Disparities in Rates of Death From HIV or Tuberculosis Before Age 65 Years, by Race, Ethnicity, and Sex, United States, 2011-2020.

OBJECTIVE: Death from tuberculosis or HIV among people from racial and ethnic minority groups who are aged <65 years is a public health concern. We describe age-adjusted, absolute, and relative death rates from HIV or tuberculosis from 2011 through 2020 by sex, race, and ethnicity among US residents. METHODS: We used mortality data from the Centers for Disease Control and Prevention online data system on deaths from multiple causes from 2011 through 2020 to calculate age-adjusted death rates and absolute and relative disparities in rates of death by sex, race, and ethnicity. We calculated corresponding 95% CIs for all rates and determined significance at P < .05 by using z tests. RESULTS: For tuberculosis, when compared with non-Hispanic White residents, non-Hispanic American Indian or Alaska Native residents had the highest level of disparity in rate of death (666.7%). Similarly, as compared with non-Hispanic White female residents, American Indian or Alaska Native female residents had a high relative disparity in death from tuberculosis (620.0%). For HIV, the age-adjusted death rate was more than 8 times higher among non-Hispanic Black residents than among non-Hispanic White residents, and the relative disparity was 735.1%. When compared with non-Hispanic White female residents, Black female residents had a high relative disparity in death from HIV (1529.2%). CONCLUSION: Large disparities in rates of death from tuberculosis or HIV among US residents aged <65 years based on sex, race, and ethnicity indicate an ongoing unmet need for effective interventions. Intervention strategies are needed to address disparities in rates of death and infection among racial and ethnic minority populations.

Characteristics of Emergency Department Patient Visits Referred for Follow-Up Medical Care After Discharge, National Hospital Ambulatory Medicare Care Survey-United States, 2018.

Objective: To describe characteristics of a nationally representative sample of patient visits that ended with a referral for follow-up medical care after discharge from hospital emergency department (ED) visits. Methods: We used 2018 National Hospital Ambulatory Medical Care Survey data to identify patient characteristics associated with higher rates of visits with referrals for follow-up medical care after ED discharge from nonfederal short-stay and general hospitals throughout the United States. Referral included categories of all disposition variables that indicated referral to a source of care consistent with the patient's clinical condition at ED discharge. Results: Approximately 97 million of 130 million visits (29 700/100 000 US resident population) were referred for follow-up medical care during 2018. Visit referral rates were higher among females (33 100) than among males (26 300/100 000 population); higher among Black patients (61 700) than among White patients (25 600/100 000 population); highest in the South (33 200/100 000 population); and similar rates in Nonmetropolitan (29 900/100 000 population) and Metropolitan Statistical Areas (30 200/100 000 population). Visit referral rates were higher for patients with Medicaid/Children's Health Insurance Program (CHIP) (66 900) than those with Medicare (31 500) or private insurance (14 000/100 000 population). Abnormal clinical findings and injuries were the discharge diagnoses most often referred for follow-up medical care. Conclusion: Higher visit referral rates were observed among female sex, non-Hispanic Black race, Medicaid/CHIP, abnormal clinical findings, and injuries. Future studies might reveal reasons that prompted higher referral rates among various patients' characteristics.

Incidence of notifiable diseases among American Indians/Alaska Natives - United States, 2007-2011.

American Indian/Alaska Native (AI/AN) populations experience substantial disparities in the incidence of multiple diseases compared with other racial/ethnic groups in the United States. A major goal of Healthy People 2020 is to eliminate health disparities, monitor disease trends, and identify population groups and diseases for targeted interventions. High rates of certain infectious diseases continue to be a major problem facing AI/AN populations. During 1990-2011, incidence rates for some infectious diseases declined among AI/AN populations, but disparities remain and AI/AN populations are still disproportionately affected. To describe disparities in selected notifiable diseases among AI/ANs, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for 2007-2011, the most recent 5 years for which data are available. The results of this analysis of 26 infectious diseases indicate that incidence rates of 14 diseases were higher for AI/ANs than for whites. Interventions are needed to address and reduce disparities in chlamydia, gonorrhea, West Nile virus, spotted fever rickettsiosis, and other infections among AI/ANs.

Completeness of reporting of race and ethnicity data in the nationally notifiable diseases surveillance system, United States, 2006-2010.

