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National Center for Health Statistics (US) . Health, United States, 2009: With Special Feature on Medical Technology. Hyattsville (MD): National Center for Health Statistics (US); 2010 Jan.

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Health, United States, 2009: With Special Feature on Medical Technology.

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Health, United States, 2009 is the 33rd report on the health status of the Nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). The National Committee on Vital and Health Statistics served in a review capacity.

The Health, United States series presents national trends in health statistics. Each report includes an executive summary, highlights, a chartbook, trend tables, extensive appendixes, and an index.


The 2009 Chartbook includes 36 charts, with 14 charts illustrating this year’s special feature on medical technology. As advances in medical technologies continue to transform the provision of health care and improve the length and quality of life, questions are raised about their appropriate and equitable use and how to best control their contributions to rising health care expenditures. The Chartbook assesses the Nation’s health by presenting trends and current information on selected determinants and measures of health status and the utilization of health care. Many measures are shown separately for persons of different ages because of the strong effect of age on health. Selected figures also highlight differences in determinants and measures of health status and utilization of health care based on such characteristics as sex, race, Hispanic origin, education, and poverty level.

Trend Tables

The Chartbook section is followed by 150 trend tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. A major criterion used in selecting the trend tables is availability of comparable national data over a period of several years. The tables present data for selected years to highlight major trends in health statistics. Earlier editions of Health, United States may present data for additional years that are not included in the current printed report. Where possible, these additional years of data are available in Excel® spreadsheet files on the Health, United States website. Tables containing additional data years are listed in Appendix III.

Racial and Ethnic Data

Many tables in Health, United States present data according to race and Hispanic origin, consistent with a department-wide emphasis on expanding racial and ethnic detail when presenting health data. Trend data on race and ethnicity are presented in the greatest detail possible after taking into account the quality of data, the amount of missing data, and the number of observations. These issues significantly impact the availability of reportable data for certain populations, such as the Native Hawaiian and Other Pacific Islander population and the American Indian and Alaska Native population. Standards for the classification of federal data on race and ethnicity are described in Appendix II, Race.

Education and Income Data

Many tables in Health, United States present data according to socioeconomic status, using education and family income as proxy measures. Education and income data are generally obtained directly from survey respondents and are not generally available from records-based data collection systems. State vital statistics systems currently report mother’s education on the birth certificate and, based on an informant, decedent’s education on the death certificate. See Appendix II, Education; Family income; Poverty.

Disability Data

Disability is a complex concept and can include the presence of physical or mental impairments that limit a person’s ability to perform an important activity and affect the use of, or need for, supports, accommodations, or interventions required to improve functioning. Information on disability in the U.S. population is critical to health planning and policy. Several current initiatives are under way to coordinate and standardize measurement of disability across federal data systems. This year’s report introduces the first detailed trend table (Table 55) using data from the NCHS National Health Interview Survey (NHIS) to create disability measures consistent with two of the conceptual components that have been indentified in disability models and disability legislation: basic actions difficulty and complex activity limitation. Basic actions difficulty captures limitations or difficulties in movement and sensory, emotional, or mental functioning that are associated with some health problem. Complex activity limitation describes limitations or restrictions on a person’s ability to participate fully in social role activities such as working or maintaining a household. Data on health insurance coverage from NHIS for persons with basic actions difficulty or complex activity limitation have been added to Tables 137140. Health, United States also includes the following disability-related information for the civilian noninstitutionalized population: vision and hearing limitations for adults (Table 56), and disability-related information for Medicare enrollees (Table 144), Medicaid recipients (Table 145), and veterans with service-connected disabilities (Figure 3 and Table 147). For more information on disability statistics, see: Altman B, Bernstein A. Disability and health in the United States, 2001–2005. Hyattsville, MD: NCHS; 2008. Available from:

Statistical Significance

All differences between estimates noted in this report were determined to be significant by using two-sided significance tests at the 0.05 level. Terms such as “similar” and “no difference” indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not significant.

Overall estimates generally have relatively small sampling errors, but estimates for certain population subgroups may be based on small numbers and have relatively large sampling errors. Numbers of births and deaths from the Vital Statistics System represent complete counts (except for births in those states where data are based on a 50% sample for certain years). Therefore, they are not subject to sampling error. However, when the figures are used for analytical purposes, such as the comparison of rates over a period, the number of events that actually occurred may be considered as one of a large series of possible results that could have arisen under the same circumstances. When the number of events is small and the probability of such an event is small, considerable caution must be observed in interpreting the conditions described by the figures. Estimates that are unreliable because of large sampling errors or small numbers of events have been noted with asterisks in selected tables. The criteria used to designate unreliable estimates are indicated in an accompanying footnote.

