OBJECTIVES:Nearly half of US adults have hypertension. The prevalence of hypertension is higher among adults with disabilities than among those without disabilities; however, national estimates use old data and definitions, and hypertension awareness and control are understudied. This study compared hypertension prevalence, awareness, and control among adults with and without disabilities. METHODS:We analyzed data from the National Health and Nutrition Examination Survey (August 2021-August 2023) for adults aged ≥18 years (N = 5999). To determine disability status, we used the Washington Group on Disability Statistics questionnaire, which covers the domains of seeing, hearing, walking, communication, cognition, self-care, upper-body function, and affect. Hypertension was defined as blood pressure ≥130/80 mm Hg or use of antihypertensive medication. Among adults with hypertension, awareness was defined as self-report of physician diagnosis and control as blood pressure <130/80 mm Hg. We estimated adjusted prevalence ratios (APRs) using logistic regression, adjusting for demographic and health characteristics and accounting for the complex survey design. RESULTS:Hypertension prevalence was significantly higher among adults with disabilities than among those without disabilities (57.2% vs 45.1%; P < .001). Among those with hypertension, the prevalence of awareness (71.3% vs 55.0%; P < .001) and control (27.3% vs 18.4%; P < .001) was significantly higher among adults with disabilities than among those without disabilities. Adjusted analyses showed a higher prevalence of hypertension (APR = 1.12; 95% CI, 1.04-1.21), awareness (APR = 1.22; 95% CI, 1.14-1.30), and control (APR = 1.31; 95% CI, 1.12-1.54) among adults with disabilities than among those without disabilities. CONCLUSIONS:Primary prevention may be particularly important for adults with disabilities. Improving awareness and control remains a key public health challenge regardless of disability status.

This report provides health data from the National Center for Health Statistics.

This report provides health data from the National Center for Health Statistics.

Abstract Background Accurate Pediatric Reference Intervals (PRIs) are critical for assessing health, diagnosing disease, and establishing treatment efficacy. A recent literature review established that current PRIs are inconsistent, and partitioning reference intervals into arbitrary age groups may conceal the underlying biochemistry of child development. To overcome these challenges, continuous PRIs derived using specimens collected with standardized procedures from a well-defined population were proposed. The National Health and Nutrition Examination Survey (NHANES) meets these criteria and could be used to provide accurate PRIs for public health and clinical community use. However, no U.S. studies have described developing continuous PRIs for biomarkers. This study investigates a potential approach to develop continuous hemoglobin PRIs with NHANES data. Methods Total hemoglobin values for children and adolescents 1–19 years from NHANES 2011–2018 were assessed. To exclude potentially abnormal hemoglobin values, individuals with diabetes, anemia, BMI >95th percentile, serum cotinine >10 ng/L, C-reactive protein >10 mg/dL, and self-reported tobacco use, or poor health were excluded. Hemoglobin values at the 5th, 50th, and 95th percentiles were estimated at 6-month increments of age for males and females using survey weights. Continuous curves over the age range were then generated using smoothing methods. Results The initial sample size was 16 315, of which 3 183 had missing hemoglobin values. After applying exclusions (n = 3 311), the final sample size was 9 821, of which 51.8% were males and 48.2% were females. Males had higher hemoglobin levels with a steeper slope in the curve over the age range and an increase in slope with adolescence, whereas hemoglobin levels in females peaked around age 12 before plateauing. Conclusion This investigation suggests that cross-sectional NHANES data can be used to develop continuous hemoglobin PRIs that reflect the physiologic changes commonly obscured by age group binning. More detailed assessments of appropriate sample exclusions and smoothing methods are underway.

BACKGROUND:To compare prevalence of hypertension and stage II hypertension assessed by 2 blood pressure (BP) observation protocols. METHODS:Participants aged 18 years and older (n = 4,689) in the National Health and Nutrition Examination Survey (NHANES 2017-2018) had their BP measured following 2 protocols: the legacy auscultation protocol (AP) and oscillometric protocol (OP). The order of protocols was randomly assigned. Prevalence estimates for hypertension (BP ≥130/80 mm Hg or use of medication for hypertension) and stage II hypertension (BP ≥140/90 mm Hg) were determined overall, by demographics, and by risk factors for each protocol. Ratios (OP% ÷ AP%) and kappa statistics were calculated. RESULTS:Age-adjusted hypertension prevalence was 44.5% (95% confidence interval [CI]: 41.1%-48.0%) using OP and 45.1% (95% CI: 41.5%-48.7%) using AP, prevalence ratio = 0.99 (95% CI = 0.94-1.04). Age-adjusted stage II hypertension prevalence was 15.8% (95% CI: 13.6%-18.2%) using AP and 17.1% (95% CI: 14.7%-19.7%) using OP, prevalence ratio = 0.92 (95% CI = 0.81-1.04). For both hypertension and stage II hypertension, the prevalence ratios by demographics and by risk factors all included unity in their 95% CI, except for stage II hypertension in adults 60+ years (ratio: 0.88 [95% CI: 0.78-0.98]). Kappa for agreement between protocols for hypertension and stage II hypertension was 0.75 (95% CI = 0.71-0.79) and 0.67 (95% CI = 0.61-0.72), respectively. CONCLUSIONS:In adults and for nearly all subcategories there were no significant differences in prevalence of hypertension and stage II hypertension between protocols, indicating that protocol change may not affect the national prevalence estimates of hypertension and stage II hypertension.

