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National Center for Health Statistics (US) . Health, United States, 2006: With Chartbook on Trends in the Health of Americans. Hyattsville (MD): National Center for Health Statistics (US); 2006 Nov.

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Health, United States, 2006: With Chartbook on Trends in the Health of Americans.

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Highlights

Health, United States, 2006, is the 30th report on the health status of the Nation. In a chartbook and 147 trend tables, it presents current and historic information on the health of the U.S. population. The trend tables are organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures and payors. The 2006 Chartbook on Trends in the Health of Americans focuses on selected determinants and measures of health and includes a special feature on pain, which affects quality of life for virtually all Americans at some point in their lives.

Life Expectancy and Mortality

Life expectancy and infant mortality rates are often used to gauge the overall health of a population. Life expectancy shows a long-term upward trend and infant mortality shows a long-term downward trend. As overall death rates have declined, racial and ethnic disparities in mortality persist, but the gap in life expectancy between the black and white populations has narrowed.

In 2004, life expectancy at birth for the total population reached a record high of 77.9 years (preliminary data), up from 75.4 years in 1990 (Table 27).

Between 1990 and 2004, life expectancy at birth increased 3.4 years for males and 1.6 years for females (preliminary data). The gap in life expectancy between males and females narrowed from 7.0 years in 1990 to 5.2 years in 2004 (Figure 24 and Table 27).

Between 1990 and 2004 (preliminary data), life expectancy at birth increased more for the black than for the white population, thereby narrowing the gap in life expectancy between these two racial groups. In 1990, life expectancy at birth for the white population was 7.0 years longer than for the black population. By 2004, the difference had narrowed to 5.0 years (Table 27).

Overall mortality was 29% higher for black Americans than for white Americans in 2004 (preliminary data) compared with 37% higher in 1990. In 2004, age-adjusted death rates for the black population exceeded those for the white population by 44% for stroke, 30% for heart disease, 23% for cancer, and 774% for HIV disease (preliminary data and Table 29).

In 2004, the infant mortality rate decreased to 6.8 infant deaths per 1,000 live births (preliminary data). In 2002, the infant mortality rate had increased for the first time in more than 40 years (Figure 25 and Table 22).

Large disparities in infant mortality rates among racial and ethnic groups continue to exist. In 2003, infant mortality rates were highest for infants of non-Hispanic black mothers (13.6 deaths per 1,000 live births), American Indian mothers (8.7 per 1,000), and Puerto Rican mothers (8.2 per 1,000); and lowest for infants of Cuban mothers (4.6 per 1,000 live births) and Asian or Pacific Islander mothers (4.8 per 1,000) (Table 19).

The leading cause of death differs by age group. In 2004, the leading cause of death was congenital malformations for infants; unintentional injuries for children, adolescents, and young adults (age 1–44 years); cancer for middle-aged adults age 45–64 years; and heart disease for older adults age 65 years and over (preliminary data and Table 32).

Age-adjusted mortality from heart disease, the leading cause of death overall, declined 16% between 2000 and 2004 (preliminary data), continuing a long-term downward trend (Figure 27 and Table 36).

Age-adjusted mortality from cancer, the second leading cause of death overall, decreased 8% between 2000 and 2004 (preliminary data), continuing the decline that began in 1990 (Figure 27 and Table 38).

The age-adjusted death rate for motor-vehicle injuries has remained stable between 2000 and 2004 (preliminary data) after declining steadily between 1970 and 2000. Death rates for motor vehicle injuries are higher at age 15–24 years and 75 years and over than at other ages (Table 44).

The age-adjusted death rate for HIV disease has declined slowly between 1999 and 2004 (preliminary data), after a sharp decrease between 1995 and 1999. The death rate for HIV disease is higher at age 35–54 years than at other ages (Table 42).

In 2004, homicide continued to be the leading cause of death for young black males 15–24 years of age. The homicide rate for young black males declined by 12% from 2003 to 2004 (preliminary data and Table 45).

In 2003, young American Indian males 15–24 years of age continued to have substantially higher death rates for motor vehicle-related injuries and for suicide than young males in other race/ethnicity groups. Death rates for the American Indian population are known to be underestimated (Tables 44 and 46).

The suicide rate for non-Hispanic white men 65 years of age and over is higher than in other groups. In 2003, the suicide rate for older non-Hispanic white men was 2–4 times the rate for older men in other race/ethnicity groups and about 8 times the rate for older non-Hispanic white women (Table 46).

