Leading Health Indicators: Data Trends and Disparities

Leading Health Indicators: Data Trends and Disparities

Richard J. Klein, MPHSuzanne E. Proctor, MSPH

National Center for Health StatisticsCenters for Disease Control and Prevention

Physical ActivityModerate physical activity in adultsVigorous physical activity in adolescents Overweight and ObesityObesity in adults Overweight/obesity in children/adolescents

Tobacco Use Cigarette smoking by adults Cigarette smoking by adolescents

Substance Abuse Alcohol and illicit drug use by adolescentsIllicit drug use by adults Binge drinking by adults

Responsible Sexual Behavior Abstinence or condom use by adolescents Condom use by adults Gonorrhea infections*

Mental HealthTreatment of adults with recognized depressionSuicides*

Injury and ViolenceDeaths from motor vehicle crashes Homicides

Environmental QualityOzone pollution exposureEnvironmental tobacco smoke exposureChildren exposed to tobacco smoke at home*Pediatric asthma hospitalizations*

ImmunizationFully immunized children aged 19-35 monthsInfluenza vaccination in high-risk adults Pneumococcal vaccination in high-risk adults

Access to CarePersons with health insuranceSource of ongoing care Early prenatal care * Supplemental measure

Leading Health Indicators and Measures

Data sources for the LHI measures

Same national and State source: Number of measures

National Vital Statistics System 4National Household Survey on Drug Abuse 4Youth Risk Behavior Surveillance System 3Aerometric Information Retrieval System 1Healthcare Cost and Utilization Project 1National Immunization Survey 1 STD Surveillance System 1

Behavioral Risk Factor Surveillance System (State) and different national source:

National Health Interview Survey 7National Health and Nutrition Examination Survey 2National Survey of Family Growth 1

National data source only:

National Health and Nutrition Examination Survey 1

Physical Activity

Adults and adolescents engaging in physical activity

* Adolescents: Students in grades 9 to 12 participating in activity that makes them sweat and breathe hard (at least 20 minutes, 3 or more days per week).

** Adults: Persons aged 18 years and over participating in moderate activity (at least 30 minutes, 5 days per week) and/or vigorous activity

(at least 20 minutes, 3 days per week). Data for adults are age-adjusted to the 2000 standard population. Data for 2001 are preliminary.

Sources: National Health Interview Survey, CDC, NCHS (adults) and Youth Risk Behavior Surveillance System, CDC, NCCDPHP (adolescents).

0

20

40

60

80

100

1993 1995 1997 1999 2001

2010 target

Adolescents*

2010 target

Adults**

Per

cen

t

Adults engaging in physical activity, by gender and education, 2000

Female

Male

Some college

High school graduate

Grades 9-11

Less than 9th grade

College graduate

All adults

42

32

27

19

14

35

28

32

0 10 20 30 40 50

Age-adjusted percent

2010 target

I 95% Confidence Interval.

Notes: Physical activity is defined as moderate activity (at least 30 minutes, 5 days per week) and/or vigorous activity (at least 20 minutes, 3 days per week).

Gender data are for persons 18 years and over. Education data are for persons 25 and over. Data are age adjusted to the 2000 standard population.

Source: National Health Interview Survey, CDC, NCHS.

Summary

Physical activity remained steady during the past decade

Males are significantly more likely to exercise than females

Adults with more education are more likely to exercise

Adolescents living in the South are the least likely to exercise

Overweight and Obesity

Obesity in adults aged 20 years and over,by race/ethnicity

All adults Mexican American*

Black, notHispanic

White, notHispanic

23

31 30

34

22

29 2934

0

10

20

30

40

50

1988 - 1994 1999 - 2000

Ag

e-a

dju

ste

d p

erce

nt

I 95% Confidence Interval

* Can be of any race.

Notes: Obesity is defined as Body Mass Index (BMI) > 30. Data are age-adjusted to the 2000 standard population.

Source: National Health and Nutrition Examination Survey, CDC, NCHS.

2010 target

Overweight in youth aged 6-19 years, by race/ethnicity

All youth Mexican American*

Black, notHispanic

White, notHispanic

11

15 14

22

10 12

15

24

0

10

20

30

40

1988 – 1994 1999 - 2000

Per

cen

t

I 95% Confidence Interval


Note: Overweight is defined as at or above the age- and gender-specific 95th percentile of BMI. Confidence intervals for 1988-1994 are estimated.

Source: National Health and Nutrition Examination Survey, CDC, NCHS.

2010 target

Obesity in adults, 1999

18.721.5

30.5

0

5

10

15

20

25

30

35

Age-adjusted percent

BRFSS NHIS NHANES*

* NHANES data are for 1999-2000.


Notes: Obesity is defined as Body Mass Index (BMI) > 30. Data are for persons 20 years and over. Data are age adjusted to the 2000 standard population.

Sources: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP; National Health Interview Survey (NHIS),CDC, NCHS; National Health and Nutrition Examination

Survey (NHANES),CDC, NCHS.