Purpose Health plan claims may provide complete longitudinal data for timely, real-world population-level COVID-19 assessment. However, these data often lack laboratory results, the standard for COVID-19 diagnosis. Methods We assessed the validity of ICD-10-CM diagnosis codes for identifying patients hospitalized with COVID-19 in U.S. claims databases, compared to linked laboratory results, among six Food and Drug Administration Sentinel System data partners (two large national insurers, four integrated delivery systems) from February 20-October 17, 2020. We identified patients hospitalized with COVID-19 according to five ICD-10-CM diagnosis code-based algorithms, which included combinations of codes U07.1, B97.29, general coronavirus codes, and diagnosis codes for severe symptoms. We calculated the positive predictive value (PPV) and sensitivity of each algorithm relative to laboratory test results. We stratified results by data source type and across three time periods: February 20-March 31 (Time A), April 1-30 (Time B), May 1-October 17 (Time C). Results The five algorithms identified between 34 806 and 47 293 patients across the study periods; 23% with known laboratory results contributed to PPV calculations. PPVs were high and similar across algorithms. PPV of U07.1 alone was stable around 93% for integrated delivery systems, but declined over time from 93% to 70% among national insurers. Overall PPV of U07.1 across all data partners was 94.1% (95% CI, 92.3%-95.5%) in Time A and 81.2% (95% CI, 80.1%-82.2%) in Time C. Sensitivity was consistent across algorithms and over time, at 94.9% (95% CI, 94.2%-95.5%). Conclusion Our results support the use of code U07.1 to identify hospitalized COVID-19 patients in U.S. claims data.

We present summaries of the scientific discussions at the workshop that was convened on June 6-7, 2018, by the NHLBI.120National Heart, Lung, and Blood Institute. Promoting Cardiovascular Health in Early Childhood (0-5 years) and Transitions in Childhood through Adolescence—Executive Summary. 2018. https://www.nhlbi.nih.gov/events/2018/promoting-cardiovascular-health-early-childhood-0-5-years-and-transitions-childhood. Accessed October 2, 2018.Google Scholar The workshop addresses the state of the science and research needs for promoting CVH using an integrated and synergistic approach and focusing on basic and population science research and clinical trials. Training to develop the next generation of researchers is also an integral component.

Introduction: National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care-utilizing adults and differences in associations by age group. Methods: Analyses included 8,410 health care-utilizing adults aged >= 20 years from the 2013-2016 National Health and Nutrition Examination Surveys (analyzed in 2018). Logistic regression was used to examine associations between receipt of medical advice to increase physical activity in the past year and measured health conditions, reported health behaviors, and demographic characteristics. Models were stratified by age group (20-39, 40-59, and >= 60 years). Results: Physical activity medical advice was received by 42.9% (95% CI=40.8, 44.9) of adults overall. By age group, 32.7% of younger adults, 46.7% of middle-aged adults, and 48.9% of older adults received advice. Among all adults and across all age groups, receipt of advice was higher among adults with chronic health conditions: obesity (63.0%, 95% CI=60.3, 65.7), hypertension (56.5%, 95%=CI 53.8, 59.2), diabetes (69.8%, 95% CI=66.5, 72.8), hypercholesterolemia (55.6%, 95% CI=52.3, 59.0), and low high-density lipoprotein cholesterol (53.8%, 95% CI=50.1, 57.4). Among all adults, those with obesity, hypertension, and diabetes had significantly greater odds of receipt of advice after adjustment. Stronger associations between diabetes and hypercholesterolemia and receiving physical activity advice were observed among younger adults. Conclusions: Receipt of physical activity medical advice was highest among adults with specific chronic health conditions, and this pattern was stronger among younger adults with diabetes and hypercholesterolemia. However, most health care-utilizing adults did not receive physical activity medical advice. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

ImportanceFavorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors.ObjectiveTo analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016.Design, Setting, and ParticipantsSerial cross-sectional analysis of US population-weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Surveys for 1999 through 2016. Linear temporal trends were analyzed using multivariable regression models with regression coefficients (β) reported as change per 1 year.ExposuresSurvey year; examined periods spanned 10 to 18 years based on data availability.Main Outcomes and MeasuresAge- and race/ethnicity-adjusted mean levels of high-density lipoprotein (HDL), non-HDL, and total cholesterol. Among fasting adolescents (aged 12-19 years), mean levels of low-density lipoprotein cholesterol, geometric mean levels of triglycerides, and mean levels of apolipoprotein B. Prevalence of ideal and adverse (vs borderline) levels of lipids and apolipoprotein B per pediatric lipid guidelines.ResultsIn total, 26 047 youths were included (weighted mean age, 12.4 years; female, 51%). Among all youths, the adjusted mean total cholesterol level declined from 164 mg/dL (95% CI, 161 to 167 mg/dL) in 1999-2000 to 155 mg/dL (95% CI, 154 to 157 mg/dL) in 2015-2016 (β for linear trend, -0.6 mg/dL [95% CI, -0.7 to -0.4 mg/dL] per year). Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7 to 53.3 mg/dL) in 2007-2008 to 55.0 mg/dL (95% CI, 53.8 to 56.3 mg/dL) in 2015-2016 (β, 0.2 mg/dL [95% CI, 0.1 to 0.4 mg/dL] per year) and non-HDL cholesterol decreased from 108 mg/dL (95% CI, 106 to 110 mg/dL) to 100 mg/dL (95% CI, 99 to 102 mg/dL) during the same years (β, -0.9 mg/dL [95% CI, -1.2 to -0.6 mg/dL] per year). Among fasting adolescents, geometric mean levels of triglycerides declined from 78 mg/dL (95% CI, 74 to 82 mg/dL) in 1999-2000 to 63 mg/dL (95% CI, 58 to 68 mg/dL) in 2013-2014 (log-transformed β, -0.015 [95% CI, -0.020 to -0.010] per year), mean levels of low-density lipoprotein cholesterol declined from 92 mg/dL (95% CI, 89 to 95 mg/dL) to 86 mg/dL (95% CI, 83 to 90 mg/dL) during the same years (β, -0.4 mg/dL [95% CI, -0.7 to -0.2 mg/dL] per year), and mean levels of apolipoprotein B declined from 70 mg/dL (95% CI, 68 to 72 mg/dL) in 2005-2006 to 67 mg/dL (95% CI, 65 to 70 mg/dL) in 2013-2014 (β, -0.4 mg/dL [95% CI, -0.7 to -0.04 mg/dL] per year). Favorable trends were generally also observed in the prevalence of ideal and adverse levels. By the end of the study period, 51.4% (95% CI, 48.5% to 54.2%) of all youths had ideal levels for HDL, non-HDL, and total cholesterol; among adolescents, 46.8% (95% CI, 40.9% to 52.6%) had ideal levels for all lipids and apolipoprotein B, whereas 15.2% (95% CI, 13.1% to 17.3%) of children aged 6 to 11 years and 25.2% (95% CI, 22.2% to 28.2%) of adolescents aged 12 to 19 years had at least 1 adverse level.Conclusions and RelevanceBetween 1999 and 2016, favorable trends were observed in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.

Misclassification of body mass index (BMI) categories arising from self-reported weight and height can bias hazard ratios in studies of BMI and mortality. We examined the effects on hazard ratios of such misclassification using national US survey data for 1976 through 2010 that had both measured and self-reported weight and height along with mortality follow-up for 48,763 adults and a subset of 17,405 healthy never-smokers. BMI was categorized as <22.5 (low), 22.5-24.9 (referent), 25.0-29.9 (overweight), 30.0-34.9 (class I obesity), and ≥35.0 (class II-III obesity). Misreporting at higher BMI categories tended to bias hazard ratios upwards for those categories, but that effect was augmented, counterbalanced, or even reversed by misreporting in other BMI categories, in particular those that affected the reference category. For example, among healthy male never-smokers, misclassifications affecting the overweight and the reference categories changed the hazard ratio for overweight from 0.85 with measured data to 1.24 with self-reported data. Both the magnitude and direction of bias varied according to the underlying hazard ratios in measured data, showing that findings on bias from one study should not be extrapolated to a study with different underlying hazard ratios. Because of misclassification effects, self-reported weight and height cannot reliably indicate the lowest-risk BMI category.