Health Behaviors

Health behaviors have a significant effect on health status. Pregnant teenagers are less likely to receive early prenatal care and more likely to drop out of school and to live in poverty, than are other parents. Heavy and chronic use of alcohol and use of illicit drugs increase the risk of disease and injuries. Cigarette smoking increases the risk of lung cancer, heart disease, emphysema, and other diseases. Regular physical activity lessens the risk of disease and enhances mental and physical functioning.

The birth rate for teenagers declined in 2004 for the 13th consecutive year, to 41.1 births per 1,000 women age 15–19 years, 1% lower than in 2003. Rates declined for teenagers age 15–17 years and 18–19 years, but increased for teenagers age 10–14 years (Table 4).

In 2004, the birth rate for unmarried women reached a record high of 46.1 births per 1,000 unmarried women age 15–44 years, up 3% from 2003. In 2004, 36% of all births were to unmarried women and the percentages generally increased for all age, race, and Hispanic origin subgroups (Table 10).

Between 2003 and 2005, the percentage of high school students who reported smoking cigarettes in the past month remained stable at 22%–23% after declining from 36% in 1997 (Figure 10).

In 2005, 30% of students in grades 11–12 reported binge drinking five or more alcoholic drinks in a row and 22% reported marijuana use in the past month (Figure 11).

Between 1993 and 2005, the percentage of high school students who reported attempting suicide (8%–9%) and whose suicide attempts required medical attention (2%–3%) remained fairly constant. Girls were more likely than boys to consider or attempt suicide. However in 2003 adolescent boys (15–19 years of age) were more than 4 times as likely to die from suicide as were adolescent girls, in part reflecting their choice of more lethal methods, such as firearms (Tables 46 and 62).

The percentage of adults who reported consuming five or more alcoholic drinks in one day declines with age. In 2004, among current drinkers, 56% of adults 18–24 years of age compared with 9% of adults 65 years of age and over reported this level of alcohol consumption in the past year (Table 68).

In 2004, 23% of men and 19% of women 18 years of age and over were current smokers. This is a sharp decline from 1965, when more than one-half of adult men and one-third of adult women smoked, but declines have slowed since 1990 (Table 63).

In 2004, almost one-third of adults 18 years of age and over engaged in regular leisure-time physical activity. Adults in families with incomes above twice the poverty level were more likely to engage in regular leisure-time physical activity (34%) than adults in lower-income families (20%–21%) (age adjusted) (Table 72).

More than one-half of adults 65 years of age and over were inactive in their leisure-time, one-quarter had some level of leisure-time activity with an additional 22% reporting regular leisure-time activity in 2004 (Table 72).

Health Status and Risk Factors

Measures of morbidity presented in this report include the incidence and prevalence of specific diseases and conditions. Other measures of health status include limitation of activity and limitations in activities of daily living caused by chronic conditions, and respondent-assessed health status.

Low birthweight is associated with elevated risk of death and disability in infants. In 2004, the low birthweight rate (less than 2,500 grams, or 5.5 pounds, at birth) increased to 8.1%, up from 7.0% in 1990 (Table 13).

Between 1976–1980 and 2003–2004, the prevalence of overweight among children 6–11 years of age more than doubled from 7% to 19% and the prevalence of overweight among adolescents 12–19 years of age more than tripled from 5% to 17% (Figure 13 and Table 74).

Among adults 20–74 years of age, overweight and obesity rates have increased since 1960–1962. These increases are driven largely by increases in the percentage of adults who are obese. From 1960–1962 through 2003–2004, the percentage of adults who are overweight but not obese has remained steady at 32%–34% (age adjusted). During that time period, the percentage of obese adults has increased from 13% to 34% (age adjusted) (Figure 13 and Table 73).

The prevalence of hypertension, defined as elevated blood pressure or taking antihypertensive medication, increases with age. In 2001–2004, 30% of men and 33% of women age 45–54 years had hypertension, compared with 69% of men and 82% of women age 75 years and over (Table 69).

Between 1988–1994 and 2001–2004, the percentage of adults with elevated serum cholesterol levels greater than 240 mg/dL declined substantially for older adults. However, older women were more likely to have high serum cholesterol than men. In 2001–2004, 26% of women age 65–74 years had high serum cholesterol, compared with 11% of men age 65–74 years (Table 70).

In 2001–2004, the prevalence of diabetes (including diagnosed and undiagnosed) increased with age from 11% among adults 40–59 years of age to 23% among adults 60 years of age and over. The percentage of adults with undiagnosed diabetes was 3% among those 40–59 years of age and 6% among those 60 years of age and over (Table 55).

