Background:Since 1972, low-density lipoprotein cholesterol (LDL-C) has been calculated by the Friedewald equation, which estimates very low-density lipoprotein cholesterol as triglycerides divided by 5 and is accurate only for triglycerides <400 mg/dL. The Martin equation, published in 2013 (for triglycerides <400 mg/dL), replaced 5 with a factor varying over an array of non-high-density lipoprotein cholesterol and triglyceride levels. This array was extended in 2021 for triglycerides 400-<800 mg/dL. In 2020, the Sampson equation, accurate for triglycerides <800 mg/dL, was developed using multiple least squares regression. This report compares LDL-C as calculated by the Friedewald, Martin, and Sampson equations in a nationally representative sample of adults with triglycerides <400 mg/dL across the distribution of clinical cut points for LDL-C (<70 mg/dL, 70-<100 mg/dL, 100-<160 mg/dL, 160-<190 mg/dL, and ≥190 mg/dL) to assess the impact of equation choice on national estimates. Methods:Using data on 4,461 adults in the 2015-2018 National Health and Nutrition Examination Survey, classification agreement into the LDL-C categories used for clinical management across the three equations was assessed using kappa statistics for men and women overall and by demographic subgroups. A sensitivity analysis assessed classification agreement between the Martin and Sampson equations for adults with triglycerides <800 mg/dL. Results:During 2015-2018, 9.8%-10.0% of adults age 20 and older had LDL-C levels <70 mg/dL (Friedewald: 10.0%, Martin: 9.8%, Sampson: 9.8%). Less than 3% had LDL-C >190 mg/dL (Friedewald: 2.3%, Martin: 2.4%, Sampson: 2.6%). Very good agreement between the equations was seen in all subgroups (kappa >0.8). Conclusions:The three equations for LDL-C produce similar U.S. population-level percent distributions for adults age 20 and older across LDL-C categories.
Objective:This report examines selected measures of healthcare use among teenagers ages 12-17 by parent- or self-report. Agreement between parent-reported and teen self-reported data is also evaluated. Methods:The percentage of teenagers with doctor visits, wellness visits, having a usual place of care, having a personal doctor or nurse, and having time alone with a doctor were estimated using teen-reported data from the National Health Interview Survey-Teen collected from July 2021 through December 2023. These estimates were compared with parent-reported estimates from the same time period using data from the National Health Interview Survey. Cohen's kappa and prevalence-adjusted, bias-adjusted kappa (PABAK) values were used to evaluate agreement between parent and teen responses. Results:Across all measures, parents reported higher healthcare use for their teenagers than teenagers reported for themselves (for example, 91.4% of parents reported a doctor's visit in the last 12 months compared with 83.0% of teenagers). Cohen's kappa values across measures showed fair to slight agreement, with PABAK values showing slightly higher agreement, ranging from slight to substantial. Percentage agreement patterns were most often driven by both parent and teenager affirming healthcare use indicators, except for having time alone with a doctor, which was driven slightly more by the parent and teenager both reporting the teenager had not received this service. Disagreement patterns were driven by parents affirming services the teenager did not; disagreement was highest for having a personal doctor or nurse and time alone with a doctor.
Objectives:This report presents national estimates of difficulties in functioning for children ages 2-17. Methods:2021-2023 National Health Interview Survey (NHIS) data were used to assess difficulties in functioning among children. NHIS has included the Child Functioning Module, developed jointly by UNICEF and the Washington Group on Disability Statistics, since 2019. The module's questions ask about difficulties in the following functional domains: seeing, hearing, walking, communication, behavior, and learning (for all children ages 2-17); fine motor and playing (for children ages 2-4); and self-care, remembering, concentrating, coping with change, relationships, and affect (anxiety and depression) (for children ages 5-17). Prevalence estimates were calculated for different levels of difficulty (a lot of difficulty, some difficulty, or no difficulty) and are presented for overall functioning, by individual functional domain, and by number of functional domains where difficulties were reported. Differences in functioning by age, sex, race and Hispanic origin, urbanization level, and family income are also presented. Results:In 2021-2023, about one-quarter (24.9%) of children ages 2-4 experienced difficulties in functioning (4.1% experienced a lot of difficulty in one or more domains and 20.8% experienced some difficulty). Among children ages 5-17, just over one-half (50.8%) experienced functioning difficulties (13.0% experienced a lot of difficulty and 37.8% experienced some difficulty). The prevalence of functioning difficulties varied by sex, with boys being more likely than girls to experience a lot of difficulty in at least one domain, but differences across other characteristics varied. Functioning difficulties were most prevalent in the domains of communication, learning, behavior, and playing among children ages 2-4. For those ages 5-17, the most prevalent domains were anxiety, accepting change, behavior, depression, and making friends. Among children who experienced functioning difficulties, most had difficulty in only one functional domain.
