American Health: Demographics and Spending of Health Care Consumers - 3rd edition

AMERICAN HEALTH I II AMERICAN HEALTH 3 rd EDITION New Strategist Publications, Inc. Ithaca, New York AMERICAN ...

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AMERICAN HEALTH

I

II AMERICAN HEALTH

3

rd

EDITION

New Strategist Publications, Inc. Ithaca, New York

AMERICAN HEALTH

III

New Strategist Publications, Inc. P.O. Box 242, Ithaca, New York 14851 800/848-0842; 607/273-0913 www.newstrategist.com

Copyright 2010. NEW STRATEGIST PUBLICATIONS, INC.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microﬁlming, recording, or otherwise without written permission from the Publisher.

ISBN 978-1-935114-81-9 (hardcover) ISBN 978-1-935114-82-6 (paper) Printed in the United States of America

IV AMERICAN HEALTH

Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 1. Addictions Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Men Are More Likely than Women to Smoke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Health Professionals Are Advising Smokers to Quit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 By 11th Grade, Most Teens Have Smoked a Cigarette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Drinking Varies by Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Most High School Students Have Tried Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Marijuana Is the Most Commonly Used Illicit Drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Thirty-Eight Percent of High School Students Have Smoked Pot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Teen Drug Use Fell in the Past Decade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Most Addicts Do Not Get the Treatment They Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Chapter 2. Aging Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 With Age, Health Problems Grow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Most Older Americans Can Care for Themselves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 Fewer People Are in Nursing Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Chapter 3. Alternative Medicine Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Millions Turn to Alternative Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Alternative Therapies Are Most Commonly Used for Back Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 We Spend Billions on Alternative Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

Chapter 4. Attitudes toward Health Care Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 Fewer Americans Have Conﬁdence in the Medical Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Most People Say Their Health Is Very Good or Excellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 Inability to Pay for Health Care Is a Problem for Many . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Many Patients Want More Time with Health Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Most Patients Say Providers Always Explain, Listen, and Show Respect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85 Fewer than Half Give Their Health Care Provider the Highest Rating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92

Chapter 5. Births Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95 Only 65 Percent of Pregnancies Result in Live Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 Americans Support Abortion Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 More Women Are Childless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 The Birth Rate Has Risen Since 2000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 Nearly 4 Million Women Gave Birth in 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 More than One-Third of Newborns Are Hispanic or Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Many Births Are to Unmarried Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Forty Percent of Births Are First Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 Older Mothers Are More Likely to Have Caesareans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Hispanics Have Higher Fertility Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 Breastfeeding Is Increasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122

AMERICAN HEALTH

V

Chapter 6. Coverage and Cost Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125 Health Care Costs Have Grown Rapidly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Fewer Are Covered by Employment-Based Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 Hispanics Are Most Likely to Be Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Cost Is the Primary Reason for Being Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139 Most Children Are Insured through a Family Member’s Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143 Most Low-Income Workers Do Not Have Access to Employer-Provided Health Insurance . . . . . . . . . . . . . . . . . .147 Health Care Spending Rises with Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Sixteen Percent of Health Care Costs Are Paid for Out-of-Pocket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162 Insurance Covers Most of the Cost of Physician Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 Insurance Payments Cover Nearly All Hospital Inpatient Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166 Older Adults Are Most Likely to Buy Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Eyeglasses and Contact Lenses Are Not Covered by Much Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Nearly Half the Cost of Dental Visits Is Paid for Out-of-Pocket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175 Few Americans Visit Chiropractors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178 Medicaid Rolls Are Growing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182

Chapter 7. Deaths Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185 Hospice Care Is Expanding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186 Leading Causes of Death Differ by Sex, Race, and Hispanic Origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 Heart Disease Is the Leading Killer of the Oldest Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 Accidents Are the Primary Cause of Death among Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196 Accidental Deaths Become Less Common with Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199 The Oldest Adults Die from a Wide Variety of Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202 Americans Are Living Longer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

Chapter 8. Disability Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209 Most Older Americans Have a Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210 Many Have Difﬁculties in Physical Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214 Nearly 11 Million Need Personal Assistance to Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220 Many Children Have a Learning Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222 Chronic Health Conditions Often Limit Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225

Chapter 9. Diseases and Conditions Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229 Serious Diseases Are More Common among the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230 Biological Differences between Men and Women Are behind Disease Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . .234 Prevalence of Many Diseases Is Highest among Non-Hispanic Whites and Blacks . . . . . . . . . . . . . . . . . . . . . . . .238 Low Incomes Are Related to Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242 Higher Education Is Linked to Better Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .246 Hypertension Rate Has Risen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250 Prevalence of High Cholesterol Is Declining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 Diabetes Is Increasingly Common . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256 Many Americans Report Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259 Most Have Been Tested for Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264 AIDS Hits Minorities Hard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269 Flu Shots Have Become Increasingly Popular . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272 Children’s Health Problems Vary by Age, Sex, and Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .274 Prescription Drug Use Is Increasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .278 Some Health Conditions Are More Costly than Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281

Chapter 10. Health Care Visits Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .287 Physician Visits Have Declined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288 Women Are More Likely than Men to Visit Health Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294 Teenagers Are Least Likely to Visit a Doctor Frequently . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299 VI AMERICAN HEALTH

Women Seek Health Care More Often than Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304 Preventive Care Visits Are Most Common among the Young . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307 Most Doctor Visits include a Blood Pressure Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 Most Doctor Visits Last Less than 15 Minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316 Most Patients Prefer to See a Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319 Drugs Are Prescribed at Most Doctor Visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .321 Most People See a Dentist Regularly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .327

Chapter 11. Hospital Care Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .333 Blacks Are Most Likely to Use Hospital Outpatient Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .334 Acute Health Problems Are the Most Common Reason for Visiting Hospital Outpatient Departments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .337 Emergency Room Visits Rise Sharply in the Oldest Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .343 Emergency Room Visits by Older Adults Are Most Likely to Be Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . .346 Older Adults Are Far More Likely to Need Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .352 The Oldest Account for the Largest Share of Hospitalizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355 Heart Disease Is Most Likely to Lead to Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .360 Hospitals Provide a Wide Variety of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .365

Chapter 12. Mental Health Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373 More than One in Four Adults Has a Diagnosable Mental Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .374 Women Are More Likely to Experience Mental Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .379 Income Is Strongly Linked to Mental Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .383 Many Teenagers Struggle with Mental Health Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .386

Chapter 13. Sexual Attitudes and Behavior Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .389 Americans Have Increasingly Liberal Attitudes toward Sexual Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .390 Most Teenagers Think Anything Goes between Consenting Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .394 Most Teenagers Have Sex before Reaching Age 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .397 Younger Teens Are Less Likely to Use Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .400 Nearly Everyone Has Had Sex by Age 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .403 Most Women Use Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408

Chapter 14. Weight and Exercise Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .413 Shifts in Eating Habits Reﬂect Fads and Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .414 Decades of Overeating Tip the Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .418 Most Americans Are Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .421 Americans Are in Denial about Their Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .424 Many Children Are Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .426 Most Want to Lose Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .429 Americans Do Not Exercise Enough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .431 Most High School Students Play Sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .434 Participation in Some Sports Is Declining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .436

Glossary

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .440

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .448 Index

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .452

AMERICAN HEALTH

VII

List of Tables Chapter 1. Addictions 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27

Cigarette Smoking Status of People Aged 18 or Older by Selected Characteristics, 2008 . . . . . . . . . . . . .5 Percent Distribution of People Aged 18 or Older by Cigarette Smoking Status, 2008 . . . . . . . . . . . . . . . .6 Current Smokers by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Cigarette Smoking by People Aged 12 or Older, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Advised to Quit Smoking during Routine Health Check-Up, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Cigarette Use among 12-to-17-year-Olds, 1999–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Tobacco Use among 9th to 12th Graders, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Attitudes of 8th, 10th, and 12th Graders toward Cigarette Smoking, 1999 and 2009 . . . . . . . . . . . . . . .13 Alcohol Drinking Status of People Aged 18 or Older by Selected Characteristics, 2008 . . . . . . . . . . . .15 Percent Distribution of People Aged 18 or Older by Alcohol Drinking Status, 2008 . . . . . . . . . . . . . . . .16 Alcohol Use by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Alcohol Use by People Aged 12 or Older, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Binge Drinking and Heavy Alcohol Use by People Aged 12 or Older, 2008 . . . . . . . . . . . . . . . . . . . . . .19 Alcohol Consumption among 12-to-17-Year-Olds, 1999–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Alcohol Use by 9th to 12th Graders, 2007. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Attitudes of 8th, 10th, and 12th Graders toward Drinking, 1999 and 2009 . . . . . . . . . . . . . . . . . . . . . . . .22 Illicit Drug Use by People Aged 12 or Older, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Lifetime Illicit Drug Use by Type of Drug and Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Past Year Illicit Drug Use by Type of Drug and Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Past Month Illicit Drug Use by Type of Drug and Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Lifetime Marijuana Use by People Aged 12 to 25, 1965 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Marijuana Use by People Aged 12 or Older, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Marijuana Use among 12-to-17-Year-Olds, 1999–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Marijuana Use by 9th to 12th Graders, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Drug Use by 8th, 10th, and 12th Graders, 1999 and 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Attitudes of 12th Graders toward Drug Use, 1999 and 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Treatment for Drug or Alcohol Problems in Past Year, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Chapter 2. Aging 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10

Healthy Behavior of Adults Aged 55 or Older by Age, 2004–07. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Difﬁculties in Physical and Social Functioning among Adults Aged 55 or Older by Age, 2004–07. . . . .39 Health Care Access among Adults Aged 55 or Older by Age, 2004–07 . . . . . . . . . . . . . . . . . . . . . . . . . .40 Difﬁculty Performing Activities of Daily Living among Medicare Beneﬁciaries, 2006 . . . . . . . . . . . . . .42 People Aged 65 or Older Who Need Help Performing Activities of Daily Living, 2008 . . . . . . . . . . . . .42 Difﬁculty Performing Instrumental Activities of Daily Living among Medicare Beneﬁciaries, 2006 . . .43 Incontinence among Medicare Beneﬁciaries, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Number of Nursing Home Residents and Rate of Nursing Home Care, 1977 to 2004 . . . . . . . . . . . . . . .46 Nursing Home Residents Aged 65 or Older by Sex, Race, and Hispanic Origin, 2004 . . . . . . . . . . . . . .47 Nursing Home Residents by Marital Status and Prior Living Arrangement, 2004 . . . . . . . . . . . . . . . . . .48

Chapter 3. Alternative Medicine 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16

Users of Alternative and Complementary Medicine by Type and Age, 2007 . . . . . . . . . . . . . . . . . . . . . .51 Users of Alternative and Complementary Medicine by Age, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Users of Alternative and Complementary Medicine by Sex, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Users of Alternative and Complementary Medicine by Race and Hispanic Origin, 2007 . . . . . . . . . . . .53 Users of Alternative and Complementary Medicine by Region, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Users of Alternative and Complementary Medicine by Education, 2007 . . . . . . . . . . . . . . . . . . . . . . . . .54 Users of Alternative and Complementary Medicine by Health Insurance Status, 2007 . . . . . . . . . . . . . .54 Users of Alternative and Complementary Medicine by Drinking Status, 2007 . . . . . . . . . . . . . . . . . . . .55 Users of Alternative and Complementary Medicine by Smoking Status, 2007 . . . . . . . . . . . . . . . . . . . .55 Users of Alternative and Complementary Medicine by Number of Doctor Visits, 2007 . . . . . . . . . . . . .56 Users of Alternative and Complementary Medicine by Number of Health Conditions, 2007 . . . . . . . . .56 Characteristics of Children Who Use Complementary and Alternative Medicine, 2007. . . . . . . . . . . . . .57 Alternative Medicine Use among Adults by Disease or Condition, 2007 . . . . . . . . . . . . . . . . . . . . . . . . .59 Alternative Medicine Use among Children by Disease or Condition, 2007 . . . . . . . . . . . . . . . . . . . . . . .59 Adult Use of Nonvitamin, Nonmineral Natural Products by Type, 2007 . . . . . . . . . . . . . . . . . . . . . . . . .60 Children’s Use of Nonvitamin, Nonmineral Natural Products by Type, 2007. . . . . . . . . . . . . . . . . . . . . .60

VIII AMERICAN HEALTH

3.17 3.18 3.19

Total Visits and Out-of-Pocket Costs for Visits to Alternative and Complementary Medicine Practitioners by Type, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 Per-Person Visits and Out-of-Pocket Costs of Visits to Alternative and Complementary Medicine Practitioners by Type, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Cost of Alternative and Complementary Medicine Materials and Therapy, 2007 . . . . . . . . . . . . . . . . . . .64

Chapter 4. Attitudes toward Health Care 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25

Conﬁdence in Medicine, 1978 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Spending on Improving the Nation’s Health, 1978 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 Government Should Help Pay for Medical Care, 1988 and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Health Status by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71 Health Status of Children by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 Health Status, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Days of Poor Physical Health in Past Month, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Frequent Poor Physical Health in Past Month, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Days of Activity Limitation in Past Month, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Frequent Activity Limitation Days in Past Month, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 People with Problems Receiving Medical Care by Reason, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 People with Problems Receiving Prescriptions by Reason, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 People with Problems Receiving Dental Care by Reason, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Attitude toward Scheduling Routine Health Care Appointments among Adults, 2007 . . . . . . . . . . . . . .81 Attitude toward Scheduling Routine Health Care Appointments for Children, 2007 . . . . . . . . . . . . . . . .82 Health Care Provider Spent Enough Time with Adult Patient, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Health Care Provider Spent Enough Time with Children and Their Parents, 2007 . . . . . . . . . . . . . . . . .84 Health Care Provider Explained Things Clearly to Adult Patient, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . .86 Health Care Provider Explained Things Clearly to Parents of Patients under Age 18, 2007 . . . . . . . . . .87 Health Care Provider Listened Carefully to Adult Patient, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 Health Care Provider Listened Carefully to Parents of Patients under Age 18, 2007 . . . . . . . . . . . . . . . .89 Health Care Provider Showed Respect for What Adult Patient Had to Say, 2007 . . . . . . . . . . . . . . . . . .90 Health Care Provider Showed Respect for What Parents of Patients under Age 18 Had to Say, 2007 . . .91 Adult Patients’ Rating of Health Care Received from Doctor’s Ofﬁce or Clinic, 2007 . . . . . . . . . . . . . .93 Parents’ Rating of Health Care Received by Children at Doctor’s Ofﬁce or Clinic, 2007 . . . . . . . . . . . .94

Chapter 5. Births 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22

Pregnancy Outcomes by Age, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 Pregnancy Outcomes by Race and Hispanic Origin, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 Abortions by Selected Characteristics, 1995 to 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99 Support for Legal Abortion by Reason, 1972 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100 Childless Women by Age, 1990 to 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102 Number of Children Ever Born to Women Aged 40 to 44, 1976 to 2006 . . . . . . . . . . . . . . . . . . . . . . . .102 Number of Children Ever Born to Women by Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 Birth Rates by Age, 1990 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Average Age of Women When Giving Birth by Race and Hispanic Origin, 1990 and 2006 . . . . . . . . . .105 Characteristics of Women Aged 15 to 44 Giving Birth in the Past Year, 2006 . . . . . . . . . . . . . . . . . . . .107 Births by Age, Race, and Hispanic Origin, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 Births to Hispanics by Age and Hispanic Origin, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Births to Unmarried Women by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Births to Unmarried Women by Race and Hispanic Origin, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Women Who Have Ever Had a Nonmarital Birth, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 Births by Age of Mother and Birth Order, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 Births by Race, Hispanic Origin, and Birth Order, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116 Births by Age and Method of Delivery, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118 Births by Age and Plurality, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 Births by Selected Characteristics, Race, and Hispanic Origin, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . .121 Births to Hispanics by Selected Characteristics and Hispanic Origin, 2006 . . . . . . . . . . . . . . . . . . . . . .121 Breastfeeding Trends, 2000 to 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123

Chapter 6. Coverage and Cost 6.1 6.2 6.3

National Health Care Expenditures, 1960 to 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 National Health Care Expenditures by Type of Expenditure, 1960 and 2007 . . . . . . . . . . . . . . . . . . . .127 Personal Health Care Expenditures, 1960 to 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128 AMERICAN HEALTH

IX

6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 6.34 6.35 6.36 6.37 6.38 6.39 6.40 6.41 6.42

Out-of-Pocket Payments for Personal Health Care Expenditures, 1960 to 2007 . . . . . . . . . . . . . . . . . .128 Consumer Price Index for Health Care by Type of Product or Service, 2008 . . . . . . . . . . . . . . . . . . . .129 Health Care Spending by Country, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 Health Insurance Coverage by Type, 1990 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 Employment-Based Private Health Insurance by Age, 2000 and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . .133 People without Health Insurance by Age, 2000 and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 Health Insurance Coverage by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136 Health Insurance Coverage by Sex, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Health Insurance Coverage by Race and Hispanic Origin, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 Number Who Lack Health Insurance Coverage by Selected Characteristics and Reason, 2008 . . . . . .140 Percent Who Lack Health Insurance Coverage by Reason, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Percent Who Lack Health Insurance Coverage by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . .142 Children by Health Insurance Coverage Status, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144 Percent Distribution of Children by Health Insurance Coverage Status, 2008 . . . . . . . . . . . . . . . . . . . .145 Children without Health Insurance, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146 Health Care Beneﬁts 2009: Medical Beneﬁts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148 Health Care Beneﬁts 2009: Outpatient Prescription Drug Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . .149 Health Care Beneﬁts 2009: Dental Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150 Health Care Beneﬁts 2009: Vision Beneﬁts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Employee Contributions for Employer-Provided Health Care Coverage, 2009 . . . . . . . . . . . . . . . . . . .152 Out-of-Pocket Spending on Health Care, 2008: Average Household Spending by Age of Householder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154 Out-of-Pocket Spending on Health Care, 2008: Indexed Household Spending by Age of Householder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156 Out-of-Pocket Spending on Health Care, 2008: Total Spending by Age of Householder . . . . . . . . . . .158 Out-of-Pocket Spending on Health Care, 2008: Market Shares by Age of Householder . . . . . . . . . . . .160 Total Spending on All Health Services by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . .163 Spending on Physician Visits by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 Spending on Hospital Inpatient Services by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . .167 Spending on Hospital Outpatient Services by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . .168 Spending on Emergency Room Services by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . .169 Spending on Prescription Drugs by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 Spending on Optometrist Ofﬁce Visits by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . .173 Spending on Vision Aids by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174 Spending on Visits to General Dentists by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . .176 Spending on Orthodontic Ofﬁce Visits by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . .177 Spending on Visits to Nurses or Nurse Practitioners by Selected Characteristics, 2007 . . . . . . . . . . . .179 Spending on Chiropractic Ofﬁce Visits by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . .180 Spending on Home Health Care Services by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . .181 Medicaid Coverage by Selected Characteristics, 2000 and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183 Medicare Enrollees by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184

Chapter 7. Deaths 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18

Home Health and Hospice Care Agencies, Patients, and Discharges, 2000 and 2007. . . . . . . . . . . . . . .187 Leading Causes of Death, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189 Leading Causes of Death among Females, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190 Leading Causes of Death among Males, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190 Leading Causes of Death among Asians, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191 Leading Causes of Death among Blacks, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191 Leading Causes of Death among Hispanics, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192 Leading Causes of Death among Non-Hispanic Whites, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192 Number of Deaths from the 15 Leading Causes of Death, 2006: Number of Deaths . . . . . . . . . . . . . . .194 Number of Deaths from the 15 Leading Causes of Death, 2006: Distribution by Age . . . . . . . . . . . . . .194 Number of Deaths from the 15 Leading Causes of Death, 2006: Distribution by Cause . . . . . . . . . . . .195 Leading Causes of Death for Infants, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197 Leading Causes of Death for Children Aged 1 to 4, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197 Leading Causes of Death for Children Aged 5 to 14, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 Leading Causes of Death for People Aged 15 to 24, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 Leading Causes of Death for People Aged 25 to 34, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200 Leading Causes of Death for People Aged 35 to 44, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200 Leading Causes of Death for People Aged 45 to 54, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201

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7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26

Leading Causes of Death for People Aged 55 to 64, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201 Leading Causes of Death for People Aged 65 or Older, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203 Leading Causes of Death for People Aged 65 to 74, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203 Leading Causes of Death for People Aged 75 to 84, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 Leading Causes of Death for People Aged 85 or Older, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 Life Expectancy by Age, 1950 to 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206 Life Expectancy by Age and Sex, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207 Life Expectancy by Sex, Age, and Race, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .208

Chapter 8. Disability 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12

Disability Status of People Aged 15 or Older, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211 Disability Status of Children under Age 15, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213 Difﬁculties in Physical Functioning among Adults by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 Difﬁculties in Physical Functioning among Adults by Sex, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216 Difﬁculties in Physical Functioning among Adults by Race and Hispanic Origin, 2008 . . . . . . . . . . . .217 Difﬁculties in Physical Functioning among Adults by Household Income, 2008 . . . . . . . . . . . . . . . . .218 Difﬁculties in Physical Functioning among Adults by Educational Attainment, 2008 . . . . . . . . . . . . . .219 Need for Assistance, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221 Children with a Learning Disability or Attention Deﬁcit Hyperactivity Disorder, 2008 . . . . . . . . . . . . .223 Children Receiving Special Education or Early Intervention Services by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224 Limitations in Usual Activities due to Health Problems by Selected Characteristics, 2008 . . . . . . . . . .226 Limitations in Work Activity due to Health Problems by Selected Characteristics, 2008. . . . . . . . . . . .227

Chapter 9. Diseases and Conditions 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 9.34 9.35 9.36

Number of Health Conditions among Adults by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .231 Percent Distribution of Health Conditions among Adults by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . .232 Percent of Adults with Health Conditions by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233 Number of Health Conditions among Adults by Sex, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235 Percent Distribution of Health Conditions among Adults by Sex, 2008 . . . . . . . . . . . . . . . . . . . . . . . . .236 Percent of Adults with Health Conditions by Sex, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237 Number of Health Conditions among Adults by Race and Hispanic Origin, 2008 . . . . . . . . . . . . . . . . .239 Percent Distribution of Health Conditions among Adults by Race and Hispanic Origin, 2008 . . . . . . .240 Percent of Adults with Health Conditions by Race and Hispanic Origin, 2008 . . . . . . . . . . . . . . . . . . .241 Number of Health Conditions among Adults by Household Income, 2008 . . . . . . . . . . . . . . . . . . . . . .243 Percent Distribution of Health Conditions among Adults by Household Income, 2008 . . . . . . . . . . . .244 Percent of Adults with Health Conditions by Household Income, 2008 . . . . . . . . . . . . . . . . . . . . . . . . .245 Number of Health Conditions among Adults by Education, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247 Percent Distribution of Health Conditions among Adults by Education, 2008 . . . . . . . . . . . . . . . . . . . .248 Percent of Adults with Health Conditions by Education, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249 Hypertension by Sex and Age, 1988–94 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251 Hypertension by Race, Hispanic Origin, and Sex, 1988–94 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . .251 People with High Blood Pressure by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . .252 High Cholesterol by Sex and Age, 1988–94 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254 High Cholesterol by Race, Hispanic Origin, and Sex, 1988–94 and 2003–06 . . . . . . . . . . . . . . . . . . . .254 Cholesterol Status by Selected Characteristics, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255 Diabetes by Selected Characteristics, 1988–94 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257 People with Diabetes by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258 People with Asthma by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260 People with Arthritis by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261 People with Heart Disease by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262 Cancer Survival Rates, 1975–77 and 1999–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .263 People Aged 50 or Older Who Have Ever Had a Colonoscopy by Selected Characteristics, 2008. . . . .265 Men Who Have Had Prostate Cancer Screening by Selected Characteristics, 2008 . . . . . . . . . . . . . . . .266 Women Who Have Had a Pap Test by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . .267 Women Who Have Had a Mammogram by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . .268 Cumulative AIDS Cases by Age, Sex, Race, and Hispanic Origin, through 2007 . . . . . . . . . . . . . . . . .270 Cumulative AIDS Cases by Sex and Transmission Category, through 2007 . . . . . . . . . . . . . . . . . . . . .271 Inﬂuenza Vaccination among Adults by Age, 1989 to 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273 Health Conditions among Children by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . .275 Distribution of Health Conditions by Selected Characteristics of Children, 2008 . . . . . . . . . . . . . . . . .276 AMERICAN HEALTH

XI

9.37 9.38 9.39 9.40 9.41 9.42 9.43 9.44

Percent of Children with Health Conditions by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . .277 Prescription Drug Use by Sex and Age, 1988–94 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279 Prescription Drug Use by Race, Hispanic Origin, and Age, 1988–94 and 2003–06 . . . . . . . . . . . . . . . .280 Number of Health Events by Condition and Type of Service, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . .282 Number of People Experiencing Health Events by Condition and Type of Service, 2007 . . . . . . . . . . .283 Cost of Health Events by Condition and Type of Service, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .284 Average Expense Per Health Event, by Condition and Type of Service, 2007 . . . . . . . . . . . . . . . . . . . .285 Average Expense Per Person Experiencing Health Event, by Condition and Type of Service, 2007 . . .286

Chapter 10. Health Care Visits 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 10.34 10.35

Health Care Visits, 1996 to 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289 Delayed Medical Care, 1997 and 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290 Did Not Get Prescriptions, 1997 and 2007. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291 Health Care Visits by Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292 Health Care Visits by Race and Hispanic Origin, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292 Health Care Visits by Sex, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293 Number of Ofﬁce Visits to Health Care Professionals by Selected Characteristics, 2008 . . . . . . . . . . .295 Percent Distribution of Ofﬁce Visits to Health Care Professionals by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .296 Length of Time since Last Ofﬁce Visit to a Health Care Professional by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297 Percent Distribution by Length of Time since Last Ofﬁce Visit to a Health Care Professional, 2008 . .298 Problems with Health Care Access for Children by Selected Characteristics, 2008 . . . . . . . . . . . . . . . .300 Percent of Children with Problems Accessing Health Care, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301 Length of Time since Child’s Last Ofﬁce Visit to a Health Care Professional by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302 Percent Distribution of Children by Length of Time Since Child’s Last Ofﬁce Visit to a Health Care Professional, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303 Physician Ofﬁce Visits by Sex and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305 Physician Ofﬁce Visits by Race, Hispanic Origin, and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306 Physician Ofﬁce Visits for Preventive Care, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .308 Physician Ofﬁce Visits by Major Reason for Visit, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309 Physician Ofﬁce Visits by Detailed Reason for Visit, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310 Physician Ofﬁce Visits by Major Disease Category and Primary Diagnosis Group, 2006 . . . . . . . . . . .311 Physician Ofﬁce Visits by Services Provided, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313 Blood Pressure Measurements by Selected Characteristics, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .314 Physician Ofﬁce Visits by Education Services and Nonmedication Treatments Ordered or Provided, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315 Physician Ofﬁce Visits by Time Spent with Physician, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .317 Physician Ofﬁce Visits by Continuity of Care, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .318 Physician Ofﬁce Visits by Providers Seen, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .320 Physician Ofﬁce Visits by Drug Therapy and Physician Specialty, 2006 . . . . . . . . . . . . . . . . . . . . . . . .322 Number of Unique Prescriptions and Reﬁlls Purchased by Selected Characteristics, 2006 . . . . . . . . . .323 Medications Most Frequently Prescribed during Physician Ofﬁce Visits by Therapeutic Class, 2006 . .324 Twenty-Five Drug Brands on Which Households Spend the Most, 2007 . . . . . . . . . . . . . . . . . . . . . . . .325 Ten Drug Brands Prescribed the Most by Number of Purchases, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . .326 Length of Time since Last Dental Visit by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . .328 Percent Distribution by Length of Time since Last Dental Visit by Selected Characteristics, 2008 . . .329 Dental Care Access and Length of Time since Last Dental Visit among Children, 2008 . . . . . . . . . . . .330 Percent Distribution of Children by Dental Care Access and Length of Time since Last Dental Visit, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .331

Chapter 11. Hospital Care 11.1 11.2 11.3 11.4 11.5 11.6 11.7

Hospital Outpatient Department Visits by Sex and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .335 Hospital Outpatient Department Visits by Race, Hispanic Origin, and Age, 2006 . . . . . . . . . . . . . . . . .336 Hospital Outpatient Department Visits by Major Reason for Visit, 2006 . . . . . . . . . . . . . . . . . . . . . . . .338 Visits to Hospital Outpatient Departments by Detailed Reason for Visit, 2006 . . . . . . . . . . . . . . . . . . .339 Hospital Outpatient Department Visits by Primary Diagnosis, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . .340 Hospital Outpatient Department Visits by Provider Seen, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .340 Hospital Outpatient Department Visits by Services Ordered or Provided, 2006 . . . . . . . . . . . . . . . . . .341

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11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24

Hospital Outpatient Department Visits by Therapeutic Services Ordered or Provided, 2006 . . . . . . . .342 Hospital Emergency Department Visits by Sex and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .344 Hospital Emergency Department Visits by Race and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .345 Emergency Department Visits by Selected Characteristics and Urgency of Problem, 2006 . . . . . . . . .347 Hospital Emergency Department Visits by Reason for Visit, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . .348 Hospital Emergency Department Visits by Primary Diagnosis, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . .349 Hospital Emergency Department Visits by Provider Seen, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .350 Visits to Hospital Emergency Departments by Diagnostic and Screening Services Ordered or Provided, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .351 Overnight Hospital Stays by Selected Characteristics, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .353 Hospital Discharges and Length of Stay, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .354 Number of Hospital Discharges by Diagnosis and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .356 Percent Distribution of Hospital Discharges by Diagnosis and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . .358 Number and Rate of Discharges from Hospitals by Diagnosis, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . .361 Length of Hospital Stay by Diagnosis, 1980 and 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .363 Number of Hospital Discharges by Procedure and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366 Percent Distribution of Hospital Discharges by Procedure and Age, 2006 . . . . . . . . . . . . . . . . . . . . . . .368 Discharges from Hospitals by Procedure, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .370

Chapter 12. Mental Health 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12

Prevalence of Mental Disorders, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375 Mental Health Status in Past Month, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .376 Frequent Mental Stress in Past Month, 1995 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .376 Americans with a History of Depression by Selected Characteristics, 2009 . . . . . . . . . . . . . . . . . . . . . .377 Americans Who Have Looked Online for Mental Health Information, by Selected Characteristics, 2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .378 Mental Health Conditions among Adults by Age, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .380 Mental Health Conditions among Adults by Sex, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .381 Mental Health Conditions among Adults by Race and Hispanic Origin, 2008 . . . . . . . . . . . . . . . . . . . .382 Mental Health Conditions among Adults by Household Income, 2008 . . . . . . . . . . . . . . . . . . . . . . . . .384 Mental Health Conditions among Adults by Education, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .385 High School Students Who Felt Sad or Hopeless, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .387 Suicidal Ideation among High School Students, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .388

Chapter 13. Sexual Attitudes and Behavior 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22

Sex Education in Public Schools, 1974 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .391 Premarital Sex, 1972 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .392 Homosexual Relations, 1973 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .393 Attitude of Teenagers toward Sexual Activity, Childbearing, and Cohabitation, 2002 . . . . . . . . . . . . . .395 Attitude of Boys Aged 15 to 19 toward Pregnancy, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .396 Attitude of Girls Aged 15 to 19 toward Pregnancy, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .396 Sexual Intercourse Experience of Boys Aged 15 to 19, 1988 and 2002 . . . . . . . . . . . . . . . . . . . . . . . . .398 Sexual Intercourse Experience of Girls Aged 15 to 19, 1988 and 2002 . . . . . . . . . . . . . . . . . . . . . . . . .398 Sexual Behavior of 9th to 12th Graders by Sex, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399 Contraceptive Use among People Aged 15 to 19, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .401 Reason People Aged 15 to 19 Have Never Had Sexual Intercourse, 2002 . . . . . . . . . . . . . . . . . . . . . . .402 Men Ever Having Had Sexual Intercourse by Age and Marital Status, 2002 . . . . . . . . . . . . . . . . . . . . .404 Women Ever Having Had Sexual Intercourse by Age and Marital Status, 2002 . . . . . . . . . . . . . . . . . .404 People Aged 18 or Older by Number of Sex Partners in Past Year, 1988 to 2008 . . . . . . . . . . . . . . . . .405 Relationship between Men Aged 15 to 44 and Last Sexual Partner, 2002 . . . . . . . . . . . . . . . . . . . . . . .406 Relationship between Women Aged 15 to 44 and First Male Sexual Partner, 2002 . . . . . . . . . . . . . . . .407 Current Contraceptive Use Status of Women, 1982 and 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .409 Current Method of Contraception among Women by Age, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .410 Current Method of Contraception among Women by Marital Status, 2002 . . . . . . . . . . . . . . . . . . . . . .410 Current Method of Contraception among Women by Race and Hispanic Origin, 2002 . . . . . . . . . . . . .411 Current Method of Contraception among Women by Education, 2002 . . . . . . . . . . . . . . . . . . . . . . . . .411 Use of Family Planning Services by Selected Characteristics, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . .412

Chapter 14. Weight and Exercise 14.1 14.2

Food and Beverage Consumption, 2000 and 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .415 Average Measured Weight by Sex and Age, 1976–80 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . .419 AMERICAN HEALTH

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14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17

Average Measured Weight by Race, Hispanic Origin, Age, and Sex, 2003–06. . . . . . . . . . . . . . . . . . . .420 Caloric Intake by Sex and Age, 1976–80 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .420 Adults Measured as Having a Healthy Weight by Sex and Age, 1976–80 and 2003–06. . . . . . . . . . . . .422 Adults Measured as Overweight by Sex and Age, 1976–80 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . .422 Adults Measured as Obese by Sex and Age, 1976–80 and 2003–06 . . . . . . . . . . . . . . . . . . . . . . . . . . . .423 Self-Reported Weight Status of People Aged 18 or Older by Selected Characteristics, 2008 . . . . . . . .425 Children Measured as Overweight by Sex, Race, Hispanic Origin, and Age, 2003–06 . . . . . . . . . . . . .427 Weight Problems and Dieting Behavior of 9th to 12th Graders by Sex, 2007 . . . . . . . . . . . . . . . . . . . .428 People Who Want to Lose Weight, 1951 to 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430 Self-Reported and Ideal Weight by Sex, 1990 to 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430 Physical Activity Status of People Aged 18 or Older, 2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .432 Frequency of Vigorous Physical Activity among People Aged 18 or Older, 2008 . . . . . . . . . . . . . . . . .433 Participation of High School Students in Physical Education Classes, Team Sports, and Physical Activity, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .435 Sports Participation of People Aged 7 or Older, 1998 and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .437 Sports Participation of Children Aged 7 to 17, 1998 and 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .438

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List of Illustrations Chapter 1. Addictions Most teens have smoked cigarettes by age 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Health status determines smoking advice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Nearly half of 10th graders have tried a cigarette. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Regular drinking rises with education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Many teens drink heavily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Psychotherapeutics are the second most commonly used illicit drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Marijuana use is commonplace among teens and young adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Fewer 12th graders think regular marijuana use is risky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Hispanics are least likely to get help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Chapter 2. Aging Most people aged 65 or older received a ﬂu shot in the past year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Incontinence is a growing problem with age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 The number of nursing home residents peaked in 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Chapter 3. Alternative Medicine Educated people are most likely to turn to alternative medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Arthritis is one of the top ﬁve reasons why people turn to alternative therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Americans spent $34 billion on alternative medicine practitioners and products . . . . . . . . . . . . . . . . . . . . . . . . . . .61

Chapter 4. Attitudes toward Health Care Most think government should be responsible for health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 The middle aged report more days of poor physical health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 Older Americans are least likely to experience problems getting needed medical care . . . . . . . . . . . . . . . . . . . . . .76 Older people are most satisﬁed with the time their provider spends with them . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Younger adults are least likely to think health care providers listen carefully or show respect . . . . . . . . . . . . . . . .85 Medicare recipients are most satisﬁed with their health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92