In 2004, approximately 2.2 million workplace injuries and illnesses in the private sector involved days away from work, job transfer, or restricted duties at work for a rate of 2.5 cases per 100 full-time workers. Transportation and warehousing reported the highest injury and illness rate, 4.9 cases per 100. The next highest rates were reported by the agriculture, forestry, fishing and hunting (3.7 per 100), and manufacturing industries (3.6 per 100) (Table 50).

Poor and near poor children are more likely to have untreated dental caries than children in families with incomes above twice the poverty level. In 1999–2002, 32% of poor children 6–17 years of age had untreated dental caries, compared with 13% of children in families with incomes at least twice the poverty level (Table 75).

Between 1988–1994 and 1999–2002, approximately one-quarter (24%–28%) of adults 18–64 years of age had untreated dental caries, down from nearly one-half (48%) in 1971–1974 (Table 75).

In 2004, 17% of persons 65 years of age and over had any trouble seeing even with glasses and 11% were deaf or had a lot of trouble hearing (Table 59).

In 2004, limitation of activity due to chronic health conditions was reported for 7% of children under the age of 18 years. Among school-age children (5–17 years of age), learning disabilities and Attention Deficit/Hyperactivity Disorder (ADHD or ADD) were frequently reported as a cause of activity limitation (Figure 16 and Table 58).

Arthritis and other musculoskeletal conditions were the leading cause of activity limitation among working-age adults 18–64 years of age in 2003–2004. Mental illness was the second most frequently mentioned condition causing activity limitation among adults 18–44 years of age and the third most frequently mentioned among adults 45–54 years of age (Figure 17).

Among persons age 65 years of age and over, arthritis and heart disease or other circulatory conditions were the two most frequently reported causes of activity limitation in 2003–2004 (Figure 18).

Health Care Access and Utilization

People use health care services for many reasons: to treat illnesses, injuries, and health conditions; to prevent or delay future health care problems; to reduce pain and increase quality of life; and to obtain information about their health status and prognoses. The health care delivery system offers a wide variety of services, ranging from preventive and primary care, to new and better medicines, to use of sophisticated and increasingly technological and complex procedures and interventions.

In 2003–2004, 6% of children under 6 years of age and 15% of children 6–17 years of age had no health care visit to a doctor or clinic within the past 12 months (Table 79).

Adults 18–64 years of age were the most likely to report not receiving needed medical care or delaying their care due to cost. In 2004, 7% of adults 18–64 years of age reported that they did not get needed care during the past 12 months, 10% delayed care, and 9% did not get prescription drugs due to the cost (Table 78).

In 2004, 20%–21% of people under age 65 years who were uninsured for all or part of the preceding year did not receive needed health care in the past 12 months due to cost, compared with 2% of people with health insurance for the full year (Table 78).

Almost all adults 65 years of age and over have Medicare coverage. Despite having this health insurance, among those with incomes below or near the poverty level, in 2004, 4%–6% did not get needed medical care during the past 12 months, 6%–9% delayed their care, and 8%–12% did not get the prescription drugs they needed due to the cost. Medicare coverage for prescription drugs began in 2006 (Table 78).

In 2003–2004, visit rates to physician offices and hospital outpatient departments among persons 18–44 years of age were more than twice as high for women as for men, largely due to medical care associated with female reproduction (Figure 22).

The percentage of mothers receiving prenatal care in the first trimester of pregnancy remained unchanged at 84% for the 43-state reporting areas for which comparable trend data were available in 2004. In 2004 the percentage of mothers with early prenatal care varied substantially by race and ethnicity, from 70% for American Indian mothers to 89% for non-Hispanic white mothers (Table 7).

In 2004, 83% of children 19–35 months of age received the combined vaccination series of four doses of DTaP (diphtheria-tetanus-acellular pertussis) vaccine, three doses of polio vaccine, one dose of MMR (measles-mumps-rubella vaccine), and three doses of Hib (Haemophilus influenzae type b) vaccine. Children living below the poverty threshold were less likely to have received the combined vaccination series than were children living at or above poverty (78% compared with 85%) (Table 81).

In 2004, 65% of noninstitutionalized adults 65 years of age and over reported an influenza vaccination within the past year, more than double the percentage in 1989. In 2004, the percentage of older adults ever having received a pneumococcal vaccine was 57%, up sharply from 14% in 1989 (Table 83).