CONTEXT: During 1994-1997, approximately 70% and 60% of the cases of conditions reported to the National Notifiable Diseases Surveillance System included persons of known race and ethnicity, respectively. A major goal of the Healthy People 2020 initiative is to eliminate health disparities. OBJECTIVE: To describe trends in the completeness of race and ethnicity in case reports of the National Notifiable Diseases Surveillance System during 2006-2010. METHODS: The National Notifiable Diseases Surveillance System is a public health surveillance system that aggregates case reports of infectious diseases and conditions that are designated nationally notifiable and are collected by US states and territories. The Centers for Disease Control and Prevention (Atlanta, Georgia) maintains this surveillance system in collaboration with the Council of State and Territorial Epidemiologists. We used Cochran-Armitage Trend Test (SAS, version 9.2) to test the hypothesis that the percentage of case reports with the completeness of race and ethnicity data increased or decreased linearly during 2006-2010. MAIN OUTCOME MEASURE: Completeness of race and ethnicity variables. RESULTS: The 32 conditions reviewed included 1 030 804 case records. Seventy percent of records included a known value for race, and 49% of records included ethnicity during 2006-2010. During 2006-2010, race was known in 70% or more of records in 24 of 32 conditions and in 23 of 51 jurisdictions. During 2006-2010, the systemwide reporting of race remained at the same level of completeness (70%) but the reporting of ethnicity increased slightly from 48% in 2006 to 53% in 2010. In comparison with race, the proportions of records coded to ethnicity were less among all conditions. CONCLUSIONS: Significant change has occurred in the completeness of reporting of ethnicity but not race during 2006-2010. However, the reporting of ethnicity still lags substantially behind the reporting of race. Jurisdictions that identify conditions with lower rates of completeness of race and ethnicity can assess the net benefits of efforts to improve the completeness of race and ethnicity data.

Reasons for visits to emergency departments for Medicaid and State Children's Health Insurance Program patients: United States, 2004.

OBJECTIVE: To describe the primary reason for visits to hospital emergency departments (EDs) by patients whose expected source of payment was Medicaid/State Children's Health Insurance Program (SCHIP). The primary reason for an ED visit is particularly important because it reflects the patients' perspective of the problem that necessitated a visit to the ED. STUDY DESIGN: Retrospective study. METHODS: Data for 2004 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for reasons for ED visits. NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of non-federal, short-stay, and general hospitals in the United States. Data are collected annually and are weighted to generate national estimates. RESULTS: An estimated 24.5 million visits were made to hospital EDs in 2004 by patients whose expected method of payment was Medicaid/SCHIP (annual rate = 795 visits/7,000 Medicaid/SCHIP enrollees). Medicaid/SCHIP enrollees aged 25-44 years recorded the highest visit rate at 1,281 visits/1,000 persons. The rate of visits for African American Medicaid/SCHIP enrollees was 36% higher than that of whites (1,016 vs. 746 visits, respectively/1,000 persons). Nine of the 10 leading reasons for ED visits are similar for both Medicaid/SCHIP enrollees and the general population. Among Medicaid/SCHIP enrollees, the leading reason for visits include fever (54 visits/7,000 persons), stomach pain (37 visits/1,000 persons), and cough (35 visits/1,000 persons). For the general population, the leading reasons for visits include stomach pain (79 visits/7,000 persons), chest pain (19 visits/1,000 persons), and fever (74 visits/1,000 persons). For patients with an expected payment source other than Medicaid/SCHIP, 7 of the 10 leading reasons for visits are similar to Medicaid/SCHIP enrollees. For this category, the leading reason for visits are chest pain (18 visits/1,000 persons), stomach pain (16 visits/1,000 persons), and fever (70 visits/1,000 persons). CONCLUSION: Although Medicaid/SCHIP enrollees shared the same leading reasons with the general population in their visits to EDs, they had higher rates of visits for these reasons. It is possible that the general population is making a higher proportion of visits for the same reasons to settings other than EDs, relative to the Medicaid population. Differences in the age distribution of these populations could also be a factor in the observed visit rates.

Medicaid/State Children's Health Insurance Program patients and infectious diseases treated in emergency departments: U.S., 2003.