Introduction:Personal care aides (aides) are a key part of the long-term care infrastructure and provide hands-on care and support with essential activities of daily living to older and disabled Americans. This report presents the number of aides employed in adult day services centers (ADSC) and residential care communities (RCC), the hours they spend with their service users, and their training and benefits. Methods:Data are from the ADSC and RCC provider components of the 2022 National Post-acute and Long-term Care Study, conducted biennially by the National Center for Health Statistics. The study includes several questions on staffing, including about the number of registered nurses (RNs), licensed practical nurses (LPNs) or licensed vocational nurses (LVNs), and aides employed directly by ADSCs and RCCs. Full-time equivalent (FTE) staff is based on the number of full-time and part-time employees. A measure of hours per user (participant or resident) per day was used to compare staffing levels in the two settings relative to the number of users. Responses to questions on number of hours of training required and types of training and benefits offered to aides were used to compare in and across ADSC and RCC settings. Results:Of the 15,600 nursing (RN, LPN or LVN, and aide) FTEs employed in ADSCs and 452,000 employed in RCCs, the majority were aides (63.2% and 76.0%, respectively). Both settings often employed at least one aide (56.2% and 75.6%). The average total of all nursing staffing hours per participant or resident per day was 1 hour and 34 minutes for ADSCs and 4 hours and 25 minutes for RCCs. A lower percentage of ADSCs than RCCs offered training in dementia care (50.8% and 72.3%) and end-of-life issues (19.7% and 58.4%).
Objective:This report describes differences in the experience of family food insecurity in the past 30 days among working adults ages 18-64 by selected work conditions. Methods:Using data from the 2021 National Health Interview Survey on working adults ages 18-64, family food insecurity in the past 30 days was examined by selected work conditions, including type of work shift, work schedule inflexibilities, advance notice of work schedule, and monthly change in earnings. Bivariate associations between family food insecurity and each type of work condition were examined, and logistic regression models were used to estimate associations adjusting for age, sex, race and Hispanic origin, nativity status, marital status, presence of children in family, educational attainment, family income as a percentage of the federal poverty level, employed full time, occupation, health status, disability status, rural residence, and region. Model-adjusted prevalence of family food insecurity among working adults by type of work conditions is reported. Results:In 2021, 4.4% of working adults ages 18-64 lived in families experiencing food insecurity. Differences in family food insecurity by work conditions persisted even after adjusting for potential confounders. After adjustment, those working rotating or other types of shifts were more likely to report family food insecurity (5.7%) compared with day shift workers (4.0%). Workers who reported that it was very difficult or somewhat difficult to change their work schedule were more likely to experience family food insecurity (6.3%) than workers who reported it was very easy or somewhat easy to change their work schedule (3.8%). Food insecurity also varied by monthly change in earnings, from 3.9% among workers whose earnings did not change to 5.5% among workers whose earnings changed at least a moderate amount from month to month.