In 2004, 54% of children 2–5 years of age and 84% of children 6–17 years of age had a dental visit in the past year. Children with family income below or near the poverty level were less likely than children with higher family income to have had a visit (Figure 19 and Table 91).

Use of prescription medications among adults increases with age. In 1999–2002, the percentage of adults who reported using prescription medications in the prior month rose from 36% of those 18–44 years of age to 64% at 45–64 years of age and 85% at 65 years of age and over. In each age group women were more likely than men to use prescription drugs (Table 93).

In 1999–2002, more than one-half of adults 65 years of age and over took three or more prescription drugs in the past month (Table 93).

In 2004, adults 75 years of age and over had a higher rate of visits to the hospital emergency department than other age groups (58 visits per 100 persons compared with 29–45 per 100 persons in other age groups) (Table 89).

Children under 6 years of age were more likely than children 6–17 years of age to have had an emergency department (ED) visit within the past 12 months in 2004 (26% compared with 18%) (Table 86).

In 2003–2004, falls accounted for 34% of hospital emergency department injury visits for men 65 years of age and over and 48% for women in that age group. Falls also accounted for 22%–24% of children's injury-related visits to emergency departments (Table 88).

Heart disease and injuries were among the most common reasons for inpatient hospitalization among adults 45–64 years of age in 2004. Among this age group, the discharge rate for heart disease was 80% higher for men than for women and the discharge rate for injuries was 18% higher for men than women (Table 97).

Between 1993–1994 and 2003–2004, the hospital discharge rate for cardiac catheterization among adults 75 years of age and over increased 42%, while the rate among adults 65–74 years of age remained stable. By 2003–2004, the cardiac catheterization rate for adults 75 years of age and over had risen to a level similar to that for adults 65–74 years of age (Table 99).

The number of gastric bypass and other inpatient bariatric procedures performed on obese adults 18–44 years of age more than tripled between 1999–2001 and 2002–2004 (data table for Figure 23). Bariatric procedures were more common among women than men (Figure 23).

Between 1992–1993 and 2003–2004, the hospital discharge rate for knee replacement surgery, which is typically performed for osteoarthritis, nearly doubled among adults 65 years of age and over (Figure 35).

Health Care System Influences, Resources, and Personnel

Major changes continue to occur in the delivery of health care in the United States, driven in part by changes in payment policies intended to rein in rising costs and by advances in technology that have allowed more complex treatments to be performed on an outpatient basis. Hospital inpatient utilization has been stable in recent years. The number of physicians continues to increase, but supply is not equally distributed across the country, and some office-based physicians are not accepting new patients. The supply of other practitioners, including pharmacists and nurses, may not be increasing as rapidly as needed to keep in pace with our aging population.

In 2004, 43% of doctor visits were to specialty care physicians, up from 34% in 1980. During this period, the proportion of office-based doctor visits to general and family practice physicians decreased from 34% to 23% (Table 90).

In 2004, 63% of surgeries were performed on an outpatient basis, compared with 51% in 1990 and 16% in 1980 (Table 100).

The age-adjusted average length of inpatient hospital stays has remained stable at 4.8 to 4.9 days during the period 2000–2004, after declining from 7.5 days in 1980 (Table 96).

Between 1990 and 2004, the number of community hospital beds declined from about 927,000 to 808,000. Since 1990, the community hospital occupancy rate has remained steady at 62%–67% (Table 112).

Between 1990 and 2002, the overall number of inpatient mental health beds in the United States declined by 22%. In Veterans Affairs medical centers the number of mental health beds declined by 55%, in state and county mental hospitals and private psychiatric hospitals the decline was 42%, and in psychiatric units of non-federal general hospitals the decline was 25% (Table 113).

In 2004, there were over 7,500 Medicare-certified home health agencies, up from about 6,900 in 2003, but below the high of 10,800 in 1997. The number of Medicare-certified hospices increased to over 2,600 after remaining stable at about 2,300 from 1997 to 2003 (Table 118).

In 2004, there were nearly 1.8 million nursing home beds in about 16,000 facilities certified for use by Medicare and Medicaid beneficiaries. Between 1995 and 2004, nursing home bed occupancy was relatively stable, estimated at 83% in 2004. Occupancy rates were 90% or higher in 11 states and the District of Columbia in 2004 (Table 116).