Chapter 5. Births Non-Hispanic white women are least likely to end a pregnancy through abortion . . . . . . . . . . . . . . . . . . . . . . . . . .96 Nearly 90 percent support abortion if a woman’s health is in danger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Women are having fewer children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 The birth rate is higher today than in 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 Ten percent of women aged 25 to 29 gave birth in 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 Most babies are born to women in their twenties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Most births to women under age 25 are out-of-wedlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Most births are second or higher order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 More than 40 percent of births to women aged 40 or older are by Caesarean . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Asian mothers are least likely to have been born in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 Breastfeeding is more likely for babies born to married mothers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122

Chapter 6. Coverage and Cost Only 25 percent of prescription drug expenses are paid for out-of-pocket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 The ranks of the uninsured are growing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 Fewer than half of Hispanics have employment-based coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 More than half of the uninsured in the South say cost is the reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139 Only 7 percent of non-Hispanic white children are without health insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143 Fewer than half of workers in the bottom wage quartile have access to employer-provided health insurance . . . .147 Out-of-pocket health care spending exceeds $4,000 a year among householders aged 65 or older. . . . . . . . . . . . .153 Government insurance programs pay for nearly one-third of health care expenses . . . . . . . . . . . . . . . . . . . . . . . .162 People aged 18 to 44 are least likely to see a doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 The uninsured pay little out-of-pocket for hospital care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166

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Medicare covers one-quarter of the nation’s spending on prescription drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Seventy-one percent of the cost of glasses and contact lenses is paid for out-of-pocket . . . . . . . . . . . . . . . . . . . . .172 Children pay the least out-of-pocket for dental care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175 The elderly with Medicare and other public insurance are most likely to have had a home health care expense in 2007. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178 Women outnumber men among Medicare enrollees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182

Chapter 7. Deaths More than one million are in hospice care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186 Half of males and nearly half of females die of heart disease or cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 The majority of deaths occur among people aged 75 or older . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 Nearly half of deaths among 15-to-24-year-olds are due to accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196 Few deaths in the 55-to-64 age group are caused by accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199 Cancer accounts for only 12 percent of deaths to people aged 85 or older . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202 Life expectancy at birth reached 77.9 years in 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

Chapter 8. Disability Among people aged 65 or older, the disabled slightly outnumber those without a disability . . . . . . . . . . . . . . . . .210 Physical difﬁculties are less common among the educated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214 Most of those who need personal assistance get help from relatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220 Receipt of special education services varies by race and Hispanic origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222 Limitations are greater for those with less education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225

Chapter 9. Diseases and Conditions More than one-third of people aged 75 or older have heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230 Women are more likely than men to have arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234 Blacks and Hispanics are most likely to have diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238 People with lower incomes are more likely to have had a heart attack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242 Many health problems vary by educational attainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .246 Women are slightly more likely than men to have hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250 Older men and women have seen cholesterol levels decline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 Nearly one in ﬁve older Americans has diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256 Arthritis increases with age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259 Medical tests are popular . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264 Hispanics account for a small share of AIDS cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269 The percentage of people aged 65 or older who get a ﬂu shot has more than doubled . . . . . . . . . . . . . . . . . . . . . .272 Non-Hispanic white children are most likely to be taking prescription medication. . . . . . . . . . . . . . . . . . . . . . . . .274 Most Americans aged 65 or older take multiple prescription medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .278 Cancer is the most expensive health condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281

Chapter 10. Health Care Visits Physician visits have declined recently as people tighten their belts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288 Many men did not go to the doctor in 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294 Hispanic children are least likely to have health insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299 Older men and women visit doctors the most. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304 New health problems—such as colds, ﬂu, and injuries—account for the largest share of doctor visits . . . . . . . . .307 Only 7 percent of physician ofﬁce visits include a cholesterol test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 Few patients spend more than half an hour with the doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316 Nurses are seen on only 24 percent of doctor visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319 Cardiovascular physicians are most likely to prescribe drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .321 More than one in four children without health insurance has an unmet dental need . . . . . . . . . . . . . . . . . . . . . . . .327

Chapter 11. Hospital Care The black rate is more than double the white rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .334 Nearly half of children visiting hospital outpatient departments are there for acute health problems . . . . . . . . . . .337 Emergency room visit rates are lowest among 45-to-64-year-olds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .343 Many visits to emergency rooms are not for emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .346 Among older men and women, hospital stays are about the same length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .352

XVI AMERICAN HEALTH

People aged 45 or older account for most hospital discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355 Hospital stays have gotten shorter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .360 More than one-third of procedures are performed on people aged 65 or older . . . . . . . . . . . . . . . . . . . . . . . . . . . .365

Chapter 12. Mental Health Mental health is getting worse among the middle aged . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .374 Blacks are most likely to feel like everything is an effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .379 Many low-income people feel like everything is an effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .383 Hispanic girls are most likely to seriously consider suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .386

Chapter 13. Sexual Attitudes and Behavior Many people think premarital sex is OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .390 Teens’ tolerance of premarital sex has limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .394 Today’s teens are less likely than teens in 1988 to have had sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .397 Many teens have unprotected sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .400 Women no longer wait for marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .403 Educational attainment inﬂuences birth control choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408

Chapter 14. Weight and Exercise Carbonated beverages are more popular than any other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .414 The average woman weighs more than 160 pounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .418 Fewer women are at a healthy weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .421 Fantasy versus reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .424 Among teen boys, Hispanics are most likely to be overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .426 Women would have to lose 16 pounds to be at their ideal weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .429 The majority of college graduates participate in vigorous activity at least once a week . . . . . . . . . . . . . . . . . . . . .431 Boys are more likely than girls to play sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .434 Fewer children are playing basketball . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .436

AMERICAN HEALTH

XVII

ADDICTIONS

Introduction The consumers of health care drive one of the nation’s largest and most important industries. Understanding who those consumers are, what they want, and how their wants and needs are changing is vital to health insurance companies, hospitals, doctors, pharmaceutical companies, government policy makers, and every business that provides its employees with health insurance. Fortunately, there are enough statistics collected and published about health care consumers to answer almost any question. The problem is not whether numbers exist, but ﬁnding and making sense of them. The third edition of American Health: Demographics and Spending of Health Care Consumers brings together in one volume the many sources of data on health care consumers, providing a comprehensive look at the demand for health care. With more than 300 tables, American Health provides a comprehensive look at the demographics of health care consumers and the services they use, ranging from ﬁsh oil supplements to mammograms, from doctor visits to birth control pills. It includes detailed health care spending data from the federal government’s highly respected Consumer Expenditure Survey and the less wellknown Medical Expenditure Panel Survey. It presents the latest data on health care coverage and the reasons why people do not have health insurance. It has the latest information on the growing girth of the population, in pounds and percentages. It examines teen attitudes toward sex and teen and adult use of contraception. It explores the changing attitudes of Americans toward the role of the federal government in providing health care in the United States.

How to use this book American Health is divided into 14 chapters, each examining a different facet of health care. The topics are Addictions, Aging, Alternative Medicine, Attitudes toward Health Care, Births, Coverage and Cost, Deaths, Disability, Diseases and Conditions, Health Care Visits, Hospital Care, Mental Health, Sexual Attitudes and Behavior, and Weight and Exercise. Each chapter includes tables showing the demographics of health care consumers as well as explanatory text and charts revealing the most important trends. Most of the tables in American Health are based on data collected by the federal government, in particular the National Center for Health Statistics and the Census Bureau. The federal government continues to be the best source of up-to-date, reliable information on the changing characteristics of Americans. Despite the volume of data produced by the federal government, ﬁnding relevant health care information and compiling it in a meaningful way is time-consuming—and often frustrating—because the government publishes its health care information in a wide array of reports and on numerous web sites. The National Center for Health Statistics collates some of this information in the annual publication Health, United States. Because the purpose of Health, United States is to provide an overview of the health care industry, only a fraction of the volume focuses on health care consumers.

AMERICAN HEALTH

1

American Health goes further, giving readers a comprehensive look at health care from the individual perspective. To explore the attitudes of Americans toward health care, American Health presents data from the General Social Survey of the University of Chicago’s National Opinion Research Center, the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey, and the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Other attitudinal data included in the book are from the Pew Internet & American Life Project, Gallup, and the Monitoring the Future Survey of the University of Michigan’s Institute for Social Research. While the federal government collected most of the data in American Health, the majority of tables published here are not just reprints of the government’s tabulations. Instead, most were individually compiled and created by New Strategist to reveal the trends—the story behind the statistics. If you need more information, you can explore the data source cited at the bottom of each table. American Health includes a list of tables to help you locate the information you need. For a more detailed search, use the index at the back of the book. Also at the back of the book are a complete bibliography of data sources and a lengthy glossary deﬁning the terms used in the tables and text. With American Health in hand you will discover the change that lies ahead not just for the health care industry, but also for the nation. Because health care is one of the largest industries in the United States, the ever-changing demands of its customers will shape the future of every American alive today—and those yet to be born.

2 AMERICAN HEALTH

ADDICTIONS CHAPTER

1

Addictions ■ One in ﬁve Americans smokes cigarettes. Forty-six million adults currently smoke cigarettes, and an even larger 48 million have quit smoking.

■ Most high school seniors have tried cigarettes. More than one in four has smoked a cigarette in the past 30 days.

■ Half of adults are regular drinkers. The proportion is highest among college graduates and those with household incomes of $100,000 or more.

■ Forty-ﬁve percent of high school students have had a drink in the past month. Among high school seniors, more than one-third have participated in heavy drinking in the past 30 days—deﬁned as having ﬁve or more drinks on one occasion.

■ Marijuana is the most commonly used illicit drug. Nearly 17 percent of 12-to-17-year-olds and 50 percent of 18-to-25-year-olds have ever used marijuana.

■ Twenty-three million needed drug or alcohol treatment in the past year. Only 2 million received treatment at a facility specializing in drug and alcohol problems.

AMERICAN HEALTH

3

Men Are More Likely than Women to Smoke Most men and women have never smoked, however. The number of Americans who have quit smoking is greater than the number of current smokers, 48 million to 46 million, according to the National Center for Health Statistics. An even larger number of adults (129 million) have never smoked. A substantial 21 percent of people aged 18 or older are current smokers. The ﬁgure is 22.7 percent among men and 18.5 percent among women. There are differences in smoking rates based on a variety of demographic characteristics, including age, race and Hispanic origin, education, and household income. Perhaps not surprisingly, the share of people who currently smoke falls with age, from 23 percent of 18-to-44-year-olds to only 6 percent of those aged 75 or older. One reason for the decline is the health problems caused by smoking, which are more likely to appear at older ages. As smokers get older, many either are forced by health problems to quit or die from smoking-related illnesses. ■ Despite considerable effort to educate teenagers about the dangers of cigarettes, most still give them a try and many take up the habit.

Most teens have smoked cigarettes by age 18 (percent of people aged 12 to 18 who have ever smoked cigarettes, 2008)

60

53% 42%

40 40%

34% 26%

20 20%

17% 10% 5%

0

0%

aged a12

4 AMERICAN HEALTH

aged b 13

aged c 14

aged d 15

aged e 16

agedf 17

aged g 18

ADDICTIONS

Table 1.1

Cigarette Smoking Status of People Aged 18 or Older by Selected Characteristics, 2008

(number of people aged 18 or older by selected characteristics and cigarette smoking status, 2008; numbers in thousands) total

all current smokers

every-day smokers

some-day smokers

former smokers

nonsmokers

TOTAL PEOPLE Sex Men Women

225,227

45,954

36,647

9,308

48,072

128,694

108,755 116,472

24,819 21,136

19,210 17,436

5,609 3,699

26,279 21,793

56,285 72,409

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

110,615 77,335 19,869 17,409

25,328 17,224 2,428 975

19,557 14,314 1,965 811

5,771 2,911 462 165

13,655 19,363 7,966 7,089

70,713 39,734 9,203 9,043

Race and Hispanic origin Asian 10,501 Black 26,765 Hispanic 30,583 Non-Hispanic white 154,483

1,024 5,572 4,799 33,621

808 4,240 2,842 28,028

215 1,332 1,957 5,592

1,247 3,663 4,412 38,067

8,120 17,177 21,130 81,013

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

7,902 14,375 12,408 4,974

6,577 12,085 9,911 3,328

1,326 2,290 2,497 1,646

6,659 13,090 13,548 12,867

14,124 25,700 28,646 38,340

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

18,661 7,161 7,717 4,468 5,411

15,320 5,655 6,301 3,479 3,924

3,341 1,506 1,416 989 1,486

13,249 6,724 8,843 5,481 9,654

35,554 17,567 21,416 15,707 27,762

Note: “Current smokers” have smoked at least 100 cigarettes in lifetime and still smoke; “every-day smokers” are current smokers who smoke every day; “some-day smokers” are current smokers who smoke on some days; “former smokers” have smoked at least 100 cigarettes in lifetime but currently do not smoke; “nonsmokers” have smoked fewer than 100 cigarettes in lifetime. Numbers by smoking status may not add to total because “unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

5

Table 1.2

Percent Distribution of People Aged 18 or Older by Cigarette Smoking Status, 2008

(percent distribution of people aged 18 or older by cigarette smoking status and selected characteristics, 2008) total

all current smokers

every-day smokers

some-day smokers

former smokers

nonsmokers

TOTAL PEOPLE Sex Men Women

100.0%

20.6%

16.5%

4.2%

21.6%

57.8%

100.0 100.0

22.7 18.5

17.5 15.2

5.2 3.3

24.8 18.3

52.5 63.3

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

100.0 100.0 100.0 100.0

23.1 22.6 12.4 5.7

17.8 18.8 10.0 4.7

5.3 3.8 2.4 1.0

12.4 25.4 40.7 41.4

64.5 52.1 47.0 52.9

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

100.0 100.0 100.0 100.0

9.7 20.5 14.9 22.6

7.6 15.6 9.1 18.8

2.0 4.9 5.8 3.8

12.7 15.0 17.0 23.5

77.6 64.5 68.0 53.8

Education Less than high school High school graduate Some college College graduate

100.0 100.0 100.0 100.0

29.9 28.1 22.1 8.6

24.8 23.6 17.6 5.7

5.1 4.6 4.5 2.9

19.8 23.1 25.4 24.1

50.3 48.8 52.5 67.3

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

29.4 23.0 19.5 16.6 12.0

24.2 18.2 15.8 12.8 8.7

5.3 4.9 3.7 3.8 3.2

18.0 20.8 24.2 22.6 23.8

52.6 56.1 56.3 60.8 64.3

Note: “Current smokers” have smoked at least 100 cigarettes in lifetime and still smoke; “every-day smokers” are current smokers who smoke every day; “some-day smokers” are current smokers who smoke on some days; “former smokers” have smoked at least 100 cigarettes in lifetime but currently do not smoke; “nonsmokers” have smoked fewer than 100 cigarettes in lifetime. Numbers by smoking status may not add to total because “unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

6 AMERICAN HEALTH

ADDICTIONS

Table 1.3

Current Smokers by Selected Characteristics, 2008

(percent of people aged 18 or older who currently smoke, by selected characteristics, 2008) percent

TOTAL PEOPLE Sex Men Women

18.4% 20.3 16.7

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

22.3 23.7 20.0 21.0 16.8 8.2

Race and Hispanic origin Black Hispanic White Other

21.2 15.7 17.9 16.0

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

31.0 27.7 22.7 20.8 13.0

Education Not a high school graduate High school graduate Some college College graduate

30.1 24.9 20.0 8.8

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp; calculations by New Strategist

AMERICAN HEALTH

7

Table 1.4

Cigarette Smoking by People Aged 12 or Older, 2008

(percent of people aged 12 or older who reported any, past year, or past month use of cigarettes, 2008) ever smoked

Total people Aged 12 Aged 13 Aged 14 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 Aged 26 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 49 Aged 50 to 54 Aged 55 to 59 Aged 60 to 64 Aged 65 or older

65.1% 5.0 10.1 16.9 25.5 34.4 42.0 53.2 60.9 62.0 65.2 66.5 68.4 69.3 71.5 72.1 68.5 68.3 71.7 73.8 72.6 75.5 73.8 65.3

smoked in past year

28.0% 2.4 5.9 9.9 17.2 22.9 29.0 41.6 46.0 45.0 46.6 47.0 45.0 43.9 45.4 44.1 35.4 29.7 30.2 31.1 30.1 22.3 20.4 11.2

smoked in past month

23.9% 1.2 2.9 5.0 10.1 14.1 19.4 30.2 34.3 36.9 38.5 37.7 36.0 36.0 37.6 37.1 30.4 26.1 27.4 28.8 27.1 20.6 18.0 10.3

Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

8 AMERICAN HEALTH

ADDICTIONS

Health Professionals Are Advising Smokers to Quit Some smokers are more likely to receive this advice than others, however. Decades ago, it was not uncommon for physicians and other health care workers to smoke, and few advised their patients to give up the habit. Although some health professionals still do not address the issue, the majority of smokers who had a routine health checkup in the past year report that a physician or other health professional advised them to quit smoking. Not all smokers were advised to quit smoking. People aged 45 to 64 were more likely than older or younger adults to say they had been given this advice. Only 45 percent of Hispanics were advised to quit smoking compared with 61 percent of blacks. As would be expected, people who characterize their health status as only fair or poor were most likely to say they were advised to quit smoking. ■ Health care providers need to do more than admonish their patients to quit smoking. They need to provide guidance on how to quit smoking so that patients can adopt their advice.

Health status determines smoking advice

90

(percent of smokers aged 18 or older who had a routine health checkup in the past year and were advised to quit smoking, by self-assessed health status, 2007)

60

60%

30

30%

0

0%

51%

53%

excellent a

veryb good

66%

66%

fair d

poor e

58%

good c

AMERICAN HEALTH

9

Table 1.5

Advised to Quit Smoking during Routine Health Checkup, 2007

(number of current smokers aged 18 or older who had a routine health checkup in the previous year, and percent distribution by whether they were advised to quit smoking, 2007; numbers in thousands) total

Current smokers with health checkup in past 12 months

not told to quit

57.5%

24.2%

8,395 8,655 2,453

53.9 61.2 56.9

26.6 22.1 23.0

Sex Female Male

9,478 10,025

56.9 58.1

23.9 24.4

Race and Hispanic origin Black Hispanic White and other, non-Hispanic

2,725 1,292 14,511

61.0 45.8 57.5

20.9 27.9 24.6

Income status Poor Near poor Low income Middle income High income

3,273 893 2,598 6,264 6,475

59.4 51.0 49.3 57.8 60.5

24.5 33.9 26.2 20.9 25.0

Self-reported health status Excellent Very good Good Fair Poor

2,845 5,566 6,703 3,140 1,250

50.6 53.2 58.4 66.3 65.6

27.7 26.7 22.7 21.3 20.1

Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

19,503

told to quit

Note: “Poor” income status refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Percentages do not sum to 100 because “no response” is not shown. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

10 AMERICAN HEALTH

ADDICTIONS

By 11th Grade, Most Teens Have Smoked a Cigarette Most have at least puffed on a cigarette by 9th or 10th grade. During the teen years, experimentation is common, including trying cigarettes. By the time they reach their junior year, more than half of students have tried smoking. Most do not continue to smoke, but more than one-quarter of high school seniors are current smokers, a habit they may ﬁnd difﬁcult to kick. Most students in 8th, 10th, and 12th grades disapprove or strongly disapprove of people who smoke one or more packs of cigarettes a day. Disapproval of smoking is greater than it was a decade ago. Antismoking efforts seem to have had some effect. The share of teens who think smoking poses a great physical risk rises from 59 percent among 8th graders to 75 percent among high school seniors. ■ Attitudes toward smoking clearly inﬂuence smoking rates. To the degree that teens disapprove of smokers, this may discourage them from taking up the habit.

Nearly half of 10th graders have tried a cigarette

75

(percent of high school students who have ever tried a cigarette, by grade, 2007)

59% 50 50%

49%

53%

43%

25 25%

0

0%

9th a grade

10thb grade

11th c grade

12thd grade

AMERICAN HEALTH

11

Table 1.6

Cigarette Use among 12-to-17-Year-Olds, 1999–2004

(percent of 12-to-17-year-olds by cigarette use status, by selected characteristics, 1999–2004)

ever tried a cigarette, even a few puffs

ever smoked a whole cigarette

smoked a whole cigarette in past month

tried to quit smoking in past year (among those who had ever smoked a whole cigarette)

Total aged 12 to 17

39.9%

24.0%

13.0%

58.7%

Age Aged 12 to 13 Aged 14 to 15 Aged 16 to 17

18.5 41.9 59.7

6.9 23.9 41.5

3.3 11.4 24.4

69.7 63.7 54.1

Race and Hispanic origin Mexican American Non-Hispanic white Non-Hispanic black

41.2 41.2 33.6

23.5 26.4 15.7

9.9 14.9 8.0

57.4 54.8 71.6

Current grade 8th grade and below 9th and 10th grade 11th grade and above

27.8 54.3 61.9

14.1 35.3 43.1

6.9 19.1 27.4

69.7 53.9 51.5

Poverty status Poverty to income ratio less than one Poverty to income ratio one to less than two Poverty to income ration two or greater

46.2 43.4 36.6

28.4 26.0 21.5

15.8 16.1 10.7

61.3 62.4 54.5

Source: National Center for Health Statistics, Smoking, Alcohol Use, and Illicit Drug Use Reported by Adolescents Aged 12–17 Years: United States, 1999–2004, National Health Statistics Reports, No. 15, 2009, Internet site http://www.cdc.gov/nchs/ products/nhsr.htm

12 AMERICAN HEALTH

ADDICTIONS

Table 1.7

Tobacco Use among 9th to 12th Graders, 2007

(percent of 9th to 12th graders by tobacco use status, by grade, 2007) total

Lifetime cigarette use (ever tried a cigarette) Lifetime daily cigarette use (ever smoked a cigarette every day for 30 days) Current cigarette use (smoked a cigarette in the past 30 days) Current frequent cigarette use (smoked a cigarette on 20 of the past 30 days) Smoked more than 10 cigarettes a day on days they smoked in past 30 days (among current smokers) Tried to quit smoking during past year (among current smokers) Purchased cigarettes at a store or gas station during the past 30 days Used chewing tobacco, snuff, or dip during the past 30 days Smoked cigars, cigarillos, or little cigars in the past 30 days Used tobacco of any kind in the past 30 days

50.3%

9th grade

42.7%

10th grade

11th grade

12th grade

48.8%

53.4%

59.3%

12.4

8.3

12.0

13.8

16.8

20.0

14.3

19.6

21.6

26.5

8.1

4.3

7.0

10.1

12.2

10.7

10.1

9.0

9.0

13.6

49.7

48.6

51.9

49.9

48.5

16.0

9.7

15.0

17.8

25.6

7.9

6.3

8.7

7.6

8.9

13.6 25.7

9.9 18.6

12.5 24.8

15.5 28.2

17.6 33.4

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance–United States, 2007, Mortality and Morbidity Weekly Report, Vol. 57/SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Table 1.8

Attitudes of 8th, 10th, and 12th Graders toward Cigarette Smoking, 1999 and 2009

(percent of 8th, 10th, and 12th graders who think smoking one or more packs of cigarettes per day presents a great physical risk, and percent who disapprove or strongly disapprove of those who smoke one to ﬁve cigarettes per day, 1999 and 2009; percentage point change, 1999–2009) 2009

1999

GREAT RISK 8th graders 10th graders 12th graders

59.1% 67.3 74.9

54.8% 62.7 70.8

DISAPPROVE 8th graders 10th graders 12th graders

87.1 84.5 81.8

81.4 76.1 69.5

percentage point change

4.3 4.6 4.1

5.7 8.4 12.3

Source: Institute for Social Research, University of Michigan, Monitoring the Future Survey, 2009, Internet site http:// monitoringthefuture.org/data/09data.html; calculations by New Strategist

AMERICAN HEALTH

13

Drinking Varies by Demographics The afﬂuent are most likely to be regular drinkers. There are distinct demographic differences in the likelihood of being a regular drinker. Men are most likely to drink regularly, as are non-Hispanic whites, college graduates, and people with household incomes of $100,000 or more. The percentage of people who drink regularly falls with age. The oldest Americans are more likely to be lifetime abstainers than to be current regular drinkers. Among adults aged 18 to 44, 56 percent are regular drinkers. Among those aged 75 or older, only 27 percent say they drink regularly. By law, the sale of alcoholic beverages is restricted to people aged 21 or older. It is clear, however, that people under age 21 have access to alcohol. More than half of 19- and 20-year-olds have consumed alcoholic beverages in the past month. Even among 16-year-olds drinking is not rare—22 percent have consumed alcohol in the past month. More disturbing is the rate of binge drinking among people under age 21. One in ﬁve 17-year-olds has had ﬁve or more drinks on at least one occasion in the past month. The share is even higher among those aged 18 to 20, although the highest rate of binge drinking is found among people aged 21, with nearly half saying they had binged in the past month. ■ News about the health beneﬁts of moderate alcohol consumption may boost the percentage of middle-aged and older adults who drink regularly. 90

Regular drinking rises with education (percent of people aged 18 or older who are regular drinkers, by education, 2008)

60

62% 60%

52% 46% 36%

30

30%

0

0%

lessa than high school

14 AMERICAN HEALTH

highb school graduate

someccollege

collegedgraduate

ADDICTIONS

Table 1.9

Alcohol Drinking Status of People Aged 18 or Older by Selected Characteristics, 2008

(number of people aged 18 or older by selected characteristics and alcohol drinking status, 2008; numbers in thousands) total

lifetime abstainer

former infrequent

former regular

current infrequent

current regular

TOTAL PEOPLE Sex Men Women

225,227

46,369

18,982

12,995

30,023

110,924

108,755 116,472

15,328 31,041

7,725 11,257

7,590 5,405

10,555 19,468

63,970 46,954

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

110,615 77,335 19,869 17,409

23,470 12,746 4,797 5,356

5,370 7,544 3,042 3,027

3,595 5,368 1,847 2,185

14,541 11,183 2,426 1,873

60,848 38,344 7,219 4,513

Race and Hispanic origin Asian 10,501 Black 26,765 Hispanic 30,583 Non-Hispanic white 154,483

4,335 7,933 9,286 24,374

615 2,873 1,965 13,293

162 1,515 1,454 9,611

1,317 3,624 3,791 20,793

3,906 9,922 13,279 82,405

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

9,124 11,055 8,535 7,809

3,843 5,934 5,072 3,377

2,929 4,003 3,102 2,409

3,243 7,930 8,791 6,936

9,159 23,391 28,278 35,049

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

17,600 6,890 7,494 3,958 5,423

7,979 2,723 2,994 1,763 2,054

5,688 1,815 1,974 1,085 1,562

8,189 5,013 5,655 3,957 5,081

26,819 14,653 19,420 14,563 28,228

Note: “Lifetime abstainer” had fewer than 12 drinks in lifetime; “former” drinker had more than 12 drinks in lifetime, no drinks in past year; “current” drinker had more than 12 drinks in lifetime, drinks in past year; “infrequent” drinker had fewer than 12 drinks in one year; “regular” drinker had more than 12 drinks in one year. Numbers by drinking status may not add to total because “unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

15

Table 1.10

Percent Distribution of People Aged 18 or Older by Alcohol Drinking Status, 2008

(percent distribution of people aged 18 or older by alcohol drinking status and selected characteristics, 2008) total

lifetime abstainer

former infrequent

former regular

current infrequent

current regular

TOTAL PEOPLE Sex Men Women

100.0%

21.0%

8.6%

5.9%

13.6%

50.3%

100.0 100.0

14.8 27.2

7.4 9.5

7.2 4.6

10.0 17.0

60.1 41.5

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

100.0 100.0 100.0 100.0

21.6 16.9 24.7 31.5

5.0 10.0 15.7 17.8

3.3 7.1 9.5 12.9

13.4 14.8 12.5 11.0

56.1 50.8 37.2 26.6

Race and Hispanic origin Asian

100.0

Black Hispanic Non-Hispanic white

100.0 100.0 100.0

42.5 30.8 31.8 16.1

6.2 11.8 7.4 8.2

1.6 6.4 5.7 6.0

12.7 13.7 12.8 13.7

37.0 36.9 41.5 55.6

Education Less than high school High school graduate Some college College graduate

100.0 100.0 100.0 100.0

31.2 20.8 16.2 14.6

12.0 10.7 9.6 6.4

8.9 7.2 5.8 4.5

12.0 15.2 16.1 12.4

35.5 45.7 51.9 61.9

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

25.7 22.0 20.2 16.4 14.1

11.3 8.5 8.1 7.7 4.9

8.0 5.7 5.5 4.7 3.4

12.5 16.1 15.0 14.9 12.0

41.7 47.5 51.0 55.9 65.4

Note: “Lifetime abstainer” had fewer than 12 drinks in lifetime; “former” drinker had more than 12 drinks in lifetime, no drinks in past year; “current” drinker had more than 12 drinks in lifetime, drinks in past year; “infrequent” drinker had fewer than 12 drinks in one year; “regular” drinker had more than 12 drinks in one year. Numbers by drinking status may not add to total because “unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

16 AMERICAN HEALTH

ADDICTIONS

Table 1.11

Alcohol Use by Selected Characteristics, 2008

(percent of people aged 18 or older who have had at least one drink of alcohol in the past 30 days, by selected characteristics, 2008) TOTAL PEOPLE Sex Men Women

percent

54.5% 61.3 47.7

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

49.9 60.5 60.5 58.5 53.5 40.7

Race and Hispanic origin Black Hispanic White Other

42.0 41.5 59.3 40.2

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

32.4 39.2 47.3 53.3 66.6

Education Not a high school graduate High school graduate Some college College graduate

32.3 46.3 55.3 66.2

Source: Centers for Disease Control and Prevention, Behavorial Risk Factor Surveillance System, 2008 Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

AMERICAN HEALTH

17

Table 1.12

Alcohol Use by People Aged 12 or Older, 2008

(percent of people aged 12 or older who drank alcoholic beverages during their lifetime, during the past year, and during the past month, by age, 2008) lifetime

Total people Aged 12 Aged 13 Aged 14 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 Aged 26 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 49 Aged 50 to 54 Aged 55 to 59 Aged 60 to 64 Aged 65 or older

82.2% 9.9 17.8 32.3 44.5 56.8 63.3 73.6 79.8 82.4 89.1 90.4 90.4 91.1 91.5 90.8 89.3 90.2 89.9 90.6 87.7 92.0 86.9 77.5

past year

66.1% 6.2 12.7 23.9 36.9 47.0 53.5 63.6 72.0 74.8 84.5 83.7 82.8 84.6 82.5 81.5 77.2 74.5 74.8 73.2 68.5 68.7 64.1 50.7

past month

51.6% 2.1 4.6 10.6 15.5 22.2 30.3 41.5 50.5 55.5 70.6 70.4 69.0 69.8 67.8 67.4 59.9 59.4 60.3 59.6 54.9 54.6 50.3 39.7

Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

18 AMERICAN HEALTH

ADDICTIONS

Table 1.13

Binge Drinking and Heavy Alcohol Use by People Aged 12 or Older, 2008

(percent of people aged 12 or older who drank alcoholic beverages, participated in binge drinking, or participated in heavy drinking during the past month, by age, 2008) drinking in past month any

Total people Aged 12 Aged 13 Aged 14 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 Aged 26 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 49 Aged 50 to 54 Aged 55 to 59 Aged 60 to 64 Aged 65 or older

51.6% 2.1 4.6 10.6 15.5 22.2 30.3 41.5 50.5 55.5 70.6 70.4 69.0 69.8 67.8 67.4 59.9 59.4 60.3 59.6 54.9 54.6 50.3 39.7

binge

23.3% 0.9 2.1 5.1 8.6 14.7 19.6 28.2 35.5 38.4 49.0 46.9 45.0 46.2 42.5 42.6 30.8 27.4 26.1 23.9 20.3 17.6 14.6 8.2

heavy

6.9% 0.1 0.3 0.6 1.5 3.7 5.2 9.1 13.1 15.4 17.3 18.0 14.8 15.9 13.4 13.2 8.1 7.4 6.7 7.4 6.4 5.2 3.6 2.2

Note: Binge drinking is deﬁned as having ﬁve or more drinks on the same occasion on at least one day in the 30 days prior to the survey. Heavy drinking is having ﬁve or more drinks on the same occasion on each of ﬁve or more days in the 30 days prior to the survey. Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

AMERICAN HEALTH

19

Most High School Students Have Tried Alcohol Heavy drinking is common among some teens. High school students do not ﬁnd it difﬁcult to get alcoholic beverages. By 9th and 10th grade, most have had an alcoholic drink. Most 12th graders have had a drink in the past 30 days. Of great concern is the number of high school students who have engaged in episodic heavy drinking, deﬁned as consuming ﬁve or more alcoholic beverages on one occasion. Seventeen percent of 9th graders report doing so, as do more than one-third of high school seniors. Most students do not believe there is a great physical risk in consuming one or two drinks every day. This is precisely the message that has come out of research linking moderate alcohol consumption with health beneﬁts. Although most students think there is no great risk in daily drinking, they were more likely in 2006 than in 1996 to disapprove of people who drink that much. ■ Despite efforts to keep alcoholic beverages out of the hands of teenagers, they continue to ﬁnd ways to get drinks.

Many teens drink heavily (percent 45 of high school students who have engaged in episodic heavy drinking in the past 30 days, by grade, 2007)

36.5% 30

29.9%

30%

23.7% 17.0% 15

15%

0

0%

9tha grade

20 AMERICAN HEALTH

10thb grade

11thc grade

12thd grade

ADDICTIONS

Table 1.14

Alcohol Consumption among 12-to-17-Year-Olds, 1999–2004

(percent of 12-to-17-year-olds by alcohol consumption status, by selected characteristics, 1999–2004) ever had an alcoholic drink

TOTAL AGED 12 TO 17 Age Aged 12 to 13 Aged 14 to 15 Aged 16 to 17

had a drink in past month

drank ﬁve or more drinks at one time in past month

38.8%

21.1%

10.4%

15.1 37.3 64.2

5.9 20.2 37.4

2.1 8.2 20.9

Non-Hispanic white Non-Hispanic black

41.7 41.2 29.5

21.7 22.9 13.7

11.9 12.1 3.5

Current grade 8th grade and below 9th and 10th grade 11th grade and above

23.4 56.9 66.7

10.6 34.0 39.2

4.0 18.3 20.7

Poverty to income ratio Less than one One to less than two Two or greater

35.0 39.5 40.7

17.8 20.6 23.1

8.9 10.3 11.1

Race and Hispanic origin Mexican American

Source: National Center for Health Statistics, Smoking, Alcohol Use, and Illicit Drug Use Reported by Adolescents Aged 12–17 Years: United States, 1999–2004, National Health Statistics Reports, No. 15, 2009, Internet site http://www.cdc.gov/nchs/ products/nhsr.htm

Table 1.15

Alcohol Use by 9th to 12th Graders, 2007

(percent of 9th to 12th graders who have ever used or currently use acohol, and percent who have drunk heavily in past 30 days, by grade, 2007)

lifetime use (ever had one or more drinks)

Total in 9th to 12th grade 9th graders 10th graders 11th graders 12th graders

75.0% 65.5 74.7 79.4 82.8

current use (one or more drinks in past 30 days)

44.7% 35.7 41.8 49.0 54.9

episodic heavy drinking (drank ﬁve or more drinks in a row in past 30 days)

26.0% 17.0 23.7 29.9 36.5

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance–United States, 2007, Mortality and Morbidity Weekly Report, Vol. 57/SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

AMERICAN HEALTH

21

Table 1.16

Attitudes of 8th, 10th, and 12th Graders toward Drinking, 1999 and 2009

(percent of 8th, 10th, and 12th graders who think taking one or two drinks of alcohol nearly every day is a great physical risk, and percent who disapprove or strongly disapprove of those who drink one or two drinks of alcohol nearly every day, 1999 and 2009; percentage point change, 1999–2009) percentage point change

2009

1999

GREAT RISK 8th graders 10th graders 12th graders

31.5% 33.8 23.7

29.7% 32.9 21.8

1.8 0.9 1.9

DISAPPROVE 8th graders 10th graders 12th graders

78.5 77.6 70.5

77.0 75.4 67.2

1.5 2.2 3.3

Source: Institute for Social Research, University of Michigan, Monitoring the Future Survey, 2009, Internet site http:// monitoringthefuture.org/data/09data.html; calculations by New Strategist

22 AMERICAN HEALTH

ADDICTIONS

Marijuana Is the Most Commonly Used Illicit Drug Forty-one percent of people aged 12 or older have tried it. A remarkable 47 percent of people aged 12 or older have used illicit drugs at least once in their lifetime. The rate is relatively high primarily because of drug use by baby boomers and younger generations. Only 13.5 percent of people aged 65 or older admit to ever using an illicit drug compared with the majority of those aged 19 to 59. Although many people have given illicit drugs a try, relatively few have used them in the past year (14 percent) and a much smaller 8 percent have used them in the past month. But the share of current (past month) users is much higher among young adults, with 17 to 22 percent of those aged 18 to 24 falling into this category. The most commonly used illicit drug is marijuana. The popularity of marijuana is the primary reason for the relatively high proportion of lifetime drug users in the population. When marijuana is factored out, a smaller 30 percent of people aged 12 or older have ever tried illicit drugs. Other than marijuana, psychotherapeutics are the most commonly used illicit drugs. ■ Recent efforts in some states to soften harsh penalties for drug possession, as well as the movement to allow the medicinal use of marijuana, suggest that public perceptions of drug use—and the best way to deal with it—are changing.