Objective:This report presents national estimates of the percentage of adults age 65 and older who met the federal physical activity guidelines for both aerobic and muscle-strengthening activities during leisure time by sociodemographic and health-related characteristics. Methods:Data from the 2022 National Health Interview Survey were used to estimate the percentage of adults age 65 and older who met the U.S. Department of Health and Human Services 2018 Federal Physical Activity Guidelines for Americans for both aerobic and muscle-strengthening activities during leisure time. Adults were considered to have met the guidelines if they met both aerobic and muscle-strengthening recommendations. Estimates are presented by age group, sex, race and Hispanic origin, education, family income, urbanization level, respondent-assessed health status, chronic conditions, disability status, severity of depression symptoms, severity of anxiety symptoms, and body mass index. Results:Overall, 13.9% (age adjusted) of adults age 65 and older met federal physical activity guidelines for both aerobic and muscle-strengthening activities in 2022. Differences were seen by several sociodemographic characteristics. Men (16.9%), White non-Hispanic adults (15.2%), and those living in metropolitan areas (14.7%) were more likely to meet the guidelines. The percentage meeting the federal physical activity guidelines increased with increasing education level and family income and decreased with number of chronic conditions. Older adults who reported poor health status had the lowest percentage meeting the guidelines compared with those reporting good, very good, or excellent health. Older adults without disabilities were three times more likely to meet the federal physical activity guidelines than adults with disabilities (15.9% compared with 5.0%, respectively). Older adults with no depression or anxiety symptoms were more likely to meet the guidelines than those with mild symptoms or moderate or severe symptoms.
Objective:This report examines the prevalence of symptoms of anxiety and depression among adults by sociodemographic and geographic characteristics, and how those may have changed between 2019 and 2022. Methods:Data from the 2022 National Health Interview Survey were used to examine the prevalence of symptoms of anxiety, using the Generalized Anxiety Disorder scale (GAD-7), and symptoms of depression, using the Patient Health Questionnaire depression scale (PHQ-8). Results:During 2022, about one in five adults age 18 and older experienced any symptoms of anxiety (18.2%) or symptoms of depression (21.4%) in the past 2 weeks. The severity of symptoms differed by sociodemographic and geographic characteristics. The percentages of adults with mild, moderate, or severe symptoms of both anxiety and depression were highest among adults ages 18-29 and decreased with age and were higher among women than men. Asian non-Hispanic adults were least likely to experience moderate and severe symptoms of anxiety and depression compared with the other race and Hispanic-origin groups examined. In addition, the percentage of adults with any symptoms of anxiety and depression was highest among those with less than a high school education and with family incomes less than 100% of the federal poverty level and was higher among those living in rural areas. A significant increase was seen in the percentage of adults with anxiety symptoms (from 15.6% to 18.2%, respectively) and depression symptoms (from 18.5% to 21.4%, respectively) between 2019 and 2022. Increases in symptoms of anxiety and depression were seen throughout the subgroups examined, including adults ages 18-44, Black non-Hispanic and White non-Hispanic adults, adults with a high school education or more, and adults with family incomes of 100% of the federal poverty level or higher, as well as adults from all regions and urbanization levels.
Objective:This report describes care received at health centers in the United States in 2022. Estimates are presented for selected characteristics. Methods:The data presented in this report are from the 2022 National Ambulatory Medical Care Survey Health Center Component. Data were collected from federally qualified health centers and federally qualified health center look-alikes and weighted to produce nationally representative estimates of visits to health centers from all 50 U.S. states and the District of Columbia. Results:During 2022, an estimated 89.5 million visits were made by adults to health centers in the United States, an overall rate of 349.4 visits per 1,000 adults. The visit rate among women was higher than for men. Differences in visit rates by age were not significant. Adults who were not married accounted for 48.2% of visits, and adults who were married accounted for 37.6% of visits. More than one-half of health center visits were disease-related (61.4%). Symptoms-related diagnoses accounted for 22.0% of visits. Screenings (12.6%) and examinations (10.2%) were also frequent reasons for health center visits. Social determinants of health were listed as a reason for the visit at 2.0% of health center visits. Endocrine diseases represented the most frequently mentioned disease category (29.1%), overall and among adults age 45 and older. Mental disorders represented the most common disease category among adults ages 18-44. Conclusions:Women visited health centers at a higher rate than men. In addition, patient and visit characteristics, including marital status and diagnoses, differed by age.
