Hysterectomy Among Women Age 18 and Older: United States, 2021.

Hysterectomy is one of the most common procedures for women in the United States (1,2). Hysterectomy removes the uterus and is used to treat conditions such as uterine fibroids, endometriosis, and gynecological cancer (3). It can be performed on an inpatient or outpatient basis (4,5). This report uses 2021 National Health Interview Survey (NHIS) data to describe the percentage of women age 18 and older who have had a hysterectomy by selected sociodemographic characteristics.

Suicide Among Adults Age 55 and Older, 2021.

Suicide is a leading cause of mortality in the United States, with an ageadjusted rate of 14.1 deaths per 100,000 population in 2021 (1). Older adults tend to have higher rates of suicide, although they represent a low percentage of the total number of suicides (2). Factors that specifically affect older adults can include declines in physical and cognitive functioning, changes in mental health, and other factors often associated with getting older, like bereavement, loneliness, and lack of social connectedness (3-8). This report presents suicide rates for adults age 55 and older by sex and mechanism of suicide.

Adults Living in Families Experiencing Food Insecurity in the Past 30 Days: United States, 2021.

In 2021, 33.8 million people in the United States were food insecure, that is, they did not have consistent, dependable access to sufficient quality or quantity of food (1,2). Food insecurity affects health outcomes (3), increasing the risk of high cholesterol, hypertension, chronic health conditions, and changes in functional limitations (4-6), and is a social determinant of health. This report explores selected sociodemographic characteristics of adults aged 18 and over living in families experiencing food insecurity.

Unintentional Fall Deaths Among Adults Aged 65 and Over: United States, 2020.

Unintentional fall injuries occur most frequently among people in older age groups, with over 2 million fall events treated in emergency departments each year among adults aged 65 and over (1,2). A variety of factors contribute to the risk of falling, including difficulties in seeing, walking, and balance; disabilities; medication effects; and environmental walking obstacles, among other factors (3-6). Deaths due to unintentional falls are a leading cause of unintentional injury deaths among adults aged 65 and over (7). Reducing unintentional fall-related deaths among older adults is a key objective for Healthy People 2030 (8). This report presents unintentional fall death rates for adults aged 65 and over, by demographic characteristics.

Harmonizing Disability Data To Improve Disability Research And Policy.

Disability is complex and multifaceted, complicating governments' efforts to collect the high-quality, comprehensive data necessary for developing, implementing, and monitoring policies. Yet data are needed to obtain information on functioning in the population, to identify the population with disabilities, and to disaggregate indicators of well-being by disability to determine whether people with disabilities are participating in society to the same extent as those without disabilities. In this article we discuss the need for data harmonization to improve disability research and policy. We describe standard question sets on disability developed for inclusion in surveys and administrative systems, as well as the need for coordination of both statistical and administrative data systems. Until disability data become more harmonized, it will not be possible to support the development of comprehensive, evidence-based policies and programs to address the needs of the population with disabilities.

Assessing Anxiety and Depression: A Comparison of National Health Interview Survey Measures.

Objective-This report examines differences across two different sets of measures used to assess anxiety and depression in the National Health Interview Survey (NHIS).

Children Living in Households That Experienced Food Insecurity: United States, 2019-2020.

Food insecurity, which affects an estimated 15 million Americans (1), is the limited or uncertain availability of safe and nutritionally adequate foods, or the limited or uncertain ability to acquire acceptable foods in socially acceptable ways (2). Food insecurity has been consistently associated with poor health outcomes in children, including poorer overall health status, acute and chronic health problems, and limited healthcare access (3). This report describes the percentage of children aged 0-17 years living in food-insecure households during the past 30 days by selected sociodemographic and family characteristics using 2019-2020 National Health Interview Survey data.

Stressful Life Events Among Children Aged 5-17 Years by Disability Status: United States, 2019.

Children with disabilities are at increased risk of experiencing stressful life events (1,2). These events include various forms of abuse, neglect, and household instability, such as exposure to violence, parental or guardian incarceration, and living with someone with mental illness or alcohol or drug problems (3). Stressful life events experienced in childhood may have lifelong effects on physical and mental health outcomes (4-11), as well as socioeconomic outcomes, including educational attainment and employment (12). This report presents disparities in four stressful life events among children aged 5-17 years by disability status using 2019 National Health Interview Survey (NHIS) data.

Disparities in Stressful Life Events Among Children Aged 5-17 Years: United States, 2019.

