显著较高(每10万旅行日32.1例[95%置信区间(CI) = 31.7-32.4]);在船员中，他们在美国南部地区明显更高(25.9 [CI = 25.1-26.7])。本报告是2006-2019年MIDRS监测数据的首次详细摘要。在此期间，AGE发病率下降。大型和超大型船舶以及航程超过7天的旅客发病率更高。在超大型船舶和持续6-7天的航行中，船员中AGE的发病率较高。船舶尺寸和航程长度与AGE发病率有关，需要采取更有针对性的措施，防止在高风险情况下航行的乘客和船员中出现不成比例的AGE发病率。公共卫生行动:海事AGE监测提供了在美国管辖范围内旅行的游轮人群中胃肠疾病流行病学的重要信息。AGE疾病具有高度传染性，可在血管内迅速传播。美国的州和地方公共卫生部门可以利用本报告中的数据，更好地向旅行公众通报年龄增长的风险，以及他们在尽量减少乘船旅行时患病风险方面所起作用的重要性。减少接触年龄层疾病、限制疾病传播和预防年龄层疾病暴发的关键要素是适当的手部卫生习惯和及时隔离有症状者。乘客可与邮轮公司合作，通过勤洗手、及时报告AGE疾病症状以及在发病后立即与其他人隔离等方式，促进船上公共卫生。进入和正确使用洗手站可以减少游轮上疾病传播的风险。
{"title":"Acute Gastroenteritis on Cruise Ships - Maritime Illness Database and Reporting System, United States, 2006-2019.","authors":"Keisha A Jenkins,&nbsp;George H Vaughan,&nbsp;Luis O Rodriguez,&nbsp;Amy Freeland","doi":"10.15585/mmwr.ss7006a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss7006a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Gastrointestinal illness is common worldwide and can be transmitted by an infected person or contaminated food, water, or environmental surfaces. Outbreaks of gastrointestinal illness commonly occur in crowded living accommodations or communities where persons are physically close. Pathogens that cause gastrointestinal illness outbreaks can spread quickly in closed and semienclosed environments, such as cruise ships. CDC's Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2006-2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;VSP maintains the Maritime Illness Database and Reporting System (MIDRS) for monitoring cases of AGE illness among passengers and crew sailing on cruise ships carrying ≥13 passengers and within 15 days of arrival at U.S. ports from foreign ports of call. Cruise ships under VSP jurisdiction are required to submit a standardized report (24-hour report) of AGE case counts for passengers and crew 24-36 hours before arrival at the first U.S. port after traveling internationally. If the cumulative number of AGE cases increases after submission of the 24-hour report, an updated report must be submitted no less than 4 hours before the ship arrives at the U.S. port. A special report is submitted to MIDRS when vessels are within 15 days of arrival at a U.S. port and cumulative case counts reach 2% of the passenger or crew population during a voyage. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ship's medical staff.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During 2006-2019, a total of 37,276 voyage reports from 252 cruise ships were submitted to MIDRS. Of the 252 cruise ships, 80.6% were extra large in size (60,001-120,000 gross registered tons [GRT]), 37.0% and 32.9% had voyages lasting 3-5 days and 8-10 days, respectively, and 53.2% were traveling to a port in the Southeast region of the United States at the time the final MIDRS report was submitted. During 2006-2019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). Incidence rates decreased from 32.5 cases per 100,000 travel days to 16.9 for passengers and from 13.5 to 5.2 for crew. Among passengers, AGE incidence rates increased with increasing ship size and voyage length. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 6-7 days. Geographically, passenger incidence rates were highest among ships underway to ports in California, Alaska, Texas, New York, Florida, and Louisiana. Among passengers, AGE incidence rates were significantly higher on ships anchoring in California (32.1 per 100,0","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"70 6","pages":"1-19"},"PeriodicalIF":24.9,"publicationDate":"2021-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441232","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: 3