60

Psychotherapeutics are the second most commonly used illicit drug

(percent of people aged 12 or older who have used selected illicit drugs in their lifetime, by type of drug, 2008)

41%

40

40%

20

20%

21% 15%

14% 9%

0

0%

marijuana a and hashish

psychotherapeutics b

cocaine c

hallucinogens d

inhalants e

AMERICAN HEALTH

23

Table 1.17

Illicit Drug Use by People Aged 12 or Older, 2008

(percent of people aged 12 or older who ever used any illicit drug, who used an illicit drug in the past year, and who used an illicit drug in the past month, by age, 2008) ever used

Total people Aged 12 Aged 13 Aged 14 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 Aged 26 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 49 Aged 50 to 54 Aged 55 to 59 Aged 60 to 64 Aged 65 or older

47.0% 11.2 15.2 21.5 28.4 35.8 42.0 47.5 52.5 55.7 59.0 60.1 59.1 59.9 61.7 61.1 55.4 55.2 60.2 62.7 58.0 51.9 41.3 13.5

used in past year

14.2% 7.2 9.9 14.9 20.4 27.5 31.8 34.7 37.6 36.9 35.6 34.8 28.8 29.6 28.7 23.4 16.4 14.6 12.9 11.5 8.1 7.7 5.2 1.4

used in past month

8.0% 3.1 3.4 6.7 10.5 13.5 17.0 20.3 22.2 22.3 20.9 20.7 17.3 17.4 15.4 13.0 9.6 8.6 6.3 7.0 4.3 5.0 3.0 1.0

Note: Illicit drugs include marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and any prescription-type psychotherapeutic used nonmedically. Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

24 AMERICAN HEALTH

ADDICTIONS

Table 1.18

Lifetime Illicit Drug Use by Type of Drug and Age, 2008

(percent of people aged 12 or older having used illicit drugs in their lifetime, by type of drug and age of user, 2008) total

Any illicit drug in lifetime

47.0%

Marijuana or hashish

41.0

Cocaine

12 to 13

13.2%

14 to 15

16 to 17

18 to 20

21 to 25

26 to 34

35 or older

25.1%

38.9%

51.6%

59.9%

58.2%

45.7%

3.0

14.6

30.4

45.1

53.9

51.3

40.6

14.7

0.2

1.2

4.1

10.9

16.7

16.7

16.4

Crack

3.4

–

0.3

0.6

1.8

3.4

4.8

3.7

Heroin

1.5

0.0

0.3

0.5

1.1

1.6

1.9

1.7

14.4

0.9

3.1

7.4

14.2

20.1

22.2

13.6

LSD

9.4

0.1

0.8

2.2

4.3

8.0

14.2

10.3

PCP

2.7

0.1

0.5

0.6

1.0

1.9

2.1

3.4

Ecstasy

5.2

0.3

1.6

4.3

9.3

14.0

13.2

2.4

Inhalants

8.9

8.1

10.4

9.3

9.4

11.0

12.8

7.7

Nonmedical use of any psychotherapeutic

20.8

5.4

10.2

17.3

25.1

32.0

28.0

18.9

Pain relievers

14.0

4.5

8.7

14.6

21.7

26.3

21.3

10.8

OxyContin

1.9

0.2

1.1

2.7

4.7

5.7

3.7

0.9

Tranquilizers

8.6

0.5

2.3

5.6

10.2

13.6

12.2

7.9

Stimulants

8.5

0.9

2.4

4.6

7.8

12.3

11.2

8.4

Methamphetamine

5.0

0.3

0.6

1.5

2.7

6.0

7.2

5.3

Sedatives

3.6

0.5

0.8

1.1

1.3

1.7

2.1

4.8

30.3

11.7

17.9

23.9

31.8

39.9

38.4

29.0

Hallucinogens

Any illicit drug other than marijuana

Note: Illicit drugs include marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and any prescription-type psychotherapeutic used nonmedically. “–” means sample is too small to make a reliable estimate. Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

AMERICAN HEALTH

25

Table 1.19

Past Year Illicit Drug Use by Type of Drug and Age, 2008

(percent of people aged 12 or older having used illicit drugs in past year, by type of drug and age of user, 2008) total

12 to 13

14 to 15

16 to 17

18 to 20

21 to 25

26 to 34

35 or older

Any illicit drug in lifetime

14.2%

8.6%

17.7%

29.6%

36.3%

31.5%

19.8%

8.1%

Marijuana or hashish

10.3

2.5

11.6

23.9

30.9

25.3

14.9

5.2

Cocaine

2.1

0.1

1.0

2.5

5.8

5.4

4.0

1.1

Crack

0.4

–

0.1

0.2

0.7

0.6

0.7

0.4

Heroin

0.2

0.0

0.2

0.3

0.4

0.5

0.3

0.1

Hallucinogens

1.5

0.7

2.4

5.0

8.2

5.2

1.7

0.2

LSD

0.3

0.1

0.5

1.5

2.1

1.1

0.2

0.0

PCP

0.0

0.1

0.3

0.3

0.1

0.1

0.0

–

Ecstasy

0.9

0.2

1.2

2.7

5.1

3.1

1.1

0.1

Inhalants

0.8

4.2

4.4

3.2

2.4

1.1

0.5

0.2

Nonmedical use of any psychotherapeutic

6.1

3.5

7.0

12.1

15.2

14.5

8.4

3.5

Pain relievers

4.8

3.0

6.1

9.9

12.4

11.7

6.6

2.5

OxyContin

0.6

0.2

0.8

1.7

2.1

1.6

0.9

0.2

Tranquilizers

2.0

0.2

1.6

3.8

5.6

5.1

3.1

1.1

Stimulants

1.1

0.5

1.5

2.4

3.6

3.2

1.6

0.4

Methamphetamine

0.3

0.1

0.3

0.7

0.8

0.9

0.6

0.2

Sedatives

0.2

0.2

0.6

0.6

0.5

0.5

0.4

0.1

Any illicit drug other than marijuana

8.0

7.1

11.1

15.7

19.8

18.3

11.2

4.4

Note: Illicit drugs include marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and any prescription-type psychotherapeutic used nonmedically. “–” means sample is too small to make a reliable estimate. Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

26 AMERICAN HEALTH

ADDICTIONS

Table 1.20

Past Month Illicit Drug Use by Type of Drug and Age, 2008

(percent of people aged 12 or older having used illicit drugs in past month, by type of drug and age of user, 2008) total

12 to 13

14 to 15

16 to 17

18 to 20

21 to 25

26 to 34

35 or older

Any illicit drug in lifetime

8.0%

3.3%

8.6%

15.2%

21.5%

18.4%

11.2%

Marijuana or hashish

6.1

1.0

5.7

12.7

18.7

15.0

8.8

3.2

4.7%

Cocaine

0.7

0.0

0.4

0.7

1.6

1.5

1.5

0.4

Crack

0.1

–

0.0

0.0

0.2

0.2

0.3

0.1

Heroin

0.1

–

0.0

0.1

0.2

0.2

0.1

0.1

Hallucinogens

0.4

0.3

1.0

1.6

2.3

1.3

0.6

0.0

LSD

0.1

–

0.2

0.4

0.3

0.3

0.0

–

PCP

0.0

0.0

0.0

0.1

0.0

0.0

0.0

–

Ecstasy

0.2

0.0

0.5

0.7

1.3

0.6

0.4

0.0

Inhalants

0.3

1.2

1.3

0.7

0.5

0.2

0.1

0.1

Nonmedical use of any psychotherapeutic

2.5

1.5

3.0

4.0

6.0

5.8

3.2

1.6

Pain relievers

1.9

1.2

2.4

3.1

4.8

4.4

2.4

1.2

OxyContin

0.2

–

0.2

0.4

0.4

0.4

0.3

0.1

Tranquilizers

0.7

0.1

0.6

1.1

1.7

1.7

1.0

0.5

Stimulants

0.4

0.2

0.6

0.6

1.0

1.1

0.7

0.1

Methamphetamine

0.1

0.0

0.1

0.2

0.1

0.3

0.3

0.1

Sedatives

0.1

0.1

0.1

0.2

0.1

0.3

0.1

0.1

Any illicit drug other than marijuana

3.4

2.6

4.7

5.6

8.4

7.5

4.6

2.1

Note: Illicit drugs include marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and any prescription-type psychotherapeutic used nonmedically. “–” means sample is too small to make a reliable estimate. Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

AMERICAN HEALTH

27

Thirty-Eight Percent of High School Students Have Smoked Pot More than half of people aged 18 to 25 have used marijuana. Marijuana is the most commonly used illicit drug and is readily available to most teenagers and young adults. In 2008, the majority of people ranging in age from 21 to 29 and 40 to 54 had used marijuana at some point in their lives. In 1965, few young adults had ever smoked marijuana. Use of the drug exploded in the 1970s, rising from 22 percent among people aged 18 to 25 in 1970 to more than 50 percent in 1980. The percentage of Americans who have experimented with marijuana at least once has hovered between 44 and 52 percent ever since. Overall, 38 percent of students in grades 9 through 12 have tried marijuana, and 20 percent have used it in the past month. The share of high school students who have smoked pot in the past month rises with age, from 15 percent of 9th graders to 25 percent of high school seniors. ■ The widespread use of marijuana among teenagers and young adults signals a high degree of acceptance of the drug’s use. This portends continued division in the nation about marijuana laws and the use of pot for medicinal purposes. 75

Marijuana use is commonplace among teens and young adults

12 to

(percent of people aged 12 to 25 who have ever used marijuana, by age for selected years, 1965 to 2008)

18 to

5050%

2525% 100000

00%

a

1965

b

1970

c

1975

d

1980

75000

e

1985

all 12 to 17 aged

aged dual18 to 25

f

1990

g

1995

h

2000

2005

50000

25000

0

28 AMERICAN HEALTH

with

w/out

2008

ADDICTIONS

Table 1.21

Lifetime Marijuana Use by People Aged 12 to 25, 1965 to 2008

(percent of people aged 12 to 25 who have ever used marijuana, selected years, 1965 to 2008) 2008 2005 2000 1995 1990 1985 1980 1975 1970 1965

12 to 17

18 to 25

16.5% 17.4 20.4 16.4 11.9 15.4 19.4 15.8 7.4 1.8

50.4% 52.4 51.8 44.1 46.6 51.5 53.0 41.6 22.0 5.1

Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

Table 1.22

Marijuana Use by People Aged 12 or Older, 2008

(percent of people aged 12 or older who ever used marijuana, who used marijuana in the past year, and who used marijuana in the past month, by age, 2008) ever used

Total people Aged 12 Aged 13 Aged 14 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 Aged 26 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 49 Aged 50 to 54 Aged 55 to 59 Aged 60 to 64 Aged 65 or older

41.0% 1.5 4.6 9.8 19.2 26.5 34.4 40.6 46.0 49.8 52.7 53.6 53.4 54.2 55.8 54.6 48.3 48.5 55.1 57.6 53.2 47.5 34.6 9.3

used in past year

10.3% 1.1 3.8 8.1 14.8 21.2 26.6 29.3 32.2 31.5 30.4 28.5 22.4 23.3 21.9 18.2 11.8 10.0 7.9 7.6 5.3 5.1 3.2 0.4

used in past month

6.1% 0.5 1.4 3.6 7.7 10.9 14.5 17.8 19.4 18.9 17.8 17.3 14.0 13.3 12.5 10.5 7.2 6.1 4.1 4.7 3.0 3.9 2.3 0.3

Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

AMERICAN HEALTH

29

Table 1.23

Marijuana Use among 12-to-17-Year-Olds, 1999–2004

(percent distribution of 12-to-17-year-olds by number of times they have used marijuana, by selected characteristics, 1999–2004) never

79.0%

1 or 2 times

7.6%

20 or more times

3 to 19 times

TOTAL 12 TO 17 Age Aged 12 to 13 Aged 14 to 15 Aged 16 to 17

6.6%

6.8%

96.2 81.1 59.4

2.0 9.8 11.2

1.5 5.0 13.4

– 4.1 16.0

Race and Hispanic origin Mexican American Non-Hispanic white Non-Hispanic black

75.8 79.7 76.6

9.9 7.1 9.4

7.6 6.1 8.3

6.6 7.1 5.7

Current grade 8th grade and below 9th and 10th grade 11th grade and above

90.4 64.8 60.2

4.5 12.4 9.9

2.8 11.2 13.5

2.3 11.6 16.4

Poverty to income ratio Less than one One to less than two Two or greater

76.1 76.0 81.1

8.6 9.7 6.5

8.7 7.4 5.6

6.6 6.9 6.8

Note: “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Smoking, Alcohol Use, and Illicit Drug Use Reported by Adolescents Aged 12–17 Years: United States, 1999–2004, National Health Statistics Reports, No. 15, 2009, Internet site http://www.cdc.gov/nchs/ products/nhsr.htm

Table 1.24

Marijuana Use by 9th to 12th Graders, 2007

(percent of 9th to 12th graders who have ever used marijuana or have used marijuana in the past 30 days, by grade, 2007) lifetime

Total in 9th to 12th grade 9th graders 10th graders 11th graders 12th graders

38.1% 27.5 36.9 42.4 49.1

past month

19.7% 14.7 19.3 21.4 25.1

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance–United States, 2007, Mortality and Morbidity Weekly Report, Vol. 57/SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

30 AMERICAN HEALTH

ADDICTIONS

Teen Drug Use Fell in the Past Decade But students are less likely to think some drug use poses a great risk to health. Between 1999 and 2009, the percentage of high school students using a variety of illicit drugs declined. The largest drop was in the use of marijuana, the share of 10th graders who had smoked pot in the past 30 days falling from 19 to 16 percent, and the share ever having tried pot falling from 41 to 32 percent. Among high school seniors, any illicit drug use fell from 55 to 47 percent between 1999 and 2009. Declines occurred in the use of most illicit drugs, including marijuana, inhalants, hallucinogens, and amphetamines. Among high school seniors, a growing majority disapproves of trying a range of drugs including marijuana, amphetamines, and steroids. The percentage that disapproves of trying marijuana climbed from 49 to 55 percent between 1999 and 2009. A growing percentage of high school seniors also think drug use poses a great physical risk. But the share that believes regular marijuana use is a great risk fell from 57 to 52 percent between 1999 and 2009. ■ The ambivalence of boomer parents about their own youthful drug use may be one reason for the more casual attitude toward marijuana use among today’s teens.

Fewer 12th graders think regular marijuana use is risky

75 (percent of 12th graders who think smoking marijuana regularly poses a great physical risk, 1999 and 2009)

57% 52%

50

50%

25

25%

0

0%

1999 1999

2009 2009

AMERICAN HEALTH

31

Table 1.25

Drug Use by 8th, 10th, and 12th Graders, 1999 and 2009

(percent of 8th, 10th, and 12th graders who have ever used illicit drugs and who have used illicit drugs in the past 30 days, by type of drug, 1999 and 2009; percentage point change, 1999–2009) ever used 2009

8TH GRADERS Any illicit drug Any illicit drug other than marijuana Marijuana Inhalants Hallucinogens Cocaine Amphetamines Tranquilizers Steroids 10TH GRADERS Any illicit drug Any illicit drug other than marijuana Marijuana Inhalants Hallucinogens Cocaine Amphetamines Tranquilizers Steroids 12TH GRADERS Any illicit drug Any illicit drug other than marijuana Marijuana Inhalants Hallucinogens Cocaine Amphetamines Tranquilizers Steroids

1999

used in past 30 days percentage point change

2009

19.9%

28.3%

–8.4

8.1%

10.4 15.7 14.9 3.0 2.6 6.0 3.9 1.3

16.3 22.0 19.7 4.8 4.7 10.7 4.4 2.7

–5.9 –6.3 –4.8 –1.8 –2.1 –4.7 –0.5 –1.4

36.0

46.2

16.7 32.3 12.3 6.1 4.6 10.3 7.0 1.3

1999

percentage point change

12.2%

–4.1

3.5 6.5 3.8 0.9 0.8 1.9 1.2 0.4

5.5 9.7 5.0 1.3 1.3 3.4 1.1 0.7

–2.0 –3.2 –1.2 –0.4 –0.5 –1.5 0.1 –0.3

–10.2

17.8

22.1

–4.3

24.0 40.9 17.0 9.7 7.7 15.7 7.9 2.7

–7.3 –8.6 –4.7 –3.6 –3.1 –5.4 –0.9 –1.4

5.7 15.9 2.2 1.4 0.9 3.3 2.0 0.5

8.6 19.4 2.6 2.9 1.8 5.0 2.2 0.9

–2.9 –3.5 –0.4 –1.5 –0.9 –1.7 –0.2 –0.4

46.7

54.7

–8.0

23.3

25.9

–2.6

24.0 42.0 9.5 7.4 6.0 9.9 9.3 2.2

29.0 49.7 15.4 13.7 9.8 16.3 9.3 2.9

–5.0 –7.7 –5.9 –6.3 –3.8 –6.4 0.0 –0.7

8.6 20.6 1.2 1.6 1.3 3.0 2.7 1.0

10.4 23.1 2.0 3.5 2.6 4.5 2.5 0.9

–1.8 –2.5 –0.8 –1.9 –1.3 –1.5 0.2 0.1

Source: Institute for Social Research, University of Michigan, Monitoring the Future Survey, 2009, Internet site http:// monitoringthefuture.org/data/09data.html; calculations by New Strategist

32 AMERICAN HEALTH

ADDICTIONS

Table 1.26

Attitudes of 12th Graders toward Drug Use, 1999 and 2009

(percentage of 12th graders who think the use of illicit drugs is a great physical risk and percent who disapprove or strongly disapprove of those aged 18 or older using illicit drugs, by type of drug, 1999 and 2009; percentage point change, 1999–2009) 2009

1999

GREAT RISK Try marijuana once or twice Smoke marijuana occasionally Smoke marijuana regularly Try LSD once or twice Try MDMA (Ecstasy) once or twice Try cocaine once or twice Take amphetamines once or twice Try sedatives once or twice Take steroids

18.5% 27.4 52.4 37.1 53.3 53.1 41.9 29.6 60.2

15.8% 23.9 57.4 34.9 35.0 52.1 32.2 26.1 62.1

DISAPPROVE Try marijuana once or twice Smoke marijuana occasionally Smoke marijuana regularly Try LSD once or twice Try MDMA (Ecstasy) once or twice Try cocaine once or twice Take amphetamines once or twice Try sedatives once or twice Take steroids

54.8 65.6 80.3 88.2 88.2 90.8 88.2 87.7 90.3

48.8 62.5 78.6 83.0 82.1 89.1 81.9 86.6 88.9

percentage point change

2.9 3.5 –5.0 2.2 18.3 1.0 9.7 3.5 –1.9

6.0 3.1 1.7 5.2 6.1 1.7 6.3 1.1 1.4

Source: Institute for Social Research, University of Michigan, Monitoring the Future Survey, 2009, Internet site http:// monitoringthefuture.org/data/09data.html; calculations by New Strategist

AMERICAN HEALTH

33

Most Addicts Do Not Get the Treatment They Need Few who need treatment receive it from a specialty facility. Although some people with drug or alcohol problems are able to resolve them on their own, many need some type of assistance. Support groups such as Alcoholics or Narcotics Anonymous can be effective for highly motivated individuals, but many people, particularly those who are heavy users of drugs or alcohol, need more intensive treatment at a specialized facility. Most, however, do not get needed treatment. Of 23 million people who were identiﬁed as needing specialized treatment for drug or alcohol problems in 2008, only 10 percent received treatment at a specialized facility. Overall, a substantial 9.2 percent of people aged 12 or older were identiﬁed as needing treatment for drug or alcohol problems in 2008. By age, 18-to-25-year-olds are far more likely to need treatment (21 percent) than older adults (7 percent). Males are more likely to need treatment (12 percent) than females (7 percent). ■ Although lack of ﬁnancial resources keeps many people from receiving needed drug or alcohol treatment, the shortage of facilities is also a problem.

Hispanics are least likely to get help 15

(percent of people aged 12 or older needing treatment for drug or alcohol abuse who received treatment at a specialty facility, by race and Hispanic origin, 2008)

13.2%

10

10%

5

5%

0

0%

10.3%

5.4%

34 AMERICAN HEALTH

a black

b Hispanic

c white non-Hispanic

ADDICTIONS

Table 1.27

Treatment for Drug or Alcohol Problems in Past Year, 2008

(number and percent of people aged 12 or older having needed treatment for drug or alcohol problems in past year, number and percent having received treatment at a specialty facility, and percent needing treatment who received treatment at a specialty facility, 2008; numbers in thousands) received treatment at specialty facility

total needing treatment number

TOTAL PEOPLE Age Aged 12 to 17 Aged 18 to 25 Aged 26 or older

23,051 1,938 6,986 14,126

Sex Female Male

percent of population

9.2%

number

percent of population

percent of those needing treatment who received treatment at specialty facility

2,287

0.9%

9.9%

7.8 21.2 7.4

143 498 1,646

0.6 1.5 0.9

7.4 7.1 11.6

8,608 14,443

6.7 11.9

797 1,490

0.6 1.2

9.3 10.3

Race and Hispanic origin Not Hispanic 19,659 Asian 451 Black 2,804 White 15,848 Hispanic 3,392

9.2 4.2 9.5 9.4 9.7

2,105 40 369 1,633 182

1.0 0.4 1.2 1.0 0.5

10.7 – 13.2 10.3 5.4

Note: Respondents were classiﬁed as needing treatment if they met at least one of three criteria during the past year: (1) dependent on any illicit drug or alcohol; (2) abuse of any illicit drug or alcohol; or (3) received treatment for any illicit drug or alcohol problem at a specialty facility. Specialty facility is deﬁned as drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), and mental health centers. Illicit drugs are deﬁned as marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and any prescription-type psychotherapeutic used nonmedically. “–” means sample is too small to make a reliable estimate. Source: SAMHSA, Ofﬁce of Applied Studies, National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm

AMERICAN HEALTH

35

AGING CHAPTER

2

Aging ■ Half of people aged 55 or older engage in any leisure-time physical activity. The proportion falls from 58 percent among 55-to-64-year-olds to just 29 percent of people aged 85 or older.

■ Walking is one of the biggest problems for the elderly. The proportion of people who say they would ﬁnd it “very difﬁcult” or “impossible” to walk a quarter of a mile rises from a substantial 17 percent of 55-to-64-year-olds to the 56 percent majority of people aged 85 or older.

■ Incontinence is a growing problem with age. One-third of people aged 75 to 84 have bladder incontinence.

■ The nursing home population is declining. Between 1999 and 2004, the number of people in nursing homes fell by more than 100,000 as assisted living facilities grew in popularity.

AMERICAN HEALTH

37

With Age, Health Problems Grow Difﬁculties emerge in the 55-to-64 age group. Older Americans are not as physically active as they should be. Only 52 percent of people aged 55 or older say they engage in any leisure-time physical activity. The proportion falls from 58 percent among 55-to-64-year-olds to just 29 percent of people aged 85 or older. Perhaps because of this inactivity, many older Americans report difﬁculties in physical functioning. The proportion of people who say they would ﬁnd it “very difﬁcult” or “impossible” to walk a quarter of a mile rises from a substantial 17 percent of 55-to-64-year-olds to the 56 percent majority of people aged 85 or older. One-third of people aged 85 or older say they ﬁnd it very difﬁcult or impossible to go shopping. As inﬁrmities increase, older Americans visit the doctor frequently. Because they have universal health insurance through Medicare, more than 95 percent of people aged 65 or older have a regular source of health care. Most have had a pneumonia vaccination and most get an annual ﬂu shot. Ninety-four percent have been to a doctor in the past year. ■ Nearly one-third of people aged 85 or older have been to an emergency room in the past year.

90

Most people aged 65 or older received a ﬂu shot in the past year (percent of people aged 55 or older who have had a ﬂu shot in the past year, 2004–07)

� 6060%

�

�

� 3030%

00%

38 AMERICAN HEALTH

55 a to 64

65 b to 74

75 c to 84

85 ordolder

�

AGING

Table 2.1

Healthy Behavior of Adults Aged 55 or Older by Age, 2004–07

(percentage of people aged 55 or older with selected health behaviors in past 12 months, by type of behavior and age, 2004–07) total 55 or older

Any leisure-time physical activity Regular leisure-time physical activity Strengthening activity Healthy weight Never smoked Current nonsmoker Averages seven to eight hours of sleep

51.9% 24.0 15.8 33.6 50.4 86.5 62.3

aged 65 or older 55 to 64

58.1% 27.4 18.9 29.5 48.4 81.3 64.1

total

46.5% 21.0 13.0 37.2 52.0 91.0 60.8

65 to 74

52.9% 24.9 15.0 31.6 48.4 87.7 63.5

75 to 84

42.3% 18.7 11.6 40.5 53.2 93.9 59.4

85 or older

29.2% 9.8 8.6 53.1 65.5 97.8 52.5

Note: Regular physical activity is vigorous activity at least three times per week for at least 20 minutes each time or moderate physical activity at least ﬁve times per week for at least 30 minutes each time. Strengthening activities are calisthenics, weight lifting or any activities designed to strengthen muscles done during leisure time. Source: National Center for Health Statistics, Health Characteristics of Adults Aged 55 Years and Over: United States, 2004–2007, National Health Statistics Reports, No. 16, 2009, Internet site http://www.cdc.gov/nchs/products/nhsr.htm; calculations by New Strategist

Table 2.2

Difﬁculties in Physical and Social Functioning among Adults Aged 55 or Older by Age, 2004–07

(percentage of people aged 55 or older with difﬁculties in physical functioning, by type of difﬁculty and age, 2004–07) total 55 or older

aged 65 or older 55 to 64

total

65 to 74

75 to 84

85 or older

PERCENT WITH DIFFICULTY Walk quarter of a mile

25.0%

17.3%

31.9%

23.9%

37.3%

56.1%

Climb 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects Shopping Socializing Relaxing

19.4 27.6 10.7 30.3 11.0 9.4 15.2 20.9 13.3 9.7 4.1

13.4 20.1 10.7 23.4 8.7 7.5 11.0 15.5 9.6 7.0 3.5

24.7 34.4 10.8 36.4 13.1 11.1 19.1 26.0 16.6 12.2 4.6

18.2 26.3 9.9 30.7 10.0 8.3 13.5 19.7 11.6 8.1 3.3

28.6 39.6 11.2 39.9 14.9 12.9 22.2 29.5 19.2 13.9 5.2

45.2 59.3 13.8 53.1 22.2 18.6 37.5 47.9 34.1 27.6 9.0

Note: Respondents were classiﬁed as having difﬁculties if they responded “very difﬁcult” or “can’t do at all.” Source: National Center for Health Statistics, Health Characteristics of Adults Aged 55 Years and Over: United States, 2004–2007, National Health Statistics Reports, No. 16, 2009, Internet site http://www.cdc.gov/nchs/products/nhsr.htm; calculations by New Strategist

AMERICAN HEALTH

39

Table 2.3

Health Care Access among Adults Aged 55 or Older by Age, 2004–07

(percentage of people aged 55 or older with health care contacts in past 12 months, by type of contact and age, 2004–07) total 55 or older

aged 65 or older 55 to 64

total

65 to 74

75 to 84

85 or older

Has a regular source of health care Pneumonia immunization (ever) Flu vaccine Dentist visit Doctor visit

94.3% 40.3 51.1 61.4 91.3

91.9% 21.2 36.5 65.9 87.8

96.4% 57.0 63.8 57.4 94.3

95.7% 50.9 58.9 59.2 93.4

97.1% 64.4 68.7 56.9 94.9

97.5% 62.2 71.6 50.6 96.6

Emergency room visit Home care visit

21.5 4.8

18.8 2.2

24.0 7.1

20.6 4.4

26.3 8.3

32.5 15.9

Source: National Center for Health Statistics, Health Characteristics of Adults Aged 55 Years and Over: United States, 2004–2007, National Health Statistics Reports, No. 16, 2009, Internet site http://www.cdc.gov/nchs/products/nhsr.htm; calculations by New Strategist

40 AMERICAN HEALTH

AGING

Most Older Americans Can Care for Themselves When disabilities become too great, some must go to a nursing home. As people age, the percentage with problems caring for themselves increases. But until the age of 85 or older, few of the noninstitutionalized elderly have many difﬁculties performing daily activities. Among people aged 65 to 74 living in the community, walking presents the greatest challenge. Even so, only 18 percent say they have difﬁculty walking. In the 75-to-84 age group, a larger 26 percent have problems walking and one-third have trouble with heavy housework. In the 85-orolder age group, a larger percentage face obstacles to independent living. Forty-three percent have problems walking, nearly one in three has difﬁculty shopping, 23 percent have difﬁculty bathing, and 24 percent have problems with even light housework. When the difﬁculties in caring for oneself become too great, some of the elderly move into institutions where they receive care. Most of the institutionalized population aged 65 or older has problems carrying out daily activities. Caregivers, many of them family members, are one reason why many older people can remain in their homes despite increasing disability. According to the Family Caregiver Alliance, 34 million family members help care for people aged 50 or older. ■ Allowing people to live independently in old age will become increasingly important as the large baby-boom generation enters the ﬁnal decades of life.

Incontinence is a growing problem with age

60

(percent of Medicare beneﬁciaries aged 65 or older with bladder incontinence, by age, 2006)

44.5% 40

40%

20

20%

0

0%

33.1% 23.0%

65 a to 74

75 to b84

85 orcolder

AMERICAN HEALTH

41

Table 2.4

Difﬁculty Performing Activities of Daily Living among Medicare Beneﬁciaries, 2006

(percent of Medicare beneﬁciaries aged 65 or older with difﬁculty performing activities of daily living, by place of residence and age, 2006) bathing, showering

dressing

eating

getting in/out of bed/chairs

using toilet

walking

TOTAL MEDICARE BENEFICIARIES

Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

13.5% 6.9 14.2 34.0

9.8% 5.7 9.8 24.1

Live in community Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

9.9 6.0 10.9 23.0

6.7 4.9 6.8 13.5

Live in facility Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

90.8 89.2 91.9 90.4

78.8 74.2 81.2 78.4

4.4% 2.3 4.4 11.7

14.4% 9.4 15.7 28.2

25.5% 18.2 27.3 45.8

7.9% 4.0 8.3 20.3

2.3 1.7 2.4 4.5

12.0 8.8 13.5 20.3

23.9 17.7 25.9 42.7

4.8 3.1 5.4 10.2

49.9 54.3 50.7 48.4

66.9 61.6 66.4 68.6

60.9 61.8 59.4 61.6

73.3 73.5 75.8 71.6

Note: Facilities include nursing homes, retirement homes, personal care facilities, distinct long-term units in a hospital complex, mental health facilities and centers, assisted and foster care homes, and institutions for the mentally retarded and developmentally disabled.