Between 1999 and 2004, the number of dental hygienists and assistants, diagnostic medical sonographers, pharmacy technicians, message therapists, and medical equipment preparers increased by 6%–12% annually. The hourly wages of pharmacists, radiation therapists, physician assistants, and nuclear medicine technologists rose 6%–8% annually (Table 108).

In 2003–2004, 27% of physicians reported they were not accepting new Medicaid patients and 41% were not accepting new capitated privately insured patients, compared with 12%–14% not accepting new Medicare and non-capitated privately-insured patients. Two-fifths of physician offices perform some lab tests in the office. Practices with 10 or more physicians were more likely to perform lab tests in the office (62%) than offices with one physician (27%) (Table 117).

Health Insurance Coverage and Payors

Major payors for health care include public programs such as Medicare and Medicaid, and private health insurers. Medicaid is jointly funded by the federal and state governments to provide health care for certain groups of low-income persons. Medicare is funded through the federal government and covers the health care of most persons 65 years of age and over and disabled persons. Almost 70% of the population under 65 years of age has private health insurance, most of which is obtained through the workplace.

Uninsured Population

Between 1995 and 2004, the percentage of the population under 65 years of age with no health insurance coverage (public or private) at a point in time ranged between 16.1% and 17.5%. Among the under 65 population, the poor and near poor (those with family incomes less than 200% of poverty) were much more likely than the nonpoor to be uninsured (Figure 6 and Table 135).

In 2004, 9% of children under 18 years of age had no health insurance coverage at a point in time. Between 2000 and 2004, among children in families with income just above the poverty level (100%–150% of poverty), the percentage uninsured dropped from 25% to 16%. However, children in low-income families remained substantially more likely than children in higher-income families to lack coverage (Table 135).

In 2004, 30% of young adults 18–24 years of age were uninsured at a point in time. This age group was more than twice as likely to be uninsured as those 45–64 years of age (Table 135).

In 2004, persons of Hispanic origin and American Indians under 65 years of age were more likely to have no health insurance coverage at a point in time than were those in other racial and ethnic groups. Non-Hispanic white persons were the least likely to lack coverage (Table 135).

Many people under 65 years of age, particularly those with a low family income, do not have health insurance coverage consistently throughout the year. In 2004, one-fifth of people under 65 years of age were uninsured for at least part of the 12 months prior to interview. Two-fifths of people of Mexican origin were similarly uninsured for at least part of the 12 months prior to interview (data table for Figure 7).

The likelihood of being uninsured varies substantially among the states. In 2002–2004, the average percentage of the population with no health insurance coverage ranged from 8.5% in Minnesota to 25% in Texas (Table 147).

Private Health Insurance

During 2002 to 2004, 69% of the population under 65 years of age had private health insurance. Between 1995 and 2001 the proportion had fluctuated between 71%–73% after declining from 77% in 1984 (Figure 6 and Table 133).

Between 2001 and 2004, the proportion of the population under 65 years of age with private health insurance obtained through the workplace (a current or former employer or union) declined from 67% to 64% (Table 133).

Federal and State Health Insurance Programs

In 2005, the Medicare program had about 43 million enrollees and expenditures of $336 billion (preliminary data Table 137).

Of the 36 million Medicare enrollees in the fee-for-service program in 2003, 11% were 85 years of age and over and 16% were disability beneficiaries under 65 years of age (Table 138).

In 2004, among children under 18 years of age, 26% were covered by Medicaid or the State Children's Health Insurance Program, a 7 percentage point increase since 2000 (Table 134).

In 2003, children under 21 years of age accounted for 48% of Medicaid recipients but only 17% of expenditures. Aged, blind, and disabled persons accounted for 23% of recipients and 67% of expenditures (Table 140).

Health Care Expenditures

The United States spends more on health per capita than any other country, and health spending continues to increase rapidly. Spending increases are due to increased intensity and cost of services, and a higher volume of services needed to treat an aging population.

The United States spends a larger share of the gross domestic product (GDP) on health than does any other major industrialized country. In 2003, the United States devoted 15% of its GDP to health, compared with over 11% in Switzerland and Germany, and more than 10% in Iceland, France, and Norway, the countries with the next highest shares (Table 119).

In 2004, national health care expenditures in the United States totaled $1.9 trillion, a 7.9% increase compared with an 8.6% per year increase from 2000–2003. In the 1990s, annual growth had slowed to 6.6% following an average annual growth rate of 11% during the 1980s (Table 120).

In 2004, national health expenditures in the United States grew 7.9%, compared with 7.0% growth in the GDP. Health expenditures as a percentage of the GDP was 16% in 2004 (Figure 8 and Table 120).

