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National Center for Health Statistics (US). Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville (MD): National Center for Health Statistics (US); 2012 May.

Cover of Health, United States, 2011

Health, United States, 2011: With Special Feature on Socioeconomic Status and Health.

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Preface

Health, United States, 2011 is the 35th 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 an annual look at national trends in health statistics. The report contains a Chartbook that assesses the Nation’s health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization, health risk factors, prevention, health insurance, and personal health care expenditures. This year’s Chartbook includes a Special Feature on Socioeconomic Status and Health. The report also contains 151 Trend Tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. A companion product to Health, United StatesHealth, United States: In Brief—features information extracted from the full report. The complete report, In Brief, and related data products are available on the Health, United States website at: http://www.cdc.gov/nchs/hus.htm.

The 2011 Edition

Health, United States, 2011 includes a summary “At a Glance” table that displays selected indicators of health and their determinants, cross-referenced to charts and tables in the report. It also contains a Highlights section, a Chartbook, detailed Trend Tables, extensive Appendixes, and an Index. Major sections of the 2011 report are described below.

Chartbook

The 2011 Chartbook contains 41 charts, including 20 (Figures 22–41) on this year’s Special Feature on Socioeconomic Status and Health (SES). This feature includes charts on the relationship between SES and health by using a four-category education variable and a four-category relative family income variable as SES measures. Charts on trends in poverty and differences in relative family income by race and Hispanic origin for children and adults are presented to provide context for the other charts. This feature explores the SES gradient in health measures for both children and adults and how that gradient differs across racial and ethnic groups. When possible, trend data are presented to examine changes in SES disparities over time. Charts present information on associations between SES and morbidity and mortality, prevention and risk factors, and access to care and health insurance.

Trend Tables

The Chartbook is followed by 151 Trend Tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. The tables present data for selected years, to highlight major trends in health statistics. Additional years of data may be available in Excel spreadsheet files on the Health, United States website. Trend Tables for which additional data years are available are listed in Appendix III. Comparability across years in Health, United States is fostered by including similar Trend Tables in each volume, and timeliness is maintained by improving the content of ongoing tables and adding new tables each year to reflect emerging topics in public health. A key criterion used in selecting these tables is the availability of comparable national data over a period of several years.

Health, United States, 2011 includes eight new Trend Tables on the following subjects:

  • Drug poisoning death rates (Table 36), based on data from the National Vital Statistics System.
  • Prevalence of health-related behaviors for children 6–11 years of age (Table 66), based on data from the National Survey of Children’s Health.
  • Prevalence of cigarette smoking (Table 63), selected disability and health status measures (Tables 57 and 58), and selected access to medical care measures (Table 80) by urbanization level, based on data from the National Health Interview Survey and the 2006 NCHS Urban–Rural Classification Scheme for Counties.
  • Utilization of colorectal tests and procedures (Table 92), based on data from the National Health Interview Survey.
  • Cost of hospital discharges with common hospital operating room procedures (Table 132), based on data from the Healthcare Cost and Utilization Project.

Appendixes

Appendix I. Data Sources describes each data source used in Health, United States, 2011 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 contains information on the methods used in the report.

Appendix III. Additional Data Years Available lists tables for which additional years of trend data are available in Excel spreadsheet files on the Health, United States website.

Index

The Index to the Trend Tables and 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 or African American, and Hispanic-origin populations; education; injury; disability; and metropolitan and nonmetropolitan data. Many of the Index topics are also available as conveniently grouped data packages on the Health, United States website.

Data Considerations

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 the data, the amount of missing data, and the number of observations. These issues significantly affect 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 an appendix. (See Appendix II, Race.)

Education and Income Data

Many tables in Health, United States present data according to SES, using education and family income as proxy measures. Education and income data are generally obtained directly from survey respondents and are not usually available from records-based data collection systems. Categories shown for income data were expanded in Health, United States, 2010. 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 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 to improve functioning. Information on disability in the U.S. population is critical to health planning and policy. Several initiatives are currently under way to coordinate and standardize the measurement of disability across federal data systems. Health, United States, 2009 introduced the first detailed Trend Table using data from the National Health Interview Survey to create disability measures consistent with two of the conceptual components that have been identified in disability models and 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 a health problem. Complex activity limitation describes limitations or restrictions in a person’s ability to participate fully in social role activities such as working or maintaining a household. Health, United States, 2010 expanded the use of these measures to many of the tables from the National Health Interview Survey and this year’s report added two tables on disability measure by urbanization level (Tables 57 and 58). Health, United States also includes the following disability-related information for the civilian noninstitutionalized population: vision and hearing limitations for adults (Table 55) and disability-related information for Medicare enrollees (Table 145), Medicaid recipients (Table 146), and veterans with service-connected disabilities (Table 148). 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: http://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf.

Statistical Significance

All differences between estimates noted in the Highlights section of Health, United States were determined to be statistically significant at the 0.05 level using two-sided significance tests (z tests). In the Chartbook, weighted least squares regression was performed to test for the presence of a statistically significant increase or decrease in the estimates during the time period (see Technical Notes accompanying the Chartbook). Terms such as “similar,” “stable,” and “no difference” indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between statistics does not necessarily suggest that the difference was tested and found to be not significant. Because statistically significant differences or trends are partly a function of sample size (the larger the sample size, the smaller the change that can be detected), statistically significant differences or trends do not necessarily have public health significance (1).

Overall estimates generally have relatively small standard errors, but estimates for certain population subgroups may be based on small numbers and have relatively large standard errors. Although 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 selected years) and are not subject to sampling error, the counts are subject to random variation, which means that the number of events that actually occur in a given year 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 standard errors or small numbers of events have been noted with an asterisk. The criteria used to designate or suppress unreliable estimates are indicated in the table footnotes.

For NCHS surveys, point estimates and their corresponding variances were calculated using the SUDAAN software package (2), which takes into consideration the complex survey design. Standard errors for other surveys or data sets were computed using the methodology recommended by the programs providing the data or were provided directly by those programs. Standard errors are available for selected tables in the Excel spreadsheet version on the Health, United States website at: http://www.cdc.gov/nchs/hus.htm.

Access to Health, United States

Health, United States can be accessed in its entirety at: http://www.cdc.gov/nchs/hus.htm. The website is a user-friendly resource for Health, United States and related products. In addition to the full report, it contains the In Brief companion report and data conveniently grouped by topic. The Chartbook figures are provided as PowerPoint slides, and the Trend Tables and Chartbook data tables as Excel spreadsheet files and individual PDFs. Many Excel spreadsheet files include additional years of data not shown in the printed report, along with standard errors where available. Spreadsheet files for selected tables will be updated on the website as available. Visitors to the website can join the Health, United States electronic mailing list to receive announcements about release dates and notices of updates to tables. Previous editions of Health, United States, and their Chartbooks, can also be accessed from the website.

Printed copies of Health, United States can be purchased from the Government Printing Office at: http://bookstore.gpo.gov.

Questions?

If you have questions about Health, United States or related data products, 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: http://www.cdc.gov/nchs/

References

1.
CDC. Youth Risk Behavior Survey (YRBS): Interpretation of YRBS trend data. 2010. Available from: http://www​.cdc.gov/HealthyYouth​/yrbs/pdf​/YRBS_trend_interpretation.pdf.
2.
SUDAAN, release 10.0.1 [computer software] Research Triangle Park NC: RTI International; 2009.
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