Table 2.5

People Aged 65 or Older Who Need Help Performing Activities of Daily Living, 2008

(percent of noninstitutionalized people aged 65 or older who need help performing activities of daily living, by age, 2008) any activity

Total aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

4.7% 2.6 5.5 14.9

bathing, showering

3.4% 1.6 4.2 12.2

dressing

3.0% 1.4 3.3 11.0

getting in/out of bed/chairs

2.5% 1.3 2.8 8.9

using toilet

getting around inside home

2.1% 1.3 2.0 7.8

Source: National Center for Health Statistics, Health Data Interactive, Internet site http://www.cdc.gov/nchs/hdi.htm

42 AMERICAN HEALTH

2.2% 1.1 2.4 7.8

AGING

Table 2.6

Difﬁculty Performing Instrumental Activities of Daily Living among Medicare Beneﬁciaries, 2006

(percent of Medicare beneﬁciaries aged 65 or older with difﬁculty performing instrumental activities of daily living, by place of residence and age, 2006) using the telephone

light housework

heavy housework

preparing meals

shopping

managing money

TOTAL MEDICARE BENEFICIARIES

Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

9.1% 4.5 9.7 23.2

11.7% 8.0 12.6 24.2

29.8% 22.2 32.7 52.0

9.3% 5.5 10.1 22.6

16.6% 9.3 17.4 39.4

10.2% 4.5 10.1 30.0

Live in community Aged 65 or older

7.0

Aged 65 to 74 Aged 75 to 84 Aged 85 or older

4.0 7.7 16.9

11.7 8.0 12.6 24.2

29.8 22.2 32.7 52.0

9.3 5.5 10.1 22.6

13.8 8.5 14.8 32.0

7.0 3.6 7.1 20.3

Live in facility Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

55.7 48.6 57.1 56.4

– – – –

– – – –

– – – –

78.6 80.5 79.3 77.6

80.4 78.6 80.6 80.6

Note: Facilities include nursing homes, retirement homes, personal care facilities, distinct long-term units in a hospital complex, mental health facilities and centers, assisted and foster care homes, and institutions for the mentally retarded and developmentally disabled. “–” means not applicable. Source: National Center for Health Statistics, Health Data Interactive, Internet site http://www.cdc.gov/nchs/hdi.htm

AMERICAN HEALTH

43

Table 2.7

Incontinence among Medicare Beneﬁciaries, 2006

(percent of Medicare beneﬁciaries aged 65 or older with bladder incontinence, by place of residence, age, and sex, 2006) total

men

women

Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

29.8% 23.0 33.1 44.5

18.9% 13.4 23.4 32.2

37.8% 31.4 40.1 49.8

Live in community Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

28.1 22.6 31.5 40.6

17.9 13.1 22.1 30.2

35.9 30.9 38.6 45.6

Live in facility Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

65.1 60.6 68.0 64.3

57.4 – 65.0 52.4

67.5 67.0 69.2 66.6

TOTAL MEDICARE BENEFICIARIES

Note: Facilities include nursing homes, retirement homes, personal care facilities, distinct long-term units in a hospital complex, mental health facilities and centers, assisted and foster care homes, and institutions for the mentally retarded and developmentally disabled. “–” means data are not available. Source: National Center for Health Statistics, Health Data Interactive, Internet site http://www.cdc.gov/nchs/hdi.htm

44 AMERICAN HEALTH

AGING

Fewer People Are in Nursing Homes The rise of assisted living facilities may explain the decline. The number of Americans in nursing homes peaked in 1999 and was about the same in 2004 (1.5 million) as it was in 1985—despite tremendous growth in the older population. The rate at which Americans are institutionalized in nursing homes has fallen signiﬁcantly over the past 30 years, according to results from the National Nursing Home Survey. In 1977, 47.2 of every 1,000 people aged 65 or older were in nursing homes. By 2004, the rate had fallen by 23 percent to 36.3 per 1,000. The decline has taken many by surprise because a rapid expansion of the nursing home population had been predicted due to the aging of the population. The rise of assisted living facilities is one factor that may explain the decline in the nursing home population. Nursing home residents are overwhelmingly female (71 percent), and the proportion increases with advancing age. Among nursing home residents aged 85 or older, 82 percent are female. The 53 percent majority of nursing home residents are widowed. Among those who had been living in a private or semiprivate residence before admission, 41 percent had been living alone. ■ The declining rate of nursing home care is good news for an aging population. 2400000

The number of nursing home residents peaked in 1999 (number of nursing home residents, 1977 to 2004)

1,600,000 1600000

800,000 800000

00

1977 a

1985 b

1995 c

1997 d

1999 e

2004 f

AMERICAN HEALTH

45

Table 2.8

Number of Nursing Home Residents and Rate of Nursing Home Care, 1977 to 2004

(total number of nursing home residents and number of residents per 1,000 people by age, selected years, 1977 to 2004) 2004

1999

1997

1995

1985

1977

Total number of nursing home residents 1,492,000 1,628,300 1,608,700 1,548,600 1,491,400 1,303,100 Number of residents per 1,000 people Under age 65 0.7 Aged 65 or older 36.3 Aged 65 to 74 9.4 Aged 75 to 84 36.1 Aged 85 or older 138.7

0.7 42.5 10.7 42.6 181.3

0.6 42.9 10.7 45.0 188.7

0.5 41.8 10.1 45.3 192.9

0.8 46.3 12.6 57.1 223.8

0.9 47.2 14.4 64.3 227.8

percent change, 1977–2004

14.5% –22.2 –23.1 –34.7 –43.9 –39.1

Source: National Center for Health Statistics, National Nursing Home Surveys, Trends in Nursing Homes, Internet site http:// www.cdc.gov/nchs/nnhs/nursing_home_trends.htm; and Health Data Interactive, Internet site http://www.cdc.gov/nchs/hdi.htm

46 AMERICAN HEALTH

AGING

Table 2.9

Nursing Home Residents Aged 65 or Older by Sex, Race, and Hispanic Origin, 2004

(number and percent distribution of nursing home home residents aged 65 or older by sex, race, Hispanic origin, and age, 2004) aged 65 or older total

under age 65

total

65 to 74

75 to 84

85 or older

Total nursing home residents Female Male

1,492,200 1,061,700 430,500

175,000 81,300 93,700

1,317,200 980,400 336,800

174,100 98,800 75,400

468,900 328,000 140,800

674,200 553,600 120,600

Black Hispanic White

186,100 57,200 1,276,000

40,700 13,100 127,100

145,400 44,100 1,148,900

34,500 11,300 134,200

54,600 18,800 405,800

56,300 14,100 608,900

PERCENT DISTRIBUTION BY AGE Total nursing home residents 100.0% Female 100.0 Male 100.0

11.7% 7.7 21.8

88.3% 92.3 78.2

11.7% 9.3 17.5

31.4% 30.9 32.7

45.2% 52.1 28.0

Black Hispanic White

21.9 22.9 10.0

78.1 77.1 90.0

18.5 19.8 10.5

29.3 32.9 31.8

30.3 24.7 47.7

100.0% 70.0 30.0

100.0% 82.1 17.9

11.6 4.0 86.5

8.4 2.1 90.3

100.0 100.0 100.0

PERCENT DISTRIBUTION BY SEX, RACE, AND HISPANIC ORIGIN Total nursing home residents 100.0% 100.0% 100.0% 100.0% Female 71.1 46.5 74.4 56.7 Male 28.9 53.5 25.6 43.3 Black Hispanic White

12.5 3.8 85.5

23.3 7.5 72.6

11.0 3.3 87.2

19.8 6.5 77.1

Source: National Center for Health Statistics, National Nursing Home Survey: 2004 Overview, Vital and Health Statistics, Series 13, No. 167, 2009, Internet site http://www.cdc.gov/nchs/nnhs.htm

AMERICAN HEALTH

47

Table 2.10

Nursing Home Residents by Marital Status and Prior Living Arrangement, 2004

(number and percent distribution of nursing home residents and median length of stay in days, by marital status, previous residence, and previous living arrangement, 2004) number

Total nursing home residents

1,492,200

percent distribution

median length of stay

100.0%

463

Current marital status Married Widowed Divorced or separated Single or never married Unknown

301,400 795,800 152,000 221,500 21,500

20.2 53.3 10.2 14.8 1.4

345 480 543 556 255

Residence before admission Private or semiprivate residence Assisted living Nursing home Hospital-based skilled nursing facility Acute care hospital Other institution Unknown

434,600 118,100 172,900 128,400 535,100 55,500 47,600

29.1 7.9 11.6 8.6 35.9 3.7 3.2

581 439 521 368 346 803 746

100.0% 41.2 49.9 2.1 6.9

581 632 523 863 642

Living arrangement before admission for those living in private or semiprivate residence Total in private or semiprivate residence 434,600 Alone 178,900 With family members 216,700 With nonfamily members 9,000 Other and unknown 30,000

Source: National Center for Health Statistics, National Nursing Home Survey: 2004 Overview, Vital and Health Statistics, Series 13, No. 167, 2009, Internet site http://www.cdc.gov/nchs/nnhs.htm

48 AMERICAN HEALTH

ALTERNATIVE MEDICINE CHAPTER

3

Alternative Medicine ■ Thirty-eight percent of Americans have turned to alternative medicine in the past year. Women are more likely than men to use alternative medicine, and the likelihood of use peaks in the 50-to-59 age group.

■ Back pain is the most common reason for seeking alternative medicine. Seventeen percent of the users of alternative medicine sought treatment for back pain.

■ Americans spend billions on alternative medicine. The public spent $34 billion out-of-pocket on alternative medicine in 2007, 11 percent of all out-ofpocket health care expenditures in that year.

AMERICAN HEALTH

49

Millions Turn to Alternative Medicine Herbal supplements are the most commonly used alternative medicine among both children and adults. Thirty-eight percent of adults and 12 percent of children have used some type of complementary or alternative medicine in the past year, according to the National Center for Health Statistics. Included in the deﬁnition of complementary and alternative medicine are treatments and practitioners such as acupuncture, homeopaths, traditional healers, diet-based therapies, chiropractic manipulations, pilates, meditation, yoga, and tai chi. Women are more likely than men to have used alternative therapies in the past year (43 versus 34 percent). By age, usage peaks among 50-to-59-year-olds at 44 percent. American Indians are more likely than other racial or ethnic groups to turn to alternative medicine, half having done so in the past year. The use of alternative medicine rises with education from a low of 21 percent among people who did not complete high school to a peak of 55 percent among those with a graduate degree. Among people aged 18 to 64, those with private health insurance are most likely to use alternative therapies. The more frequently someone visits a doctor, the more likely he or she is to seek alternatives to traditional medicine. Similarly, the more health problems people have, the more likely they are to use alternative therapies. Not surprisingly, children whose parents use alternative or complementary medicine are most likely to use it themselves. While 12 percent of all children have used it, among those whose parents use alternative therapies the proportion doubles to 24 percent. ■ The use of alternative therapies has become widely accepted by Americans and is even encouraged by some medical doctors.

Educated people are most likely to turn to alternative medicine (percent of people aged 18 or older who used alternative or complementary medicine in the past 12 months, by education, 2007) 60

55% 45%

47%

50%

40 40%

31% 20 20%

0 0%

21%

not a a high school graduate

50 AMERICAN HEALTH

highb school graduate or GED

some c college, no degree

d associate’s degree

e bachelor’s degree

f graduate degree

ALTERNATIVE MEDICINE

Table 3.1

Use of Alternative and Complementary Medicine by Type and Age, 2007

(number and percent of people who used complementary or alternative medicine in the past 12 months by age, 2007; numbers in thousands) children (under age 18) number

adults (aged 18 or older) number

percent

11.8%

87,217

38.3%

79 150 907 237 767

0.1 0.2 1.3 0.3 1.1

214 3,141 3,909 729 812

0.1 1.4 1.8 0.3 0.4

Biologically based therapies Chelation therapy Nonvitamin, nonmineral natural products Diet-based therapies Vegetarian diet Atkins diet South Beach diet

72 2,850 565 367 88 128

0.1 3.9 0.8 0.5 0.1 0.2

111 38,797 7,893 3,351 2,673 2,334

0.0 17.7 3.6 1.5 1.2 1.1

Manipulative and body-based therapies Chiropractic or osteopathic manipulation Massage Movement therapies Pilates

2,020 743 299 245

2.8 1.0 0.4 0.3

18,740 18,068 3,146 3,015

8.6 8.3 1.5 1.4

Mind–body therapies Meditation Guided imagery Progressive relaxation Deep breathing exercises Yoga Tai chi

725 293 329 1,558 1,505 113

1.0 0.4 0.5 2.2 2.1 0.2

20,541 4,866 6,454 27,794 13,172 2,267

9.4 2.2 2.9 12.7 6.1 1.0

161

0.2

1,216

0.5

ANY USE

Alternative medical systems Ayurveda Acupuncture Homeopathic treatment Naturopathy Traditional healers

Energy healing therapy/Reiki

8,720

percent

Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008, Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

AMERICAN HEALTH

51

Table 3.2

Users of Alternative and Complementary Medicine by Age, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by age, 2007) total

18 to 29

30 to 39

40 to 49

50 to 59

60 to 69

70 to 84

85 or older

Any alternative or complementary medicine 38.3%

36.3%

39.6%

40.1%

44.1%

41.0%

32.1%

24.2%

Biologically based therapies

19.9

15.9

19.8

20.4

24.2

25.4

19.3

13.7

Mind–body therapies including prayer

19.2

21.3

19.9

19.7

22.9

17.3

11.9

9.8

3.4

3.2

3.6

4.6

4.9

2.8

1.8

1.9

15.2

15.1

17.2

17.4

17.3

13.8

9.9

7.0

Alternative medical systems Manipulative and body-based therapies

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

Table 3.3

Users of Alternative and Complementary Medicine by Sex, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by sex, 2007) total

Any alternative or complementary medicine Biologically based therapies Mind–body therapies including prayer Alternative medical systems Manipulative and body-based therapies

38.3% 19.9 19.2 3.4 15.2

female

42.8% 21.9 23.8 4.2 18.1

male

33.5% 17.8 14.4 2.7 12.2

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

52 AMERICAN HEALTH

ALTERNATIVE MEDICINE

Table 3.4

Users of Alternative and Complementary Medicine by Race and Hispanic Origin, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by race and Hispanic origin, 2007) American Indian

total

Asian

black

Hispanic

non-Hispanic white

Any alternative or complementary medicine

38.3%

50.3%

39.9%

25.5%

23.7%

43.1%

Biologically based therapies

19.9

23.7

19.6

12.3

11.8

22.7

Mind–body therapies including prayer

19.2

23.3

23.4

14.8

10.6

21.4

3.4

13.2

5.4

1.4

3.0

3.7

15.2

13.4

11.1

6.5

6.7

18.7

Alternative medical systems Manipulative and body-based therapies

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Note: Asians and blacks are those who identify themselves as being of the race alone. Non-Hispanic whites are those who identify themselves as being white alone and not Hispanic. American Indians are those who identify themselves as being American Indian or Alaska Native alone. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

Table 3.5

Users of Alternative and Complementary Medicine by Region, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by region, 2007) Any alternative or complementary medicine Biologically based therapies Mind–body therapies including prayer Alternative medical systems Manipulative and body-based therapies

total

38.3% 19.9 19.2 3.4 15.2

Northeast

38.0% 18.2 21.1 3.8 15.0

Midwest

41.4% 20.4 20.6 2.8 17.9

South

32.5% 17.7 15.0 2.4 11.5

West

44.6% 24.4 23.2 5.6 18.4

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

AMERICAN HEALTH

53

Table 3.6

Users of Alternative and Complementary Medicine by Education, 2007

(percent of total people and people aged 25 or older who used selected complementary and alternative medicine categories during the past 12 months by education, 2007) aged 25 or older total 18 or older

Any alternative or complementary medicine 38.3%

not a high school graduate

high school graduate or GED

associate’s degree

bachelor’s degree

graduate degree

31.0%

45.0%

47.2%

49.6%

55.4%

Biologically based therapies

19.9

9.8

16.3

24.4

24.9

27.5

30.1

Mind–body therapies including prayer

19.2

7.6

12.1

22.0

24.3

25.5

34.2

3.4

2.1

2.0

4.3

3.6

5.4

6.1

15.2

6.4

11.5

18.0

18.2

20.7

23.6

Alternative medical systems Manipulative and body-based therapies

20.8%

some college, no degree

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children:

Table 3.7

Users of Alternative and Complementary Medicine by Health Insurance Status, 2007

(percent of total people and people aged 18 to 64 who used selected complementary and alternative medicine categories during the past 12 months by health insurance status, 2007) aged 18 to 64

Any alternative or complementary medicine Biologically based therapies Mind–body therapies including prayer Alternative medical systems Manipulative and body-based therapies

total 18 or older

38.3% 19.9 19.2 3.4 15.2

private insurance

42.7% 21.3 22.0 3.9 19.0

public insurance

30.6% 14.9 18.7 2.6 9.6

uninsured

31.5% 17.0 16.2 4.0 9.8

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/

54 AMERICAN HEALTH

ALTERNATIVE MEDICINE

Table 3.8

Users of Alternative and Complementary Medicine by Drinking Status, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by drinking status, 2007)

Any alternative or complementary medicine Biologically based therapies Mind–body therapies including prayer Alternative medical systems Manipulative and body-based therapies

total

abstainer

38.3% 19.9 19.2 3.4 15.2

23.5% 11.1 11.0 2.2 7.5

former drinker

37.6% 19.3 19.8 3.2 12.8

infrequent or light drinker

44.6% 23.7 23.0 4.0 18.3

moderate or heavy drinker

45.4% 24.2 22.3 3.8 19.3

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind-body therapies include biofeedback, meditation, guided imagery, progressive relxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation; massage; and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm Advance Data, No. 343, 2004; Internet site http://www.cdc.gov/nchs/pressroom/04news/adultsmedicine.htm

Table 3.9

Users of Alternative and Complementary Medicine by Smoking Status, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by smoking status, 2007) total

Any alternative or complementary medicine Biologically based therapies Mind–body therapies including prayer Alternative medical systems Manipulative and body-based therapies

38.3% 19.9 19.2 3.4 15.2

never smoked

former smoker

current smoker

36.0% 18.6 17.8 3.3 14.8

48.1% 26.8 24.7 4.8 19.2

35.6% 17.0 19.4 2.4 12.8

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind-body therapies include biofeedback, meditation, guided imagery, progressive relxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation; massage; and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm Advance Data, No. 343, 2004; Internet site http://www.cdc.gov/nchs/pressroom/04news/adultsmedicine.htm

AMERICAN HEALTH

55

Table 3.10

Users of Alternative and Complementary Medicine by Number of Doctor Visits, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by number of doctor visits in past 12 months, 2007) total

none

two to three

one

four to nine

ten or more

Any alternative or complementary medicine

38.3%

24.5%

32.3%

39.4%

47.2%

53.4%

Biologically based therapies

19.9

13.0

16.8

20.9

25.1

25.3

Mind–body therapies including prayer

19.2

13.2

14.7

19.7

23.8

28.8

3.4

2.0

2.7

3.1

4.2

6.7

15.2

6.0

10.7

15.0

20.6

28.3

Alternative medical systems Manipulative and body-based therapies

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

Table 3.11

Users of Alternative and Complementary Medicine by Number of Health Conditions, 2007

(percent of people aged 18 or older who used selected complementary and alternative medicine categories during the past 12 months by number of health conditions, 2007)

Any alternative or complementary medicine Biologically based therapies Mind–body therapies including prayer Alternative medical systems Manipulative and body-based therapies

total

38.3% 19.9 19.2 3.4 15.2

none

21.3% 10.0 9.8 1.4 7.5

one to two

33.3% 16.5 16.2 2.2 12.5

three to ﬁve

42.3% 22.8 19.5 3.9 18.1

six or more

53.8% 28.4 30.6 5.7 22.1

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

56 AMERICAN HEALTH

ALTERNATIVE MEDICINE

Table 3.12

Characteristics of Children Who Use Complementary and Alternative Medicine, 2007

(percent of people under age 18 who used complementary or alternative medicine (CAM) in the past 12 months, by selected characteristics, 2007) mind–body therapies

alternative medical systems

manipulative and body-based therapies

Total children Children whose parent uses CAM

11.8% 23.9

any

biologically based therapies

Sex Female Male

12.6 11.0

4.6 4.8

4.9 3.8

2.8 2.4

4.2 3.2

Age Aged 0 to 4 Aged 5 to 11 Aged 12 to 17

7.6 10.7 16.4

3.2 4.3 6.3

1.9 3.9 6.8

2.9 2.5 2.5

2.1 2.8 5.9

Race and Hispanic origin Black Hispanic Non-Hispanic white

5.9 7.9 12.8

1.7 2.8 5.2

3.0 2.8 4.4

1.4 2.5 2.8

0.8 1.9 4.4

Family structure Mother and father Mother, no father

12.7 9.6

5.2 3.3

4.3 4.8

2.7 2.2

4.2 2.5

Parent’s education Not a high school graduate High school graduate or GED More than high school

4.8 8.0 14.7

1.7 2.8 6.1

1.9 2.3 5.6

1.5 1.7 3.2

1.3 2.5 4.6

Number of health conditions No conditions One to two conditions Three to ﬁve conditions Six or more conditions

4.0 8.5 14.1 23.8

1.3 2.9 6.0 8.8

1.1 3.2 4.8 10.2

1.9 1.5 2.9 5.6

1.4 2.3 4.2 5.4

4.9 3.6 3.4 6.0 12.0

2.5 2.1 4.5 5.0 12.9

2.6 1.6 2.6 2.5 6.3

1.9 1.9 3.1 5.6 10.0

Delayed conventional care because of worry about costs Yes 16.9 7.3

6.6

5.0

6.2

No

4.2

2.6

3.6

Number of visits to doctor in past 12 months No visits 7.7 One visit 7.8 Two to three visits 11.1 Four to nine visits 15.0 10 or more visits 28.4

11.6

4.7% 10.3

4.6

4.3% 9.8

2.6% 4.2

3.7% 7.5

Deﬁnitions: Biologically based therapies include chelation therapy; nonvitamin, nonmineral, natural products; and diet-based therapies. Mind–body therapies include biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, tai chi, and qi gong. Alternative medical systems include acupuncture, ayurveda, homeopathic treatment, naturopathy, and traditional healers. Manipulative body-based therapies include chiropractic or osteopathic manipulation, massage, and movement therapies. Note: Asians and blacks are those who identify themselves as being of the race alone. Non-Hispanic whites are those who identify themselves as being white alone and not Hispanic. Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

AMERICAN HEALTH

57

Alternative Therapies Are Most Commonly Used for Back Problems The lack of effective conventional treatment encourages experimentation. Among adults who have used alternative therapies in the past 12 months, back pain is the most common condition for which relief is sought. Seventeen percent of the users of alternative medicine are treating back pain. Neck problems, joint pain, and arthritis are also at the top of the list. Among children who use alternative medicine, back pain is the number-one reason, followed by colds, anxiety, and ADHD. Fish oil is the most popular natural product consumed for health reasons. Thirty-seven percent of adults have used ﬁsh oil in the past 30 days. Among children, Echinacea is number-one at 37 percent and ﬁsh oil is second. More than 30 percent of children under age 18 have used ﬁsh oil for health reasons in the past month. ■ Most people who use alternative therapies do so in combination with conventional treatment, making it important for physicians to know what else their patients are doing to solve their medical problem.

Arthritis is one of the top ﬁve reasons why people turn to alternative therapies (percent of alternative medicine users, by condition being treated, 2007)

20

17.1% 15 15%

10 10%

5.9% 5 5%

0 0%

back a pain or problem

58 AMERICAN HEALTH

neck b pain or problem

5.2%

joint c pain or stiffness

3.5%

2.8%

arthritis d

anxiety e

ALTERNATIVE MEDICINE

Table 3.13

Alternative Medicine Use among Adults by Disease or Condition, 2007

(percent of people aged 18 or older who used complementary and alternative medicine in the past 12 months by selected diseases and conditions for which it was used, 2007) 18 or older

Back pain or problem Neck pain or problem Joint pain or stiffness Arthritis Anxiety Cholesterol Head or chest cold Severe headache or migraine Insomnia or trouble sleeping Stress Stomach or intestinal illness Depression Regular headaches Hypertension Fibromyalgia Diabetes Sprain or strain Coronary heart disease

17.1% 5.9 5.2 3.5 2.8 2.1 2.0 1.6 1.4 1.3 1.2 1.2 1.0 0.9 0.8 0.7 0.7 0.7

Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

Table 3.14

Alternative Medicine Use among Children by Disease or Condition, 2007

(percent of people under age 18 who used complementary and alternative medicine in the past 12 months by selected diseases and conditions for which it was used, 2007) under 18

Back pain or problem Head or chest cold Anxiety or stress ADHD/ADD Insomnia or trouble sleeping Asthma Sinusitis Other allergies Respiratory allergy Sore throat other than strep or tonsillitis Depression Abdominal pain

6.7% 6.6 4.8 2.5 1.8 1.6 1.5 1.4 1.3 1.1 1.0 0.8

Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

AMERICAN HEALTH

59

Table 3.15

Adult Use of Nonvitamin, Nonmineral Natural Products by Type, 2007

(percent of people aged 18 or older who used nonvitamin, nonmineral, natural products during the past 30 days for health reasons, 2007) 18 or older

Fish oil or omega 3 or DHA Glucosamine Echinacea Flaxseed oil or pills Ginseng Combination herb pill Ginkgo biloba Chondroitin Garlic supplements Coenzyme Q-10 Fiber or psyllium Green tea pills Cranberry (pills, gelcaps) Saw palmetto Soy supplements or isofavones Melatonin Grape seed extract MSM (methylsulfonylmethane) Milk thistle Lutein

37.4% 19.9 19.8 15.9 14.1 13.0 11.3 11.2 11.0 8.7 6.6 6.3 6.0 5.1 5.0 4.6 4.3 4.1 3.7 3.4

Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

Table 3.16

Children’s Use of Nonvitamin, Nonmineral Natural Products by Type, 2007

(percent of people under age 18 who used nonvitamin, nonmineral, natural products during the past 30 days for health reasons, 2007) under 18

Echinacea Fish oil or omega 3 or DHA Combination herb pill Flaxseed oi or pills Prebiotics or probiotics Goldenseal Garlic supplements Melatonin Cranberry (pills, gelcaps)

37.2% 30.5 17.9 16.7 13.6 8.6 5.9 5.8 1.8

Source: National Center for Health Statistics, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008; Internet site http://nccam.nih.gov/news/camstats/2007/ index.htm

60 AMERICAN HEALTH

ALTERNATIVE MEDICINE

We Spend Billions on Alternative Medicine Among alternative practitioners, the public spends the most on massage therapists. Eighteen million people visited a massage therapist in 2007, spending $4.2 billion on the service. Chiropractors rank second in spending, with 19 million people spending $3.9 billion on chiropractic care. No other type of alternative therapy practitioner surpassed the $1 billion threshold. Among those visiting a massage therapist in 2007, the average number of visits was 2.16 at a cost of $47 per visit. Among those visiting chiropractors, the average number of visits was a larger 3.45, but the cost per visit was a smaller $22. The American public spent nearly $15 billion on herbal supplements in 2007, with an average of 5.4 purchases per person. Another $4 billion was spent on yoga, tai chi, and qi gong therapy. The public spent $3 billion on homeopathic medicine during the year. Overall, the National Center for Health Statistics estimates that Americans spent $34 billion out-of-pocket in 2007 on visits to alternative practitioners and on purchases of alternative products. This ﬁgure amounted to a substantial 11 percent of all out-of-pocket health care expenditures in that year. ■ The public devotes a large share of its out-of-pocket health care spending to alternative medicine.

Americans spent $34 billion on alternative medicine practitioners and products (out-of-pocket spending on alternative practitioners and products, by type of spending, 2007; in billions of dollars) 15

$14.8

$10 billion 10

$5 billion 5

0 $0

$4.2

a nonvitamin, nonmineral natural products

bto visits massage therapists

$4.1

$3.9

$3.8

yoga,c tai chi, and qi gong therapies

d to visits chiropractors

visitse to other alternative practitioners

$2.9

f homeopathic medicine products

AMERICAN HEALTH

61

Table 3.17

Total Visits and Out-of-Pocket Costs for Visits to Alternative and Complementary Medicine Practitioners by Type, 2007

(number of people who saw a complementary and alternative medicine practitioner in the past 12 months, total number of practitioner visits, and total out-of-pocket costs, by type of therapy, 2007; numbers in thousands) total seeing a practitioner

total visits to practitioners

total out-of-pocket costs

38,146 4,965 3,141 214 862 729 812

354,203 27,734 17,629 1,068 3,411 3,180 2,446

$11,938,611 1,392,508 827,336 18,793 167,416 275,863 103,100

1,828 111 1,488 270

9,600 426 8,273 902

630,479 31,913 566,650 31,916

33,044 18,740 18,068 3,146

276,861 151,220 95,296 30,345

8,629,455 3,901,894 4,175,124 552,438

Mind–body therapies Biofeedback Relaxation techniques Hypnosis

3,821 362 3,131 561

32,806 1,991 28,882 1,933

864,567 83,542 707,175 73,850

Energy healing therapy

1,216

7,203

421,602

TOTAL

Alternative medical systems Acupuncture Ayurveda Homeopathic treatment Naturopathy Traditional healers Biologically based therapies Chelation therapy Nonvitamin, nonmineral, and natural products Diet-based therapies Manipulative and body-based therapies Chiropractic or osteopathic manipulation Massage Movement therapies

Source: National Center for Health Statistics, Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007, National Health Statistics Report, No. 18, 2009, Internet site http://www.cdc .gov/nchs/products/nhsr.htm

62 AMERICAN HEALTH

ALTERNATIVE MEDICINE

Table 3.18

Per-Person Visits and Out-of-Pocket Costs of Visits to Alternative and Complementary Medicine Practitioners by Type, 2007

(median number of visits to a complementary and alternative medicine practitioner per person in the past 12 months, out-of-pocket costs per person, and out-of-pocket costs per visit, by type of therapy, 2007) visits per person

out-of-pocket costs per person

out-of-pocket costs per visit

Alternative medical systems Acupuncture Ayurveda Homeopathic treatment Naturopathy Traditional healers

3.86 2.83 2.42 – 2.00 1.98 –

$121.92 101.00 122.35 – 86.73 251.84 28.57

$29.37 39.59 48.25 – 32.16 63.25 19.00

Biologically based therapies Chelation therapy Nonvitamin, nonmineral, and natural products Diet-based therapies

2.13 – 2.32 –

97.86 224.52 102.16 –

29.62 – 32.90 –

Manipulative and body-based therapies Chiropractic or osteopathic manipulation Massage Movement therapies

3.43 3.45 2.16 4.98

121.30 104.29 136.73 –

29.45 21.62 46.65 4.55

Mind–body therapies Biofeedback Relaxation techniques Hypnosis

3.22 2.38 3.47 –

– – – –

– – – 44.06

Energy healing therapy

2.26

59.58

28.47

TOTAL

Note: “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007, National Health Statistics Report, No. 18, 2009, Internet site http://www.cdc .gov/nchs/products/nhsr.htm

AMERICAN HEALTH

63

Table 3.19

Cost of Alternative and Complementary Medicine Materials and Therapy, 2007

(selected characteristics of purchases of complementary and alternative medicine materials or therapy in the past 12 months, by type, 2007)

Total persons purchasing (in 000s) Total number of purchases (in 000s) Total out-of-pocket costs (in 000s) Purchases per person Out-of-pocket costs per person Out-of-pocket costs per purchase

nonvitamin, nonmineral natural products (herbal supplements)

homeopathic medicine

yoga, tai chi and qi gong

relaxation techniques

24,905 438,094 $14,824,409 5.41 $176.77 $19.18

3,326 69,300 $2,944,215 1.58 $37.99 $15.28

5,981 327,207 $4,065,964 24.90 $49.43 $4.37

6,442 – $187,772 – $18.30 –

Note: Relaxation techniques include meditation, guided imagery, progressive relaxation, and deep-breathing exercises. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007, National Health Statistics Report, No. 18, 2009, Internet site http://www.cdc .gov/nchs/products/nhsr.htm

64 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE CHAPTER

4

Attitudes toward Health Care ■ Few have much conﬁdence in the medical community. Only 39 percent of the public says it has a “great deal” of conﬁdence in the medical community, down from 48 percent in 1978.

■ Most think the government should be responsible for health care. The 54 percent majority of the public says it is primarily the federal government’s responsibility to make sure people can pay their medical bills.

■ Fifty-ﬁve percent rate their health as “excellent” or “very good.” The percentage of people aged 18 or older who rate their health highly is declining, and the public is reporting more days of poor physical health.

■ People under age 65 are least satisﬁed with their health care. People aged 65 or older on Medicare are most likely to give the health care they receive the highest rating.

AMERICAN HEALTH

65

Fewer Americans Have Conﬁdence in the Medical Community The reputation of the medical community is eroding as problems with the health care system increase. The percentage of people with a great deal of conﬁdence in the leaders of the medical community fell to 39 percent in 2008. One reason for declining conﬁdence is the sense that the nation is not doing enough to protect and improve the public’s health. Seventy-seven percent of Americans think the nation spends too little on health, up sharply from the 57 percent of 1978. The 54 percent majority of the public says it is primarily the federal government’s responsibility to make sure people can pay their medical bills. The middle aged are particularly upset about the nation’s health care system. Only 32 percent of people aged 45 to 64 have a great deal of conﬁdence in the medical community, and 81 percent think the nation spends too little on improving and protecting the nation’s health. ■ As costs rise and growing numbers of Americans lose their health insurance, the demand for change in the nation’s health care delivery system will grow.

Most think government should be responsible for health care (percent distribution of people aged 18 or older by opinion on whose responsibility it is to pay for medical care, 2008)

16% people should help themselves c

54% federal government’s responsibility

a b c

a b 30% government and individuals are responsible

66 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.1

Conﬁdence in Medicine, 1978 to 2008 “As far as the people running these institutions are concerned, would you say you have a great deal of conﬁdence, only some conﬁdence, or hardly any conﬁdence at all in them: Medicine?”

(percent of people aged 18 or older responding, 1978 to 2008; and percent responding by demographic characteristic, 2008) a great deal

only some

hardly any

TREND 2008 1998 1988 1978

39.2% 45.6 53.2 47.6

50.3% 45.4 40.9 43.6

10.5% 8.9 5.9 8.7

2008 PROFILE Total people

39.2

50.3

10.5

Men Women

39.9 38.5

48.7 51.7

11.4 9.8

Black Hispanic White

33.9 50.0 39.1

50.9 41.8 50.6

15.3 8.2 10.3

Aged 18 to 44 Aged 45 to 64 Aged 65 or older

43.2 32.3 42.6

46.5 56.4 47.7

10.3 11.3 9.6

Not a college graduate Bachelor’s degree or more

37.7 43.1

50.4 50.1

11.9 6.8

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

AMERICAN HEALTH

67

Table 4.2

Spending on Improving Nation’s Health, 1978 to 2008

“We are faced with many problems in this country, none of which can be solved easily or inexpensively. Do you think we’re spending too much money, too little money, or about the right amount on improving and protecting the nation’s health?” (percent of people aged 18 or older responding, 1978 to 2008; and percent responding by demographic characteristic, 2008) too little

about right

too much

TREND 2008 1998 1988 1978

77.1% 68.5 69.6 57.4

18.1% 25.3 27.3 35.7

4.8% 6.3 3.1 6.9

2008 PROFILE Total people

77.1

18.1

4.8

Men Women

74.7 79.2

18.3 17.9

7.0 2.8

Black Hispanic White

86.6

6.7

6.7

76.5

19.5

4.0

Aged 18 to 44 Aged 45 to 64 Aged 65 or older

76.0 81.3 70.0

18.4 15.3 23.7

5.5 3.4 6.4

Not a college graduate Bachelor’s degree or more

75.5 81.4

19.5 14.2

5.0 4.3

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

68 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.3

Government Should Help Pay for Medical Care, 1988 and 2008

“In general, some people think that it is the responsibility of the government in Washington to see to it that people have help in paying for doctors and hospital bills; they are at point 1. Others think that these matters are not the responsibility of the federal government and that people should take care of these things themselves; they are at point 5. Where would you place yourself on the scale?” (percent of people aged 18 or older responding, 1988 to 2008; and percent responding by demographic characteristic, 2008) 1 government should help

2

3 agree with both

4

5 people should help themselves

TREND 2008 1998 1988

34.9% 25.5 26.3

18.7% 23.3 21.5

30.0% 32.9 37.0

2008 PROFILE Total people

34.9

18.7

30.0

9.3

7.1

Men Women

33.6 36.2

19.2 18.2

27.9 31.9

11.0 7.7

8.4 6.0

Black Hispanic White

54.2 41.6 31.5

18.1 15.7 18.5

23.8 32.1 31.3

1.0 3.5 11.3

2.8 7.0 7.4

Aged 18 to 44 Aged 45 to 64 Aged 65 or older

36.4 35.4 28.9

21.4 17.7 12.1

28.9 27.5 39.5

7.7 11.2 9.8

5.7 8.2 9.8

Not a college graduate Bachelor’s degree or more

37.4 28.0

16.5 24.6

30.8 27.8

7.7 13.6

7.6 6.0

9.3% 10.1 8.7

7.1% 8.3 6.6

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

AMERICAN HEALTH

69

Most People Say Their Health Is Very Good or Excellent But the percentage has been declining. In 2008, the 66 percent majority of Americans—including children under age 18—reported their health as very good or excellent. Not surprisingly, the proportion declines with age from more than 80 percent of children under age 18 to just 34 percent of people aged 75 or older. Among adults aged 18 or older, 55 percent rate their health as very good or excellent. But the proportion who rate their health that highly has fallen by nearly 4 percentage points since 1995, according to the federal government’s Behavioral Risk Factor Surveillance System. The decline has occurred in every age group under age 65. The average number of days of poor physical health reported by people aged 18 or older in the past month increased from 3.1 to 3.6 between 1995 and 2008, with both men and women and all but the oldest age group recording an increase. The percentage of people who reported poor physical health on 14 of the past 30 days climbed from 9.2 to 10.8 percent during those years. Again, all but the oldest age group saw an increase. The number of days of activity limitation during the past month due to poor health rose from 1.7 to 2.2 between 1995 and 2008, with people aged 65 or older the only ones to experience a decline. ■ Growing economic insecurity among middle-aged and younger adults could be making them sick. 9

ninety

The middle aged report more days of poor physical health

oh-eig

(average number of days in the past 30 days of poor physical health, by age, 1995 and 2008) 66 days

33 days 100000

00 days

all 1995

2008 dual

75000

18 a to 24

25 b to 34

35 to c 44

50000

45 to d54

55 to e64

65 tof 74

25000

0

70 AMERICAN HEALTH

with

w/out

75 org older

ATTITUDES TOWARD HEALTH CARE

Table 4.4

Health Status by Selected Characteristics, 2008

(total number of people, and percent distribution by self-reported health status, by selected characteristics, 2008; numbers in thousands) total number

TOTAL PEOPLE Sex Female Male

percent

excellent

very good

good

fair

poor

299,082

100.0%

35.5%

30.4%

24.0%

7.4%

2.4%

152,579 146,503

100.0 100.0

35.3 35.7

29.1 31.7

22.6 25.5

6.6 8.3

2.2 2.7

49,087 24,771 110,613 77,489 19,858 17,264

100.0 100.0 100.0 100.0 100.0 100.0

56.6 53.4 37.5 24.3 15.6 10.3

26.6 27.5 33.4 31.5 28.2 23.7

15.1 16.6 22.6 28.4 34.3 37.4

1.4 2.1 5.3 11.2 15.6 19.6

0.2 0.2 1.1 4.2 6.2 8.7

Race and Hispanic origin Asian 13,554 Black 38,247 Hispanic 46,385 Non-Hispanic white 196,018

100.0 100.0 100.0 100.0

36.7 32.2 34.5 36.1

31.8 26.3 27.3 31.9

25.1 28.1 28.6 22.2

4.6 10.1 7.6 7.0

1.5 3.0 1.9 2.5

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

82,233 39,912 48,526 32,762 56,639

100.0 100.0 100.0 100.0 100.0

25.8 32.3 36.2 40.5 49.8

25.5 30.5 33.7 34.4 32.1

29.4 27.1 23.6 19.8 14.9

13.8 7.8 5.4 4.3 2.6

5.4 2.3 1.2 0.9 0.5

Education Not a high school graduate High school graduate Some college Bachelor’s degree or more

28,879 55,405 51,574 54,951

100.0 100.0 100.0 100.0

15.1 21.4 26.4 39.1

21.4 30.3 34.2 36.1

34.4 32.0 27.7 19.6

20.4 12.2 8.9 4.1

8.6 4.1 2.8 1.0

Health insurance coverage among people under age 65 Private 170,213 Medicaid 36,678 Other 8,767 Uninsured 43,675

100.0 100.0 100.0 100.0

42.6 34.3 24.5 30.3

33.3 24.1 21.7 29.9

19.2 27.1 25.9 29.5

3.9 10.4 17.5 8.1

0.8 4.0 10.1 2.0

Age Under age 12 Aged 12 to 17 Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 243, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

71

Table 4.5

Health Status of Children by Selected Characteristics, 2008

(number of people under age 18, and percent distribution by parent-reported health status, by selected characteristics, 2008; numbers in thousands) total number

TOTAL CHILDREN Sex Female Male

73,858

100.0%

percent

excellent

very good

26.9%

15.6%

good

fair/poor

36,108 37,749

100.0 100.0

56.6 54.5

26.7 27.1

14.9 16.3

1.7 1.8

Age Aged 0 to 4 Aged 5 to 11 Aged 12 to 17

20,911 28,176 24,771

100.0 100.0 100.0

59.4 54.5 53.4

25.2 27.6 27.5

13.9 16.0 16.6

1.2 1.8 2.3

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

2,979 11,415 15,802 41,323

100.0 100.0 100.0 100.0

57.7 50.3 47.2 59.9

27.7 24.8 27.6 27.2

13.8 20.8 23.1 11.5

0.6 3.8 2.1 1.2

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

52,429 16,944 2,273 2,212

100.0 100.0 100.0 100.0

58.6 48.0 55.1 40.9

26.8 26.5 30.3 27.1

13.3 21.8 13.4 25.5

1.1 3.5 1.1 5.8

Parent’s education Less than high school diploma High school diploma More than high school

9,011 15,892 45,541

100.0 100.0 100.0

43.0 49.3 61.4

25.8 28.6 26.4

27.2 19.7 11.1

3.9 2.3 1.0

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

20,277 9,832 12,472 8,351 14,741

100.0 100.0 100.0 100.0 100.0

45.1 52.5 56.3 59.1 70.5

26.6 30.2 29.1 29.6 22.5

24.2 16.2 13.5 10.4 6.3

4.1 1.2 1.1 0.7 0.6

Health insurance coverage Private Medicaid/other public Other Uninsured

42,845 22,082 1,762 6,634

100.0 100.0 100.0 100.0

62.0 45.6 56.6 47.6

26.9 26.2 27.0 29.3

10.3 24.6 13.9 20.3

0.7 3.6 2.4 2.5

55.5%

1.8%

Note: “Mother and father” can include biological, adoptive, step, in-law, or foster relationships. Legal guardians are classiﬁed as neither mother nor father. Parent’s education is the education level of the parent with the higher level of education. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

72 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.6

Health Status, 1995 to 2008 “How is your general health?”