OBJECTIVE: Emergency departments (EDs) are a critical source of medical care in the U.S. Information is sparse concerning infectious disease visits among Medicaid entitlement enrollees nationwide. The objective of this study was to describe infectious diseases in terms of Medicaid/State Children's Health Insurance Program (SCHIP) as an expected source of payment. METHODS: Data for 2003 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of nonfederal, short-stay, and general hospitals in the U.S. Data are collected annually and are weighted to generate national estimates. RESULTS: Nationally in 2003, an estimated 21.6 million visits were made to hospital EDs for infectious diseases (rate = 76 visits/1,000 people). Medicaid/SCHIP was the expected source of payment for an estimated 6.7 million infectious disease-related visits (rate = 200 visits/1,000 people covered by Medicaid). Children aged < 15 years made 39% of visits nationwide (nationwide rate = 139 visits/1,000 people). Of Medicaid visits, 63% were made by children < 15 years of age (Medicaid enrollees rate = 255 visits/1,000 people). The rate of visits for Medicaid enrollees was comparable for females and males (198 visits vs. 201/1,000 people). The rate of visits for black Medicaid enrollees was 33% higher than for white Medicaid enrollees (255 vs. 192 visits/1,000 people). Upper respiratory tract infection (URTI) is the most frequent infectious condition recorded at ED visits. An estimated 47% of ED visits with an expected pay source of Medicaid relate to URTIs (93 visits/1,000 people), compared with 38% of ED visits in general (29 visits/1,000 people). CONCLUSION: Medicaid enrollee-specific ED visit rates for infectious diseases were higher by age group, gender, race, and region, compared with national rates. Because approximately half of visits relate to URTIs for a Medicaid payment group, URTIs should form the basis for development of appropriate control strategies.

Summary of notifiable diseases--United States, 2004.

The Summary of Notifiable Diseases--United States, 2004 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2004. Unless otherwise noted, the data are final totals for 2004 reported as of December 2, 2005. These statistics are collected and compiled from reports sent by state health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The Summary is available at http://www.cdc.gov/mmwr/summary.html. This site also includes publications from previous years.

Infectious diseases treated in emergency departments: United States, 2001.

Emergency departments (EDs) are an important source of medical care in the United States. Information is limited concerning epidemiologic patterns of ED visits for infectious diseases. Data for 2001 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. The NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of non-federal, short-stay, and general hospitals in the United States. Data are collected annually and are weighted to generate national estimates. In 2001, an estimated 19.8 million visits were made to hospital EDs for infectious diseases (rate=71 visits/1,000 persons). Children under 15 years old made 36% of these visits and had the highest rate of visits (rate=119 visits/1,000 persons). The rate of visits for females was 37% higher than for males (82 versus 60/1,000 persons). Although the white population had the highest volume of visits, the rate of visits for blacks was more than twice that of whites (130 versus 64 visits/1,000 persons). Laboratory tests were ordered in 84% of visits. An estimated 18% of visits to the EDs concern infectious diseases. The issue of health care access and ED use is complex and the reasons for the higher rate of visits for blacks than for whites are not fully understood.

Struck-by-lightning deaths in the United States.

The objective of the research reported here was to examine the epidemiologic characteristics of struck-by-lightning deaths. Using data from both the National Centers for Health Statistics (NCHS) multiple-cause-of-death tapes and the Census of Fatal Occupational Injuries (CFOI), which is maintained by the Bureau of Labor Statistics, the authors calculated numbers and annualized rates of lightning-related deaths for the United States. They used resident estimates from population microdata files maintained by the Census Bureau as the denominators. Work-related fatality rates were calculated with denominators derived from the Current Population Survey of employment data. Four illustrative investigative case reports of lightning-related deaths were contributed by the New Mexico Office of the Medical Investigator. It was found that a total of 374 struck-by-lightning deaths had occurred during 1995-2000 (an average annualized rate of 0.23 deaths per million persons). The majority of deaths (286 deaths, 75 percent) were from the South and the Midwest. The numbers of lightning deaths were highest in Florida (49 deaths) and Texas (32 deaths). A total of 129 work-related lightning deaths occurred during 1995-2002 (an average annual rate of 0.12 deaths per million workers). Agriculture and construction industries recorded the most fatalities at 44 and 39 deaths, respectively. Fatal occupational injuries resulting from being struck by lightning were highest in Florida (21 deaths) and Texas (11 deaths). In the two national surveillance systems examined, incidence rates were higher for males and people 20-44 years of age. In conclusion, three of every four struck-by-lightning deaths were from the South and the Midwest, and during 1995-2002, one of every four struck-by-lightning deaths was work-related. Although prevention programs could target the entire nation, interventions might be most effective if directed to regions with the majority of fatalities because they have the majority of lightning strikes per year.