Importance Access to appropriate prescription medications, use of inappropriate or ineffective treatments, and adverse drug events are public health concerns among US children and adolescents. Objective To evaluate trends in use of prescription medications among US children and adolescents. Design, Setting, and Participants US children and adolescents aged 0 to 19 years in the 1999-2014 National Health and Nutrition Examination Survey (NHANES)—serial cross-sectional, nationally representative surveys of the civilian noninstitutionalized population. Exposures Sex, age, race and Hispanic origin, household income and education, insurance status, current health status. Main Outcomes and Measures Use of any prescription medications or 2 or more prescription medications taken in the past 30 days; use of medications by therapeutic class; trends in medication use across 4-year periods from 1999-2002 to 2011-2014. Data were collected though in-home interview and direct observation of the prescription container. Results Data on prescription medication use were available for 38 277 children and adolescents (mean age, 10 years; 49% girls). Overall, use of any prescription medication in the past 30 days decreased from 24.6% (95% CI, 22.6% to 26.6%) in 1999-2002 to 21.9% (95% CI, 20.3% to 23.6%) in 2011-2014 (&bgr; = −0.41 percentage points every 2 years [95% CI, −0.79 to −0.03]; P = .04), but there was no linear trend in the use of 2 or more prescription medications (8.5% [95% CI, 7.6% to 9.4%] in 2011-2014). In 2011-2014, the most commonly used medication classes were asthma medications (6.1% [95% CI, 5.4% to 6.8%]), antibiotics (4.5% [95% CI, 3.7% to 5.5%]), attention-deficit/hyperactivity disorder (ADHD) medications (3.5% [95% CI, 2.9% to 4.2%]), topical agents (eg, dermatologic agents, nasal steroids) (3.5% [95% CI, 3.0% to 4.1%]), and antihistamines (2.0% [95% CI, 1.7% to 2.5%]). There were significant linear trends in 14 of 39 therapeutic classes or subclasses, or in individual medications, with 8 showing increases, including asthma and ADHD medications and contraceptives, and 6 showing decreases, including antibiotics, antihistamines, and upper respiratory combination medications. Conclusions and Relevance In this study of US children and adolescents based on a nationally representative survey, estimates of prescription medication use showed an overall decrease in use of any medication from 1999-2014. The prevalence of asthma medication, ADHD medication, and contraceptive use increased among certain age groups, whereas use of antibiotics, antihistamines, and upper respiratory combination medications decreased.

BACKGROUND Home blood pressure monitoring (HBPM) has a substantial role in hypertension management and control. METHODS Cross-sectional data for noninstitutionalized US adults 18 years and older (10,958) from the National Health and Nutrition Examination Survey (NHANES), years 2011-2014, were used to examine factors related to HBPM. RESULTS In 2011-2014, estimated 9.5% of US adults engaged in weekly HBPM, 7.2% engaged in monthly HBPM, 8.0% engaged in HBPM less than once a month, and 75.3% didn't engage any HBPM. The frequency of HBPM increased with age, body mass index, and the number of health care visits (all, P < 0.05). Also, race/ethnicity (Non-Hispanic Blacks and non-Hispanic Asians), health insurance, diagnosed with diabetes, told by a health care provider to engage in HBPM, and diagnosed as hypertensive, were all associated with more frequent HBPM (P < 0.05). Adjusting for covariates, hypertensives who were aware of, treated for, and controlled engaged in more frequent HBPM compared to their respective references: unaware (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.53-2.63), untreated (OR = 1.99, 95% CI = 1.52-2.60), and uncontrolled (OR = 1.42, 95% CI = 1.13-1.82). Hypertensive adults (aware/unaware, treated/untreated, or controlled/uncontrolled), who received providers' recommendations to perform HBPM, were more likely to do so compared to those who did not receive recommendations (OR = 8.04, 95% CI = 6.56-9.86; OR = 7.98, 95% CI = 6.54-9.72; OR = 8.75, 95% CI = 7.18-10.67, respectively). CONCLUSIONS Seventeen percent of US adults engaged in monthly or more frequent HBPM and health care providers' recommendations to engage in HBPM have a significant impact on the frequency of HBPM.

Purpose: Racial disparities in childhood asthma prevalence increased after the 1990s. Obesity, which also varies by race/ethnicity, is an asthma risk factor but its contribution to asthma prevalence disparities is unknown. Methods: We analyzed nationally representative National Health Examination and Nutrition Survey data for 2-19 year olds with logistic regression and decomposition analyses to assess the contributions of weight status to racial disparities in asthma prevalence, controlling for sex, age, and income status. Results: From 1988-1994 to 2011-2014, asthma prevalence increased more among non-Hispanic black (NHB) (8.4% to 18.0%) than non-Hispanic white (NHW) youth (7.2% to 10.3%). Logistic regression showed that obesity was an asthma risk factor for all groups but that a three-way "weight status-race/ethnicitytime" interaction was not significant. That is, weight status did not modify the race/ethnicity association with asthma over time. In decomposition analyses, weight status had a small contribution to NHB/NHW asthma prevalence disparities but most of the disparity remained unexplained by weight status or other asthma risk factors (sex, age and income status). Conclusions: NHB youth had a greater asthma prevalence increase from 1988-1994 to 2011-2014 than NHW youth. Most of the racial disparity in asthma prevalence remained unexplained after considering weight status and other characteristics. Published by Elsevier Inc.