(percent of noninstitutionalized people aged 18 or older responding excellent or very good, by selected characteristics, 1995 to 2008; percentage point change, 1995–2008)

55.1%

56.2%

58.7%

1995

percentage point change 1995 to 2008

55.1 55.4

55.4 57.5

59.5 57.7

–4.4 –2.3

60.9 63.0 61.1 54.1 48.8 38.3

62.8 67.1 63.2 56.4 49.1 36.2

63.1 69.8 65.1 59.5 49.9 37.2

–2.2 –6.8 –4.0 –5.4 –1.1 1.1

percent responding excellent or very good

TOTAL PEOPLE Sex Female Male Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

2008

2000

–3.6

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp; calculations by New Strategist

Table 4.7

Days of Poor Physical Health in Past Month, 1995 to 2008

“Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?” (average number of days during the past 30 days when physical health was not good among noninstitutionalized people aged 18 or older, by selected characteristics, 1995 to 2008; change in days, 1995–2008) average number of days 2008

2000

1995

change in days, 1995 to 2008

TOTAL PEOPLE

3.6

3.3

3.1

0.5

Sex Female Male

4.0 3.2

3.7 2.9

3.6 2.5

0.4 0.7

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2.1 2.3 2.9 4.0 4.9 4.8 6.0

1.9 2.1 2.8 3.5 4.6 4.9 6.3

1.9 2.1 2.5 3.3 3.9 4.7 6.2

0.2 0.2 0.4 0.7 1.0 0.1 –0.2

Source: Centers for Disease Control and Prevention, Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/HRQOL/; calculations by New Strategist

AMERICAN HEALTH

73

Table 4.8

Frequent Poor Physical Health in Past Month, 1995 to 2008

(percentage of noninstitutionalized people aged 18 or older with 14 or more days in the past 30 days when physical health was not good, by selected characteristics, 1995 to 2008; percentage point change, 1995–2008) percent with 14 or more days of poor physical health

TOTAL PEOPLE Sex Female Male Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2008

1995

percentage point change, 1995–2008

11.5 8.6

10.8 7.3

1.2 2.3

4.3 5.4 7.9 10.6 15.1 16.0 20.8

4.4 5.1 7.0 10.1 12.6 15.5 21.0

0.6 1.1 1.1 2.4 3.2 0.0 –1.6

2000

10.8%

10.1%

12.0 9.6 5.0 6.2 8.1 12.5 15.8 15.5 19.4

9.2%

1.6

Source: Centers for Disease Control and Prevention, Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/HRQOL/; calculations by New Strategist

Table 4.9

Days of Activity Limitation in Past Month, 1995 to 2008

“During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?” (average number of days during the past 30 days when poor physical or mental health prevented noninstitutionalized people aged 18 or older from doing their usual activities, by selected characteristics, 1995 to 2008; change in days, 1995–2008) days of activity limitation

TOTAL PEOPLE Sex Female Male Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2008

2000

1995

change in days, 1995–2008

2.2

1.9

1.7

0.5

2.4 2.1

2.1 1.7

1.9 1.5

0.5 0.6

1.5 1.6 1.9 2.7 3.0 2.5 3.0

1.2 1.2 1.7 2.2 2.6 2.3 3.1

1.1 1.2 1.5 1.8 2.0 2.5 3.2

0.4 0.4 0.4 0.9 1.0 0.0 –0.2

Source: Centers for Disease Control and Prevention, Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/HRQOL/; calculations by New Strategist

74 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.10

Frequent Activity Limitation Days in Past Month, 1995 to 2008

(percentage of noninstitutionalized people aged 18 or older with 14 or more days in the past 30 days when poor physical or mental health limited activities, by selected characteristics, 1995 to 2008; percentage point change, 1995–2008) percent with 14 or more days of activity limitations

TOTAL PEOPLE Sex Female Male Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2008

2000

5.8%

5.1%

1995

percentage point change, 1995 to 2008

7.6 6.4

6.4 5.1

5.8 4.4

1.8 2.0

3.9 4.4 5.8 8.7 10.2 8.1 9.9

3.0 2.9 4.9 7.0 8.7 7.7 10.3

2.2 3.1 4.4 5.7 6.8 8.3 11.0

1.7 1.3 1.4 3.0 3.4 –0.2 –1.1

7.0%

1.9

Source: Centers for Disease Control and Prevention, Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/HRQOL/; calculations by New Strategist

AMERICAN HEALTH

75

Inability to Pay for Health Care Is a Problem for Many For the uninsured, it is a serious issue. In 2008, a substantial 5 percent of Americans had problems getting needed medical care. Cost is the most commonly cited reason for not getting needed medical care, with 45 percent of those with problems citing cost. Three percent of adults had problems getting needed prescriptions in 2008, with cost cited by 48 percent. More than 5 percent had problems getting dental care, and 72 percent of those with problems said cost was the main reason. The impact of the Medicare program, which covers nearly everyone aged 65 or older, can be seen in these statistics. Among people aged 65 or older, only 3 percent had problems getting medical care and just 14 percent of those with problems said cost was a factor. In contrast, 6 percent of people under age 65 had problems getting medical care and about half said cost was the reason. ■ As health care costs rise, affordability is keeping many Americans from getting care.

Older Americans are least likely to experience problems getting needed medical care (percent 12 of people who had problems getting needed medical care, by age and health insurance status, 2008)

10% 8

8%

6% 4

4%

0

0%

4% 3%

65 oraolder

b any private insurance

c public insurance only under 65

76 AMERICAN HEALTH

d uninsured

ATTITUDES TOWARD HEALTH CARE

Table 4.11

People with Problems Receiving Medical Care by Reason, 2007

(percent of people aged 18 or older unable to get or delayed in receiving needed medical care in past 12 months, and percent distribution of people with problems in receiving medical care by main reason, by selected characteristics, 2007) percent with problems receiving medical care

percent distribution by main reason for problems total

could not afford

insurance related

other reasons

TOTAL PEOPLE Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

4.7%

100.0%

44.7%

9.4%

45.9%

5.7 6.1 3.0

100.0 100.0 100.0

50.9 47.5 13.6

8.9 9.4 8.1

40.2 43.1 78.3

Sex Female Male

5.1 4.3

100.0 100.0

46.5 42.5

9.5 9.4

44.0 48.1

Education Not a high school graduate High school graduate At least some college

4.1 5.5 5.1

100.0 100.0 100.0

52.6 53.8 35.9

9.0 7.3 11.1

38.4 38.9 53.0

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public

3.7 5.5 9.7

100.0 100.0 100.0

29.0 42.1 83.0

11.9 13.4 3.2

59.1 44.5 13.8

2.8 3.1 3.1

100.0 100.0 100.0

– – –

– – –

– – –

Income status Poor Near poor Low income Middle income High income

8.0 6.6 5.7 4.2 3.4

100.0 100.0 100.0 100.0 100.0

64.8 56.6 58.3 42.9 20.7

8.3 9.0 4.5 10.8 12.0

26.9 34.4 37.2 46.3 67.3

Note: “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

77

Table 4.12

People with Problems Receiving Prescriptions by Reason, 2007

(percent of people aged 18 or older unable to get or delayed in receiving needed prescription medications in past 12 months, and percent distribution of people with problems in receiving medications by main reason, by selected characteristics, 2007) percent with problems receiving prescriptions

percent distribution by main reason for problems total

could not afford

insurance related

other reasons

TOTAL PEOPLE Age Aged 18 to 44

3.1%

100.0%

48.4%

18.0%

33.6%

3.4

Aged 45 to 64 Aged 65 or older

4.7 3.3

100.0 100.0 100.0

56.0 50.0 27.0

14.1 18.8 26.5

29.9 31.2 46.5

Sex Female Male

3.6 2.7

100.0 100.0

50.2 45.8

18.4 17.6

31.4 36.6

Education Not a high school graduate High school graduate At least some college

2.6 4.0 3.5

100.0 100.0 100.0

55.2 56.2 39.9

19.6 13.3 20.8

25.2 30.5 39.3

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public

2.5 3.9 5.1

100.0 100.0 100.0

39.1 41.6 87.6

19.3 26.6 3.1

41.6 31.8 9.3

3.4 2.9 4.8

100.0 100.0 100.0

– – –

– – –

– – –

Income status Poor Near poor Low income Middle income High income

5.6 4.2 4.3 2.7 2.1

100.0 100.0 100.0 100.0 100.0

71.4 – 58.8 48.9 19.5

8.6 – 14.5 22.9 25.2

20.0 – 26.7 28.2 55.3

Note: “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

78 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.13

People with Problems Receiving Dental Care by Reason, 2007

(percent of people aged 18 or older unable to get or delayed in receiving needed dental care in past 12 months, and percent distribution of people with problems in receiving dental care by main reason, by selected characteristics, 2007) percent with problems receiving dental care

percent distribution by main reason for problems total

could not afford

insurance related

other reasons

TOTAL PEOPLE Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

5.5%

100.0%

72.4%

5.5%

22.1%

6.6 7.0 3.7

100.0 100.0 100.0

77.3 72.5 53.6

4.6 6.8 1.7

18.1 20.7 44.7

Sex Female Male

5.9 5.0

100.0 100.0

72.0 73.0

6.1 4.8

21.9 22.2

Education Not a high school graduate High school graduate At least some college

5.8 6.9 5.3

100.0 100.0 100.0

74.0 79.8 65.3

5.4 4.3 5.9

20.6 15.9 28.8

4.0 6.7 12.5

100.0 100.0 100.0

67.4 63.1 90.4

5.9 12.5 2.2

26.7 24.4 7.4

4.0 3.5 4.0

100.0 100.0 100.0

– – –

– – –

– – –

9.0 9.8 7.4 5.5 3.1

100.0 100.0 100.0 100.0 100.0

77.2 72.1 76.9 76.7 58.1

5.7 4.8 5.4 5.1 6.4

17.1 23.1 17.7 18.2 35.5

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

79

Many Patients Want More Time with Health Care Providers Younger people are most likely to feel they have been hurried. Among people who have made appointments for routine health care in the past 12 months, the largest share (42 percent) say they always get an appointment as soon as they want and another 32 percent say they usually do. They have even better luck getting appointments for their children, with 71 percent saying they always get in as soon as they want. Nearly half (47 percent) of adults who visited a physician or health care clinic in the past 12 months say their health care provider always spent enough time with them. Another 37 percent say they usually get enough time with their provider. But a substantial 13 percent say they only sometimes or never get enough time. There are signiﬁcant differences by age in responses to this question. Only 43 percent of people aged 18 to 44 say their provider always spends enough time with them. Among people aged 65 or older, the 53 percent majority says their providers give them enough time. ■ Older adults have more—and more complex—health problems, requiring health care providers to spend more time with them.

Older people are most satisﬁed with the time their provider spends with them 60

(percent of people aged 18 or older who saw a health care provider in the past 12 months who say their provider always spent enough time with them, by age, 2007)

53.0% 48.5% 43.2%

40

40%

20

20%

0

0%

80 AMERICAN HEALTH

18 a to 44

45 b to 64

65 orcolder

ATTITUDES TOWARD HEALTH CARE

Table 4.14

Attitude toward Scheduling Routine Health Care Appointments among Adults, 2007

(total number of people aged 18 or older, number who made appointments for routine health care in past 12 months, and percent distribution by how often they got appointment as soon as wanted, 2007; people in thousands) total with appointments

TOTAL ADULTS Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

total

number

100.0%

always

42.4%

usually

sometimes/ never

percent

227,400

135,444

111,042 77,665 38,694

56,102 50,889 28,453

100.0 100.0 100.0

38.5 43.6 48.0

34.0 31.7 29.7

17.9 12.3 6.9

Sex Female Male

117,154 110,247

79,687 55,756

100.0 100.0

40.7 44.9

33.2 30.8

14.3 12.3

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

11,016 25,884 30,732 155,765

5,740 12,696 12,801 101,875

100.0 100.0 100.0 100.0

32.9 43.1 39.1 43.3

35.4 24.2 31.9 33.2

21.7 15.9 17.2 12.1

137,021 17,670 34,016

85,543 10,473 10,975

100.0 100.0 100.0

42.2 36.0 35.4

33.1 31.1 32.9

14.5 18.8 17.9

13,333 20,473 4,618

9,490 15,731 3,117

100.0 100.0 100.0

47.7 48.2 48.7

29.3 30.1 28.0

8.5 5.6 7.5

24,387 9,440 29,261 69,898 94,415

12,076 4,882 15,864 38,655 63,968

100.0 100.0 100.0 100.0 100.0

39.9 43.8 41.5 41.9 43.3

28.9 28.8 30.6 32.8 33.2

16.1 14.6 13.6 13.0 13.2

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

32.2%

13.5%

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

81

Table 4.15

Attitude toward Scheduling Routine Health Care Appointments for Children, 2007

(total number of people under age 18, number who had appointments for routine health care in past 12 months, and percent distribution by how often they got appointment as soon as wanted, 2007; people in thousands) total with appointments total

number

percent

always

usually

sometimes/ never

TOTAL CHILDREN Age Under age 5

73,909

48,766

100.0%

70.7%

20,181

Aged 5 to 17

53,727

14,856 33,910

100.0 100.0

71.3 70.5

23.2 21.1

5.5 8.1

Sex Female Male

36,527 37,382

23,796 24,970

100.0 100.0

71.8 69.7

21.0 22.4

7.0 7.6

3,011

Race and Hispanic origin Asian, non-Hispanic

21.7%

7.3%

Black, non-Hispanic Hispanic White and other, non-Hispanic

10,820 15,658 41,846

1,874 6,724 8,680 29,859

100.0 100.0 100.0 100.0

66.8 70.5 67.0 72.5

24.4 21.4 23.4 20.9

8.4 8.1 9.3 6.3

Health insurance status Any private insurance Public insurance only Uninsured

44,401 23,642 5,866

31,739 14,290 2,738

100.0 100.0 100.0

71.9 68.4 68.8

21.5 22.0 23.1

6.2 9.5 7.9

Income status Poor Near poor Low income Middle income High income

13,771 3,850 11,221 23,336 21,730

8,332 2,324 6,337 14,979 16,793

100.0 100.0 100.0 100.0 100.0

68.6 65.8 67.0 71.7 73.0

23.1 27.2 21.0 21.2 21.0

8.0 6.9 10.9 6.9 6.0

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

82 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.16

Health Care Provider Spent Enough Time with Adult Patient, 2007

(total number of people aged 18 or older, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider spent enough time with them, 2007; people in thousands) total with health care visit

TOTAL ADULTS Age Aged 18 to 44

total

number

100.0%

always

47.1%

usually

sometimes/ never

percent

227,400

144,024

111,042 77,665 38,694

61,128 53,379 29,517

100.0 100.0 100.0

43.2 48.5 53.0

37.9 36.1 34.7

15.8 12.3 8.5

Sex Female Male

117,154 110,247

83,379 60,645

100.0 100.0

46.4 48.2

36.9 36.1

13.4 12.4

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

11,016 25,884 30,732 155,765

6,192 14,919 14,050 106,287

100.0 100.0 100.0 100.0

37.8 55.5 43.3 47.0

43.2 25.7 38.7 37.6

15.4 13.9 13.6 12.5

137,021 17,670 34,016

90,631 11,594 12,282

100.0 100.0 100.0

46.4 43.2 41.9

38.0 33.6 33.8

12.8 18.4 20.3

13,333 20,473 4,618

9,741 16,343 3,327

100.0 100.0 100.0

54.3 52.8 50.9

33.4 35.7 33.7

9.5 7.3 10.9

24,387 9,440 29,261 69,898 94,415

13,843 5,196 16,871 41,617 66,497

100.0 100.0 100.0 100.0 100.0

47.5 48.3 44.3 46.9 47.8

30.9 32.5 34.5 37.5 38.1

16.7 14.8 16.8 12.2 11.6

Aged 45 to 64 Aged 65 or older

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

36.6%

13.0%

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

83

Table 4.17

Health Care Provider Spent Enough Time with Children and Their Parents, 2007

(total number of people under age 18, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider spent enough time with them and their parents, 2007; people in thousands) total with health care visit total

number

percent

always

usually

sometimes/ never

TOTAL CHILDREN Age Under age 5 Aged 5 to 17

73,909

55,873

100.0%

72.5%

20.4%

6.7%

20,181 53,727

16,738 39,135

100.0 100.0

71.4 73.0

20.8 20.3

7.6 6.3

Sex Female Male

36,527 37,382

27,462 28,411

100.0 100.0

71.7 73.3

21.5 19.4

6.6 6.8

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

3,011 10,820 15,658 41,846

2,206 7,826 10,635 33,246

100.0 100.0 100.0 100.0

60.7 74.0 69.0 74.0

32.0 18.4 19.2 20.9

6.7 7.2 11.5 4.8

Health insurance status Any private insurance Public insurance only Uninsured

44,401 23,642 5,866

35,277 17,334 3,262

100.0 100.0 100.0

73.6 70.7 69.9

21.0 19.4 19.3

5.0 9.4 10.3

Income status Poor Near poor Low income Middle income High income

13,771 3,850 11,221 23,336 21,730

10,054 2,824 7,386 17,196 18,413

100.0 100.0 100.0 100.0 100.0

71.2 68.0 70.7 73.4 73.8

17.4 23.1 20.0 20.8 21.6

10.7 8.8 8.9 5.5 4.5

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

84 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Most Patients Say Providers Always Explain, Listen, and Show Respect But the shares could be higher. More than half (59 percent) of adults who visited a doctor or health care clinic in the past year say their health care provider always explains things clearly to them, while 31 percent say this is usually true. Parents are more likely to say their child’s health care provider always explains things clearly to them, with 79 percent saying this is always true. One reason for the difference between parents and adults seeking care may be the fact that it is more difﬁcult to ask enough questions and elicit information as a patient than as an observer. Fifty-eight percent of adults say their health care provider always listens carefully to them. Parents are even more likely to say their children’s health care provider listens carefully (75 percent). Sixty percent of adults and 79 percent of parents say their health care provider always shows respect for what they have to say. Older adults are more likely than younger ones to say their providers always explain, listen, and show respect. This may reﬂect differing expectations and attitudes toward authority ﬁgures. Younger generations may expect more information about their care. ■ While explaining things clearly, listening carefully, and showing respect may not always be important to a patient’s wellbeing, they enhance patients’ opinions of the quality of care they receive.

Younger adults are least likely to think health care providers listen carefully or show respect (percent of people aged 18 or older who say their health care provider always explains things clearly, listens carefully, and shows respect for what they have to say, by age, 2007) 75

58%

59%

59%

54%

57%

64%

60%

58%

18 to

65%

45 to

50 50%

65 plu

75

25 25%

to 4 1818 to 44 to 64 4545 to 64

0 0%

50

6565 or older plus

aclearly explains

listens b carefully

showsc respect

25

0

a

b

c

AMERICAN HEALTH

85

Table 4.18

Health Care Provider Explained Things Clearly to Adult Patient, 2007

(total number of people aged 18 or older, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider explained things clearly to them, 2007; people in thousands) total with health care visit

TOTAL ADULTS Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

total

number

100.0%

always

58.7%

usually

sometimes/ never

percent

227,400

144,024

111,042 77,665 38,694

61,128 53,379 29,517

100.0 100.0 100.0

57.9 59.2 59.4

31.0 30.1 30.8

8.2 7.7 6.1

Sex Female Male

117,154 110,247

83,379 60,645

100.0 100.0

58.6 58.7

30.9 30.2

7.3 8.0

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

11,016 25,884 30,732 155,765

6,192 14,919 14,050 106,287

100.0 100.0 100.0 100.0

47.5 66.2 52.9 58.9

38.3 19.7 30.5 31.9

10.4 9.3 12.5 6.5

137,021 17,670 34,016

90,631 11,594 12,282

100.0 100.0 100.0

60.1 53.7 50.9

31.0 27.7 30.4

6.3 13.6 15.2

13,333 20,473 4,618

9,741 16,343 3,327

100.0 100.0 100.0

58.8 59.5 61.1

32.0 31.4 24.0

6.2 5.1 10.6

24,387 9,440 29,261 69,898 94,415

13,843 5,196 16,871 41,617 66,497

100.0 100.0 100.0 100.0 100.0

56.4 56.5 55.8 57.1 61.0

27.4 28.3 30.1 31.5 31.0

11.7 10.7 9.4 8.1 5.7

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

30.6%

7.6%

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

86 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.19

Health Care Provider Explained Things Clearly to Parents of Patients under Age 18, 2007

(total number of people under age 18, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider explained things clearly to their parents, 2007; people in thousands) total with health care visit total

number

percent

always

usually

sometimes/ never

TOTAL CHILDREN Age Under age 5 Aged 5 to 17

73,909

55,873

100.0%

78.8%

17.3%

3.4%

20,181 53,727

16,738 39,135

100.0 100.0

77.7 79.2

18.6 16.8

3.5 3.4

Sex Female Male

36,527 37,382

27,462 28,411

100.0 100.0

78.5 79.0

17.5 17.1

3.6 3.2

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

3,011 10,820 15,658 41,846

2,206 7,826 10,635 33,246

100.0 100.0 100.0 100.0

68.9 78.1 78.0 79.8

23.6 17.1 16.6 17.1

4.7 4.3 4.8 2.7

Health insurance status Any private insurance Public insurance only Uninsured

44,401 23,642 5,866

35,277 17,334 3,262

100.0 100.0 100.0

80.2 77.7 68.8

16.6 17.2 25.7

2.6 4.7 5.6

Income status Poor Near poor Low income Middle income High income

13,771 3,850 11,221 23,336 21,730

10,054 2,824 7,386 17,196 18,413

100.0 100.0 100.0 100.0 100.0

77.6 74.4 76.3 79.5 80.4

16.4 21.4 17.7 16.8 17.4

5.3 4.2 5.2 3.2 1.7

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

87

Table 4.20

Health Care Provider Listened Carefully to Adult Patient, 2007

(total number of people aged 18 or older, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider listened carefully to them, 2007; people in thousands) total with health care visit

TOTAL ADULTS Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

total

number

100.0%

always

57.1%

usually

sometimes/ never

percent

227,400

144,024

111,042 77,665 38,694

61,128 53,379 29,517

100.0 100.0 100.0

54.2 56.8 63.9

32.8 32.1 27.3

10.2 8.3 5.0

Sex Female Male

117,154 110,247

83,379 60,645

100.0 100.0

55.7 59.1

32.9 29.3

8.3 8.6

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

11,016 25,884 30,732 155,765

6,192 14,919 14,050 106,287

100.0 100.0 100.0 100.0

47.7 65.7 52.4 57.2

39.4 20.1 33.0 32.3

9.4 9.8 10.7 7.8

137,021 17,670 34,016

90,631 11,594 12,282

100.0 100.0 100.0

56.7 53.2 48.2

33.1 28.6 31.1

7.6 13.8 17.5

13,333 20,473 4,618

9,741 16,343 3,327

100.0 100.0 100.0

65.5 63.3 63.0

25.7 28.4 26.6

5.7 4.2 5.9

24,387 9,440 29,261 69,898 94,415

13,843 5,196 16,871 41,617 66,497

100.0 100.0 100.0 100.0 100.0

58.1 56.3 55.9 57.3 57.2

25.1 28.0 29.5 31.4 33.5

12.7 11.4 10.5 8.1 7.0

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

31.4%

8.4%

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

88 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.21

Health Care Provider Listened Carefully to Parents of Patients under Age 18, 2007

(total number of people under age 18, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider listened carefully to their parents, 2007; people in thousands) total with health care visit total

number

percent

always

usually

sometimes/ never

TOTAL CHILDREN Age Under age 5 Aged 5 to 17

73,909

55,873

100.0%

75.3%

19.1%

5.0%

20,181 53,727

16,738 39,135

100.0 100.0

75.4 75.3

19.0 19.1

5.4 4.8

Sex Female Male

36,527 37,382

27,462 28,411

100.0 100.0

75.3 75.2

19.1 19.1

4.9 5.0

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

3,011 10,820 15,658 41,846

2,206 7,826 10,635 33,246

100.0 100.0 100.0 100.0

68.6 77.6 74.7 75.3

25.8 17.2 18.6 19.3

2.8 4.8 6.3 4.8

Health insurance status Any private insurance Public insurance only Uninsured

44,401 23,642 5,866

35,277 17,334 3,262

100.0 100.0 100.0

76.5 73.8 70.1

18.9 19.0 22.2

4.0 6.7 7.2

Income status Poor Near poor Low income Middle income High income

13,771 3,850 11,221 23,336 21,730

10,054 2,824 7,386 17,196 18,413

100.0 100.0 100.0 100.0 100.0

72.0 72.7 72.9 77.8 76.1

19.2 21.9 19.6 17.3 20.1

7.9 5.3 6.4 4.4 3.3

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

89

Table 4.22

Health Care Provider Showed Respect for What Adult Patient Had to Say, 2007

(total number of people aged 18 or older, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider showed respect for what they had to say, 2004; people in thousands) total with health care visit

TOTAL ADULTS Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

total

number

100.0%

always

60.1%

usually

sometimes/ never

percent

227,400

144,024

111,042 77,665 38,694

61,128 53,379 29,517

100.0 100.0 100.0

57.8 60.0 65.1

30.7 29.5 26.2

8.4 7.6 4.9

Sex Female Male

117,154 110,247

83,379 60,645

100.0 100.0

59.7 60.7

29.7 28.8

7.3 7.5

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

11,016 25,884 30,732 155,765

6,192 14,919 14,050 106,287

100.0 100.0 100.0 100.0

52.1 69.5 59.2 59.4

37.0 17.9 27.9 30.7

6.9 8.1 8.7 7.1

137,021 17,670 34,016

90,631 11,594 12,282

100.0 100.0 100.0

60.5 54.6 50.5

30.1 28.6 31.8

6.7 12.0 14.0

13,333 20,473 4,618

9,741 16,343 3,327

100.0 100.0 100.0

67.1 64.7 61.6

23.4 27.4 28.2

6.0 3.8 6.3

24,387 9,440 29,261 69,898 94,415

13,843 5,196 16,871 41,617 66,497

100.0 100.0 100.0 100.0 100.0

58.4 57.8 59.7 59.1 61.4

25.6 28.3 27.3 30.0 30.3

11.1 9.5 8.7 7.5 6.0

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

29.3%

7.4%

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

90 AMERICAN HEALTH

ATTITUDES TOWARD HEALTH CARE

Table 4.23

Health Care Provider Showed Respect for What Parents of Patients under Age 18 Had to Say, 2007

(total number of people under age 18, number having visited a doctor or health care clinic in past 12 months, and percent distribution by whether the health care provider showed respect for what parents had to say, 2007; people in thousands) total with health care visit total

number

percent

always

usually

sometimes/ never

TOTAL CHILDREN Age Under age 5 Aged 5 to 17

73,909

55,873

100.0%

79.0%

16.2%

4.4%

20,181 53,727

16,738 39,135

100.0 100.0

78.8 79.0

16.3 16.2

4.7 4.2

Sex Female Male

36,527 37,382

27,462 28,411

100.0 100.0

79.1 78.8

16.5 16.0

4.0 4.8

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

3,011 10,820 15,658 41,846

2,206 7,826 10,635 33,246

100.0 100.0 100.0 100.0

74.4 80.4 78.9 78.8

19.8 14.8 16.0 16.4

3.3 4.4 4.8 4.3

Health insurance status Any private insurance Public insurance only Uninsured

44,401 23,642 5,866

35,277 17,334 3,262

100.0 100.0 100.0

80.0 78.1 72.7

15.6 16.7 20.3

4.0 4.8 6.6

Income status Poor Near poor Low income Middle income High income

13,771 3,850 11,221 23,336 21,730

10,054 2,824 7,386 17,196 18,413

100.0 100.0 100.0 100.0 100.0

78.0 74.8 77.3 79.3 80.5

15.4 20.2 16.3 16.1 16.2

6.0 4.8 5.6 4.3 3.0

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

91

Fewer than Half Give Their Health Care Provider the Highest Rating Parents rate their children’s health care provider more highly than their own. The federal government’s Medical Expenditure Panel Survey asks people aged 18 or older who visited a doctor or health care clinic in the past year to rate the health care they received on a scale of 0 (worst) to 10 (best). The largest share (47 percent) rate their care a 9 or 10. Another 37 percent rate their care a 7 or 8 on the scale. Only 13 percent give the care they received a rating of 6 or less. There are sizable differences in opinions by demographic characteristic. Younger adults are least likely to rate the care they receive a 9 or 10 (41 percent), while people aged 65 or older are most likely to give the care they receive the highest rating (59 percent). Perhaps not surprisingly, people without insurance are more likely than the insured to give the care they receive a low rating. Parents have a higher opinion of the care their children receive than the care they receive. More than two-thirds rate their child’s health care provider a 9 or 10. Even among parents without insurance, more than 60 percent give their children’s care a rating of 9 or 10. ■ Medicare recipients are much more satisﬁed with their health care experience than younger Americans.

Medicare recipients are most satisﬁed with their health care (percent of people aged 18 or older who rate the health care they receive at a 9 or 10 on a 10-point scale, by type of insurance, 2007)

75

61% 50

58%

50%

25

25%

0

0%

45%

a and Medicare private (65+)

92 AMERICAN HEALTH

b Medicare only (65+)

c private insurance (under 65)

42%

40%

d public insurance (under 65)

e no insurance (under 65)

ATTITUDES TOWARD HEALTH CARE

Table 4.24

Adult Patients’ Rating of Health Care Received from Doctor’s Ofﬁce or Clinic, 2007

(total number of people aged 18 or older, number having visited a doctor or health care clinic in past 12 months, and percent distribution by rating given for health care received on a scale from 0 (worst) to 10 (best), 2007; people in thousands) total with health care visit

TOTAL ADULTS Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

total

number

rating

percent

9 to 10

47.3%

36.5%

12.9%

0 to 6

144,024

111,042 77,665 38,694

61,128 53,379 29,517

100.0 100.0 100.0

41.3 47.6 59.0

40.6 36.5 28.1

14.9 12.9 8.9

Sex Female Male

117,154 110,247

83,379 60,645

100.0 100.0

47.5 46.9

36.7 36.2

12.4 13.7

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

11,016 25,884 30,732 155,765

6,192 14,919 14,050 106,287

100.0 100.0 100.0 100.0

35.6 47.9 47.0 47.9

45.0 31.7 33.7 37.2

15.4 15.3 14.9 12.0

137,021 17,670 34,016

90,631 11,594 12,282

100.0 100.0 100.0

45.0 42.2 40.3

40.5 31.9 32.1

11.8 20.5 23.5

13,333 20,473 4,618

9,741 16,343 3,327

100.0 100.0 100.0

58.1 60.8 53.2

28.2 28.2 27.4

9.9 7.2 13.7

24,387 9,440 29,261 69,898 94,415

13,843 5,196 16,871 41,617 66,497

100.0 100.0 100.0 100.0 100.0

45.2 50.0 48.2 46.0 48.0

30.7 29.4 32.0 36.4 39.5

19.0 15.9 14.9 14.2 10.1

Health insurance status Under age 65 Any private insurance Public insurance only Uninsured Aged 65 or older Medicare only Medicare and private Medicare and other public Income status Poor Near poor Low income Middle income High income

100.0%

7 to 8

227,400

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

93

Table 4.25

Parents’ Rating of Health Care Received by Children at Doctor’s Ofﬁce or Clinic, 2007

(total number of people under age 18, number having visited a doctor or health care clinic in past 12 months, and percent distribution by rating given by parents for health care received by children on a scale from 0 (worst) to 10 (best), 2007; people in thousands) total with health care visit total

number

rating

percent

9 to 10

68.2%

26.5%

7 to 8

0 to 6

TOTAL CHILDREN Age

73,909

55,873

100.0%

5.0%

Under age 5 Aged 5 to 17

20,181 53,727

16,738 39,135

100.0 100.0

68.3 68.2

27.0 26.2

4.5 5.3

Sex Female Male

36,527 37,382

27,462 28,411

100.0 100.0

69.5 66.9

25.5 27.4

4.7 5.4

Race and Hispanic origin Asian, non-Hispanic Black, non-Hispanic Hispanic White and other, non-Hispanic

3,011 10,820 15,658 41,846

2,206 7,826 10,635 33,246

100.0 100.0 100.0 100.0

55.7 67.3 67.6 69.6

39.1 27.4 24.7 25.9

5.3 5.0 7.3 4.3

Health insurance status Any private insurance Public insurance only Uninsured

44,401 23,642 5,866

35,277 17,334 3,262

100.0 100.0 100.0

70.3 64.9 63.2

26.1 26.9 28.4

3.4 7.7 7.9

Income status Poor Near poor Low income Middle income High income

13,771 3,850 11,221 23,336 21,730

10,054 2,824 7,386 17,196 18,413

100.0 100.0 100.0 100.0 100.0

65.7 65.1 68.5 68.2 70.0

25.4 30.4 24.6 26.6 27.1

8.2 4.4 6.7 4.9 2.9

Note: Percentages do not sum to 100 because “no response” is not shown. “White and other, non-Hispanic” includes non-Hispanics from all other races except Asian and black. “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” denotes incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

94 AMERICAN HEALTH

BIRTHS CHAPTER

5

Births ■ Americans support abortion rights. The great majority supports abortion if a pregnancy threatens a woman’s life, if she has been raped, or if there is a defect in the baby.

