Multiple chronic conditions among adults aged 45 and over: trends over the past 10 years.

Studies suggest that the presence of multiple chronic conditions (MCC) adds a layer of complexity to disease management (1­6); recently the U.S. Department of Health and Human Services established a strategic framework for improving the health of this population (2). This report presents estimates of the population aged 45 and over with two or more of nine self-reported chronic conditions, using a definition of MCC that was consistent in the National Health Interview Survey (NHIS) over the recent 10-year period: hypertension, heart disease, diabetes, cancer, stroke, chronic bronchitis, emphysema, current asthma, and kidney disease. Examining trends in the prevalence of MCC informs policy on chronic disease management and prevention, and helps to predict future health care needs and use for Medicare and other payers.

Public health surveillance data: legal, policy, ethical, regulatory, and practical issues.

In the United States, data systems are created by the ongoing, systematic collection of health, demographic, and other information through federally funded national surveys, vital statistics, public and private administrative and claims data, regulatory data, and medical records data. Certain data systems are designed to support public health surveillance and have used well-defined protocols and standard analytic methods for assessing specific health outcomes, exposures, or other endpoints. However, other data systems have been designed for a different purpose but can be used by public health programs for surveillance. Several public health surveillance programs rely substantially on others' data systems. An example of data used for surveillance purposes but collected for another reason is vital statistics data. CDC's National Center for Health Statistics (NCHS) purchases, aggregates, and disseminates vital statistics (birth and death rates) that are collected at the state level. These data are used to understand disease burden, monitor trends, and guide public health action. Administrative data also can be used for surveillance purposes (e.g., Medicare and Social Security Disability data that have been linked to survey data to monitor changes in health and health-care use over time).

Health and access to care among employed and unemployed adults: United States, 2009-2010.

Lack of health insurance has been shown to be associated with problems obtaining needed health care (3), and the unemployed are less likely to have health insurance than are their employed counterparts. The number and rate of adults aged 18­64 years lacking health insurance has been increasing, in part due to the historically high unemployment rates. However, even having comprehensive health insurance coverage does not guarantee access to needed services, in part because of cost-sharing, including copayments and deductibles. Unemployed persons may retain their health insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA) or through other programs, but COBRA payments in particular may be quite expensive, and individual insurance plans may be less comprehensive than many employer-sponsored plans (4). Thus, although some unemployed adults may retain coverage for some period of time, they may be less able to meet cost-sharing requirements because of reduced income associated with unemployment. This analysis compares the health status and access to care of employed and unemployed adults and shows that unemployment is associated with unfavorable health and access to care among adults in the labor force over and above the loss of health insurance. However, it is not possible to know from these data the extent to which unemployment is a cause or effect of poor health. Poor health may be both a cause and effect of unemployment. Adults with private health insurance were more likely to have serious psychological distress and respondent-reported fair or poor health status if they were unemployed. In fact, unemployed privately insured persons were more than three times as likely to have serious psychological distress as their employed counterparts. Similar patterns were found for adults with public insurance and no health insurance. There were no significant differences between employed and unemployed adults in the percentage who had ever been diagnosed with selected chronic conditions, including hypertension, heart disease, diabetes, or cancer (NCHS unpublished analysis of NHIS data), and so the need for health care to treat these chronic conditions exists for both employed and unemployed adults. In addition to having poorer health, unemployed adults were more likely to delay or not receive needed medical care and needed prescriptions due to cost than their employed counterparts across categories of insurance coverage. Thus, the unemployed reported both worse health and less access to needed care and treatment than employed adults. This pattern was found not only for those without health insurance but also those with public and private insurance.

Emergency department visitors and visits: who used the emergency room in 2007?

KEY FINDINGS: Older adults (aged 75 and over), non-Hispanic black persons, poor persons, and persons with Medicaid coverage were more likely to have had at least one emergency department (ED) visit in a 12-month period than those in other age, race, income, and insurance groups. Among the under-65 population, the uninsured were no more likely than the insured to have had at least one ED visit in a 12-month period. Persons with Medicaid coverage were more likely to have had multiple visits to the ED in a 12-month period than those with private insurance and the uninsured. ED visits by the uninsured were no more likely to be triaged as nonurgent than visits by those with private insurance or Medicaid coverage. Persons with and without a usual source of medical care were equally likely to have had one or more ED visits in a 12-month period.

Health care utilization among adults aged 55-64 years: how has it changed over the past 10 years?

