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National Center for Health Statistics (US). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville (MD): National Center for Health Statistics (US); 2016 May.

Cover of Health, United States, 2015

Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities.

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Preface

Health, United States, 2015 is the 39th 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 Health, United States series presents an annual overview of 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 and access, health risk factors, prevention, health insurance, and personal health care expenditures. This year's Chartbook includes a Special Feature on racial and ethnic health disparities. The report also contains 114 Trend Tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. A companion report—Health, 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 2015 Edition

Health, United States, 2015 contains a summary At a Glance table that displays selected indicators of health and their determinants, cross-referenced to charts and tables in the report. This is followed by a Highlights section, a Chartbook, detailed Trend Tables, two Appendixes, and an Index. The major sections of the 2015 report are described below.

Chartbook

The 2015 Chartbook contains 27 figures, including 10 figures in this year's Special Feature on racial and ethnic health disparities (Figures 18–27). The special feature topic was chosen to commemorate the 30th anniversary of the Report of the Secretary's Task Force on Black and Minority Health (also known as the Heckler Report), which documented significant disparities in the burden of illness and mortality experienced by blacks and other minority groups compared with white persons (1). This year's Special Feature provides a current overview of racial and ethnic differences in health, by race, race and ethnicity, or detailed Hispanic origin, depending on data availability. Data are presented on selected measures of mortality (life expectancy and infant mortality), natality (preterm births and low-risk cesarean delivery), health status and risk factors (obesity, hypertension, and cigarette smoking), and health care access and utilization (influenza vaccination, lack of health insurance coverage, and difficulty accessing needed dental care) and summarizes whether racial and ethnic differences have been increasing, decreasing, or remaining stable over time.

Trend Tables

The Chartbook is followed by 114 detailed Trend Tables that highlight major trends in health statistics. Comparability across editions of Health, United States is fostered by including similar Trend Tables in each volume, and timeliness is maintained by improving the content of tables to reflect key topics in public health. An important criterion used in selecting these tables is the availability of comparable national data over a period of several years.

Appendixes

Appendix I. Data Sources describes each data source used in Health, United States, 2015 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 selected terms used in Health, United States, 2015.It also contains information on the statistical methodologies used in the report.

Index

The Index to the 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 aged 65 and over; women's health; men's health; state data; American Indian or Alaska Native, Asian, black or African American, Hispanic-origin, and white 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 at: http://www.cdc.gov/nchs/hus.htm.

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 or Other Pacific Islander population and the American Indian or 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 Trend 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 usually available from records-based data collection systems. (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 support, accommodation, or intervention to improve functioning. Information on disability in the U.S. population is critical to health planning and policy. Disability may be measured based on a specific disability or a composite measure designed to identify persons with any of a variety of disabilities. Health, United States includes data from the National Health Interview Survey to examine specific types of disability and to create composite 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, 2015 includes the following disability-related information: difficulty remembering and difficulty doing errands alone (Figure 6), basic actions difficulty and complex activity limitation (Table 42), vision and hearing limitations for adults (Tables 43 and 44), and disability-related information for Medicare enrollees (Table 108), Medicaid recipients (Table 109), and veterans with service-connected disabilities (Table 111). For more information on disability statistics, see Altman and Bernstein (2) and Brault (3).

Statistical Significance

All statements in the text describing differences, or lack thereof, in estimates indicate that statistical testing was performed. Differences between two point estimates were determined to be statistically significant at the 0.05 level using two-sided significance tests (z-tests) without correction for multiple comparisons. Data tables include point estimates and standard errors for users who would like to perform additional statistical tests. In the text, the standard terminology used when a difference between two point estimates was tested is, “Between (estimate 1) and (estimate 2).” For example, the statement “Between 2013 and 2014” indicates that the difference between the point estimate for 2013 and that for 2014 was tested for statistical significance.

The statistical significance of a time trend was assessed using weighted least squares regression applied to data for all years in the time period. (For a description of the trend testing technique, see the Technical Notes that follow the Chartbook.) The terminology used in the text to indicate testing of a trend is “During (time period 1)-(time period 2).” For example, the statement “During 2004–2014” indicates that a statistical test of trend was conducted that included estimates for all 11 years in the time period. Because statistically significant differences or trends are partly a function of sample size (i.e., the larger the sample, the smaller the change that can be detected), statistically significant differences or trends do not necessarily have public health significance (4).

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 not be significant.

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 estimates. Estimates that are unreliable because of large standard errors or small numbers of events are 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 (5), 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 spreadsheet version on the Health, United States website at: http://www.cdc.gov/nchs/hus.htm.

Accessing 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, the website contains the In Brief companion report in PDF format. Also found on the website are data conveniently organized and grouped by topic. The Chartbook figures are provided as PowerPoint slides, and the Trend Tables and Chartbook data tables are provided as spreadsheet and PDF files. Many spreadsheet files include additional years of data not shown in the printed report, along with standard errors where available. Visitors to the website can join the Health, United States e-mail list (http://www.cdc.gov/nchs/hus/hus_electronic_mailing.htm to receive announcements about release dates and notices of updates. 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 U.S. 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, Room 5419
    Hyattsville, MD 20782–2064
    Phone: 1–800-CDC-INFO (1–800–232–4636)
    TTY: 1–888–232–6348

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.

References

1.
Heckler MM. Report of the Secretary's Task Force on Black and Minority Health volume I, Executive Summary. Washington, DC. HHS; Washington, DC: 1985.
2.
Altman B, Bernstein A. Disability and health in the United States, 2001–2005. Hyattsville, MD; NCHS: 2008.
3.
Brault MW. Current population reports, P70–131. Washington, DC: U.S. Census Bureau; 2012. Americans with disabilities: 2010.
4.
CDC; Youth Risk Behavior Surveillance System (YRBSS). Interpretation of YRBS trend data. Atlanta, GA: 2014.
5.
SUDAAN. release 11.0.0 [computer software]. Research Triangle Park, NC: RTI International; 2012.

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