■ Forty-ﬁve percent of newborns are Asian, black, or Hispanic. Of the 4 million babies born in 2008, only 53 percent were born to non-Hispanic whites.

■ Most babies are born to women in their twenties. More than half of Asian births are to women aged 30 or older, however.

■ Forty-one percent of births are to unmarried women. By race and Hispanic origin, out-of-wedlock births are most common among blacks (71 percent) and least common among Asians (16 percent).

■ The Caesarean rate rises with age. Only 22 percent of teenagers who gave birth in 2006 had a Caesarean delivery compared with 47 percent of women aged 40 or older.

■ Three out of four new mothers breastfeed their babies. The percentage rises as high as 86 percent among college graduates.

AMERICAN HEALTH

95

Only 65 Percent of Pregnancies Result in Live Births Women in their early thirties are most likely to carry their pregnancies to term. In 2005, there were 6.4 million pregnancies, but only 4.1 million births. Nineteen percent of pregnancies were terminated by induced abortion, while 17 percent ended as the result of miscarriage or stillbirth (fetal loss). Women aged 30 to 34 are most likely to see their pregnancies through to a live birth (71 percent). Women under age 20 are most likely to terminate their pregnancy through abortion (27 percent). Among women under age 30, abortion is more likely than a miscarriage. Among women aged 30 or older, miscarriages outnumber abortions. Fewer than half of black women who became pregnant in 2005 gave birth. Among non-Hispanic whites and Hispanics, more than two-thirds of pregnancies end in a live birth.

■ Women who delay childbearing until their late thirties or forties increase their risk of miscarriage.

Non-Hispanic white women are least likely to end a pregnancy through abortion

90

(percent distribution of pregnancies by outcome, race, and Hispanic origin, 2005)

live

induc

69%

68%

60 60%

lost 48% 37%

30 30% 15%

90

18%

14%

18% 12%

live live births induced induced abortions

0

0%

60

black, non-Hispanic

Hispanic 30

0

96 AMERICAN HEALTH

lostlosses fetal

white, non-Hispanic

BIRTHS

Table 5.1

Pregnancy Outcomes by Age, 2005

(number and percent distribution of pregnancies by outcome and age, 2005; numbers in thousands) Total pregnancies Live births Induced abortions Fetal losses

total

under 20

20 to 24

25 to 29

30 to 34

35 to 39

40 or older

6,408 4,138 1,206 1,063

740 422 203 116

1,662 1,040 396 226

1,652 1,132 287 234

1,346 951 179 216

807 483 104 220

200 111 38 51

100.0% 57.0 27.4 15.7

100.0% 62.6 23.8 13.6

100.0% 68.5 17.4 14.2

100.0% 70.7 13.3 16.0

100.0% 59.9 12.9 27.3

100.0% 55.5 19.0 25.5

11.5% 10.2 16.8 10.9

25.9% 25.1 32.8 21.3

25.8% 27.4 23.8 22.0

21.0% 23.0 14.8 20.3

12.6% 11.7 8.6 20.7

3.1% 2.7 3.2 4.8

PERCENT DISTRIBUTION BY OUTCOME

Total pregnancies Live births Induced abortions Fetal losses

100.0% 64.6 18.8 16.6

PERCENT DISTRIBUTION BY AGE

Total pregnancies Live births Induced abortions Fetal losses

100.0% 100.0 100.0 100.0

Source: National Center for Health Statistics, Estimated Pregnancy Rates for the United States, 1990–2005: An Update, National Vital Statistics Reports, Volume 58, No. 4, 2009, Internet site http://www.cdc.gov/nchs/nvss/birth_products.htm

Table 5.2

Pregnancy Outcomes by Race and Hispanic Origin, 2005

(number and percent distribution of pregnancies by outcome, race, and Hispanic origin, 2005; numbers in thousands) non-Hispanic

Total pregnancies Live births Induced abortions Fetal losses

total

Hispanic

black

white

6,408 4,138 1,206 1,063

1,451 986 263 203

1,217 587 452 177

3,329 2,303 415 611

100.0% 68.0 18.1 14.0

100.0% 48.2 37.1 14.5

100.0% 69.2 12.5 18.4

PERCENT DISTRIBUTION BY OUTCOME

Total pregnancies Live births Induced abortions Fetal losses

100.0% 64.6 18.8 16.6

PERCENT DISTRIBUTION BY RACE AND HISPANIC ORIGIN

Total pregnancies Live births Induced abortions Fetal losses

100.0% 100.0 100.0 100.0

22.6% 23.8 21.8 19.1

19.0% 14.2 37.5 16.7

52.0% 55.7 34.4 57.5

Note: Numbers by race and Hispanic origin do not sum to total because not all races are shown. Source: National Center for Health Statistics, Estimated Pregnancy Rates for the United States, 1990–2005: An Update, National Vital Statistics Reports, Volume 58, No. 4, 2009, Internet site http://www.cdc.gov/nchs/nvss/birth_products.htm

AMERICAN HEALTH

97

Americans Support Abortion Rights The number of abortions is down. The number of abortions in the United States fell by about 153,000 between 1995 and 2005, according to estimates by the Guttmacher Institute. The percentage of pregnancies ending in abortion (excluding those ending in miscarriage) also fell during those years, from 25.9 to 22.4 percent. Among women who had an abortion in 2005, fully 83 percent were unmarried. Fifty-nine percent already had given birth to one or more children. Nearly 90 percent of abortions occur within the ﬁrst 12 weeks of gestation. Americans are ambivalent about abortion. Forty-two percent of the population believes a woman should be able to obtain an abortion for any reason. The large majority favors the availability of abortion if a pregnancy endangers a woman’s health, the woman has been raped, or there is a chance of a serious defect in the baby. Fewer than half believe being unmarried, not wanting more children, or not being able to afford more children should be grounds for getting a legal abortion. ■ Most Americans support legal abortion, but only under certain circumstances. 120

Nearly 90 percent support abortion if a woman’s health is in danger (percent of people aged 18 or older who support legal abortion, by reason for abortion, 2008)

89%

80

80%

40

40%

0

0%

77%

75%

42%

any reason

danger to woman’s health

98 AMERICAN HEALTH

rape victim

chance d of serious defect in baby

45%

43%

41%

does e not want more children

low income f

unmarried g

BIRTHS

Table 5.3

Abortions by Selected Characteristics, 1995 to 2005

(total number of legal abortions amd percentage of pregnancies ending in abortion, number of legal abortions reported by states and the District of Columbia to the Centers for Disease Control (CDC), and percent distribution of reported abortions by selected characteristics of women, selected years 1995 to 2005) 2005

Total abortions (Guttmacher Institute estimate) 1,206,200 Percentage of pregnancies ending in abortion* 22.4% CDC reported abortions (44 states), number CDC reported abortions (44 states), percent

809,881

2000

1995

1,313,000

1,359,400

24.5% 847,744

25.9% 905,577

100.0%

100.0%

100.0%

Age Under age 20 Aged 20 to 24 Aged 25 or older

17.1 32.8 50.1

18.8 32.8 48.4

20.1 32.5 47.4

Marital status Married Unmarried

16.9 83.1

18.7 81.3

19.7 80.3

Number of births None One Two Three or more

41.0 26.6 19.8 12.6

40.0 27.7 20.1 12.2

45.2 26.5 18.0 10.3

Race Black White

36.9 55.1

36.3 56.6

35.0 59.6

Hispanic origin Hispanic Not Hispanic

20.3 79.7

17.2 82.8

15.1 84.9

Weeks of gestation Less than 8 9 to 12 13 to 20 21 or more

62.1 26.4 10.1 1.4

58.1 30.0 10.5 1.4

54.0 34.0 10.6 1.4

Residence In state

91.7

Out of state

9.3

91.3 8.7

91.5 8.5

* Of pregnancies ending in live birth or abortion (pregnancies ending in miscarriage are excluded). Note: CDC abortion numbers exclude Alaska, California, Louisiana, New Hampshire, Oklahoma, and West Virginia. Source: Guttmacher Institute, Abortion in the United States: Incidence and Access to Services, 2005, Perspectives on Sexual and Reproductive Health, 2008 40(1), Internet site http://www.guttmacher.org/media/presskits/2005/06/28/abortionoverview .html; and Centers for Disease Control and Prevention, Abortion Surveillance—United States, 2005, Mortality and Morbidity Weekly Report, Vol. 57/SS13, November 28, 2008, Internet site http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5713a1.htm

AMERICAN HEALTH

99

Table 5.4

Support for Legal Abortion by Reason, 1972 to 2008

(percent of respondents aged 18 or older who think it should be possible for a pregnant woman to obtain a legal abortion, by reason for abortion, selected years 1972–2008)

2008 2006 2004 2002 2000 1998 1996 1994 1993 1991 1990 1989 1988 1987 1985 1984 1983 1982 1980 1978 1977 1976 1975 1974 1973 1972

any reason

serious defect in baby

42.4% 40.4 40.6 43.0 39.9 40.9 45.0 46.3 45.3 42.6 43.4 40.3 36.1 39.2 36.9 38.6 34.3 38.5 41.1 33.3 37.7 – – – – –

74.8% 74.2 72.9 78.5 78.7 78.6 81.8 82.3 81.3 83.5 81.2 81.3 78.8 78.0 78.5 80.2 78.9 82.1 83.1 82.0 85.5 83.9 83.2 85.1 84.5 78.6

woman’s health seriously endangered

89.2% 87.9 86.0 91.6 88.5 87.9 91.6 90.6 89.8 91.5 91.8 90.1 88.7 87.9 89.3 89.5 89.7 90.4 90.1 90.6 90.5 90.8 90.7 92.4 92.3 86.9

pregnancy resulted from rape

76.7% 77.6 76.2 79.7 80.6 80.1 84.3 83.6 82.9 86.5 84.8 83.2 81.1 79.6 81.2 80.4 82.8 83.9 83.4 83.2 83.8 83.7 83.7 86.5 83.5 79.1

woman is not married and does not want to marry the man

41.2% 40.1 40.9 42.0 39.1 42.3 44.9 47.6 48.1 44.8 45.3 45.4 39.4 40.1 41.2 44.2 39.4 45.5 48.4 41.1 49.8 50.3 48.2 50.1 49.1 43.5

woman is married and does not want more children

44.7% 42.5 41.8 44.8 40.7 42.3 46.7 48.3 47.1 44.6 45.1 44.5 39.9 41.0 40.3 42.7 38.9 45.8 47.1 40.3 46.5 46.2 45.7 46.9 47.7 39.7

family has low income and cannot afford more children

42.9% 42.6 41.0 44.4 42.2 44.3 46.6 50.4 49.9 48.5 48.1 47.7 42.0 44.7 43.7 46.3 43.7 49.0 51.7 47.4 53.4 53.1 53.2 54.8 53.4 48.8

Note: “–” means data are not available. Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

100 AMERICAN HEALTH

BIRTHS

More Women Are Childless Once they reach their forties, many childless women face fertility problems. Among women aged 15 to 44, a substantial 45 percent were childless in 2006, up slightly from 42 percent in 1990. Most of the childless women in the 15-to-44 age group will eventually have children. A better measure of childlessness is the percentage of women aged 40 to 44 who have not yet had children, because most women in the age group have completed their childbearing. The percentage of childless women among 40-to-44-year-olds climbed from 16 to 20 percent between 1990 and 2006. While a few of the childless women in their early forties will eventually have children, most will remain childless. Women are having fewer children than they once did. Among women aged 40 to 44 in 1976, the 59 percent majority had given birth to three or more children. In 2006, just 28 percent of women in the age group had given birth to that many children. The percentage of women aged 40 to 44 who have had just one child grew from 10 to 17 percent during those years. Two is the most popular number in regard to children, and in 2006 34 percent of women aged 40 to 44 had given birth to two children, up from 22 percent in 1976. ■ Women who delay childbearing often have difﬁculty having children, creating a booming fertility industry.

Women are having fewer children

75

(percent distribution of women aged 40 to 44 by number of children ever borne, 1976 and 2006)

seventy

59%

oh-four

50 50%

34% 28% 25

25%

20%

17% 100000

10% 0 0%

22% 10%

all 1976

2006 dual

75000

none

one

three d or more

two

50000

25000

0

with

w/out

AMERICAN HEALTH

101

Table 5.5

Childless Women by Age, 1990 to 2006

(percent of women aged 15 to 44 who have not had a live birth, by age, selected years 1990 to 2006) total aged 15 to 44

2006 2004 2002 2000 1998 1995 1994 1992 1990

45.1% 44.6 43.5 42.8 42.2 41.8 42.0 41.2 41.6

15 to 19

93.3% 93.3 91.2 90.5 90.1 90.7 91.6 92.7 91.9

20 to 24

25 to 29

68.6% 68.9 67.0 63.6 64.0 64.3 65.3 65.9 64.6

30 to 34

45.6% 44.2 45.2 44.2 43.5 43.8 43.6 41.3 42.1

35 to 39

26.2% 27.6 27.6 28.1 27.4 26.7 26.3 26.1 25.7

40 to 44

18.9% 19.6 20.2 20.1 19.8 19.7 19.6 18.8 17.7

20.4% 19.3 17.9 19.0 19.0 17.5 17.5 15.7 16.0

Source: Bureau of the Census, Fertility of American Women, Historical Time Series Tables, Internet site http://www.census .gov/population/www/socdemo/fertility.html#hist

Table 5.6

Number of Children Ever Born to Women Aged 40 to 44, 1976 to 2006

(total number of women aged 40 to 44, and percent distribution by number of children ever borne, selected years 1976 to 2006; numbers in thousands) total aged 40 to 44 number

2006 2004 2000 1995 1990 1985 1980 1976

11,235 11,535 11,447 10,244 8,905 7,226 5,983 5,684

one or more children

percent

none

total

one

two

three

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0

20.4% 19.3 19.0 17.5 16.0 11.4 10.1 10.2

79.7% 80.8 81.0 82.6 84.1 88.6 89.9 89.9

16.9% 17.4 16.4 17.6 16.9 12.6 9.6 9.6

34.4% 34.5 35.0 35.2 35.0 32.9 24.6 21.7

18.5% 18.1 19.1 18.5 19.4 23.1 22.6 22.7

four or more

9.9% 10.8 10.5 11.3 12.8 20.0 33.1 35.9

Source: Bureau of the Census, Fertility of American Women: June 2006, detailed tables, Internet site http://www.census.gov/ population/www/socdemo/fertility/cps2006.html

102 AMERICAN HEALTH

BIRTHS

Table 5.7

Number of Children Ever Born to Women by Age, 2006

(total number of women aged 15 to 44, and percent distribution by number of children ever borne, by age, 2006; numbers in thousands) total aged 15 to 44 number

percent

one or more children none

total

54.9%

one

two

17.0%

21.7%

Total women

61,683

100.0%

45.1%

Aged 15 to 19

10,269

100.0

93.3

6.7

4.5

Aged 20 to 24

10,079

100.0

68.6

31.6

Aged 25 to 29

10,004

100.0

45.6

54.4

Aged 30 to 34

9,647

100.0

26.2

Aged 35 to 39

10,450

100.0

Aged 40 to 44

11,235

100.0

three

four or more

10.8%

5.4%

1.5

0.5

0.2

18.8

9.3

2.7

0.8

22.9

19.4

8.5

3.6

73.9

21.8

29.3

15.3

7.5

18.9

81.0

17.6

35.4

18.5

9.5

20.4

79.7

16.9

34.4

18.5

9.9

Source: Bureau of the Census, Fertility of American Women: June 2006, detailed tables, Internet site http://www.census.gov/ population/www/socdemo/fertility/cps2006.html

AMERICAN HEALTH

103

The Birth Rate Has Risen Since 2000 Much of the increase is due to births among women aged 30 or older. Between 1990 and 2008, the birth rate (the number of live births per 1,000 women aged 15 to 44) declined, dropping from 70.9 in 1990 to 68.7 in 2008. The rate bottomed out in 1997 and increased through 2007 before falling slightly in 2008. The rise since 1997 primarily has been the result of increased childbearing by women aged 30 or older. The birth rate among women aged 30 to 34 climbed 23 percent between 1990 and 2008, while the rate among women aged 35 to 39 rose 48 percent. As birth rates among younger women have declined, the average age at which women give birth has increased. Among women having their ﬁrst baby in 2006, their average age was 25.0— up from 24.2 in 1990. Age at ﬁrst birth varies by race and Hispanic origin. Black women are younger than others at their ﬁrst birth, with an average age of 22.7. Hispanics have an average age of 23.1 at their ﬁrst birth, non-Hispanic whites are an older 26.0, and Asians are the oldest at 28.5. ■ The average age at ﬁrst birth is rising for women in every racial and ethnic group.

The birth rate is higher today than in 2000 90

(number of births per 1,000 women aged 15 to 44, selected years, 1990 to 2008)

70.9% 63.6%

60 60%

65.9%

69.5%

68.7%

2007

e 2008

30 30%

0 0%

1990

104 AMERICAN HEALTH

1997

2000

BIRTHS

Table 5.8

Birth Rates by Age, 1990 to 2008

(number of live births per 1,000 women aged 15 to 44 by age, 1990 to 2008; percent change in rate for selected years) total*

2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990

68.7 69.5 68.5 66.7 66.3 66.1 64.8 65.3 65.9 64.4 64.3 63.6 64.1 64.6 65.9 67.0 68.4 69.3 70.9

Percent change 2000 to 2008 1990 to 2008

4.2% –3.1

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 or older

41.5 42.5 41.9 40.4 41.1 41.7 43.0 45.3 47.7 48.8 50.3 51.3 53.5 56.0 58.2 59.0 60.3 61.8 59.9

103.1 106.4 105.9 102.2 101.7 102.6 103.6 106.2 109.7 107.9 108.4 107.3 107.8 107.5 109.2 111.3 113.7 115.3 116.5

115.1 117.5 116.7 115.6 115.5 115.7 113.6 113.4 113.5 111.2 110.2 108.3 108.6 108.8 111.0 113.2 115.7 117.2 120.2

99.3 99.9 97.7 95.9 95.3 95.2 91.5 91.9 91.2 87.1 85.2 83.0 82.1 81.1 80.4 79.9 79.6 79.2 80.8

46.9 47.5 47.3 46.3 45.4 43.8 41.4 40.6 39.7 37.8 36.9 35.7 34.9 34.0 33.4 32.7 32.3 31.9 31.7

9.9 9.5 9.4 9.1 8.9 8.7 8.3 8.1 8.0 7.4 7.4 7.1 6.8 6.6 6.4 6.1 5.9 5.5 5.5

0.7 0.6 0.6 0.6 0.5 0.5 0.5 0.5 0.5 0.4 0.4 0.4 0.3 0.3 0.3 0.3 0.3 0.2 0.2

8.9% 22.9

18.1% 47.9

23.8% 80.0

40.0% 250.0

–13.0% –30.7

–6.0% –11.5

1.4% –4.2

* Total number of births to women of any age per 1,000 women aged 15 to 44. Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, and and Births: Preliminary Data for 2008, National Vital Statistics Report, Vol. 58, No. 16, 2010, Internet sites http:// www.cdc.gov/nchs/products/nvsr.htm; calculations by New Strategist

Table 5.9

Average Age of Women When Giving Birth by Race and Hispanic Origin, 1990 and 2006

(average age of women at ﬁrst birth, by race and Hispanic origin, 1990 and 2006; in years) Total mothers Asian Black, non-Hispanic Hispanic White, non-Hispanic

2006

1990

25.0 28.5 22.7 23.1 26.0

24.2 26.8 21.7 22.4 25.0

Source: National Center for Health Statistics, Delayed Childbearing: More Women Are Having Their First Child Later in Life, NCHS Data Brief, No. 21, August 2009, Internet site http://www.cdc.gov/nchs/data/databriefs/db21.htm

AMERICAN HEALTH

105

Nearly 4 Million Women Gave Birth in 2006 The percentage of women who have given birth in the past year peaks in the 25-to-29 age group. Among women aged 15 to 44, 6 percent gave birth in 2006. The proportion peaks at 10 percent in the 25-to-29 age group. By race and Hispanic origin, Hispanics are most likely to have given birth in the past 12 months. In 2006, just over 8 percent of Hispanic women gave birth, accounting for 21 percent of all women giving birth. About 6 percent of Asian, black, and non-Hispanic white women gave birth in 2006. Most women in the delivery room are married, but the unmarried share is a substantial 31 percent. The foreign-born accounted for 19 percent of women who gave birth in the past 12 months. Eight percent of foreign-born women gave birth in 2006 compared with 6 percent of native-born women. ■ Hispanics account for many of the foreign-born women who gave birth in 2006.

15

Ten percent of women aged 25 to 29 gave birth in 2006 (percent of women who gave birth, by age, 2006)

1010%

55%

00%

106 AMERICAN HEALTH

15 to 19

20 to 24

25 to 29

30 to 34

e

35 to 39

f

40 to 44

BIRTHS

Table 5.10

Characteristics of Women Aged 15 to 44 Giving Birth in the Past Year, 2006

(total number of women aged 15 to 44 and number, percent, and percent distribution of women who gave birth in the past year, by selected characteristics, 2006; numbers in thousands) women giving birth in past year percent of total

percent distribution

total

number

Total women aged 15 to 44

61,683

3,974

Age Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44

10,269 10,079 10,004 9,647 10,450 11,235

417 935 1,046 888 579 109

4.1 9.3 10.5 9.2 5.5 1.0

10.5 23.5 26.3 22.3 14.6 2.7

Marital status Married Widowed or divorced Never married

29,033 4,920 27,730

2,617 129 1,228

9.0 2.6 4.4

65.9 3.2 30.9

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

3,391 9,272 10,099 38,532

202 538 830 2,383

6.0 5.8 8.2 6.2

5.1 13.5 20.9 60.0

Educational attainment Not a high school graduate High school graduate Some college, associate’s degree Associate’s degree Bachelor’s degree or more

13,377 15,420 12,760 5,155 14,970

867 989 713 335 1,070

6.5 6.4 5.6 6.5 7.1

21.8 24.9 17.9 8.4 26.9

Labor force status Employed Unemployed Not in labor force

39,961 2,728 18,994

2,054 167 1,754

5.1 6.1 9.2

51.7 4.2 44.1

Household income Under $20,000 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 or more

8,862 9,128 7,571 10,724 15,421

723 610 484 705 949

8.2 6.7 6.4 6.6 6.2

18.2 15.3 12.2 17.7 23.9

Region Northeast Midwest South West

11,176 13,557 22,546 14,404

667 905 1,406 996

6.0 6.7 6.2 6.9

16.8 22.8 35.4 25.1

Nativity Native born Foreign born

52,002 9,681

3,203 771

6.2 8.0

80.6 19.4

6.4%

100.0%

Note: Numbers may not sum to total because not all races are shown and “not reported” is not shown. Source: Bureau of the Census, Fertility of American Women: June 2006, detailed tables, Internet site http://www.census.gov/ population/www/socdemo/fertility/cps2006.html

AMERICAN HEALTH

107

More than One-Third of Newborns Are Hispanic or Black Babies born today promise great diversity tomorrow. Of the 4.3 million babies born in 2008, more than 24 percent were born to Hispanic women and 15 percent to black women. Another 6 percent were born to Asian women. Only 53 percent of babies were born to non-Hispanic whites. As today’s children grow up, they will create an increasingly multicultural society with no single racial or ethnic group claiming the majority of the U.S. population. Among black, Hispanic, and non-Hispanic white women who gave birth in 2008, most were in their twenties. Among Asians, the ﬁgure was just 40 percent. The ﬁgure is low among Asians because of their educational attainment, as most delay childbearing while they earn their college degree. ■ More than two-thirds of Hispanic babies are born to women of Mexican origin.

Most babies are born to women in their twenties 30

(percent distribution of births, by age of mother, 2008)

20% 20

10% 10

00%

108 AMERICAN HEALTH

under 20

20 to 24

25 to 29

30 to 34

35 or older

BIRTHS

Table 5.11

Births by Age, Race, and Hispanic Origin, 2008

(number and percent distribution of births by age, race, and Hispanic origin, 2008)

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 54

total

American Indian

Asian

non-Hispanic black

Hispanic

non-Hispanic white

4,251,095 5,775 435,000 1,052,928 1,196,713 957,567 489,357 106,090 7,666

49,540 126 8,817 16,798 12,653 7,169 3,205 730 42

253,396 81 7,545 31,074 71,294 85,572 47,660 9,458 713

625,314 2,140 104,794 198,699 157,051 98,524 50,823 12,464 818

1,038,933 2,328 144,702 292,595 280,716 199,401 96,889 21,141 1,161

2,273,220 1,108 168,865 512,538 671,977 563,755 288,629 61,603 4,746

PERCENT DISTRIBUTION BY RACE AND HISPANIC ORIGIN

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 54

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

1.2% 2.2 2.0 1.6 1.1 0.7 0.7 0.7 0.5

6.0% 1.4 1.7 3.0 6.0 8.9 9.7 8.9 9.3

14.7% 37.1 24.1 18.9 13.1 10.3 10.4 11.7 10.7

24.4% 40.3 33.3 27.8 23.5 20.8 19.8 19.9 15.1

53.5% 19.2 38.8 48.7 56.2 58.9 59.0 58.1 61.9

100.0% 0.3 17.8 33.9 25.5 14.5 6.5 1.5 0.1

100.0% 0.0 3.0 12.3 28.1 33.8 18.8 3.7 0.3

100.0% 0.3 16.8 31.8 25.1 15.8 8.1 2.0 0.1

100.0% 0.2 13.9 28.2 27.0 19.2 9.3 2.0 0.1

100.0% 0.0 7.4 22.5 29.6 24.8 12.7 2.7 0.2

PERCENT DISTRIBUTION BY AGE

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 54

100.0% 0.1 10.2 24.8 28.2 22.5 11.5 2.5 0.2

Note: Births by race and Hispanic origin do not add to total because Hispanics may be of any race and “not stated” is not shown. Source: National Center for Health Statistics, Births: Preliminary Data for 2008, National Vital Statistics Report, Vol. 58, No. 16, 2010, Internet sites http://www.cdc.gov/nchs/products/nvsr.htm; calculations by New Strategist

AMERICAN HEALTH

109

Table 5.12

Births to Hispanics by Age and Hispanic Origin, 2006

(number and percent distribution of births to Hispanics by age and Hispanic origin, 2006)

Total Hispanic births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 or older

total

Mexican

Puerto Rican

Cuban

Central and South American

other Hispanic

1,039,077 148,125 303,454 280,615 194,594 91,568 19,700 1,021

718,146 107,982 216,371 193,311 129,901 58,200 11,804 577

66,932 11,852 20,998 17,051 10,385 5,347 1,222 77

16,936 1,352 3,703 4,151 4,745 2,385 566 34

165,321 14,785 40,297 48,120 37,306 19,787 4,762 264

71,742 12,154 22,085 17,982 12,257 5,849 1,346 69

PERCENT DISTRIBUTION BY HISPANIC ORIGIN

Total Hispanic births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 or older

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0

69.1% 72.9 71.3 68.9 66.8 63.6 59.9 56.5

6.4% 8.0 6.9 6.1 5.3 5.8 6.2 7.5

1.6% 0.9 1.2 1.5 2.4 2.6 2.9 3.3

15.9% 10.0 13.3 17.1 19.2 21.6 24.2 25.9

6.9% 8.2 7.3 6.4 6.3 6.4 6.8 6.8

100.0% 15.0 30.1 26.9 18.1 8.1 1.6 0.1

100.0% 17.7 31.4 25.5 15.5 8.0 1.8 0.1

100.0% 8.0 21.9 24.5 28.0 14.1 3.3 0.2

100.0% 8.9 24.4 29.1 22.6 12.0 2.9 0.2

100.0% 16.9 30.8 25.1 17.1 8.2 1.9 0.1

PERCENT DISTRIBUTION BY AGE

Total Hispanic births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 or older

100.0% 14.3 29.2 27.0 18.7 8.8 1.9 0.1

Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/nvss/new_births.htm; calculations by New Strategist

110 AMERICAN HEALTH

BIRTHS

Many Births Are to Unmarried Women More than 70 percent of black births in 2008 were to single mothers. More than 40 percent of births in 2008 were to unmarried women. The percentage varies greatly by race and Hispanic origin, however. Out-of-wedlock childbearing is least likely among Asian women and most common among blacks. The younger the mother, the more likely the birth is out-of-wedlock. Among mothers aged 15 to 44, a substantial 42 percent have had a child out-of-wedlock, according to a 2002 study of family life. The percentage of women who have had a child out-of-wedlock is highest among teenagers, blacks, and high school dropouts. Forty percent of Catholic and 47 percent of fundamentalist Protestant women have had an out-of-wedlock birth. Family structure greatly inﬂuences out-of-wedlock childbearing. Among women raised in a two-parent family, 35 percent have had a child out-of-wedlock. Among those raised in other types of families the ﬁgure is a much larger 59 percent. ■ With so many children being raised by single mothers, the out-of-wedlock share of births is likely to continue to rise. 120

Most births to women under age 25 are out-of-wedlock (percent of births to unmarried women, by age, 2008)

8080%

4040%

00%

under 15

15 to 19

20 to 24

25 to 29

30 to 34

e

35 to 39

f

40 or older

g

AMERICAN HEALTH

111

Table 5.13

Births to Unmarried Women by Age, 2008

(total number of births and number and percent to unmarried women, by age, 2008) unmarried women

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 54

total

number

4,251,095 5,775 435,000 1,052,928 1,196,713 957,567 489,357 113,756

1,727,950 5,721 377,058 641,245 397,679 193,618 88,953 23676

percent distribution

100.0% 0.3 21.8 37.1 23.0 11.2 5.1 1.4

percent of total

40.6% 99.1 86.7 60.9 33.2 20.2 18.2 20.8

Source: National Center for Health Statistics, Births: Preliminary Data for 2008, National Vital Statistics Report, Vol. 58, No. 16, 2010, Internet sites http://www.cdc.gov/nchs/products/nvsr.htm; calculations by New Strategist

Table 5.14

Births to Unmarried Women by Race and Hispanic Origin, 2006

(total number of births and number and percent to unmarried women, by race and Hispanic origin, 2006) unmarried women

Total births American Indian Asian Black, non-Hispanic Hispanic White, non-Hispanic

total

number

4,265,555 47,741 241,045 617,247 1,039,077 2,308,640

1,641,946 30,828 39,680 436,227 518,125 614,522

percent distribution

100.0% 1.9 2.4 26.6 31.6 37.4

percent of total

38.5% 64.6 16.5 70.7 49.9 26.6

Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/nvss/new_births.htm; calculations by New Strategist

112 AMERICAN HEALTH

BIRTHS

Table 5.15

Women Who Have Ever Had a Nonmarital Birth, 2002

(number of women aged 15 to 44 who have had at least one live birth, and percent who have ever borne a child outside of wedlock, by selected characteristics, 2002; numbers in thousands) total

Total women aged 15 to 44 who have had at least one birth Age at interview Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44

35,938

percent ever having had nonmarital birth

42.2%

771 3,240 5,599 7,521 9,016 9,791

92.2 68.4 54.2 41.2 35.8 29.2

Race and Hispanic origin Black, non-Hispanic Hispanic White, non-Hispanic

5,218 6,159 22,047

80.9 50.6 30.1

Education Not a high school graduate High school graduate or GED Some college, no degree Bachelor’s degree or more

11,056 13,770 6,532 4,308

51.2 39.6 40.8 27.8

Religion raised No religion Fundamentalist Protestant Other Protestant Catholic Other religion

2,229 2,266 16,359 13,189 1,736

49.3 47.0 43.4 39.6 32.4

Family structure at age 14 Living with both parents Other

25,468 10,471

35.1 59.4

Note: Education categories include only people aged 22 to 44. Source: National Center for Health Statistics, Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 25, 2005, Internet site http://www.cdc .gov/nchs/nsfg.htm

AMERICAN HEALTH

113

Forty Percent of Births Are First Births Another 31 percent are second births. Of the 4.3 million babies born in 2008, nearly 2 million were ﬁrst births—a substantial 40 percent. The 1.3 million second births accounted for 31 percent of the total. Seventeen percent of babies born in 2008 were third children, and just 11 percent were fourth or higher-order births. The older the woman, the more likely she is to be having a second, third, or higher-order birth. In fact, second or higher-order births outnumber ﬁrst births beginning in the 20-to-24 age group. Birth order also varies by race and Hispanic origin. Forty-six percent of babies born to Asians in 2008 were ﬁrst births compared with only 35 percent of babies born to Hispanics. Hispanics accounted for 24 percent of all births in 2008, but for a larger 32 percent of fourth or higher-order births. ■ Hispanics are more likely than Asians, blacks, or non-Hispanic whites to have three or four children.

Most births are second or higher order (percent distribution of births by birth order, 2008) 45

40%

30

30%

15

15%

0

0%

31%

17% 11%

ﬁrst birth

114 AMERICAN HEALTH

second birth

third birth

fourth or higher-order birth

BIRTHS

Table 5.16

Births by Age of Mother and Birth Order, 2008

(number and percent distribution of births by age of mother and birth order, 2008)

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 54

total

ﬁrst child

second child

third child

fourth or later child

4,251,095 5,775 435,000 1,052,928 1,196,713 957,567 489,357 106,090 7,666

1,705,270 5,642 349,473 512,489 431,690 270,581 110,234 23,127 2,036

1,331,563 81 71,053 347,646 394,016 328,455 158,675 29,791 1,846

705,683 6 10,590 135,741 224,046 199,260 112,631 22,037 1,372

481,916 0 1,387 50,506 139,666 153,311 104,402 30,315 2,328

PERCENT DISTRIBUTION BY BIRTH ORDER

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 54

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

40.1% 97.7 80.3 48.7 36.1 28.3 22.5 21.8 26.6

31.3% 1.4 16.3 33.0 32.9 34.3 32.4 28.1 24.1

16.6% 0.1 2.4 12.9 18.7 20.8 23.0 20.8 17.9

11.3% 0.0 0.3 4.8 11.7 16.0 21.3 28.6 30.4

100.0% 0.3 20.5 30.1 25.3 15.9 6.5 1.4 0.1

100.0% 0.0 5.3 26.1 29.6 24.7 11.9 2.2 0.1

100.0% 0.0 1.5 19.2 31.7 28.2 16.0 3.1 0.2

100.0% 0.0 0.3 10.5 29.0 31.8 21.7 6.3 0.5

PERCENT DISTRIBUTION BY AGE

Total births Under age 15 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 54

100.0% 0.1 10.2 24.8 28.2 22.5 11.5 2.5 0.2

Note: Numbers do not add to total because “not stated” is not shown. Source: National Center for Health Statistics, Births: Preliminary Data for 2008, National Vital Statistics Report, Vol. 58, No. 16, 2010, Internet sites http://www.cdc.gov/nchs/products/nvsr.htm; calculations by New Strategist

AMERICAN HEALTH

115

Table 5.17

Births by Race, Hispanic Origin, and Birth Order, 2008

(number and percent distribution of births by race, Hispanic origin, and birth order, 2008)

Total births American Indian Asian Black Hispanic White, non-Hispanic

total

ﬁrst child

second child

third child

fourth or later child

4,251,095 49,540 253,396 625,314 1,038,933 2,273,220

1,705,270 17,669 115,414 245,417 367,692 954,873

1,331,563 13,335 88,562 174,732 309,645 742,336

705,683 8,757 31,284 105,426 204,165 354,871

481,916 9,463 16,800 93,181 152,036 209,534

PERCENT DISTRIBUTION BY BIRTH ORDER

Total births American Indian Asian Black Hispanic White, non-Hispanic

100.0% 100.0 100.0 100.0 100.0 100.0

40.1% 35.7 45.5 39.2 35.4 42.0

31.3% 26.9 35.0 27.9 29.8 32.7

16.6% 17.7 12.3 16.9 19.7 15.6

11.3% 19.1 6.6 14.9 14.6 9.2

100.0% 1.2 4.4 14.9 28.9 50.3

100.0% 2.0 3.5 19.3 31.5 43.5

PERCENT DISTRIBUTION BY RACE AND HISPANIC ORIGIN

Total births American Indian Asian Black Hispanic White, non-Hispanic

100.0% 1.2 6.0 14.7 24.4 53.5

100.0% 1.0 6.8 14.4 21.6 56.0

100.0% 1.0 6.7 13.1 23.3 55.7

Note: Numbers do not add to total because “not stated” is not shown. Source: National Center for Health Statistics, Births: Preliminary Data for 2008, National Vital Statistics Report, Vol. 58, No. 16, 2010, Internet site http://www.cdc.gov/nchs/products/nvsr.htm; calculations by New Strategist

116 AMERICAN HEALTH

BIRTHS

Older Mothers Are More Likely to Have Caesareans They are also more likely to have twins. The older the mother, the more likely she is to give birth by Caesarean section. The Caesarean rate rises steeply with age, from 22 percent among teenagers to 47 percent among women aged 40 or older. Older mothers are also more likely to give birth to twins or have higher-order multiple deliveries. The rate of twin births rises from 1.6 percent among teens to 5.5 percent among women aged 40 or older. Higher-order multiple births are also more common among older women. Behind this trend are fertility technologies to help women conceive and bear children, which can result in multiple births. ■ Although the risks associated with having children later in life are well known, many women wait to begin their families because they are ﬁnishing their education or establishing a career.