Summary of notifiable diseases--United States, 2003.

The Summary of Notifiable Diseases--United States, 2003 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable diseases in the United States for 2003. Unless otherwise noted, the data are final totals for 2003 reported as of June 30, 2004. These statistics are collected and compiled from reports sent by state health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The Summary is available at http://www.cdc.gov/mmwr/summary.html. This site also includes publications from past years.

Fatal traumatic brain injury, West Virginia, 1989-1998.

OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents. METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators. RESULTS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults > or =65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade. CONCLUSION: Data presented in this report can be used to develop targeted prevention programs in West Virginia.

Trends in childhood drowning on U.S. farms, 1986-1997.

Computerized mortality data files from the National Center for Health Statistics were analyzed to describe childhood farm drowning from 1986 through 1997. Farm drowning rates were compared to the U.S. unintentional youth drowning rates for the same period. The denominator for the calculation of rates was derived from a series of farm youth estimates published by the Bureau of Census. There were 378 childhood farm drowning cases during the study period, for an average annual rate of 2.3 deaths per 100,000 farm youth resident years. This rate is comparable to unintentional drowning rates for U.S. youth (2.2/100,000 population). Fatality rates declined 28% from 1986 through 1997 (p = .0024) for farm youth and 41% for U.S. youth (p = .0001). An average 32 farm drowning incidents occur to youth annually, making drowning a legitimate concern for farm residents and visitors.

Surveillance for traumatic brain injury deaths--United States, 1989-1998.

PROBLEM/CONDITION: Data indicate that approximately 50,000 U.S. residents die as a result of traumatic brain injury (TBI) annually. Survivors of TBI are often left with neuropsychologic impairments that result in disabilities affecting work or social activity. During 1979-1992, TBI-related death rates declined 22%, from 24.6 to 19.3 deaths/100,000 population. This report describes the epidemiology and trends in TBI-related mortality during 1989-1998. REPORTING PERIOD: January 1, 1989-December 31, 1998. DESCRIPTION OF SYSTEMS: The National Center for Health Statistics (NCHS) Multiple Cause of Death public use data were analyzed for this study. RESULTS: During 1989-1998, an annual average of 53,288 deaths (range: 51,848-54,501) among U.S. residents were associated with TBI. TBI-related death rates declined 11.4%, from 21.9 to 19.4/100,000 population. The major causes of TBI-related deaths were firearm-related (40%), motor-vehicle-related (34%), and fall-related (10%). The leading causes of TBI-related deaths differed among age groups. Among youths aged 0-19 years, motor-vehicle-related TBIs were the leading cause; among persons aged 20-74 years, firearm-related TBIs were the leading cause; and among persons aged > or = 75 years, fall-related TBIs were the leading cause. Comparing rates in 1989 with rates in 1998, motor-vehicle-related causes declined by 22%; the majority of this decline occurred during the first 5 years of the period. During 1989-1998, firearm-related TBI-related deaths declined by 14%; approximately all of this decline occurred during the last 5 years of the period. In contrast, fall-related TBI-related death rates increased by 25% during the period. CONCLUSION: This analysis of mortality data identifies recent trends in TBI-related deaths occurring during 1989-1998. Fall-related TBI death rates have increased throughout the period. Firearm-related TBI death rates, which were increasing in the early 1990s, declined. Motor-vehicle-related TBI death rates, which were decreasing until the mid-1990s, have since demonstrated only a limited change. PUBLIC HEALTH ACTION: More current population-based epidemiologic studies of TBI are needed to assess recent trends of etiologic factors, provide additional guidance for public policy, and evaluate prevention strategies. Despite the decline in fatal TBI incidence, TBI morbidity and mortality remains a public health challenge. Public health, law enforcement, and transportation safety professionals can address these challenges by implementing effective interventions based on a thorough assessment of the factors that influence health-related behaviors.