This report provides health data from the National Center for Health Statistics.
Objective:This report examines telemedicine use by office-based physicians and long-term care providers in the United States, stratified by electronic health record use and by provider or practice size. Further, it examines differences in telemedicine use before and after the COVID-19 pandemic onset among office-based physicians and assesses telemedicine use during the first year of the COVID-19 pandemic for long-term care providers. Methods:Nationally representative estimates in this report are derived from data collected in the 2019 and 2021 National Electronic Health Records Survey, which assesses characteristics of office-based physicians, and the 2020 National Post-acute and Long-term Care Study, which assesses characteristics of adult day services centers and residential care communities. Measures include telemedicine using audio with video or web videoconference for patient care, electronic health record use for more than accounting or billing purposes, and size of physician practices and long-term care providers. Results:In 2021, 80.5% of physicians in office-based settings used telemedicine for patient care, up from 16.0% in 2019. In 2020, 20.5% of adult day services centers and 44.5% of residential care communities used telemedicine to care for users with COVID-19. Office-based physicians, adult day services centers, and residential care communities that used electronic health record systems were more likely to also use telemedicine compared with those not using electronic health records. Large practices and providers were more likely to use telemedicine compared with small practices and providers. Conclusion:Findings from this report describe telemedicine use among office-based physicians and long-term care providers. Practices and providers that used electronic health records and were larger were more likely to also use telemedicine for patient care during the COVID-19 pandemic.
Objective:This report provides a comprehensive look at enrollment in high-deductible health plans (HDHP), including consumer-directed health plans (CDHP) among privately insured people younger than age 65. Methods:Data from the 2019 through 2023 National Health Interview Survey were used to examine enrollment in HDHPs and CDHPs among people younger than age 65 with private health insurance. CDHPs are HDHPs with an associated health savings account or health reimbursement account. All estimates are presented by sex, age group, race and Hispanic origin, family income, family educational attainment, level of urbanization, and source of private coverage. Results:In 2023, among privately insured people younger than age 65, 41.7% were enrolled in an HDHP. Enrollment increased from 40.3% in 2019 to 43.3% in 2021, followed by a decrease to 41.7% in 2023. Among people with employment-based coverage, enrollment in an HDHP increased from 40.2% in 2019 to 43.4% in 2021, followed by a decrease to 41.9% in 2023. For people with directly purchased coverage, enrollment in an HDHP increased from 44.3% in 2019 to 47.0% in 2020, followed by a decrease to 43.1% in 2023. Generally, White non-Hispanic people were the most likely to be enrolled in an HDHP. Black non-Hispanic and Hispanic people were the least likely to be enrolled in an HDHP. Enrollment in an HDHP increased with family income and family educational attainment. In 2023, 19.5% of people younger than age 65 with private health insurance were enrolled in a CDHP. Enrollment characteristics of people with CDHPs mirrored those of people with HDHPs overall. However, children were more likely to be enrolled in an CDHP plan than adults ages 18-64. People with employment-based coverage were nearly four times more likely to be enrolled in a CDHP than their counterparts with directly purchased coverage.
Objective:Nonfinancial access barriers to care describe various reasons why adults may delay or not get medical care, beyond cost. This report focuses on five access barriers to care and describes the percentage of U.S. adults who delayed or did not get medical care in the past 12 months because of 1) being too busy with work or other commitments; 2) an appointment not being available when needed; 3) not being able to get to the doctor's office or clinic when open; 4) difficulty finding a doctor, clinic, or hospital that would accept their health insurance; and 5) it taking too long to get to the doctor's office or clinic from their house or work. Methods:Data from the 2022 National Health Interview Survey were used to produce estimates of the percentage of adults who delayed or did not get medical care in the past 12 months because of those access barriers to care, overall and by selected sociodemographic characteristics. Results:Among U.S. adults in 2022, 12.5% delayed or did not get medical care in the past 12 months because they were too busy to go to a provider, 10.6% could not find an available appointment when needed, 4.6% were unable to get to a provider when open, 4.4% had difficulty finding a doctor compatible with their health insurance, and 2.4% responded that it takes too long to get to a provider. Percentages varied by sociodemographic characteristics. Conclusion:This study provides nationally representative estimates of selected nonfinancial access barriers to medical care, both overall and for selected sociodemographic groups. Findings suggest that nonfinancial access barriers to care are widespread in the United States, and ongoing monitoring may help to address inequities in access to care.
