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.
