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Health United States Report 2016 Copyright information Permission has been obtained from the copyright holders to reproduce certain quoted material in this report. Further reproduction of this material is prohibited without specific permission of the copyright holder. All other material contained in this report is in the public domain and may be used and reprinted without special permission; citation as to source, however, is appreciated. Suggested citation National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017. Library of Congress Catalog Number 76–641496 For sale by Superintendent of Documents U.S. Government Printing Office Washington, DC 20402 U.S. Department of Health and Human Services Thomas E. Price, M.D. Secretary Centers for Disease Control and Prevention Anne Schuchat, M.D. (RADM, U.S. Public Health Service) Acting Director National Center for Health Statistics Charles J. Rothwell, M.S., M.B.A. Director Preface Health, United States, 2016 is the 40th report on the health leading causes of death, birth rates, cigarette smoking, status of the nation and is submitted by the Secretary of the obesity, untreated dental caries, diabetes prevalence, and Department of Health and Human Services to the President uncontrolled hypertension. The third section (Figures 15–19) and the Congress of the United States in compliance with presents trends in health care utilization: use of prescription Section 308 of the Public Health Service Act. This report drugs, health care and emergency department visits, was compiled by the Centers for Disease Control and overnight hospital stays, and cancer screening tests. The Prevention's (CDC) National Center for Health Statistics fourth section (Figures 20–22) focuses on changes in health (NCHS). care resources: hospitals, primary and specialist physicians, and nursing homes. The fifth section (Figures 23–27) The Health, United States series presents an annual overview describes trends in health care expenditures: personal of national trends in health statistics. The report contains a health care expenditures, mental health and substance use Chartbook that assesses the nation's health by presenting expenditures, Medicare managed care enrollment by state, trends and current information on selected measures of and health insurance coverage. morbidity, mortality, health care utilization and access, health risk factors, prevention, health insurance, and Trend Tables personal health care expenditures. This year's Chartbook focuses on long-term trends in health. The report also The Chartbook is followed by 114 detailed Trend contains 114 Trend Tables organized around four major Tables that highlight major trends in health statistics. subject areas: health status and determinants, health Comparability across editions of Health, United States is care utilization, health care resources, and health care fostered by including similar Trend Tables in each volume, expenditures. A companion report—Health, United States: In and timeliness is maintained by improving the content of Brief—features information extracted from the full report. tables to reflect key topics in public health. An important The complete report and related data products are available criterion used in selecting these tables is the availability of on the Health, United States website at: comparable national data over a period of several years. http://www.cdc.gov/nchs/hus.htm. Appendixes The 2016 Edition Appendix I. Data Sources describes each data source used Health, United States, 2016 contains a summary At a Glance in Health, United States, 2016 and provides references table that displays recent data on selected indicators of for further information about the sources. Data sources health and their determinants, cross-referenced to tables in are listed alphabetically within two broad categories: the report. This is followed by a Highlights section, which Government Sources, and Private and Global Sources. focuses on both long-term trends and current data on topics of public health interest and illustrates the breadth Appendix II. Definitions and Methods is an alphabetical of material included in Health, United States. The other listing of selected terms used in Health, United States, 2016. major sections are a Chartbook, detailed Trend Tables, two It also contains information on the statistical methodologies Appendixes, and an Index. The major sections of the 2016 used in the report. report are described below. Index Chartbook The Index to the Trend Tables and Chartbook figures is a The 2016 Chartbook contains 27 figures on long-term useful tool for locating data by topic. Tables and figures are trends in health. As Health, United States enters its 40th cross-referenced by such topics as child and adolescent year of reporting on the health of the nation, this year’s health; older population aged 65 and over; women's health; Chartbook focuses on trends in health and health care men's health; state data; American Indian or Alaska Native, since 1975. Examining long-term trends in health informs Asian, black or African American, Hispanic-origin, and white the development and implementation of effective health populations; education; injury; disability; and metropolitan policies and programs. The Chartbook has been grouped and nonmetropolitan data. Many of the Index topics are also into five sections. The first section (Figures 1–5) presents an available as conveniently grouped data packages on the overview of the demographic and socioeconomic factors Health, United States website at: that have influenced the health of the nation over the last 40 http://www.cdc.gov/nchs/hus.htm. years. The second section (Figures 6–14) focuses on health status and determinants: life expectancy, infant mortality, iii Preface Health, United States, 2016 Data Considerations information on disability statistics, see Altman and Bernstein (1) and Brault (2). Racial and Ethnic Data Statistical Significance Many tables in Health, United States present data according to race and Hispanic origin, consistent with a department- All statements in the text describing differences, or lack wide emphasis on ensuring that health data on racial thereof, in estimates indicate that statistical testing was and ethnic minority populations are presented whenever performed. Differences between two point estimates possible. Trend data on race and ethnicity are presented in were determined to be statistically significant at the 0.05 the greatest detail possible after taking into account the level using two-sided significance tests (z-tests) without quality of the data, the amount of missing data, and the correction for multiple comparisons. Data tables include number of observations. These issues significantly affect the point estimates and standard errors for users who would availability of reportable data for certain populations, such like to perform additional statistical tests. In the text, the as the Native Hawaiian or Other Pacific Islander populations standard terminology used when a difference between two and the American Indian or Alaska Native populations. point estimates was tested is, "Between (estimate 1) and Standards for the classification of federal data on race and (estimate 2)." For example, the statement "Between 2014 ethnicity are described in an appendix. (See Appendix II, and 2015" indicates that the difference between the point Race.) estimate for 2014 and that for 2015 was tested for statistical significance. Education and Income Data The statistical significance of a time trend was assessed using weighted least squares regression applied to data Many Trend Tables in Health, United States present data for all years in the time period. (For a description of the according to socioeconomic status, using education trend testing technique, see the Technical Notes that and family income as proxy measures. Education and follow the Chartbook.) The terminology used in the text to income data are generally obtained directly from survey indicate testing of a trend is "During (time period 1)–(time respondents and are not usually available from records- period 2)." For example, the statement "During 2005–2015" based data collection systems. (See Appendix II, Education; indicates that a statistical test of trend was conducted Family income; Poverty.) that included estimates for all 11 years in the time period. Because statistically significant differences or trends are Disability Data partly a function of sample size (i.e., the larger the sample, Disability can include the presence of physical or mental the smaller the change that can be detected), statistically impairments that limit a person's ability to perform an significant differences or trends do not necessarily have important activity and affect the use of or need for support, public health significance (3). accommodation, or intervention to improve functioning. Terms such as "similar," "stable," and "no difference" indicate Information on disability in the U.S. population is critical that the statistics being compared were not significantly to health planning and policy. Disability may be measured different. Lack of comment regarding the difference based on a specific disability or a composite measure between statistics does not necessarily suggest that the designed to identify persons with any of a variety of difference was tested and found to not be significant. disabilities. Health, United States includes data from the National Health Interview Survey to examine
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