Objectives-Emergency operations plans that are specific to or include response to pandemics, approaches to implement the plans, and related infection control policies and practices vary among residential care communities (RCCs). This report presents nationally representative percentages of RCCs with infection control programs by selected characteristics. Methods-Data are from the RCC component of the 2020 National Post-acute and Long-term Care Study, conducted biennially by the National Center for Health Statistics. The study asked four binary questions, including whether the RCC had a written Emergency Operations Plan that was specific to or included pandemic response, had a designated staff member or consultant responsible for coordinating the infection control program, offered annual influenza vaccination to residents, and offered annual influenza vaccination to all employees or contract staff. RCC characteristics presented in this report are bed size, chain affiliation, ownership status, and provision of dementia-specific care (RCCs that only served residents with dementia or had a dementia wing). Metropolitan statistical area (MSA) was used to characterize geographic location. Results-Most RCCs reported having a written Emergency Operations Plan that was specific to or included pandemic response. A higher percentage of RCCs with more than 26 beds and those with a designated space for dementia care reported having a written Emergency Operations Plan and a designated staff to coordinate an infection control program. The largest differences were observed in the provision of annual influenza vaccination to residents and to all employees or contract staff by MSA status, bed size, and presence of a designated space for dementia care. A higher percentage of RCCs in non-MSAs (83.4%), RCCs with a designated space for dementia care (95.0%), those with more than 50 beds (93.9%), those with 26-50 beds (93.3%), and those with nonprofit ownership (85.8%) offered annual influenza vaccination to all employees or contract staff.
Purpose-This report describes trends in emergency department visits among people younger than age 65 from 2010 through 2021, by health insurance status and selected demographic and hospital characteristics. Methods-Estimates in this report are based on data collected in the 2010-2021 National Hospital Ambulatory Medical Care Survey. Data were weighted to produce annual national estimates. Patient and hospital characteristics are presented by primary expected source of payment. Results-Private insurance and Medicaid were the most common primary expected sources of payment at emergency department visits by people younger than age 65 from 2010 through 2013. Medicaid was the most common primary expected source of payment from 2014 through 2021. Among children younger than age 18 years, the most common primary expected source of payment was Medicaid across the entire period. The percentage of visits by children with no insurance decreased from 7.4% in 2010 to 3.0% in 2021. Among adults, the percentage of visits with Medicaid increased from 25.5% in 2010 to 38.9% in 2021, and the percentage of visits by those with no insurance decreased from 24.6% to 11.1% during this period. Among Black non-Hispanic and Hispanic people, Medicaid was the most frequent primary expected source of payment during the entire period. Among White non-Hispanic people, private insurance was the most frequent primary expected source of payment through 2015, while private insurance and Medicaid were the most frequent primary expected sources of payment from 2016 through 2021.
Objectives-Using National Survey of Family Growth data from 2015-2019, this report presents updated national estimates of infertility in U.S. women and men and estimates of impaired fecundity (physical ability to have children) in U.S. women. Detailed demographic breakdowns are also presented, and overall estimates for 2015-2019 are compared with those for 2011-2015. Methods-Data for this report come primarily from the 2015-2019 National Survey of Family Growth, which consisted of 21,441 interviews with men and women ages 15-49, conducted from September 2015 through September 2019. The response rate was 65.9% for women and 62.4% for men. Results-The percentage of women ages 15-44 who had impaired fecundity did not change between 2011-2015 and 2015-2019. The percentage of married women with impaired fecundity also remained stable over this time period. Among all women, 13.4% of women ages 15-49 and 15.4% of women ages 25-49 had impaired fecundity in 2015-2019. The percentage of married women ages 15-44 who were infertile rose from 2011-2015 (6.7%) to 2015-2019 (8.7%). Among married and cohabiting women ages 15-49 in 2015-2019, 7.8% had infertility. Both infertility and impaired fecundity were associated with age for nulliparous (never had a live birth) women after adjusting for other factors. Some form of infertility (either subfertility or nonsurgical sterility) was seen in 11.4% of men ages 15-49 and 12.8% of men ages 25-49 in 2015-2019. . Conclusion-Although these findings are not nationally representative, this report illustrates how linked NHCS-HUD data may provide insight into maternal health outcomes of patients who received housing assistance compared with those who did not.