60More than 40 percent of births to women aged 40 or older are by Caesarean (percent of babies born by Caesarean delivery, by age of mother, 2006)

4040%

2020%

00%

under 20

20 to 24

25 to 29

30 to 34

e

35 to 39

f

40 or older

AMERICAN HEALTH

117

Table 5.18

Births by Age and Method of Delivery, 2006

(number and percent distribution of births by age and method of delivery, 2006) Total births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 or older

total births

vaginal

Caesarean

4,265,555 441,832 1,080,437 1,181,899 950,258 498,616 112,513

2,929,590 342,977 792,028 826,822 615,784 293,352 58,627

1,321,054 97,806 285,227 351,002 330,783 202,987 53,249

PERCENT DISTRIBUTION BY METHOD OF DELIVERY

Total births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 or older

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

PERCENT DISTRIBUTION BY AGE

Total births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 or older

100.0% 10.4 25.3 27.7 22.3 11.7 2.6

68.7% 77.6 73.3 70.0 64.8 58.8 52.1

31.0% 22.1 26.4 29.7 34.8 40.7 47.3

100.0% 11.7 27.0 28.2 21.0 10.0 2.0

100.0% 7.4 21.6 26.6 25.0 15.4 4.0

Note: Numbers do not add to total because “not stated” is not shown. Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/births.htm; calculations by New Strategist

118 AMERICAN HEALTH

BIRTHS

Table 5.19

Births by Age and Plurality, 2006

(number and percent distribution of births by age and plurality, 2006)

Total births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 or older

total

single deliveries

twin deliveries

higher-order multiple deliveries

4,265,555 441,832 1,080,437 1,181,899 950,258 498,616 105,539 6,974

4,121,930 434,577 1,055,322 1,144,629 909,814 472,756 99,337 5,495

137,085 7,160 24,595 35,785 38,036 24,285 5,847 1,377

6,540 95 520 1,485 2,408 1,575 355 102

PERCENT DISTRIBUTION BY PLURALITY

Total births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 or older

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

PERCENT DISTRIBUTION BY AGE

Total births Under age 20 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 or older

100.0% 10.4 25.3 27.7 22.3 11.7 2.5

96.6% 98.4 97.7 96.8 95.7 94.8 94.1

3.2% 1.6 2.3 3.0 4.0 4.9 5.5

0.2% 0.0 0.0 0.1 0.3 0.3 0.3

100.0% 10.5 25.6 27.8 22.1 11.5 2.4

100.0% 5.2 17.9 26.1 27.7 17.7 4.3

100.0% 1.5 8.0 22.7 36.8 24.1 5.4

Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/nvss/new_births.htm; calculations by New Strategist

AMERICAN HEALTH

119

Hispanics Have Higher Fertility Rate Those of Mexican origin have the highest fertility rate of all. On average, American women have 2.1 children in their lifetime. The ﬁgure varies by race and Hispanic origin, however. Hispanics average 3.0 children compared with fewer than two among Asians and non-Hispanic whites. Among Hispanics, those of Mexican origin have the most children—an average of 3.1 in their lifetime. Hispanic women of Cuban origin have only 1.6 children, however. Out-of-wedlock childbearing is most common among blacks, with 71 percent of black babies born to an unmarried mother in 2006. Among Hispanics, the ﬁgure is nearly 50 percent—the ﬁgure ranging from a low of 39 percent among Cubans to a high of 62 percent among Puerto Ricans. ■ Cuban Americans delay childbearing much longer than other Hispanics, with an average age at ﬁrst birth of 26.2 in 2006. 120

Asian mothers are least likely to have been born in the United States

(percent of births to women born in the 50 states or Washington, D.C., by race and Hispanic origin, 2006)

93.8%

94.0%

87.4%

80 80%

37.5%

40 40%

19.0% 0 0%

American Indian

120 AMERICAN HEALTH

Asian

black

Hispanic

non-Hispanic e white

BIRTHS

Table 5.20

Births by Selected Characteristics, Race, and Hispanic Origin, 2006

(total number of births, births per 1,000 women aged 15 to 44, average number of births in lifetime, average age at ﬁrst birth, and percent of births by selected characteristics, by race and Hispanic origin, 2006) total

American Indian

Asian

Total births 4,265,555 Births per 1,000 women aged 15 to 44 68.5 Average number of births in lifetime 2.1 Age of mother at ﬁrst birth (years) 25.0

47,721 63.1 1.8 21.9

241,045 67.5 1.9 28.5

Percent of births by selected characteristics Mother under age 20 10.4% Fourth or higher-order birth 11.2 Unmarried mother 38.5 Mother born in 50 states or D.C. 75.1

17.6% 19.1 64.6 93.8

non-Hispanic black

Hispanic

non-Hispanic white

617,247 1,039,077 2,308,640 70.6 101.5 59.5 2.1 3.0 1.9 22.7 23.1 26.0

3.3% 6.5 16.5 19.0

17.2% 15.0 70.7 87.4

14.3% 14.2 49.9 37.5

7.4% 9.1 26.6 94.0

Note: Average number of births in lifetime is the total fertility rate divided by 1000. Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/nvss/new_births.htm; calculations by New Strategist

Table 5.21

Births to Hispanics by Selected Characteristics and Hispanic Origin, 2006

(total number of births to Hispanics, births per 1,000 women aged 15 to 44, average number of births in lifetime, average age at ﬁrst birth, and percent of births by selected characteristics, by Hispanic origin, 2006)

Total births to Hispanics Births per 1,000 women aged 15 to 44 Average number of births in lifetime Age of mother at ﬁrst birth (years)

total

Mexican

Puerto Rican

Cuban

Central and South American

1,039,077 101.5 3.0 23.1

718,146 109.0 3.1 22.5

66,932 74.0 2.2 22.8

16,936 49.3 1.6 26.2

165,321 98.6 3.0 25.0

Percent of births by selected characteristics Mother under age 20 Fourth or higher-order birth Unmarried mother Mother born in 50 states or D.C.

14.3% 14.2 49.9 37.5

15.0% 15.6 48.6 35.9

17.7% 12.1 62.4 69.1

8.0% 4.9 39.4 49.1

8.9% 10.9 51.5 13.7

Note: Average number of births in lifetime is the total fertility rate divided by 1000. Number of births will not add to total because not all Hispanic origins are shown. Source: National Center for Health Statistics, Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/nvss/new_births.htm; calculations by New Strategist

AMERICAN HEALTH

121

Breastfeeding Is Increasing Three out of four newborns are breastfed. More babies are being breastfed as doctors and nutritionists encourage the practice. The percentage of newborns who are breastfed increased from 71 to 74 percent between 2000 and 2006. The likelihood of breastfeeding varies by a mother’s demographic characteristics. Older mothers are much more likely to breastfeed than younger ones, for example. Only 56 percent of babies born to women under age 20 were breastfed in 2006 compared with 78 percent of those born to women aged 30 or older. Among blacks, only 60 percent of newborns are breastfed compared with 82 percent of babies born to Hispanics. Education plays a big role in determining breastfeeding practices, and 86 percent of babies born to college graduates are being breastfed versus only 68 percent of those born to high school dropouts. ■ The percentage of black newborns who were breastfed increased by a substantial 9 percentage points between 2000 and 2006.

Breastfeeding is more likely among babies born to married mothers 90

(percent of babies who were breastfed, by mother’s marital status, 2006)

79.9%

60

60%

30

30%

0

0%

122 AMERICAN HEALTH

60.6%

married

not married

BIRTHS

Table 5.22

Breastfeeding Trends, 2000 to 2006

(percentage of babies who were ever breastfed by selected characteristics of mother and child and year of birth, 2000 and 2006; percentage point change 2000–06 ) 2006

2000

percentage point change

Total babies

73.9%

70.9%

3.0

Race and Hispanic origin of child Asian Black Hispanic Non-Hispanic white

84.4 59.9 82.1 73.8

86.2 51.2 78.5 72.3

–1.8 8.7 3.6 1.5

Mother’s age Under age 20 Aged 20 to 29 Aged 30 or older

55.6 69.2 78.0

68.4 66.0 75.4

–12.8 3.2 2.6

Mother’s education Not a high school graduate High school graduate Some college College graduate

68.3 64.9 75.3 86.3

65.4 62.4 72.1 83.0

2.9 2.5 3.2 3.3

Mother’s marital status Married Not married

79.9 60.6

75.6 59.0

4.3 1.6

Family income to poverty threshold ratio Under 100 percent of poverty level 100 to 184 percent of poverty level 185 to 349 percent of poverty level 350 percent or more above poverty level

67.1 68.5 74.4 82.5

61.0 66.3 73.4 79.0

6.1 2.2 1.0 3.5

Source: Centers for Disease Control and Prevention, Breastfeeding among U.S. Children Born 1999–2006, CDC National Immunization Survey, Internet site http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm; calculations by New Strategist

AMERICAN HEALTH

123

COVERAGE AND COST CHAPTER

6

Coverage and Cost ■ Americans spend more for health care than the citizens of any other country. Per capita spending in the United States topped $6,700 in 2006, with Norway coming in a distant second at $4,520.

■ Only 14 percent of health care costs are paid for out-of-pocket. Dental care is most likely to be paid for out-of-pocket (44 percent), hospital care the least (3 percent).

■ Fifty-eight percent of Americans have health insurance through an employer. Fourteen percent are covered by Medicaid (health insurance for the poor), 14 percent by Medicare (health insurance for people aged 65 or older), and 15 percent have no insurance.

■ Cost is the primary reason for being uninsured. Forty-eight percent of the uninsured say they do not have health insurance because it costs too much. Another 22 percent say it is because they lost or left their job.

■ Seventy-four percent of workers have access to health insurance through their employer. Among the lowest-paid workers, however, only 42 percent have access to health insurance through their employer.

■ Health care spending rises with age. Householders under age 25 spend an average of only $682 a year out-of-pocket on health care, while householders aged 75 or older spend $4,605.

AMERICAN HEALTH

125

Health Care Costs Have Grown Rapidly As costs rise, individuals are paying a smaller share of the total. Between 1960 and 2007, the nation’s spending on health care soared, climbing from just $28 billion to $2.2 trillion. The United States spends more than any other country on health care, fully $6,714 per person in 2006 (the latest data available). Norway, in second place, spent just $4,520 per capita on health care. As the number of dollars spent on health care has grown, the allocation of those dollars has remained remarkably stable. In 1960, 33.5 percent of health care expenditures went to hospital care. The share was an only slightly smaller 31.1 percent in 2007. Prescription drugs accounted for about 10 percent of health care spending in both years. As health costs have increased, more of the ﬁnancial burden has shifted to the federal government. In 1960 fully 55 percent of personal health care expenditures were paid for out-of-pocket. In 2007, the share was just 14 percent. At the same time, the share paid for by the federal government through programs such as Medicare and Medicaid climbed from almost nothing to 38 percent. The biggest change has been in prescription drugs, with the out-of-pocket share falling from 96 to 21 percent between 1960 and 2007. ■ Health care would bankrupt most families if they were forced to pay the same share of expenses out-of-pocket as they did in 1960.

Only 25 percent of prescription drug expenses are paid for out-of-pocket

120 (percent of total health care expenditures paid for out-of-pocket, by type of expenditure, 1960 and 2007)

96% 80

oh-sev

77%

80%

62%

40

40%

27%

21% 0

3% 0%

21%

100000

a care hospital

all 1960

10%

75000

bservices physician

2007 dual

nursing c home care

d drugs prescription

50000

25000

126 AMERICAN HEALTH

0

with

w/out

sixty

COVERAGE AND COST

Table 6.1

National Health Care Expenditures, 1960 to 2007

(total national health care expenditures and average annual percent change, selected years, 1960 to 2007) total (billions)

2007 2006 2005 2000 1990 1980 1970 1960

average annual percent change from previous year shown

$2,241.2 2,112.7 1,980.6 1,353.2 714.1 253.4 74.9 27.5

6.1% 6.7 7.9 6.6 10.9 13.0 10.5 –

Note: “–” means not applicable. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

Table 6.2

National Health Care Expenditures by Type of Expenditure, 1960 and 2007

(national health care expenditures and percent distribution by type of expenditure, 1960 and 2007) 2007 total (billions) TOTAL NATIONAL HEALTH CARE SPENDING

Health services and supplies Personal health care Hospital care Professional services Physician services Other professional services Dental services Other personal health care Nursing home and home health care Home health care Nursing home care Retail outlet sales of medical products Prescription drugs Other medical products Government administration and net cost of private health insurance Government public health activities Investment Research Structures and equipment

$2,241.2 2,098.1 1,878.3 696.5 702.1 478.8 62.0 95.2 66.2 190.4 59.0 131.3 289.3 227.5 61.8

1960 percent distribution

100.0% 93.6 83.8 31.1 31.3 21.4 2.8 4.2 3.0 8.5 2.6 5.9 12.9 10.2 2.8

total (billions)

$27.5 24.9 23.3 9.2 8.3 5.4 0.4 2.0 0.6 0.9 0.1 0.8 4.9 2.7 2.3

percent distribution

100.0% 90.5 84.7 33.5 30.2 19.6 1.5 7.3 2.2 3.3 0.4 2.9 17.8 9.8 8.4

155.7 64.1

6.9 2.9

1.2 0.4

4.4 1.5

143.1 42.4 100.7

6.4 1.9 4.5

2.6 0.7 1.9

9.5 2.5 6.9

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

127

Table 6.3

Personal Health Care Expenditures, 1960 to 2007

(total and per capita personal health care expenditures and percent distribution by source of payment, selected years, 1960 to 2007)

2007 2006 2005 2000 1990 1980 1970 1960

total personal health care expenditures (billions)

per capita personal health care expenditures

$1,878.3 1,765.5 1,655.1 1,139.9 607.6 214.8 62.9 23.3

$6,219 5,902 5,588 4,032 2,394 932 299 125

percent distribution by source of payment total

out-of-pocket

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0

14.3% 14.4 14.9 16.9 22.4 27.1 39.6 55.2

private health insurance

36.2% 36.1 36.2 35.4 33.7 28.5 22.3 21.4

government Medicare

21.8% 21.7 19.8 18.9 17.5 16.8 11.6 –

Medicaid

CHIP

16.2% 16.2 17.4 16.4 11.5 11.8 8.0 –

0.4% 0.4 0.4 0.2 – – – –

Note: CHIP is Children’s Health Insurance Program. Numbers do not add to total because “other private funds” are not shown. “–” means program not available. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

Table 6.4

Out-of-Pocket Payments for Personal Health Care Expenditures, 1960 to 2007

(total personal health care expenditures and percent paid out-of-pocket by type of expenditure, selected years, 1960 to 2007) total amount (billions)

2007 2006 2005 2000 1990 1980 1970 1960

$1,878.3 1,765.5 1,655.1 1,139.9 607.6 214.8 62.9 23.3

hospital care

percent paid out-of-pocket

14.3% 14.4 14.9 16.9 22.4 27.1 39.6 55.2

dental services amount (billions)

2007 2006 2005 2000 1990 1980 1970 1960

$95.2 90.5 86.4 62.0 31.5 13.3 4.7 2.0

percent paid out-of-pocket

44.2% 44.3 44.3 44.6 48.5 66.4 91.0 97.2

amount (billions)

$696.5 649.3 607.5 416.9 251.6 101.0 27.6 9.2

physician services

percent paid out-of-pocket

3.3% 3.3 3.3 3.3 4.5 5.4 9.0 20.7

nursing home care amount (billions)

$131.3 125.4 120.6 95.3 52.6 18.5 4.0 0.8

percent paid out-of-pocket

26.9% 26.1 26.1 30.1 36.1 35.7 52.0 77.3

amount (billions)

$478.8 449.7 422.2 288.6 157.6 47.1 14.0 5.4

percent paid out-of-pocket

10.4% 10.3 10.3 11.1 19.2 30.4 46.2 61.7

home health care amount (billions)

$59.0 53.0 48.1 30.5 12.6 2.4 0.2 0.1

percent paid out-of-pocket

10.1% 10.9 11.5 17.9 17.9 15.2 9.4 12.5

prescription drugs amount (billions)

$227.5 216.8 199.7 120.6 40.3 12.0 5.5 2.7

percent paid out-of-pocket

20.9% 21.6 24.4 27.7 55.5 70.3 82.4 96.0

other health care amount (billions)

$190.0 180.8 170.6 125.4 61.5 20.5 6.9 3.3

percent paid out-of-pocket

34.1% 34.2 35.1 41.1 58.1 69.2 73.0 78.1

Note: “Other expenditures” includes other professional services, nonprescription drugs, other medical nondurables, vision products, and other medical durables. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm

128 AMERICAN HEALTH

COVERAGE AND COST

Table 6.5

Consumer Price Index for Health Care by Type of Product or Service, 2008

(consumer price index for all items, for major categories, and for components of medical care, 2008; 1982–84 = 100 unless otherwise noted) 2008

All items Food Apparel Housing Energy Medical care

215.3 214.1 118.9 216.3 236.7 364.1

COMPONENTS OF MEDICAL CARE

Medical care services Professional services Physician services Dental services Eyeglasses and eye care* Services by other medical professionals* Hospital and related services Hospital services** Inpatient hospital services** Outpatient hospital services* Nursing homes and adult day care** Health insurance***

384.9 311.0 311.3 376.9 174.1 205.5 534.0 197.2 190.8 456.8 165.3 114.2

Medical care products Prescription drugs and medical supplies Nonprescription drugs and medical supplies* Internal and respiratory over-the-counter drugs Nonprescription medical equipment and supplies

296.0 378.3 158.3 188.7 185.6

* 1986 = 100 ** 1996 = 100 *** December 2005 = 100 Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm

AMERICAN HEALTH

129

Table 6.6

Health Care Spending by Country, 2006

(health care expenditures as a percent of gross domestic product, and per capita and indexed per capita health care expenditures, for the United States and selected countries, 2006) health care expenditures as a percent of GDP

United States

15.3%

Australia Austria Belgium Canada Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Japan Luxembourg Mexico Norway Poland Portugal Slovak Republic South Korea Spain Sweden Switzerland United Kingdom

8.7 10.1 10.3 10.0 6.8 9.5 8.2 11.0 10.6 9.1 8.3 9.1 7.5 9.0 8.1 7.3 6.6 8.7 6.2 10.2 7.4 6.4 8.4 9.2 11.3 8.4

per capita health care expenditures

indexed per capita health care expenditures

$6,714

100

3,141 3,606 3,462 3,678 1,509 3,362 2,668 3,449 3,371 2,483 1,504 3,340 3,082 2,614 2,578 4,303 794 4,520 910 2,120 1,308 1,464 2,458 3,202 4,311 2,760

47 54 52 55 22 50 40 51 50 37 22 50 46 39 38 64 12 67 14 32 19 22 37 48 64 41

Note: Per capita health expenditures for each country have been adjusted to U.S. dollars using gross domestic product purchasing power parities. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm

130 AMERICAN HEALTH

COVERAGE AND COST

Fewer Are Covered by Employment-Based Health Insurance Fifteen percent of the population has no health insurance. In 2008, the 67 percent majority of the U.S. population had private health insurance, down from 73 percent in 2000. The percentage of the population covered by employment-based private health insurance fell from 64 to 58 percent during those years. Only 9 percent of the population has private health insurance that they purchased directly themselves. Employment-based health insurance, which is the system through which the United States has traditionally provided health care coverage to people under age 65, is in trouble. The percentage of 18-to-64-year-olds with employment-based health insurance coverage fell from 68 to 62 percent between 2000 and 2008. Most age groups saw declines of 7 to 8 percentage points in coverage during those years. Fifteen percent of the population is without any type of health insurance, up only slightly from the 14 percent of 2000. The only factor keeping more from being uninsured is the surge in government-provided health insurance, the percentage covered by Medicare, Medicaid, or the military rising from 27 to 32 percent between 2000 and 2008. The biggest increase in the share of the uninsured has been among 25-to-34-year-olds, the ﬁgure rising from 21 to 27 percent of the age group between 2000 and 2008. ■ With fewer employers able to provide health insurance to their employees and with pre-existing conditions barring many from buying insurance in the private market, the American health insurance system is in danger of collapsing.

The ranks of the uninsured are growing (percent of the U.S. population without health insurance, by age, 2000 and 2008) 30

oh-oh

oh-ei 2020%

1010% 100000

00%

under a 18

18 b to 24

25 c to 34

75000

all 2000

2008 dual

35 to d44

45 to e54

55 tof 64

65 orgolder

50000

25000

AMERICAN HEALTH 0

with

w/out

131

Table 6.7

Health Insurance Coverage by Type, 2000 to 2008

(number and percent distribution of people by health insurance coverage status, 2000 to 2008; numbers in thousands) covered by private or government health insurance private health insurance total people

total

total

employment based

2008

301,483 255,143

200,992

176,332

2007

299,106 253,449

201,991

177,446

2006

296,824 249,829

201,690

2005

293,834 249,020

2004

government health insurance direct purchase

military

not covered

43,029

11,560

46,340

41,375

10,955

45,657

38,281

40,343

10,547

46,995

80,213

38,104

40,177

11,166

44,815

27,551

79,486

37,955

39,703

10,789

43,498

175,844

26,783

76,755

35,647

39,456

9,979

43,404

200,891

177,095

26,846

73,624

33,246

38,448

10,063

42,019

282,082 242,322

201,695

178,261

26,309

71,295

31,601

38,043

9,552

39,760

279,517 241,091

202,794

179,436

26,799

69,037

29,533

37,740

9,099

38,426

total

Medicaid

Medicare

26,777

87,411

42,641

26,673

83,031

39,554

177,152

27,066

80,270

201,167

176,924

27,055

291,166 247,669

200,924

176,247

2003

288,280 244,876

199,871

2002

285,933 243,914

2001 2000

Number

Percent distribution 2008

100.0%

84.6%

66.7%

58.5%

8.9%

29.0%

14.1%

14.3%

3.8%

15.4%

2007

100.0

84.7

67.5

59.3

8.9

27.8

13.2

13.8

3.7

15.3

2006

100.0

84.2

67.9

59.7

9.1

27.0

12.9

13.6

3.6

15.8

2005

100.0

84.7

68.5

60.2

9.2

27.3

13.0

13.7

3.8

15.3

2004

100.0

85.1

69.0

60.5

9.5

27.3

13.0

13.6

3.7

14.9

2003

100.0

84.9

69.3

61.0

9.3

26.6

12.4

13.7

3.5

15.1

2002

100.0

85.3

70.3

61.9

9.4

25.7

11.6

13.4

3.5

14.7

2001

100.0

85.9

71.5

63.2

9.3

25.3

11.2

13.5

3.4

14.1

2000

100.0

86.3

72.6

64.2

9.6

24.7

10.6

13.5

3.3

13.7

Note: Numbers may not add to total because some people have more than one type of coverage. Source: Bureau of the Census, Historical Health Insurance Tables, Current Population Survey, Internet site http://www.census .gov/hhes/www/hlthins/historic/index.html

132 AMERICAN HEALTH

COVERAGE AND COST

Table 6.8

Employment-Based Private Health Insurance by Age, 2000 and 2008

(number and percent of people under age 65 with employment-based private health insurance coverage, by age, 2000 and 2008; percent change in number and percentage point change in share, 2000–08)

Number with employmentbased insurance Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64

2008

2000

163,120 43,874 13,450 24,130 27,899 30,861 22,906

167,923 47,679 14,351 26,388 33,135 29,578 16,792

2008

Percent with employmentbased insurance Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64

61.9% 58.9 46.9 59.6 67.5 69.6 66.8

2000

68.3% 65.9 53.5 67.9 74.4 76.4 68.1

percent change 2000–08

–2.9% –8.0 –6.3 –8.6 –15.8 4.3 36.4 percentage point change 2000–08

–6.4 –7.0 –6.6 –8.3 –6.9 –6.8 –1.3

Source: Bureau of the Census, Historical Health Insurance Tables, Current Population Survey, Internet site http://www.census .gov/hhes/www/hlthins/historic/index.html

AMERICAN HEALTH

133

Table 6.9

People without Health Insurance by Age, 2000 and 2008

(number and percent of people without health insurance coverage by age, 2000 and 2008; percent change in number and percentage point change in share, 2000–08; numbers in thousands)

Number without insurance Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

2008

2000

46,340 7,348 8,200 10,754 8,035 7,054 4,301 646

38,426 8,385 7,203 8,318 6,746 4,492 3,031 251

percent change 2000–08

20.6% –12.4 13.8 29.3 19.1 57.0 41.9 157.4 percentage point change 2000–08

Percent without insurance Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

15.4% 9.9 28.6 26.5 19.4 15.9 12.5 1.7

13.7% 11.6 26.9 21.4 15.1 11.6 12.3 0.7

1.7 –1.7 1.7 5.1 4.3 4.3 0.2 1.0

Source: Bureau of the Census, Historical Health Insurance Tables, Current Population Survey, Internet site http://www.census .gov/hhes/www/hlthins/historic/index.html

134 AMERICAN HEALTH

COVERAGE AND COST

Hispanics Are Most Likely to Be Uninsured Many do not have access to employment-based health care coverage. Most Americans of working age have health insurance through an employer. Among people aged 18 to 24, however, only 47 percent have employment-based coverage. Twenty-nine percent of 18-to24-year-olds have no health insurance coverage. People aged 25 to 34 account for the largest share of the uninsured—23 percent in 2008. Females are slightly more likely than males to be covered under a government health insurance program. Women tend to have lower incomes, which is one reason for their greater participation in the Medicaid program. But women also make up the majority of older adults, and are therefore more likely to be covered by Medicare. The biggest differences in health insurance coverage are by race and Hispanic origin. Blacks and Hispanics are much less likely than Asians and non-Hispanic whites to have employer-provided health insurance. One reason for the disparity is that many blacks and Hispanics work in service industries where employers are much less likely to offer health insurance. Hispanics are particularly unlikely to have any type of health insurance, 31 percent being uninsured. ■ Without the dual requirement that employers offer health insurance and Americans buy health insurance, a growing share of the population will be uninsured. 90

Fewer than half of Hispanics have employment-based coverage

(percent of population with employment-based health insurance, by race and Hispanic origin, 2008

60

60%

65%

61% 48% 40%

30

30%

0

0%

Asian a

black b

Hispanic c

non-Hispanic d white

AMERICAN HEALTH

135

Table 6.10

Health Insurance Coverage by Age, 2008

(number and percent distribution of people by age and health insurance coverage status, 2008; numbers in thousands) covered by private or government health insurance private health insurance total

total

government health insurance

employmentown total based employment

direct purchase

total

Medicaid

Medicare

military

not covered

Total people

301,483 255,143 200,992

176,332

92,901

26,777

87,411

42,641

43,029

11,560

46,340

Under age 65

263,695 218,002 178,705

163,119

82,885

16,673

51,977

39,213

7,725

8,740

45,693

Under age 18

74,510

67,161

47,282

43,874

228

3,812

24,767

22,555

623

2,241

7,348

Aged 18 to 24

28,688

20,488

16,947

13,450

5,052

1,700

4,741

3,798

254

868

8,200

Aged 25 to 34

40,520

29,766

25,879

24,130

18,632

2,189

5,086

3,748

546

1,104

10,754

Aged 35 to 44

41,322

33,287

29,780

27,899

19,702

2,444

4,685

3,155

970

1,097

8,035

Aged 45 to 54

44,366

37,312

33,234

30,861

22,393

3,182

5,797

3,313

1,967

1,371

7,054

Aged 55 to 64

34,289

29,989

25,584

22,906

16,877

3,346

6,901

2,644

3,365

2,059

4,301

Aged 65 or older

37,788

37,142

22,287

13,212

10,016

10,103

35,434

3,428

35,304

2,821

646

PERCENT DISTRIBUTION BY COVERAGE STATUS Total people

100.0%

84.6%

66.7%

58.5%

30.8%

8.9%

29.0%

14.1%

Under age 65

100.0

82.7

67.8

61.9

31.4

6.3

19.7

14.9

14.3% 2.9

3.8%

15.4%

3.3

17.3

Under age 18

100.0

90.1

63.5

58.9

0.3

5.1

33.2

30.3

0.8

3.0

9.9

Aged 18 to 24

100.0

71.4

59.1

46.9

17.6

5.9

16.5

13.2

0.9

3.0

28.6

Aged 25 to 34

100.0

73.5

63.9

59.6

46.0

5.4

12.6

9.2

1.3

2.7

26.5

Aged 35 to 44

100.0

80.6

72.1

67.5

47.7

5.9

11.3

7.6

2.3

2.7

19.4

Aged 45 to 54

100.0

84.1

74.9

69.6

50.5

7.2

13.1

7.5

4.4

3.1

15.9

Aged 55 to 64

100.0

87.5

74.6

66.8

49.2

9.8

20.1

7.7

9.8

6.0

12.5

Aged 65 or older

100.0

98.3

59.0

35.0

26.5

26.7

93.8

9.1

93.4

7.5

1.7

PERCENT DISTRIBUTION BY AGE Total people Under age 65

100.0% 100.0% 100.0%

100.0%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

87.5

85.4

88.9

92.5

89.2

62.3

59.5

92.0

18.0

75.6

98.6

Under age 18

24.7

26.3

23.5

24.9

0.2

14.2

28.3

52.9

1.4

19.4

15.9

Aged 18 to 24

9.5

8.0

8.4

7.6

5.4

6.3

5.4

8.9

0.6

7.5

17.7

Aged 25 to 34

13.4

11.7

12.9

13.7

20.1

8.2

5.8

8.8

1.3

9.6

23.2

Aged 35 to 44

13.7

13.0

14.8

15.8

21.2

9.1

5.4

7.4

2.3

9.5

17.3

Aged 45 to 54

14.7

14.6

16.5

17.5

24.1

11.9

6.6

7.8

4.6

11.9

15.2

Aged 55 to 64

11.4

11.8

12.7

13.0

18.2

12.5

7.9

6.2

7.8

17.8

9.3

Aged 65 or older

12.5

14.6

11.1

7.5

10.8

37.7

40.5

8.0

82.0

24.4

1.4

Note: Numbers may not add to total because some people have more than one type of health insurance coverage. Source: Bureau of the Census, Historical Health Insurance Tables, Internet site http://www.census.gov/hhes/www/ cpstables/032009/health/toc.htm; calculations by New Strategist

136 AMERICAN HEALTH

COVERAGE AND COST

Table 6.11

Health Insurance Coverage by Sex, 2008

(number and percent distribution of people by sex and health insurance coverage status, 2008; numbers in thousands) covered by private or government health insurance private health insurance total

total

government health insurance

employmentown total based employment

direct purchase

total

Medicaid

Medicare

military

not covered

Total people

301,483 255,143 200,992

176,332

92,901

26,777

87,411

42,641

43,029

11,560

46,340

Females

148,094 122,886

98,346

87,414

51,367

12,278

39,868

19,421

18,860

6,194

25,208

Males

153,388 132,257 102,647

88,917

41,534

14,499

47,542

23,220

24,169

5,366

21,131

PERCENT DISTRIBUTION BY COVERAGE STATUS Total people

100.0%

84.6%

66.7%

58.5%

30.8%

8.9%

29.0%

14.1%

14.3%

3.8%

15.4%

Females

100.0

83.0

66.4

59.0

34.7

8.3

26.9

13.1

12.7

4.2

17.0

Males

100.0

86.2

66.9

58.0

27.1

9.5

31.0

15.1

15.8

3.5

13.8

PERCENT DISTRIBUTION BY SEX Total people

100.0% 100.0% 100.0%

100.0%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Females

49.1

48.2

48.9

49.6

55.3

45.9

45.6

45.5

43.8

53.6

54.4

Males

50.9

51.8

51.1

50.4

44.7

54.1

54.4

54.5

56.2

46.4

45.6

Note: Numbers may not add to total because some people have more than one type of health insurance coverage. Source: Bureau of the Census, Detailed Health Insurance Tables, Internet site http://www.census.gov/hhes/www/ cpstables/032009/health/toc.htm; calculations by New Strategist

AMERICAN HEALTH

137

Table 6.12

Health Insurance Coverage by Race and Hispanic Origin, 2008

(number and percent distribution of people by race, Hispanic origin, and health insurance coverage status, 2008; numbers in thousands) covered by private or government health insurance private health insurance total

Total people

total

government health insurance

employmentown total based employment

total

Medicaid

Medicare

military

not covered

176,332

92,901

26,777

87,411

42,641

43,029

11,560

46,340

Asian

14,548

12,065

9,998

8,946

4,333

1,216

2,969

1,704

1,290

374

2,484

Black

40,216

32,614

21,042

19,422

10,683

1,743

15,063

10,385

4,671

1,663

7,602

Hispanic

47,485

32,928

20,779

19,094

9,199

1,797

14,448

11,559

3,218

898

14,558

197,159 175,837 147,855

127,687

67,940

21,844

54,271

18,724

33,444

8,498

21,322

Non-Hispanic white

301,483 255,143 200,992

direct purchase

PERCENT DISTRIBUTION BY COVERAGE STATUS Total people

100.0%

84.6%

66.7%

58.5%

30.8%

8.9%

29.0%

14.1%

3.8%

15.4%

Asian

100.0

82.9

68.7

61.5

29.8

8.4

20.4

11.7

14.3% 8.9

2.6

17.1

Black

100.0

81.1

52.3

48.3

26.6

4.3

37.5

25.8

11.6

4.1

18.9

Hispanic

100.0

69.3

43.8

40.2

19.4

3.8

30.4

24.3

6.8

1.9

30.7

Non-Hispanic white

100.0

89.2

75.0

64.8

34.5

11.1

27.5

9.5

17.0

4.3

10.8

PERCENT DISTRIBUTION BY RACE AND HISPANIC ORIGIN Total people

100.0% 100.0% 100.0%

100.0%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Asian

4.8

4.7

5.0

5.1

4.7

4.5

3.4

4.0

3.0

3.2

5.4

Black

13.3

12.8

10.5

11.0

11.5

6.5

17.2

24.4

10.9

14.4

16.4

Hispanic

15.8

12.9

10.3

10.8

9.9

6.7

16.5

27.1

7.5

7.8

31.4

Non-Hispanic white

65.4

68.9

73.6

72.4

73.1

81.6

62.1

43.9

77.7

73.5

46.0

Note: Asians and blacks are those who identify themselves as being of the race alone and those who identify themselves as being of the race in combination with other races. Non-Hispanic whites are those who identify themselves as being white alone and not Hispanic. Hispanics may be of any race. Numbers by race and Hispanic origin may not sum to total because not all races are shown and some people have more than one type of health insurance coverage. Source: Bureau of the Census, Detailed Health Insurance Tables, Internet site http://www.census.gov/hhes/www/ cpstables/032009/health/toc.htm; calculations by New Strategist

138 AMERICAN HEALTH

COVERAGE AND COST

Cost Is the Primary Reason for Being Uninsured Employment-related reasons rank second as a cause. The number-one reason given by the uninsured for their lack of coverage is cost, cited by 48 percent. In the South, the 53 percent majority of those without insurance cite cost as the reason. Twenty-two percent of the uninsured lack insurance because they lost their job or changed jobs. Another 13 percent say their employer did not offer health insurance or the insurance company refused to cover them. Among those who are uninsured because of cost, 43 percent are non-Hispanic whites and 40 percent are Hispanic. Forty-six percent have household incomes below $35,000. ■ As health insurance costs continue to rise, a growing share of Americans will be without insurance.