KEY FINDINGS: The percentage of physician office and hospital outpatient department (OPD) visits during which an MRI/CT/PET scan was ordered doubled, to 4%, and the percentage of hospital emergency department visits with an MRI/CT scan more than tripled, to 16%. The percentage of physician office and OPD visits with at least five drugs prescribed more than doubled, to 25%. Inpatient hospitalization rates were similar in 2006 and 1996, but the types of procedures and surgeries performed have changed. Hospitalization rates for coronary artery stent insertions, hip replacements, and knee replacements rose sharply, while rates for some other procedures declined. Ambulatory surgery visit rates were almost twice as high in 2006 as in 1994-1996, and for some types of ambulatory procedures, such as colonoscopies, the increase was even greater.

Health insurance coverage trends, 1959-2007: estimates from the National Health Interview Survey.

OBJECTIVES: This report presents long-term trends in the number and percentage of persons under age 65 years with different types of health insurance coverage and with no coverage. It documents changes in how the National Health Interview Survey (NHIS) has collected information about coverage over almost 50 years. It also compares recent trends in coverage estimates based on the NHIS and the U.S. Census Bureau's Current Population Survey (CPS). METHODS: Estimates were derived from 32 years of the NHIS, from 1959 to 2007. The types of estimates available differ over these years, reflecting changes in the availability of different types of coverage and changes in the NHIS questions. Joinpoint regression was used to estimate average annual percent change over time and to identify statistically significant changes in trends. RESULTS: The percentage of persons under age 65 years with private coverage rose between 1959 and 1968, to 79%, remained stable until 1980, and then declined to 67% by 2007. During the 1980s, the percentage of persons with no coverage increased, while the percentage with private coverage declined and the percentage with Medicaid remained stable. Since 1990, the percentage of nonelderly persons without coverage has remained stable, but the number has increased by more than 6 million persons, to 43.3 million in 2007. During this period, the percentage with private coverage has continued to decline, while the percentage with Medicaid has increased. Recent trends in coverage based on the NHIS and CPS are similar.

Estimated prevalence of people with cognitive impairment: results from nationally representative community and institutional surveys.

PURPOSE: We address how the national prevalence of cognitive impairment can be estimated from two nationally representative surveys. DESIGN AND METHODS: Data are from the 1999-2001 National Health Interview Survey (NHIS) and the 1999 National Nursing Home Survey (NNHS). The NHIS represents all community-dwelling people living in the United States, and the NNHS is representative of all nursing home residents. RESULTS: NHIS data show that there are approximately 800,000 community-based elders aged 65 and older with reported confusion or memory loss, and 2.3 million elders with reported limitation of activity caused by senility or dementia. There are an estimated 632,000 nursing home residents aged 65 and older with a reported diagnosis of dementia. IMPLICATIONS: Estimates of the prevalence of cognitive impairment that are based on nationally representative data are rare, because comprehensively evaluating a national sample by using standard, validated cognitive-impairment assessment methods is difficult and expensive, and because most national surveys are broad based and designed to cover a wide variety of topics. Crude measures of cognitive impairment, such as the presence of confusion or memory loss or limitations caused by senility or dementia, that are included in these multipurpose surveys may be only rough proxies for clinically evaluated cognitive impairment, but they do appear to produce prevalence estimates that are similar to estimates found with the use of more precise case-ascertainment methods. These nationally representative data sets may be used to generate hypotheses related to the prevalence, epidemiology, and health care utilization patterns of people with cognitive impairment that can be tested in studies using more specific case-ascertainment criteria.

Trends in use of medications associated with women's ambulatory care visits.

BACKGROUND: Data from the CDC's National Health Care Survey (NHCS) can assist researchers studying women's healthcare utilization. METHODS: Using data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), component surveys of the NHCS, this paper presents prescribing trends from 1995 to 2000 for the 10 therapeutic drug classes of medications mentioned most often during women's ambulatory care visits. RESULTS: Antidepressants top the list as the most frequently mentioned therapeutic class in 1999-2000, followed by estrogens and progestins, antiarthritics, and drugs for acid/peptic disorders. The number of medications prescribed increased by about 13% during visits by women to physicians' offices and hospital outpatient departments between 1995-1996 and 1999-2000, from 144 to 162 mentions per 100 visits, respectively. CONCLUSIONS: Researchers can use the NHCS to track changes in use over time and to target potential issues related to access to care, quality of care, or cost that warrant further, in-depth study.