Mode of administration affects estimate of obesity obtained from different surveys

Self-reported data underestimate the measured prevalence of obesity Telephone

survey

In-personinterview

In-personexamination

Summary

Overweight/obesity is increasing for all ages

The increase is observed for all race/ethnic groups

Adult females are more likely to be obese than adult males

Overweight/obesity is highest among Black and Mexican-Americans

Tobacco Use

Cigarette smoking by adults and adolescents

0

10

20

30

40

1991 1993 1995 1997 1999 2001

2010 target

Adolescents*

2010 target

Adults**

* Adolescents: Students in grades 9 to 12 who reported smoking cigarettes on 1 or more of the 30 days preceding the survey.

** Adults: Persons aged 18 years and over who have smoked at least 100 cigarettes in lifetime and who now smoke every day or some days. Data are age-adjusted to the 2000 standard population. Data for 2001 are preliminary.

Sources: National Health Interview Survey, CDC, NCHS (adults). Youth Risk Behavior Surveillance System, CDC, NCCDPHP (adolescents, all years except 2000) and National Youth Tobacco Survey, CDC, OSH (adolescents, 2000).

Per

cen

t

Cigarette smoking by adults 18 years and over,by race/ethnicity and gender, 2000

All ad

ults

Hispan

ic*

Black

,

not His

panic W

hite,

not His

panic

23

33

15

2325

1821

25

0

10

20

30

40

50

Ag

e-a

dju

ste

d p

erce

nt

2010 target


Notes: Smoking is defined as having at least 100 cigarettes in lifetime and now smoking every day or some days.

Data are age-adjusted to the 2000 standard population.


* Can be of any race

Asian

or

Pacifi

c Is

lander

Femal

eM

ale

Amer

ican

India

n

or Ala

ska

Nativ

e

Cigarette smoking by adolescents in grades 9 to 12, 2001

Notes: Smoking is defined as having cigarettes on 1 or more of the 30 days preceding the survey.

Data are for all reporting States (weighted and unweighted data included).

Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP.

29.8 – 38.5 25.3 – 29.7 8.3 – 25.2 No data

Percent N

(14)(15)(15) (7)

Summary

Adult cigarette smoking has changed little during the past decade

American Indian and Alaska Native adults are the most likely to smoke

Adolescent cigarette smoking is on the decline

White adolescents are the most likely to smoke

Substance Abuse

Binge drinking by adults 18 years and over, by race/ethnicity, 2000

24.6

18.9

22.2

19.7

12.5

28.3

30.5

13.9

21.8

0 5 10 15 20 25 30 35 40

Percent* Can be of any race.

Note: Binge drinking is defined as having 5 or more drinks at once in the 30 days prior to the survey.

Source: National Household Survey on Drug Abuse, SAMHSA.

2010 target

Asian only

American Indian/Alaska Native only

Black only

White only

Female

Male

More than one race

All adults

Hispanic*

Illicit drug use in the past month byadolescents aged 12-17 years, 1999

Note: Illicit drug use is defined as using at least one of the following substances in the past month: marijuana or hashish, cocaine, inhalants, hallucinogens, heroin, or any nonmedical use of analgesics, tranquilizers, stimulants, or sedatives.Source: National Household Survey on Drug Abuse, SAMHSA.

10.8 – 16.5 9.4 – 10.7 7.4 – 9.2

Percent N

(17)(17)(17)

Summary

Alcohol abuse is increasing among adults and decreasing among adolescents

Drug use among has remained steady for both groups

Adult males are more than twice as likely to binge drink than adult females

American Indian/Alaska Native adults are the most likely to binge drink

Responsible Sexual Behavior

Responsible sexual behavior by adolescents in grades 9 - 12

Per

cen

t

0

20

40

60

80

100

1991 1993 1995 1997 1999 2001

Abstain or use condoms

Used condom at last intercourse

Never had intercourse

No intercourse in past 3 months

Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP.

Gonorrhea incidence, by age and race/ethnicity, 2000

* Can be of any raceSource: Sexually Transmitted Diseases Surveillance System, CDC, NCHSTP.

SupplementalMeasure

28

827

30

114

80

230

78

563

132

0 100 200 300 400 500 600 700 800 900

New cases per 100,000 population

2010 target = 19

Black, not Hispanic

Asian or Pacific Islander

American Indian/Alaska Native

35-44 years

15-24 years

25-34 years

All persons

White, not Hispanic

Hispanic*

Summary

Adolescents abstaining from sexual intercourse or using condoms is increasing

Nearly 3 times as many adolescents have never had intercourse as those who have

No significant differences in responsible sexual behavior among adolescent race/ethnic groups

Responsible sexual behavior decreases with each grade

Mental Health

Suicide rates, by race/ethnicity, 2000

All per

sons

Amer

ican

India

n or

Alask

a Nat

ive

Asian

or

Pacifi

c Is

lander

10.6

12.0

5.8 5.8

12.1

6.1

0

5

10

15

2010 target

* Can be of any race.Note: Data are age adjusted to the 2000 standard population.

Source: National Vital Statistics System - Mortality, CDC, NCHS.

Hispan

ic*

Black

,

not His

panic

White

,

not His

panic

Ag

e-a

dju

ste

d r

ate

per

10

0,0

00

stan

dar

d p

op

ula

tio

n

SupplementalMeasure

Suicide rates, 2000

Note: Rates are age adjusted to the 2000 standard population.