Objectives-This report describes emergency department (ED) visits by homeless status and sex. Methods-Nationally representative estimates were calculated from data collected in the 2016-2021 National Hospital Ambulatory Medical Care Survey, an annual national probability sample survey of ED visits in the United States. Visits by people experiencing homelessness were defined using data on patient residence from medical records. Visits by males and females experiencing homelessness are compared with each other and with visits by males and females not experiencing homelessness. Results-During 2016-2021, approximately 981,000 and 460,000 ED visits were made annually by males and females experiencing homelessness, respectively. Significant differences by sex were found for this population for many ED visit characteristics, including arrival by ambulance, diagnoses, and chronic conditions. ED visits by males and females experiencing homelessness also differed significantly from ED visits by males and females not experiencing homelessness based on age, geographic region, expected source of payment, primary diagnosis, chronic conditions, and other characteristics. Conclusion-This report highlights certain differences by sex among the population experiencing homelessness who visited the ED and compares them with people who visited the ED but were not experiencing homelessness.
Objectives-This report presents estimates of diagnosed dementia in the U.S. civilian noninstitutionalized population age 65 and older by selected sociodemographic characteristics. Methods-Data from the 2022 National Health Interview Survey were used to estimate the percentage of noninstitutionalized older adults with a dementia diagnosis. Information was self-reported unless a knowledgeable proxy responded to questions when the respondent was physically or mentally unable to answer. Prevalence of diagnosed dementia among older adults is presented by age, sex, race and Hispanic origin, veteran status, education, family income as a percentage of the federal poverty level, urbanization, and region. Estimates of dementia reporting by proxy respondent status and interview mode also are presented. Results-In 2022, 4.0% of adults age 65 and older reported ever having received a dementia diagnosis. The percentage of adults with a dementia diagnosis was similar for men (3.8%) and women (4.2%). The percentage of adults with a dementia diagnosis increased with age, from 1.7% in those ages 65-74 to 13.1% in those age 85 and older, and decreased with rising education level, from 7.9% in adults age 65 and older with less than a high school diploma to 2.2% in those with a college degree or higher. Overall levels of older adults with a dementia diagnosis did not vary significantly by mode of interview (telephone or in person).
Objectives-This report examines changes in telemedicine use among U.S. adults between 2021 and 2022 by selected sociodemographic and geographic characteristics. Methods-Data from the 2021 and 2022 National Health Interview Survey were used to assess changes between these 2 years in the percentage of adults who used telemedicine in the previous 12 months, by sex, age, race and Hispanic origin, family income, education, region of residence, urbanization level, and health insurance coverage. Results-Overall, the percentage of adults who used telemedicine in the past 12 months decreased from 37.0% in 2021 to 30.1% in 2022. This pattern was observed across several sociodemographic and geographic characteristics, such as sex, family income, education, region, and urbanization level. Women, adults with a college degree or higher, and adults living in more urban areas were all more likely to use telemedicine in 2022. In 2021 and 2022, uninsured adults ages 18-64 were less likely to use telemedicine compared with those who had private or public insurance, while adults age 65 and older who had Medicare only were less likely to use telemedicine compared with those with other types of insurance. However, for both age groups, telemedicine use decreased from 2021 to 2022 for all insurance types except public coverage for adults ages 18-64. Summary-National Health Interview Survey data may be used to monitor national trends and understand patterns of telemedicine use by sociodemographic and geographic characteristics as the transition forward from the global COVID-19 pandemic continues.