Prescription drug expenditures increased 8.2% in 2004, compared with 10.2% in 2003 and 14.3% in 2002. Prescription drugs posted annual increases of 3%–5% in the Consumer Price Index in 2000 to 2005 (Tables 121 and 123).

Expenditures for hospital care accounted for 30% of all national health expenditures in 2004. Physician services accounted for 21% of the total in 2004, prescription drugs for 10%, and nursing home care for 6% (Table 123).

In 2003, 96% of persons 65 years of age and over in the civilian noninstitutionalized population reported medical expenses that averaged about $8,210 per person with expense. Nineteen percent of expenses were paid out-of-pocket, 16% by private insurance, and 63% by public programs (primarily Medicare and Medicaid) (Tables 125 and 126).

The burden of out-of-pocket expenses for health care varies considerably by age. In 2003, over two-fifths of those 65 years of age and over with health care expenses paid $1,000 or more out-of-pocket, compared with 29% of those 45–64 years of age, and 12% of adults 18–44 years of age (Table 127).

In 2004, 34% of personal health care expenditures were paid by the federal government and 11% by state and local government; private health insurance paid 36% and consumers paid 15% out-of-pocket (Figure 9 and Table 124).

Special Feature: Pain

Pain affects physical and mental functioning, and can profoundly affect quality of life. In addition to the direct costs of treating pain—including visits for diagnosis and treatment, drugs, therapies, and other medical costs—it can cause loss of productivity and concentration. Patterns of self-reported pain vary considerably by age, sex, race and ethnicity, and poverty.

In 1999–2002, more than one-quarter of Americans (26%) 20 years of age and over reported that they had a problem with pain in the past 30 days that persisted for more than 24 hours (Figure 28).

Nearly 60% of adults 65 years of age and over who reported pain lasting more than 24 hours stated that it lasted for one year or more compared with 37% of young adults 20–44 years of age who reported pain in 1999–2002 (Figure 29).

In 2004, more than one-quarter of adults 18 years of age and over reported experiencing low back pain in the past 3 months (Figure 30 and Table 56).

In 2004, 15% of adults 18 years of age and over reported experiencing migraine or severe headache in the past 3 months. The percentage of young adults 18–44 years of age who reported migraine or severe headache was almost three times the percentage for adults 65 years of age and over (Figure 30 and Table 56).

In 2004, almost one-third of adults 18 years of age and over and one-half of older adults 65 years of age and over reported joint pain, aching, or stiffness (excluding the back or neck) during the 30 days prior to interview. The knee was the site of joint pain most commonly reported in all age groups (Table 57).

In 2003, the percentage of adults 18 years of age and over who reported severe joint pain increased with age. Women were more likely to report severe joint pain than men (10% compared with 7%) (Figure 32).

In 2003–2004, 50% of ED visits for persons with a severe pain recorded had narcotic analgesic drugs prescribed, or provided during the visit. Among visits with severe pain recorded, those made by children under 18 years of age and adults 65 years of age and over were less likely than visits by persons in other age groups to have a narcotic drug provided in the ED (Figure 33).

The percentage of adults who reported using a narcotic drug in the past month increased from 3.2% in 1988–1994 to 4.2% in 1999–2002 (age adjusted). This increase has been driven largely by an increase in narcotic drug use among white non-Hispanic women and women 45 years of age and over (Figure 34).

Between 1992–1993 and 2003–2004, the hospital discharge rate for knee replacement among adults 65 years of age and over increased by nearly 90%, from 39 to 73 discharges per 10,000 persons. Knee replacement was more common among older women than older men (Figure 35).

Between 1992–1993 and 2003–2004, the hospital discharge rate for hip replacement among adults 65 years of age and over (excluding those performed for fractured hips) increased almost 60% from 25 to 40 discharges per 10,000 population. Nonfracture hip replacement rates were similar among older men and women (Figure 35).

In 2002–2003, 3.5% of adults 18 years of age and over had ambulatory care visits or prescribed medicine purchases to treat migraines or other types of headache during the year. Their average annual expenditure for these treatments was $566 (in 2003 dollars) (data table for Figure 36).

In 2004, 28% of adults 18 years of age and over with low back pain in the past 3 months said they had a limitation of activity caused by a chronic condition, compared with 10% of adults who did not report recent low back pain. People with recent low back pain were almost five times as likely to have serious psychological distress as people without recent low back pain (Figure 37).

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