National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014.

OBJECTIVE: We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP). METHODS: We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC. RESULTS: Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented. CONCLUSIONS: NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562-569).

Coding of Electronic Laboratory Reports for Biosurveillance, Selected United States Hospitals, 2011.

Objective Electronic laboratory reporting has been promoted as a public health priority. The Office of the U.S. National Coordinator for Health Information Technology has endorsed two coding systems: Logical Observation Identifiers Names and Codes (LOINC) for laboratory test orders and Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for test results. Materials and Methods We examined LOINC and SNOMED CT code use in electronic laboratory data reported in 2011 by 63 non-federal hospitals to BioSense electronic syndromic surveillance system. We analyzed the frequencies, characteristics, and code concepts of test orders and results. Results A total of 14,028,774 laboratory test orders or results were reported. No test orders used SNOMED CT codes. To describe test orders, 77% used a LOINC code, 17% had no value, and 6% had a non-informative value, "OTH". Thirty-three percent (33%) of test results had missing or non-informative codes. For test results with at least one informative value, 91.8% had only LOINC codes, 0.7% had only SNOMED codes, and 7.4% had both. Of 108 SNOMED CT codes reported without LOINC codes, 45% could be matched to at least one LOINC code. Conclusion Missing or non-informative codes comprised almost a quarter of laboratory test orders and a third of test results reported to BioSense by non-federal hospitals. Use of LOINC codes for laboratory test results was more common than use of SNOMED CT. Complete and standardized coding could improve the usefulness of laboratory data for public health surveillance and response.

Practical comparison of aberration detection algorithms for biosurveillance systems.

National syndromic surveillance systems require optimal anomaly detection methods. For method performance comparison, we injected multi-day signals stochastically drawn from lognormal distributions into time series of aggregated daily visit counts from the U.S. Centers for Disease Control and Prevention's BioSense syndromic surveillance system. The time series corresponded to three different syndrome groups: rash, upper respiratory infection, and gastrointestinal illness. We included a sample of facilities with data reported every day and with median daily syndromic counts ⩾1 over the entire study period. We compared anomaly detection methods of five control chart adaptations, a linear regression model and a Poisson regression model. We assessed sensitivity and timeliness of these methods for detection of multi-day signals. At a daily background alert rate of 1% and 2%, the sensitivities and timeliness ranged from 24 to 77% and 3.3 to 6.1days, respectively. The overall sensitivity and timeliness increased substantially after stratification by weekday versus weekend and holiday. Adjusting the baseline syndromic count by the total number of facility visits gave consistently improved sensitivity and timeliness without stratification, but it provided better performance when combined with stratification. The daily syndrome/total-visit proportion method did not improve the performance. In general, alerting based on linear regression outperformed control chart based methods. A Poisson regression model obtained the best sensitivity in the series with high-count data.

Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010.

BACKGROUND: Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. METHODOLOGY: Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. FINDINGS: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. CONCLUSIONS: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans.

Automated monitoring of clusters of falls associated with severe winter weather using the BioSense system.

OBJECTIVES: To identify and characterise clusters of emergency department (ED) visits for fall injuries during the 2007-2008 winter season. METHODS: Hospital ED chief complaints and diagnoses from hospitals reporting to the Centers for Disease Control and Prevention BioSense system were analysed. The authors performed descriptive analyses, used time series charts on data aggregated by metropolitan statistical areas (MSAs), and used SaTScan to find spatial-temporal clusters of visits from falls. RESULTS: In 2007-2008, 17 clusters of falls in 13 MSAs were found; the median number of excess ED visits for falls was 71 per day. SaTScan identified 11 clusters of falls, of which seven corresponded to MSA clusters found by time series and five included more than one state/district. Most clusters coincided with known periods of snowfall or freezing rain. CONCLUSION: The results show the role that a national automated system can play in tracking widespread injuries. Such a system could be harnessed to assist with prevention strategies.

Cervical cancer screening among foreign-born women by birthplace and duration in the United States.