Source: National Vital Statistics System - Mortality, CDC, NCHS

13.0 – 21.7 10.7 – 12.9 4.4 – 10.6

Age-adjusted rate per 100,000 N

(17)(17)(17)

Summary

Whites and American Indians/Alaska Natives are twice as likely to commit suicide as other groups

Males are almost 5 times as likely to commit suicide than females

Suicide rates are highest in Western States

Injury and Violence

0

5

10

15

20

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Motor vehicle crash deaths

Motor vehicle crash deaths and homicides

Homicides

Note: Data are age adjusted to the 2000 standard population.

Source: National Vital Statistics System - Mortality, CDC, NCHS.

Ag

e-a

dju

ste

d r

ate

per

10

0,0

00

stan

dar

d p

op

ula

tio

n

2010 target

2010 target

Homicide rates, 2000*

* Data for ME, NH, and SD are for 1999.

** Data are suppressed. Too few homicides occurred in ND, VT, and WY to report reliable rates.

Note: Rates are age adjusted to the 2000 standard population.

Source: National Vital Statistics System - Mortality, CDC, NCHS

7.2 – 36.2 4.0 – 6.4 2.0 – 3.8 DSU**

Age-adjusted rate per 100,000 N

(16)(16)(16) (3)

Summary

Motor vehicle crash deaths and homicides decreased during the past decade

Males and those with less education are more likely to die from both causes

American Indians/Alaska Natives are 2 times as likely to die in a motor vehicle crash as other groups

Blacks are much more likely to die from homicide than other groups

Homicide rates are highest in the South and Southwest

Environmental Quality

Young children exposed to tobacco smoke at home, by race/ethnicity and family income level, 1998

20

2722

11

34

26

14

0

10

20

30

40

50

Per

cen

t

2010 target


Notes: Data are for children aged 6 years and under. Exposure to tobacco smoke at home is defined as living in a household

where a resident smokes inside the home at least 4 days per week. Data for American Indian or Alaska Natives and

Asian or Pacific Islanders are statistically unreliable and are not shown. Data are age-adjusted to the 2000 standard population.


* Can be of any race

All children Hispanic*Black, not

Hispanic

White, not

Hispanic

Near poor Middle/ high

Poor

SupplementalMeasure

Summary

Percent of persons exposed to ozone pollution has not changed significantly during the past 4 years

Asians are the most likely to be exposed to ozone pollution

25 States have already met the Healthy People 2010 target for ozone exposure

Black children and children with low income are the most likely to be exposed to tobacco smoke at home

Immunization

Influenza and pneumococcal vaccination among adults aged 65 and over

0

10

20

30

40

50

60

70

80

90

1989 1991 1993 1995 1997 1999 2001

Notes: Data are age adjusted to the 2000 standard population. Data for 2001 are preliminary.

Source: National Health Interview Survey (NHIS), CDC, NCHS.

* Received within the past 12 months.** Ever received.

2010 target

Influenza*

Pneumococcal**

Ag

e-a

dju

ste

d p

erce

nt

Fully immunized children aged 19 to 35 months, 2001

Notes: Fully immunized children are those receiving at least 4 doses of DTaP, 3 doses of Polio, 1 dose of MMR, 3 doses of

Hib, and 3 doses of Hepatitis B antigens.

Source: National Immunization Survey, CDC, NIP and NCHS.

63 – 71 72 – 77 78 – 82

Age-adjusted percent N

(17)(17)(17)

Summary

Percent of older adults receiving influenza and pneumococcal vaccinations increased during the 1990s but has plateaued in recent years

Blacks are the least likely of any race/ethnic group to receive either vaccination

Vaccination rates for children are lowest in the Southwest and Pacific Northwest

Access to Care

50

60

70

80

90

100

1997 1998 1999 2000 2001

0

Persons under age 65 with health insurance, by race/ethnicity, 2000

Ag

e-a

dju

ste

d p

erce

nt White, not Hispanic

All persons

Black, not Hispanic



Hispanic *

Native Hawaiian/Other Pacific Islander

Asian

American Indian or Alaska Native

2010 target

Summary

Health insurance coverage has not increased substantially during the past 4 years

Hispanics are among the least likely to have access to care for all measures

American Indians/Alaska Natives are least likely to have health insurance but most likely to have a usual source of care

Prenatal care in the first trimester is lowest in the Southwest

Resources

Healthy People 2010 Statistical Workshopfor Regional, State, and Local Health Staff

Mortality data Age adjustmentLife tablesHospital discharge statisticsState dataRace and ethnicity classificationMeasuring health disparities

Variability Small area estimationBasic epidemiologic methodsTarget-setting methodsSoftware for statistical analysisData availability via websites

For more information, contact:

Richard J. Klein, MPH [email protected]

Websites

DHHS Healthy People: www.health.gov/healthypeople

NCHS Healthy People: www.cdc.gov/nchs/healthypeople

DATA2010: www.wonder.cdc.gov/data2010

Leading Health Indicators: Data Trends and Disparities

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