Point estimates and estimates of corresponding variances of NCHS surveys that are based on a complex sampling design were calculated using the SUDAAN software package (Research Triangle Institute, Research Triangle Park, NC). Standard errors of other surveys or data sets were computed using methodology recommended by the programs providing the data or were provided directly by those programs.

Changes in This Edition

Each edition of Health, United States is prepared to maximize its usefulness as a standard reference source while maintaining its continuing relevance. Comparability is fostered by including similar trend tables in each edition. Timeliness is maintained by (a) adding new tables each year to reflect emerging topics in public health and (b) improving the content of ongoing tables. Health, United States, 2009 includes three new trend tables on the following topics: supply of dentists by state (Table 110), based on data from the American Dental Association; National Health Expenditure Account data by age (Table 128), based on data from the National Health Expenditures Accounts produced by the Centers for Medicare & Medicaid Services; and a new disability table (Table 55) using data from NHIS to create disability measures on basic actions difficulty and complex activity limitation.

The Health, United States, 2009 Chartbook section includes new charts on the number of living veterans and percentage with service-connected disability; prevalence of sleep problems; prevalence of respondent-reported heart disease, hypertension, or diabetes among persons 45–64 years of age by poverty level; occupational injuries and illnesses; prevalence of depression; and trends in personal health expenditures by payer. The Special Feature includes 14 charts on medical technology, including the increase in the number of clinical laboratories, utilization of imaging technologies, utilization of hospital and ambulatory surgical procedures using selected technologies, use of assisted reproductive technologies and mammography, trends in use of pharmaceuticals, and costs associated with hospitalizations for technologically complex procedures (Figures 2336).


Appendix I (Data Sources) describes each data source used in the report and provides references for further information about the sources. Data sources are listed alphabetically within two broad categories: Government Sources and Private and Global Sources.

Appendix II (Definitions and Methods) is an alphabetical listing of terms used in the report. It also presents standard populations used for age-adjustment (Tables I, II, and III); International Classification of Diseases (ICD) codes for causes of death shown in Health, United States, from the sixth through tenth ICD revisions and the years when the revisions were in effect (Tables IV and V); final comparability ratios between ICD–9 and ICD–10 for selected causes (Table VI); effects on health insurance rates of adding probe questions for Medicare and Medicaid coverage in NHIS (Table VII); industry codes according to the North American Industry Classification System (Table VIII); ICD–9–CM (Clinical Modification) codes for external cause-of-injury, diagnostic, and procedure categories (Tables IX, X, and XI); National Drug Code (NDC) Therapeutic Class recodes of generic analgesic drugs (Table XII); and sample tabulations of NHIS data comparing the 1977 and 1997 Standards for the classification of federal data on race and ethnicity (Tables XIII and XIV).

Appendix III (Additional Data Years Available) lists tables for which additional years of trend data are available electronically in Excel® spreadsheet files on the Health, United States website, described below under Electronic Access.


The Index to Trend Tables and Chartbook Figures is a useful tool for locating data by topic. Tables and figures are cross-referenced by such topics as child and adolescent health; older population 65 years of age and over; women’s health; men’s health; state data; American Indian and Alaska Native, Asian, Black, and Hispanic-origin populations; education; injury; disability; and metropolitan and non-metropolitan data.

Electronic Access

Health, United States may be accessed in its entirety at: From the Health, United States website, one may also register for the Health, United States electronic mailing list to receive announcements about release dates and notices of updates to tables.

Chartbook figures are available as downloadable PowerPoint® slides. Trend tables and Chartbook data tables are available as downloadable Excel® spreadsheet files. Trend tables listed in Appendix III include additional years of data not shown in the printed report or PDF files. Spreadsheet files for selected tables will be updated on the website if more current data become available near the time when the printed report is released. Users who register with the electronic mailing list will be notified of these table updates. Previous editions of Health, United States and chartbooks, starting with the 1993 edition, also may be accessed from the Health, United States website.

Copies of the Report

Copies of Health, United States, 2009 can be purchased from the Government Printing Office (GPO), U.S. Government Bookstore at:


For answers to questions about this report, please contact:

Office of Information Services, Information Dissemination Staff, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Fifth Floor, Hyattsville, MD 20782, Phone: 1–800–232–4636, E-mail: vog.cdc@yreuqshcn, Internet:

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