Stressful life events in childhood include various forms of abuse, neglect, and household instability, such as violence exposure, parental incarceration, or living with someone with mental health, alcohol, or drug problems (1). These events are key social determinants of a child's well-being and can have lifelong impacts on physical and mental health (2-9). This report presents sociodemographic disparities in stressful life events as reported by a knowledgeable adult, usually a parent, among children aged 5-17 years using the 2019 National Health Interview Survey data.

Disparities in COVID-19 Vaccination Status, Intent, and Perceived Access for Noninstitutionalized Adults, by Disability Status - National Immunization Survey Adult COVID Module, United States, May 30-June 26, 2021.

Estimates from the 2019 American Community Survey (ACS) indicated that 15.2% of adults aged ≥18 years had at least one reported functional disability (1). Persons with disabilities are more likely than are those without disabilities to have chronic health conditions (2) and also face barriers to accessing health care (3). These and other health and social inequities have placed persons with disabilities at increased risk for COVID-19-related illness and death, yet they face unique barriers to receipt of vaccination (4,5). Although CDC encourages that considerations be made when expanding vaccine access to persons with disabilities,* few public health surveillance systems measure disability status. To describe COVID-19 vaccination status and intent, as well as perceived vaccine access among adults by disability status, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed. Adults with a disability were less likely than were those without a disability to report having received ≥1 dose of COVID-19 vaccine (age-adjusted prevalence ratio [aPR] = 0.88; 95% confidence interval [CI] = 0.84-0.93) but more likely to report they would definitely get vaccinated (aPR = 1.86; 95% CI = 1.43-2.42). Among unvaccinated adults, those with a disability were more likely to report higher endorsement of vaccine as protection (aPR = 1.29; 95% CI = 1.16-1.44), yet more likely to report it would be or was difficult to get vaccinated than did adults without a disability (aPR = 2.69; 95% CI = 2.16-3.34). Reducing barriers to vaccine scheduling and making vaccination sites more accessible might improve vaccination rates among persons with disabilities.

Measuring Disability: An Examination of Differences Between the Washington Group Short Set on Functioning and the American Community Survey Disability Questions.

Objective-This report examines differences in survey reports of disability between two sets of disability questions, the Short Set on Functioning (WG-SS) developed by the Washington Group on Disability Statistics (WG) and a set of disability questions developed for the American Community Survey (ACS).

Hearing Difficulties Among Adults: United States, 2019.

Difficulty hearing is related to other functional difficulties, such as communication, and can limit participation across a range of activities including employment, education, and civic activities. While hearing loss can occur at any age, it increases with age (1,2) and has been shown to be associated with cognitive and functional decline in older adults (3-6). This report presents difficulties with hearing even when using a hearing aid among U.S. adults aged 18 and over by level of difficulty and age, sex, and race and Hispanic origin. It also presents estimates of the prevalence of hearing aid use among adults aged 45 and over to focus on the age group with higher rates of hearing difficulties.

Evaluating Survey Report of Social Security Disability Benefit Receipt Using Linked National Health Interview Survey and Social Security Administration Data.

Linking nationally representative population health survey data with Social Security Administration (SSA) disability program data provides a rich source of information on program recipients. Survey participant data from the 1998-2005 National Health Interview Survey (NHIS) were linked to SSA administrative records from 1997 through 2005. The goal of this study was to assess agreement between the actual benefit receipt based on the SSA administrative records and the survey report of benefit receipt in the linked NHIS and SSA file for the U.S. civilian noninstitutionalized population. This evaluation provides information on the expected accuracy of survey report of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefit receipt, including how participant characteristics may be associated with reporting misclassification. The results indicate that there is some underreporting of SSA disability benefit receipt based on the NHIS responses compared with the SSA administrative records. The analysis identified some differences between the concordant and discordant groups for selected characteristics, but there were no clear patterns among the different survey questions or the different survey participant characteristics.

An evaluation of the American Community Survey indicators of disability.

BACKGROUND: Collection of data in the Census for implementing disability legislation has been continuous since 1970 although the questions used have changed several times. Concerns have been raised about the ability of the newest question set developed for the American Community Survey (ACS) to adequately represent the population with disabilities because it does not capture all those eligible for certain benefit programs. OBJECTIVE: Using national data, we examine how the addition of questions on the receipt of SSI/SSDI changes the composition of the population identified by the ACS measures. In ancillary materials we also examine the addition of a work limitation question to the population identified by ACS measures. METHODS: Using descriptive secondary analysis of 2011 NHIS data we compare the characteristics of those identified by the ACS questions to those identified by the ACS questions and receipt of SSI/SSDI and those only receiving SSI/SSDI. The comparison is based on conditions, specific functional limitations and severity of limitation. RESULTS: The results provide evidence ACS questions identify a population representing persons at risk for participation difficulties including those who receive SSI/SSDI. The ACS population has higher proportions with mental health and development disabilities than comparison population. The ancillary data demonstrates the work limitation question does not make a significant difference in identifying recipients of SSI/SSDI. CONCLUSION: The analysis demonstrates that the disability measures developed for the ACS produce an unbiased picture of the population with disabilities by including persons with all conditions, more severe disability or selected types of functional limitations.