Asthma Surveillance - United States, 2006-2018. 哮喘监测-美国，2006-2018。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-09-17 DOI: 10.15585/mmwr.ss7005a1
Cynthia A Pate, Hatice S Zahran, Xiaoting Qin, Carol Johnson, Erik Hummelman, Josephine Malilay
<p><strong>Problem: </strong>Asthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthma-related complications.</p><p><strong>Reporting period: </strong>2006-2018.</p><p><strong>Description of system: </strong>The National Health Interview Survey (NHIS) is an annual cross-sectional household health survey among the civilian noninstitutionalized population in the United States. NHIS data were used to produce estimates for current asthma and among them, asthma attacks and ED/UCC visits. National Vital Statistics System (NVSS) data were used to estimate asthma deaths. Estimates of current asthma, asthma attacks, ED/UCC visits, and asthma mortality rates are described by demographic characteristics, poverty level (except for deaths), and geographic area for 2016-2018. Trends in asthma indicators by metropolitan statistical area (MSA) category for 2006-2018 were determined. Current asthma and asthma attack prevalence are provided by MSA category and state for 2016-2018. Detailed urban-rural classifications (six levels) were determined by merging 2013 National Center for Health Statistics (NCHS) urban-rural classification data with 2016-2018 NHIS data by county and state variables. All subregional estimates were accessed through the NCHS Research Data Center.</p><p><strong>Results: </strong>Current asthma was higher among boys aged <18 years, women aged ≥18 years, non-Hispanic Black (Black) persons, non-Hispanic multiple-race (multiple-race) persons, and Puerto Rican persons. Asthma attacks were more prevalent among children, females, and multiple-race persons. ED/UCC visits were more prevalent among children, women aged ≥18 years, and all racial and ethnic groups (i.e., Black, non-Hispanic Asian, multiple race, and Hispanic, including Puerto Rican, Mexican, and other Hispanic) except American Indian and Alaska Native persons compared with non-Hispanic White (White) persons. Asthma deaths were higher among adults, females, and Black persons. All pertinent asthma outcomes were also more prevalent among persons with low family incomes. Current asthma prevalence was higher in the Northeast than in the South and the West, particularly in small MSA areas. The prevalence was also higher in small and medium metropolitan areas than in large central metropolitan areas. The prevalence
问题:哮喘是一种需要持续医疗管理的气道慢性疾病。社会经济和人口因素以及保健使用可能影响城市和农村地区的健康模式。生活在农村地区的人获得保健和卫生资源的机会往往较少，健康结果也较差。表征哮喘指标(即当前哮喘患病率、哮喘发作、急诊科和紧急护理中心[ED/UCC]就诊以及哮喘相关死亡)，并确定美国不同地理区域(包括城市和农村地区之间的差异)哮喘恶化和医疗保健使用情况的差异，以及社会人口统计学因素，有助于确定哮喘相关并发症风险亚人群。报告期间:2006-2018年。系统描述:全国健康访谈调查(NHIS)是一项针对美国非机构人口的年度横断面家庭健康调查。NHIS数据用于估计当前哮喘，其中包括哮喘发作和ED/UCC就诊。使用国家生命统计系统(NVSS)的数据来估计哮喘死亡。当前哮喘、哮喘发作、ED/UCC就诊和哮喘死亡率的估计由2016-2018年的人口统计学特征、贫困水平(死亡除外)和地理区域描述。确定了2006-2018年各大城市统计区(MSA)类别哮喘指标的趋势。当前哮喘和哮喘发作患病率由MSA类别和州提供2016-2018年。通过合并2013年国家卫生统计中心(NCHS)城乡分类数据和2016-2018年国家卫生统计中心(NHIS)按县和州变量的数据，确定了详细的城乡分类(六个级别)。所有次区域估计数都是通过国家人口统计中心研究数据中心获得的。解释:尽管随着时间的推移，哮喘结局有所改善，但本报告的研究结果表明，哮喘指标的差异因人口特征、贫困水平和地理位置而持续存在。公共卫生行动:从NHIS和NVSS中确定的城乡人口哮喘结局和卫生保健使用的差异可以帮助公共卫生计划指导资源和干预措施以改善哮喘结局。这些数据还可用于制定战略目标，实现CDC控制儿童哮喘和减少紧急情况(CCARE)倡议，即到2024年减少儿童哮喘住院和ED就诊，并预防50万例哮喘相关住院和ED就诊。
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引用次数: 102
World Trade Center Health Program - United States, 2012-2020. 世界贸易中心卫生方案-美国，2012-2020年。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2021-09-10 DOI: 10.15585/mmwr.ss7004a1
Alejandro Azofeifa, Gayatri R Martin, Albeliz Santiago-Colón, Dori B Reissman, John Howard