OBJECTIVE: Mortality rates for cervical cancer have increased among foreign-born women in the United States in the last two decades. Previous research indicates that rates of Pap testing are lower among foreign-born women than in U.S.-born women. This study identifies screening rates among foreign-born women by birthplace and duration in the United States. METHODS: We used data from 4 years (1998, 1999, 2000, 2003) of the National Health Interview Survey (NHIS) to estimate Pap testing rates by birthplace (Mexico, Central America, Caribbean, South America, Europe, Russia, Africa, Middle East, India, Asia, and Southeast Asia) and percent of lifetime spent in the United States for women aged>or=18 years (n=70,775). Rates were age standardized to the 2000 U.S. population. RESULTS: After adjusting for demographic characteristics and health indicators, we found that 18.6% (95% CI 16.7, 20.6) of recent immigrants (<25% of lifetime in the United States) and 9.9% (95% CI 9.0, 10.8) of established immigrants (>or=25% of lifetime in the United States)never received a Pap test in their lifetime compared with 5.8% (95% CI 5.5, 6.1) of U.S.-born women. Adjusted prevalence of never receiving a Pap test was highest among women from Asia, Southeast Asia, and India (19.6%), South America (12.7%), Mexico (11.2%), Caribbean (11.0%), Europe (9.9%), and Central America (9.2%). CONCLUSIONS: Significant differences exist in rates of screening for cervical cancer between foreign-born groups by birthplace and by duration in the United States. Nationally and locally funded screening programs may benefit from these findings in developing screening strategies for foreign-born women.

Fall injury episodes among noninstitutionalized older adults: United States, 2001-2003.

OBJECTIVE: This report presents national estimates of fall injury episodes for noninstitutionalized U.S. adults aged 65 years and over, by selected characteristics. Circumstances surrounding the fall injury and activity limitations and utilization of health care resulting from the fall injury are also presented. METHODS: Combined data from the 2001-2003 National Health Interview Surveys (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), were analyzed to produce estimates for the U.S. civilian noninstitutionalized population. Data on nonfatal medically attended fall injuries occurring within the 3 months preceding the interview were obtained from an adult family member. RESULTS: The annualized rate of fall injury episodes for noninstitutionalized adults aged 65 years and over in 2001-2003 was 51 episodes per 1,000 population. Rates of fall injuries increased with age, and were higher for women compared with men. Non-Hispanic white older adults had higher rates of fall injuries compared with non-Hispanic black older adults. Older adults with certain chronic conditions and activity limitations had higher rates of fall injuries compared with older adults without these conditions. The most common cause of fall injuries among older adults was slipping, tripping, or stumbling, and most fall injuries occurred inside or around the outside of the home. Nearly 60 percent of older adults who experienced a fall injury visited an emergency room for treatment or advice. Nearly one-third of older adults experiencing a fall injury needed help with activities of daily living as a result, and over one-half of these persons expected to need this help for at least 6 months. A similar percentage experienced limitation in instrumental activities of daily living as a result of fall injuries. CONCLUSION: Fall injuries remain very prevalent among older adults and result in high health care utilization and activity limitations. Rates of fall injuries vary by demographic and health characteristics of older noninstitutionalized adults.

Characteristics of adults with serious psychological distress as measured by the K6 scale: United States, 2001-04.

OBJECTIVE: This report estimates the prevalence of serious psychological distress (SPD) in the noninstitutionalized adult population of the United States, as measured by the K6 scale of nonspecific psychological distress, and describes the characteristics of adults with and without SPD. These findings are compared with results from previous studies of the characteristics of adults with serious mental illnesses that cause significant disability, such as severe major depression, bipolar disorder, and schizophrenia. METHODS: The estimates in this report were derived from the Family Core and Sample Adult components of the 2001-04 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were calculated using the SUDAAN statistical package to account for the complex survey design. RESULTS: The prevalence of SPD was higher among adults 45-64 years old than younger adults 18-44 years or older adults 65 years and over. Adults with SPD were more likely to be female, have less than a high school diploma, and live in poverty, and less likely to be married than adults without SPD. Moreover, those with SPD were more likely to be obese and to be current smokers. They have a higher prevalence of ever being diagnosed with heart disease, diabetes, arthritis, and stroke than persons without SPD. Adults with SPD were more likely to report needing help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). They also used more medical care services such as doctor visits and visits to mental health professionals than adults without SPD. CONCLUSIONS: The associations between SPD and sociodemographic characteristics, health status, and health care utilization are similar to the relationships found between serious mental illnesses (for example, major depression or schizophrenia) and these same variables. Persons with SPD demonstrate disadvantage in both socioeconomic status and health outcomes.

Summary health statistics for the U.S. population: National Health Interview Survey, 2005.

OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2005 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by sex, age, race, Hispanic or Latino origin and race, education, family income, poverty status, health insurance coverage (where appropriate), place of residence, and region of residence. The topics covered are respondent-assessed health status, limitations in activities, special education or early intervention services, injury and poisoning episodes, health care access and utilization, and health insurance coverage. SOURCE OF DATA: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2005, household interviews were completed for 98,649 persons living in 38,509 households, reflecting a household response rate of 86.5%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2005. About 34 million persons (12%) were limited in their usual activities due to one or more chronic health conditions. About 4 million persons (2%) required the help of another person with activities of daily living, and about 8 million persons (4%) required the help of another person with instrumental activities of daily living. About 6% of children received special education or early intervention services. Among persons under age 65 years, about 42 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

Physical and mental health characteristics of U.S.- and foreign-born adults: United States, 1998-2003.

OBJECTIVE: This report presents national prevalence estimates of selected measures of physical health status and limitations, health care access and utilization, and mental health status among the civilian noninstitutionalized population of U.S.- and foreign-born adults aged 18 years and over in four race-ethnicity groups in the United States. METHODS: The estimates in this report were derived from the Family Core and Sample Adult components of the 1998-2003 National Health Interview Surveys, conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex survey sample design. Data were age adjusted to the 2000 U.S. standard population. RESULTS: In general, the foreign-born population was younger, less likely to have a high school diploma, more likely to be poor, heavily concentrated in the central cities of metropolitan areas, and more likely to live in large families, compared with their U.S.-born counterparts. Hispanic immigrants were the least likely to have health insurance or to have a usual source of health care compared with other immigrant groups. Non-Hispanic black and Hispanic adults, regardless of nativity, were more likely to be obese than non-Hispanic white and non-Hispanic Asian adults. However, non-Hispanic black and Hispanic immigrant adults were significantly less likely to be obese than their U.S.-born counterparts. Hispanic immigrants were more likely to be obese the longer they lived in the United States. Foreign-born nonHispanic black and Hispanic immigrant adults experienced fewer symptoms of serious psychological distress compared with their U.S.-born counterparts. CONCLUSIONS: There are significant differences in physical health status and mental health status among U.S.-born and foreign-born adults. Foreign-born adults enjoy considerable advantages over their U.S.-born counterparts for many health measures despite limited access to health care and unfavorable sociodemographic characteristics. Differences in the impact of length of stay in the United States on immigrant health suggest that the role of acculturation in understanding immigrant health is complex and may differ for various race/ethnicity groups.

Summary health statistics for U.S. children: National Health Interview Survey, 2004.

OBJECTIVES: This report presents both age-adjusted and unadjusted statistics from the 2004 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disability and Attention Deficit Hyperactivity Disorder (ADHD), prescription medication use, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, selected measures of health care access and utilization, and dental care. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U. S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States. Data are collected for all family members during face-to-face interviews with adults present at the time of interview. Additional information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 2004, most U.S. children under 18 years of age had excellent or very good health (82%). However, 9% of children had no health insurance coverage, and 5% of children had no usual place of health care. Twelve percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 7% of children had ADHD.

Summary health statistics for U.S. children: National Health Interview Survey, 2005.

OBJECTIVES: This report presents both age-adjusted and unadjusted statistics from the 2005 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), prescription medication use, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, selected measures of health care access and utilization, and dental care. SOURCE OF DATA: NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States. Data are collected for all family members during face-to-face interviews with adults present at the time of interview. Additional information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 2005, most U.S. children under 18 years of age had excellent or very good health (82%). However, 9% of children had no health insurance coverage, and 5% of children had no usual place of health care. Thirteen percent of children had ever been diagnosed with asthma. An estimated 7% of children 3-17 years of age had a diagnosed learning disability, and an estimated 7% of children had ADHD.

Summary health statistics for U.S. children: National Health Interview Survey, 2003.

OBJECTIVES: This report presents both age-adjusted and unadjusted statistics from the 2003 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), use of prescription medication, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, unmet dental needs, time since last dental contact, and selected measures of health care access. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States. Data are collected for all family members during face-to-face interviews with adults present at the time of interview. Additional information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 2003, most U.S. children under 18 years of age had excellent or very good health (83%). However, 10% of children had no health insurance coverage, and 5% of children had no usual place of health care. Thirteen percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 6% of children had ADHD.

Summary health statistics for U.S. children: National Health Interview Survey, 2002.

OBJECTIVES: This report presents both age-adjusted and unadjusted statistics from the 2002 National Health Interview Survey on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), use of prescription medication, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, unmet dental needs, time since last dental contact, and selected measures of health care access. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 2002, most U.S. children under 18 years of age had excellent or very good health (84%). However, 10% of children had no health insurance coverage, and 5% of children had no usual place of health care. Twelve percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 7% of children had ADHD.