A Framework for Monitoring Progress Using Summary Measures of Health.

OBJECTIVE: Initiatives designed to monitor health typically incorporate numerous specific measures of health and the health system to assess improvements, or lack thereof, for policy and program purposes. The addition of summary measures provides overarching information which is essential for determining whether the goals of such initiatives are met. METHOD: Summary measures are identified that relate to the individual indicators but that also reflect movement in the various parts of the system. RESULTS: A hierarchical framework that is conceptually consistent and which utilizes a succinct number of summary measures incorporating indicators of functioning and participation is proposed. DISCUSSION: While a large set of individual indicators can be useful for monitoring progress, these individual indicators do not provide an overall evaluation of health, defined broadly, at the population level. A hierarchical framework consisting of summary measures is important for monitoring the success of health improvement initiatives.

Frailty Screening in Low- and Middle-Income Countries: A Systematic Review.

OBJECTIVES: To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs). DESIGN: Systematic review. SETTING: LMICs, as defined by the World Bank on June 30, 2014. PARTICIPANTS: Elderly adults (as defined by the authors) living in LMICs. MEASUREMENTS: Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014. RESULTS: Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC. CONCLUSION: There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.

Comparability between the rates for all-listed inpatient procedures using National Hospital Discharge Survey and Medicare claims, 1999 and 2007.

OBJECTIVES: This report examines the comparability between the rates of inpatient procedures for persons aged 65 and over using the National Hospital Discharge Survey (NHDS) and Medicare claims data. METHODS: The estimates in this report are based on data from NHDS and Medicare claims submitted by hospital providers for inpatient stays among Part A fee-for-service Medicare beneficiaries aged 65 and over. The discharge rates, selected procedures rates, and comparability ratios are reported for older men and women, by age and sex, for 1999 and 2007. RESULTS: Between 1999 and 2007, observed decreases in discharge rates and in all-listed procedure rates derived from NHDS were not significant, while Medicare discharge rates decreased and procedure rates increased significantly. In 1999 and 2007, no statistically significant differences were found between NHDS and Medicare estimates for discharge rates in the age-sex groups examined except for those aged 85 and over. In both years, the comparability ratios between Medicare and NHDS procedure rates were significantly different from one for about 50% of selected procedures, and ranged from 1.12 to 1.26 in 1999 and from 1.16 to 1.41 in 2007. This reflects more procedures recorded in 1999 and 2007 in Medicare data per discharge. The comparability ratio was higher for most of the cardiac procedures, and in general, was closer to one when fewer procedures were performed per discharge and for procedures with lower utilization rates.

Pharmacokinetic characteristics of bolus-administered mannitol in patients undergoing elective craniotomy.

To better understand mannitol pharmacokinetics, the authors constructed and compared population models for high-versus low-dose bolus infusions in humans. Patients (aged 18-75, American Society of Anesthesiologists physical status 1-3) scheduled for elective craniotomy with an anticipated need for intraoperative mannitol were randomly assigned to receive either 0.5 (n = 10) or 1.0 (n = 12) g/kg of 20% mannitol over 15 minutes. Serial blood samples were collected at the predetermined intervals over 12 hours. Plasma mannitol concentrations were measured by gas chromatography and subjected to pharmacokinetic analysis; a 3-compartment model best described mannitol disposition characteristics. Weight and dose were the important covariates for rapid peripheral volume of distribution (V2) and central clearance (CL1), respectively. Estimated population means were 2.80, 8.86, and 12.0 L for central (V1), rapid (V2), and slow (V3) volumes of distribution, respectively. Clearances of the central compartments (CL1) were 0.07 versus 0.04 L/min in the high-versus low-dose group, respectively. Thus, mannitol kinetics can be considered as nonlinear. Clearances of the rapid peripheral (CL2) and slow peripheral compartments (CL3) were identical (2.07 and 0.16 L/min) in both. The current weight-based dosing guidelines yielded greater than expected plasma drug concentrations in obese patients.

Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage.

OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS: Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION: These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.