Problem/condition: After the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area).

Reporting period covered: 2012-2020.

Description of system: The U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC's National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members' authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012-2020.

Results: In 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44-57) in 2012 and 59 years (IQR: 52-66) in 2020. During 2012-2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual

问题/状况:在2001年9月11日对美国的恐怖袭击之后，大约40万人暴露于有毒污染物和其他因素，这些因素增加了他们出现某些身心健康状况的风险。此后不久，提供了联邦和非联邦资金，支助各种灾后活动，包括医疗监测和治疗。2011年，根据2010年《詹姆斯·扎德罗加9/11健康与赔赔法》的授权，疾病预防控制中心世界贸易中心(WTC)健康方案开始为世贸中心响者(即2001年9月11日恐怖袭击后参与救援、反应、恢复、清理和相关支持活动的人员)和受影响的世贸中心幸存者(即:在9/11事件中出现在灰尘或尘埃云中的人，或在纽约市灾区工作、生活或上学、儿童保育中心或成人日托中心的人)。报告涵盖期间:2012-2020年。系统描述:美国卫生与公众服务部WTC健康计划由疾病预防控制中心国家职业安全与健康研究所主任管理。WTC健康计划使用多层管理索赔系统来处理成员的授权计划健康福利。行政索赔数据主要由纽约和新泽西临床卓越中心的临床提供者生成，而在这些州之外，由全国提供者网络的临床提供者生成。本报告描述了2012-2020年期间世界卫生组织卫生规划选定指标的趋势。结果:2020年，共有104,223名成员参加了WTC健康计划，其中73.4% (n = 76,543)是响应者，26.6% (n = 27,680)是幸存者。WTC健康计划成员以男性为主(78.5%)。2012年会员年龄中位数为51岁(四分位数差[IQR]: 44-57)， 2020年为59岁(IQR: 52-66)。在2012-2020年期间，wtc相关健康状况的注册人数和认证数量在成员中有所增加，其中幸存者的变化最大。总的来说，在入学时，大多数WTC健康计划成员居住在纽约(71.7%)、新泽西(9.3%)和佛罗里达(5.7%)。2020年，wtc成员中与癌症和非癌症相关的认证总数分别为20,612和50,611。皮肤癌、男性生殖系统癌症和原位肿瘤(如皮肤和乳房)是最常见的与wtc相关的经证实的癌症。最常见的非癌症疾病是在空气消化系统和精神健康类别。每个认证会员平均拥有2.7个与wtc相关的认证条件。2020年，共有40,666名世贸中心健康计划成员接受了年度监测和筛查检查(每年平均35,245人)。2020年，接受治疗的WTC健康计划成员总数为41,387人(每年平均为32,458人)。解释:自2011年以来，世贸中心健康项目为911恐怖袭击的响应者和幸存者提供了数量有限的与911相关的健康状况的医疗保健。在研究期间，项目注册和WTC认证增加，尤其是幸存者。随着成员年龄的增长，卫生服务的使用和世贸组织卫生计划内的费用预计会增加;慢性疾病、合并症和其他与WTC暴露无关的健康相关疾病在老年人群中更为常见，这可能使WTC相关健康状况的临床管理复杂化。公共卫生行动:在WTC研究结果的背景下分析行政索赔数据可以更好地阐明WTC健康计划成员的医疗保健使用模式。这些信息可指导方案决策，也可能有助于指导今后的备灾和救灾保健工作。加强世界卫生组织卫生规划的卫生信息基础设施是及时制定规划和研究决策的必要条件。
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引用次数: 15
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