More than half the uninsured in the South say cost is the reason (percent of uninsured who do not have health insurance because of cost, by region, 2008)

60

53% 47%

44% 40

40%

20

20%

0

0%

40%

Northeast a

Midwest b

South c

West d

AMERICAN HEALTH

139

Table 6.13

Number Who Lack Health Insurance Coverage by Selected Characteristics and Reason, 2008

(number of people under age 65 without health insurance by reason for lack of insurance, by selected characteristics, 2008; numbers in thousands)

number TOTAL WITHOUT HEALTH INSURANCE

change in lost job or marital status change in or death of employment parent

ineligible due to age or left school

employer didn’t offer or insurance company refused

cost

Medicaid stopped

other reason

20,950

4,228

2,996

43,675

9,642

1,020

3,513

5,743

Female

20,021

4,212

702

1,306

2,153

9,355

2,943

1,372

Male

23,654

5,430

318

2,207

3,590

11,595

1,285

1,624

Under age 12

4,037

705

60

19

326

1,523

873

621

Aged 12 to 17

2,597

396

86

57

194

1,259

391

294

Aged 18 to 44

26,622

5,307

502

3,360

3,997

12,541

2,496

1,663

Aged 45 to 64

10,420

3,234

372

77

1,225

5,627

468

418

Sex

Age

Race and Hispanic origin Asian

1,685

294

–

111

167

899

84

173

Black

6,194

1,479

132

620

783

2,649

819

291

Hispanic

14,470

2,002

170

596

2,463

8,339

1,629

1,007

Non-Hispanic white

20,589

5,738

702

2,100

2,350

8,964

1,587

1,507

Household income Less than $35,000

19,882

3,888

594

1,499

2,830

9,535

2,847

1,380

$35,000 to $49,999

7,661

1,845

149

514

1,032

3,949

627

440

$50,000 to $74,999

6,300

1,724

84

500

857

3,212

358

370

$75,000 to $99,999

2,182

644

74

312

269

869

87

128

$100,000 or more

2,841

871

53

351

221

891

47

–

Not a high school graduate

8,597

1,578

173

140

1,572

4,784

835

734

High school graduate

9,188

2,437

265

246

1,238

4,828

738

416

Some college

6,668

2,172

212

333

985

3,122

536

187

College graduate

3,375

1,061

150

221

417

1,629

98

213

Education

Region Northeast

5,113

893

58

443

656

2,254

527

430

Midwest

8,330

2,022

291

948

1,039

3,301

670

1,073

South

18,804

4,288

494

1,268

2,520

10,025

2,028

861

West

11,429

2,438

177

855

1,528

5,371

1,004

631

Note: Figures do not sum to total because more than one reason may have been cited. “Other” reason includes moved, self-employed, never had coverage, does not want or need coverage. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

140 AMERICAN HEALTH

COVERAGE AND COST

Table 6.14

Percent Who Lack Health Insurance Coverage by Reason, 2008

(percent of people under age 65 without health insurance by reason for lack of insurance, by selected characteristics, 2008)

number TOTAL WITHOUT HEALTH INSURANCE

change in lost job or marital status change in or death of employment parent

ineligible due to age or left school

employer didn’t offer or insurance company refused

Medicaid stopped

cost

9.7%

other reason

100.0%

22.1%

2.3%

8.0%

13.1%

48.0%

6.9%

Female

100.0

21.0

3.5

6.5

10.8

46.7

14.7

6.9

Male

100.0

23.0

1.3

9.3

15.2

49.0

5.4

6.9

Under age 12

100.0

17.5

1.5

0.5

8.1

37.7

21.6

15.4

Aged 12 to 17

100.0

15.2

3.3

2.2

7.5

48.5

15.1

11.3

Aged 18 to 44

100.0

19.9

1.9

12.6

15.0

47.1

9.4

6.2

Aged 45 to 64

100.0

31.0

3.6

0.7

11.8

54.0

4.5

4.0

Asian

100.0

17.4

–

6.6

9.9

53.4

5.0

10.3

Black

100.0

23.9

2.1

10.0

12.6

42.8

13.2

4.7

Hispanic

100.0

13.8

1.2

4.1

17.0

57.6

11.3

7.0

Non-Hispanic white

100.0

27.9

3.4

10.2

11.4

43.5

7.7

7.3

Sex

Age

Race and Hispanic origin

Household income Less than $35,000

100.0

19.6

3.0

7.5

14.2

48.0

14.3

6.9

$35,000 to $49,999

100.0

24.1

1.9

6.7

13.5

51.5

8.2

5.7

$50,000 to $74,999

100.0

27.4

1.3

7.9

13.6

51.0

5.7

5.9

$75,000 to $99,999

100.0

29.5

3.4

14.3

12.3

39.8

4.0

5.9

$100,000 or more

100.0

30.7

1.9

12.4

7.8

31.4

1.7

–

Not a high school graduate

100.0

18.4

2.0

1.6

18.3

55.6

9.7

8.5

High school graduate

100.0

26.5

2.9

2.7

13.5

52.5

8.0

4.5

Some college

100.0

32.6

3.2

5.0

14.8

46.8

8.0

2.8

College graduate

100.0

31.4

4.4

6.5

12.4

48.3

2.9

6.3

Northeast

100.0

17.5

1.1

8.7

12.8

44.1

10.3

8.4

Midwest

100.0

24.3

3.5

11.4

12.5

39.6

8.0

12.9

South

100.0

22.8

2.6

6.7

13.4

53.3

10.8

4.6

West

100.0

21.3

1.5

7.5

13.4

47.0

8.8

5.5

Education

Region

Note: Figures do not sum to total because more than one reason may have been cited. “Other” reason includes moved, self-employed, never had coverage, does not want or need coverage. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

141

Table 6.15

Percent Who Lack Health Insurance Coverage by Selected Characteristics, 2008

(percent distribution of people under age 65 without health insurance by selected characteristics and reason for lack of insurance, 2008)

number TOTAL WITHOUT HEALTH INSURANCE

100.0%

change in lost job or marital status change in or death of employment parent

100.0%

100.0%

ineligible due to age or left school

100.0%

employer didn’t offer or insurance company refused

100.0%

cost

100.0%

Medicaid stopped

100.0%

other reason

100.0%

Sex Female

45.8

43.7

68.8

37.2

37.5

44.7

69.6

45.8

Male

54.2

56.3

31.2

62.8

62.5

55.3

30.4

54.2

Under age 12

9.2

7.3

5.9

0.5

5.7

7.3

20.6

20.7

Aged 12 to 17

5.9

4.1

8.4

1.6

3.4

6.0

9.2

9.8

Aged 18 to 44

61.0

55.0

49.2

95.6

69.6

59.9

59.0

55.5

Aged 45 to 64

23.9

33.5

36.5

2.2

21.3

26.9

11.1

14.0

5.8

Age

Race and Hispanic origin Asian

3.9

3.0

–

3.2

2.9

4.3

2.0

Black

14.2

15.3

12.9

17.6

13.6

12.6

19.4

9.7

Hispanic

33.1

20.8

16.7

17.0

42.9

39.8

38.5

33.6

Non-Hispanic white

47.1

59.5

68.8

59.8

40.9

42.8

37.5

50.3

Household income Less than $35,000

45.5

40.3

58.2

42.7

49.3

45.5

67.3

46.1

$35,000 to $49,999

17.5

19.1

14.6

14.6

18.0

18.8

14.8

14.7

$50,000 to $74,999

14.4

17.9

8.2

14.2

14.9

15.3

8.5

12.3

$75,000 to $99,999

5.0

6.7

7.3

8.9

4.7

4.1

2.1

4.3

$100,000 or more

6.5

9.0

5.2

10.0

3.8

4.3

1.1

–

Not a high school graduate

19.7

16.4

17.0

4.0

27.4

22.8

19.7

24.5

High school graduate

21.0

25.3

26.0

7.0

21.6

23.0

17.5

13.9

Some college

15.3

22.5

20.8

9.5

17.2

14.9

12.7

6.2

7.7

11.0

14.7

6.3

7.3

7.8

2.3

7.1

Education

College graduate Region Northeast

11.7

9.3

5.7

12.6

11.4

10.8

12.5

14.4

Midwest

19.1

21.0

28.5

27.0

18.1

15.8

15.8

35.8

South

43.1

44.5

48.4

36.1

43.9

47.9

48.0

28.7

West

26.2

25.3

17.4

24.3

26.6

25.6

23.7

21.1

Note: Figures do not sum to total because more than one reason may have been cited. “Other” reason includes moved, self-employed, never had coverage, does not want or need coverage. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

142 AMERICAN HEALTH

COVERAGE AND COST

Most Children Are Insured through a Family Member’s Employment More than one-quarter, however, are insured through Medicaid. Like their parents, children are most likely to be covered by employment-based group health insurance policies. But a substantial 30 percent of children are covered through Medicaid, the health insurance program for the poor. Medicaid coverage is much greater for blacks and Hispanics than it is for non-Hispanic whites. Among black children, 47 percent have health insurance through Medicaid, as do 46 percent of Hispanic children. Fewer than half of black or Hispanic children are covered by employment-based insurance. Ten percent of children under age 18 had no health insurance coverage in 2008. Among Hispanics, the ﬁgure is a much higher 17 percent. Many Hispanic parents work for employers who do not provide health insurance coverage. ■ Without Medicaid, a large proportion of the nation’s children would be unable to obtain necessary medical care. 24

Only 7 percent of Non-Hispanic white children are without health insurance (percent of children without health insurance, by race and Hispanic origin, 2008)

16

17% 16%

10%

8

8%

0

0%

10% 7%

Asian a

black b

Hispanic c

non-Hispanic d white

AMERICAN HEALTH

143

Table 6.16

Children by Health Insurance Coverage Status, 2008

(number of children under age 18 by selected characteristics and health insurance coverage status, 2008; numbers in thousands) covered by private or government health insurance private health insurance

TOTAL CHILDREN

total

total

total

group health

74,510

67,161

47,282

43,874

government health insurance

direct purchase

total

Medicaid

Medicare

Champus

not covered

3,812

24,767

22,555

623

2,241

7,348

Age Under age 3

12,852

11,685

7,353

6,955

555

5,234

4,854

133

378

1,167

Aged 3 to 5

12,420

11,379

7,476

7,034

600

4,735

4,324

119

408

1,042

Aged 6 to 11

24,001

21,791

15,456

14,503

1,276

7,898

7,250

179

678

2,211

Aged 12 to 17

25,236

22,307

16,998

15,382

1,381

6,900

6,127

192

777

2,929

Race and Hispanic origin Asian

3,723

3,354

2,708

2,526

246

831

701

24

113

369

Black

12,507

11,219

5,914

5,561

385

6,397

5,893

251

495

1,288

Hispanic

16,457

13,621

6,688

6,274

505

7,882

7,590

182

255

2,836

Non-Hispanic white

41,527

38,731

31,758

29,330

2,644

9,602

8,306

175

1,380

2,796

Family income Less than $25,000

15,167

12,859

3,094

2,586

413

10,682

10,436

251

238

2,308

$25,000 to $49,999

16,256

14,004

7,955

7,127

731

7,404

6,891

209

542

2,252

$50,000 to $74,999

13,487

12,284

10,339

9,630

835

2,933

2,487

69

467

1,203

$75,000 or more

28,243

26,934

25,425

24,137

1,796

3,079

2,090

68

984

1,310

Married-couple families

51,351

46,968

37,600

35,252

3,113

12,610

10,828

257

1,875

4,383

Female householder, no spouse present

17,541

15,538

6,987

6,222

487

9,832

9,509

287

261

2,002

4,262

3,575

2,225

2,005

174

1,655

1,566

52

96

687

Family status

Male householder, no spouse present

Family reference person work status Worked during year

58,195

53,189

40,631

38,037

3,054

16,372

14,701

402

1,672

5,005

Full-time

48,725

44,630

35,439

33,371

2,500

12,381

10,994

260

1,406

4,095

Part-time

9,470

8,559

5,192

4,667

554

3,991

3,707

142

265

910

Did not work

14,959

12,892

6,182

5,442

720

7,725

7,202

195

559

2,067

71,871

65,377

46,176

42,867

3,708

24,030

21,850

609

2,222

6,494

2,638

1,784

1,106

1,007

104

737

705

14

20

854

513

460

367

343

33

115

105

3

8

53

2,125

1,324

739

664

71

622

600

12

11

801

Nativity Native Foreign-born Naturalized citizen Not a citizen

Note: Asians and blacks are those who identify themselves as being of the race alone and those who identify themselves as being of the race in combination with other races. Non-Hispanic whites are those who identify themselves as being white alone and not Hispanic. Hispanics may be of any race. Numbers may not sum to total because people may have more than one type of health insurance coverage. Source: Bureau of the Census, Table H108: Health Insurance Coverage Status and Type of Coverage by Selected Characteristics for Children Under 18: 2008, Current Population Survey, Internet site http://www.census.gov/hhes/www/cpstables/032009/ health/toc.htm

144 AMERICAN HEALTH

COVERAGE AND COST

Table 6.17

Percent Distribution of Children by Health Insurance Coverage Status, 2008

(percent distribution of children under age 18 by selected characteristics and health insurance coverage status, 2008; numbers in thousands) covered by private or government health insurance private health insurance total

TOTAL CHILDREN

100.0%

total

90.1%

total

63.5%

group health

58.9%

government health insurance

direct purchase

5.1%

total

33.2%

Medicaid

30.3%

Medicare

0.8%

Champus

3.0%

not covered

9.9%

Age Under age 3

100.0

90.9

57.2

54.1

4.3

40.7

37.8

1.0

2.9

9.1

Aged 3 to 5

100.0

91.6

60.2

56.6

4.8

38.1

34.8

1.0

3.3

8.4

Aged 6 to 11

100.0

90.8

64.4

60.4

5.3

32.9

30.2

0.7

2.8

9.2

Aged 12 to 17

100.0

88.4

67.4

61.0

5.5

27.3

24.3

0.8

3.1

11.6

Race and Hispanic origin Asian

100.0

90.1

72.7

67.8

6.6

22.3

18.8

0.6

3.0

9.9

Black

100.0

89.7

47.3

44.5

3.1

51.1

47.1

2.0

4.0

10.3

Hispanic

100.0

82.8

40.6

38.1

3.1

47.9

46.1

1.1

1.5

17.2

Non-Hispanic white

100.0

93.3

76.5

70.6

6.4

23.1

20.0

0.4

3.3

6.7

Family income Less than $25,000

100.0

84.8

20.4

17.1

2.7

70.4

68.8

1.7

1.6

15.2

$25,000 to $49,999

100.0

86.1

48.9

43.8

4.5

45.5

42.4

1.3

3.3

13.9

$50,000 to $74,999

100.0

91.1

76.7

71.4

6.2

21.7

18.4

0.5

3.5

8.9

$75,000 or more

100.0

95.4

90.0

85.5

6.4

10.9

7.4

0.2

3.5

4.6

Married-couple families

100.0

91.5

73.2

68.6

6.1

24.6

21.1

0.5

3.7

8.5

Female householder, no spouse present

100.0

88.6

39.8

35.5

2.8

56.1

54.2

1.6

1.5

11.4

Male householder, no spouse present

100.0

83.9

52.2

47.0

4.1

38.8

36.7

1.2

2.3

16.1

Family status

Family reference person work status Worked during year

100.0

91.4

69.8

65.4

5.2

28.1

25.3

0.7

2.9

8.6

Full-time

100.0

91.6

72.7

68.5

5.1

25.4

22.6

0.5

2.9

8.4

Part-time

100.0

90.4

54.8

49.3

5.9

42.1

39.1

1.5

2.8

9.6

Did not work

100.0

86.2

41.3

36.4

4.8

51.6

48.1

1.3

3.7

13.8

Nativity Native

100.0

91.0

64.2

59.6

5.2

33.4

30.4

0.8

3.1

9.0

Foreign-born

100.0

67.6

41.9

38.2

3.9

27.9

26.7

0.5

0.8

32.4

Naturalized citizen

100.0

89.7

71.5

66.9

6.4

22.4

20.5

0.6

1.6

10.3

Not a citizen

100.0

62.3

34.8

31.2

3.3

29.3

28.2

0.6

0.5

37.7

Note: Asians and blacks are those who identify themselves as being of the race alone and those who identify themselves as being of the race in combination with other races. Non-Hispanic whites are those who identify themselves as being white alone and not Hispanic. Hispanics may be of any race. Numbers may not sum to total because people may have more than one type of health insurance coverage. Source: Bureau of the Census, Table H108: Health Insurance Coverage Status and Type of Coverage by Selected Characteristics for Children Under 18: 2008, Current Population Survey, Internet site http://www.census.gov/hhes/www/cpstables/032009/ health/toc.htm; calculations by New Strategist

AMERICAN HEALTH

145

Table 6.18

Children without Health Insurance, 2008

(number and percent of children under age 18 without health insurance, and percent distribution by selected characteristics, 2008; numbers in thousands) number

percent of total children

percent distribution

CHILDREN WITHOUT HEALTH INSURANCE

7,348

Age Under age 3 Aged 3 to 5 Aged 6 to 11 Aged 12 to 17

1,167 1,042 2,211 2,929

9.1 8.4 9.2 11.6

15.9 14.2 30.1 39.9

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

369 1,288 2,836 2,796

9.9 10.3 17.2 6.7

5.0 17.5 38.6 38.1

Family income Less than $25,000 $25,000 to $49,999 $50,000 to $74,999 $75,000 or more

2,308 2,252 1,203 1,310

15.2 13.9 8.9 4.6

31.4 30.6 16.4 17.8

4,383

8.5

59.6

2002

11.4

27.2

687

16.1

9.3

Family reference person work status Worked during year 5,005 Full-time 4,095 Part-time 910 Did not work 2,067

8.6 8.4 9.6 13.8

68.1 55.7 12.4 28.1

Nativity Native Foreign-born Naturalized citizen Not a citizen

9.0 32.4 10.3 37.7

88.4 11.6 0.7 10.9

Family status Married-couple families Female householder, no spouse present Male householder, no spouse present

6,494 854 53 801

9.9%

100.0%

Note: Asians and blacks are those who identify themselves as being of the race alone and those who identify themselves as being of the race in combination with other races. Non-Hispanic whites are those who identify themselves as being white alone and not Hispanic. Hispanics may be of any race. Source: Bureau of the Census, Table H108: Health Insurance Coverage Status and Type of coverage by Selected Characteristics for Children Under 18: 2008, Current Population Survey, Internet site http://www.census.gov/hhes/www/cpstables/032009/ health/toc.htm; calculations by New Strategist

146 AMERICAN HEALTH

COVERAGE AND COST

Most Low-Income Workers Do Not Have Access to Employer-Provided Health Insurance Among high-wage workers, more than 90 percent have access to employer-provided health insurance. Seventy-four percent of the nation’s workers have access to medical beneﬁts through their employer. Although more than three-quarters take advantage of this offering, about one in four does not—perhaps because they are covered through a spouse or cannot afford the expense. Seventy-two percent of workers have access to outpatient prescription drug coverage, 48 percent to dental coverage, and 29 percent to vision beneﬁts. Occupation inﬂuences the likelihood of having access to health insurance. Eighty-seven percent of managerial and professional workers have access to medical beneﬁts through their employer. Among service workers, however, the ﬁgure is only 51 percent. Full-time workers are far more likely than part-time workers to have access to employer-provided health insurance (88 versus 24 percent), and union members are more likely than nonunion workers (92 versus 70 percent). The biggest difference is by wage level. Only 42 percent of workers with wages in the bottom quartile are offered employer-provided medical beneﬁts versus 92 percent of those with wages in the top quartile. ■ Many lower-paid workers cannot afford the premiums for employer-provided health insurance.

Fewer than half of workers in the bottom wage quartile have access to employer-provided health insurance 120

(percent of workers with access to employer-provided medical beneﬁts, by wage quartile, 2009)

87% 80

80%

40

40%

0

0%

92%

79%

42%

bottom a quartile

second b quartile

third c quartile

top d quartile

AMERICAN HEALTH

147

Table 6.19

Health Care Beneﬁts, 2009: Medical Beneﬁts

(percent of workers with access to and participating in medical care beneﬁts by type of worker, 2009) medical care beneﬁts

have access

participate

percent with access who participate

Total workers* Management and professional Service Sales and ofﬁce Natural resources, construction, and maintenance Production, transportation, and material moving

74% 87 51 73

56% 69 35 53

76% 80 69 72

78

63

81

77

59

76

Full-time Part-time

88 24

68 14

77 58

Union Nonunion

92 70

78 51

84 73

Lowest quartile of wages Second quartile of wages Third quartile of wages Highest quartile of wages

42 79 87 92

25 58 69 74

59 74 80 81

* Total includes civilian workers in the private nonfarm economy, except those in private households, and workers in the public sector, except the federal government. Source: Bureau of Labor Statistics, National Compensation Survey: Employee Beneﬁts in the United States, March 2009, Internet site http://www.bls.gov/ncs/ebs/home.htm; calculations by New Strategist

148 AMERICAN HEALTH

COVERAGE AND COST

Table 6.20

Health Care Beneﬁts, 2009: Outpatient Prescription Drug Coverage

(percent of total workers with access to and participating in outpatient prescription drug coverage by type of worker, 2009) outpatient prescription drug coverage

have access

participate

percent with access who participate

Total workers* Management and professional Service Sales and ofﬁce Natural resources, construction, and maintenance Production, transportation, and material moving

72% 85 50 71

54% 68 34 51

75% 79 69 72

75

61

80

75

57

76

Full-time Part-time

86 23

66 14

77 58

Union Nonunion

90 68

76 50

84 73

Lowest quartile of wages Second quartile of wages Third quartile of wages Highest quartile of wages

40 76 84 90

24 56 67 73

59 74 79 81

* Total includes civilian workers in the private nonfarm economy, except those in private households, and workers in the public sector, except the federal government. Source: Bureau of Labor Statistics, National Compensation Survey: Employee Beneﬁts in the United States, March 2009, Internet site http://www.bls.gov/ncs/ebs/home.htm; calculations by New Strategist

AMERICAN HEALTH

149

Table 6.21

Health Care Beneﬁts, 2009: Dental Insurance

(percent of workers with access to and participating in dental beneﬁts by type of worker, 2009) dental beneﬁts

have access

participate

percent with access who participate

Total workers* Management and professional Service Sales and ofﬁce Natural resources, construction, and maintenance Production, transportation, and material moving

48% 59 32 48

38% 49 24 36

79% 83 75 75

46

39

86

50

39

79

Full-time Part-time

57 16

46 10

81 65

Union Nonunion

70 44

61 34

87 77

Lowest quartile of wages

23 49 56 66

15 37 46 56

65 76 83 85

Second quartile of wages Third quartile of wages Highest quartile of wages

* Total includes civilian workers in the private nonfarm economy, except those in private households, and workers in the public sector, except the federal government. Source: Bureau of Labor Statistics, National Compensation Survey: Employee Beneﬁts in the United States, March 2009, Internet site http://www.bls.gov/ncs/ebs/home.htm; calculations by New Strategist

150 AMERICAN HEALTH

COVERAGE AND COST

Table 6.22

Health Care Beneﬁts, 2009: Vision Beneﬁts

(percent of workers with access to and participating in vision care beneﬁts by type of worker, 2009) vision beneﬁts

have access

participate

percent with access who participate

Total workers* Management and professional Service Sales and ofﬁce Natural resources, construction, and maintenance Production, transportation, and material moving

29% 36 20 25

22% 29 14 19

77% 79 71 75

32

26

82

30

24

78

Full-time Part-time

34 10

27 7

78 67

Union Nonunion

53 24

45 18

85 74

Lowest quartile of wages Second quartile of wages Third quartile of wages Highest quartile of wages

13 27 34 42

8 20 28 34

64 75 80 81

* Total includes civilian workers in the private nonfarm economy, except those in private households, and workers in the public sector, except the federal government. Source: Bureau of Labor Statistics, National Compensation Survey: Employee Beneﬁts in the United States, March 2009, Internet site http://www.bls.gov/ncs/ebs/home.htm; calculations by New Strategist

AMERICAN HEALTH

151

Table 6.23

Employee Contributions for Employer-Provided Health Care Coverage, 2009

(percent of civilian workers who participate in employer-provided health care beneﬁts who are required to pay for coverage, and average monthly contribution, by selected characteristics of workers and single or family coverage, 2009) single coverage employee contribution required

Total workers* Management and professional Service Sales and ofﬁce Natural resources, construction, and maintenance Production, transportation, and material moving

75% 74 76 79

family coverage

average ﬂat monthly contribution

$89.86 88.05 90.90 93.30

employee contribution required

88% 90 88 92

average ﬂat monthly contribution

$347.93 352.47 360.17 359.79

64

94.84

78

351.74

75

84.63

84

303.35

Full-time Part-time

75 76

88.83 106.66

88 87

345.06 397.48

Union Nonunion

54 81

80.13 91.73

67 94

291.36 359.26

Lowest quartile of wages Second quartile of wages Third quartile of wages Highest quartile of wages

83 78 73 71

98.82 91.49 87.70 86.56

93 91 88 94

384.44 360.19 334.62 334.85

* Total includes civilian workers in the private nonfarm economy, except those in private households, and workers in the public sector, except the federal government. Source: Bureau of Labor Statistics, National Compensation Survey: Employee Beneﬁts in the United States, March 2009, Internet site http://www.bls.gov/ncs/ebs/home.htm; calculations by New Strategist

152 AMERICAN HEALTH

COVERAGE AND COST

Health Care Spending Rises with Age Householders aged 65 or older spend 55 percent more than the average household on out-of-pocket health care costs. The average American household spent $2,976 on out-of-pocket health care costs in 2008. But costs rise with age, with the youngest householders spending an average of $682 and the oldest spending more than $4,000. On some health care categories, the disparity is even greater. Younger householders spend only 19 percent as much as the average household on prescription drugs, for example, while the oldest spend nearly twice the average on this item. In the aggregate, households spent $359 billion out-of-pocket on health care in 2008. They spent $200 billion on health insurance premiums, $88 billion on medical services, $58 billion on drugs, and $14 billion on medical supplies. Householders aged 65 or older account for 31 percent of total out-of-pocket health care spending. They accounted for an even larger 37 percent of out-ofpocket spending on prescription drugs. Householders aged 55 to 64 are the biggest spenders on lab tests and X-rays ■ The elderly spend more than younger adults on out-of-pocket health care costs not only because they have more health problems, but also because nearly everyone in the age group buys into the government health insurance plan.

Out-of-pocket health care spending exceeds $4,000 a year among householders aged 65 or older 6000 (average annual out-of-pocket spending by consumer units on health care, by age, 2008)

$4,000 4000

$2,000 2000

0$0

under a 25

25 b to 34

35 c to 44

45 d to 54

55 e to 64

65 orfolder

AMERICAN HEALTH

153

154 AMERICAN HEALTH

Out-of-Pocket Spending on Health Care, 2008: Average Household Spending by Age of Householder

1,653.37

HEALTH INSURANCE

338.12 57.87 129.69 89.28 40.41 60.07

Medicare prescription drug premium

Commercial Medicare supplements/ other health insurance

Commercial Medicare supplement (not BCBS)

Other health insurance (not BCBS)

Long term care insurance

6.84

Other BCBS health insurance

Medicare payments

33.47

Commercial Medicare supplement 271.66

142.09

Health maintenance organization

Health maintenance plans (HMOs)

79.97 214.23

Preferred-provider health plan

476.60

Blue Cross, Blue Shield

Traditional fee-for-service health plan

231.75

87.61

Preferred-provider health plan (not BCBS)

Traditional fee-for-service health plan (not BCBS)

319.36

2,975.88

Commercial health insurance

2.0

8,227

under 25

2.8

20,208

25 to 34

3.3

22,834

35 to 44

2.7

25,614

45 to 54

2.1

19,826

55 to 64

1.7

24,062

total

1.8

12,580

65 to 74

aged 65 or older 75+

1.5

11,481

1.80

7.81

39.40

47.20

0.60

21.70

93.80

4.30

3.22

57.72

63.95

15.76

144.95

59.70

19.66

79.36

389.41

681.86

10.75

25.91

40.96

66.87

5.72

26.31

211.16

4.01

13.47

147.57

189.40

35.92

390.37

202.29

69.26

271.55

982.73

1,736.81

13.61

41.22

29.60

70.82

9.50

58.83

344.43

7.31

20.15

164.82

237.90

69.76

499.95

263.39

80.17

343.56

1,340.69

2,499.12

40.62

56.61

42.98

99.59

16.01

94.81

315.08

6.16

8.51

156.57

272.50

89.25

532.99

319.27

104.49

423.76

1,522.86

2,930.01

111.64

42.79

42.77

85.56

41.99

232.06

338.94

12.35

21.50

207.75

329.29

135.35

706.23

327.36

100.81

428.17

1,944.59

3,824.67

143.73

43.75

291.18

334.93

224.79

1,319.60

212.56

5.83

109.67

75.27

107.16

93.11

391.04

113.35

104.48

217.82

2,844.47

4,604.72

165.70

52.51

249.16

301.67

206.52

1,298.64

266.82

7.89

90.28

82.99

143.12

88.39

412.67

152.32

96.38

248.70

2,900.73

4,779.07

119.64

34.14

337.23

371.37

244.80

1,342.57

153.11

3.57

130.92

66.82

67.75

98.27

367.33

70.64

113.35

183.99

2,782.83

4,413.18

$50,485.67 $29,324.54 $48,159.04 $58,808.25 $61,178.63 $54,782.72 $36,843.95 $41,433.10 $31,692.05

2.5

120,770

Health care, average spending

Average spending of consumer unit, total

Average number of persons per consumer unit

Number of consumer units (in thousands, add 000)

total consumer units

(average annual out-of-pocket spending of consumer units on health care, by age of consumer unit reference person, 2008)

Table 6.24

56.51 53.64 101.09 18.23 20.15 482.10 86.62 39.75 355.73 113.78 59.90 12.91 30.88 4.22 2.88 1.60

Service by professionals other than physician

Lab tests, X-rays

Hospital room and services

Care in convalescent or nursing home

Other medical services

DRUGS

Nonprescription drugs

Nonprescription vitamins

Prescription drugs

MEDICAL SUPPLIES

Eyeglasses and contact lenses

Hearing aids

Topicals and dressings

Medical equipment for general use

Supportive, convalescent medical equipment

Rental of medical equipment –

0.10

0.17

0.33

16.48

0.71

15.15

32.94

66.60

9.25

40.65

116.50

2.49

0.41

20.42

15.18

9.20

9.29

35.57

50.46

$143.01

under 25

0.30

0.27

0.59

4.02

21.99

0.23

39.57

66.98

147.72

17.58

49.78

215.09

15.89

1.41

87.00

47.53

42.70

26.80

99.36

151.33

$472.01

25 to 34

Note: “–” means sample is too small to make a reliable estimate. Source: Bureau of Labor Statistics, unpublished data from the 2008 Consumer Expenditure Survey

1.39

35.98

Eye care services

Rental of supportive, convalescent medical equipment

182.11 254.54

Dental services

$726.64

Physician’s services

MEDICAL SERVICES

total consumer units

1.60

1.33

0.99

1.52

28.01

3.45

61.20

98.11

241.96

27.59

79.87

349.41

21.51

2.54

116.98

48.23

58.26

28.71

229.92

194.00

$710.90

35 to 44

55 to 64

0.29

1.96

4.17

7.44

40.29

5.97

77.52

137.64

296.49

41.21

93.95

431.64

14.48

0.98

128.86

61.22

71.39

36.88

313.42

210.64

0.88

3.98

1.98

4.09

39.03

11.40

82.84

144.20

528.53

63.19

122.47

714.18

31.08

7.04

151.78

92.62

76.94

55.28

342.24

258.30

$837.86 $1,021.69

45 to 54

4.16

1.16

6.89

4.93

29.56

45.36

53.38

145.45

657.92

60.28

103.24

821.45

25.52

80.95

54.09

36.87

49.96

42.84

348.15

148.53

$793.35

total

3.56

0.91

6.26

2.31

31.27

32.29

68.35

144.93

706.03

64.50

109.42

879.95

33.80

36.61

52.54

45.56

51.81

43.03

413.04

177.07

$853.45

65 to 74

aged 65 or older 75+

4.83

1.44

7.58

7.80

27.53

59.69

36.99

145.86

605.21

55.30

95.93

756.44

16.45

129.54

55.79

27.34

47.95

42.64

277.06

117.26

$728.06

COVERAGE AND COST

AMERICAN HEALTH

155

156 AMERICAN HEALTH

Out-of-Pocket Spending on Health Care, 2008: Indexed Household Spending by Age of Householder

24 25 22 26 30 20 30 41 10 63 35 6 1 36 44 19 3

100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

HEALTH INSURANCE Commercial health insurance Traditional fee-for-service health plan (not BCBS) Preferred-provider health plan (not BCBS) Blue Cross, Blue Shield Traditional fee-for-service health plan Preferred-provider health plan Health maintenance organization Commercial Medicare supplement Other BCBS health insurance Health maintenance plans (HMOs) Medicare payments Medicare prescription drug premium Commercial Medicare supplements/ other health insurance Commercial Medicare supplement (not BCBS) Other health insurance (not BCBS) Long term care insurance

23

$29,325 58

100

$50,486 100

under 25

Health care, indexed spending

Average spending of consumer units, total Average spending of consumer units, index

total consumer units

52 46 64 18

59 85 79 87 82 45 88 104 40 59 78 8 10

58

$48,159 95

25 to 34

55 33 102 23

81 108 92 114 105 87 111 116 60 107 127 17 16

84

$58,808 116

35 to 44

77 48 140 68

92 133 119 138 112 112 127 110 25 90 116 28 28

98

$61,179 121

45 to 54

66 48 106 186

118 134 115 141 148 169 154 146 64 181 125 69 73

129

$54,783 109

55 to 64

258 326 108 239

172 68 119 49 82 116 50 53 328 85 78 390 388

155

$36,844 73

total

233 279 130 276

175 78 110 66 87 111 67 58 270 115 98 384 357

161

$41,433 82

65 to 74

aged 65 or older

286 378 84 199

168 58 129 30 77 123 32 47 391 52 56 397 423

148

$31,692 63

75+

(indexed average annual out-of-pocket spending of consumer units on health care, by age of consumer unit reference person, 2008; index deﬁnition: an index of 100 is the average for all consumer units; an index of 125 means that spending by consumer units in that group is 25 percent above the average for all consumer units; an index of 75 indicates spending that is 25 percent below the average for all consumer units)

Table 6.25

100

100 100 100 100 100 100 100

Nonprescription drugs Nonprescription vitamins Prescription drugs

MEDICAL SUPPLIES

Eyeglasses and contact lenses Hearing aids Topicals and dressings Medical equipment for general use Supportive, convalescent medical equipment Rental of medical equipment Rental of supportive, convalescent medical equipment

25 5 53 8 6 6 –

29

47 23 19

24

20 28 14 26 16 28 20 2 12

under 25

66 2 71 95 20 17 22

59

57 44 42

45

65 83 39 74 76 89 86 8 79

25 to 34

102 27 91 36 34 83 115

86

92 69 68

72

98 107 90 80 103 90 116 14 107

35 to 44

Note: “–” means sample is too small to make a reliable estimate. Source: Calculations by New Strategist based on the Bureau of Labor Statistics’ 2008 Consumer Expenditure Survey

100

100 100 100

DRUGS

100 100 100 100 100 100 100 100 100

MEDICAL SERVICES Physician’s services Dental services Eye care services Service by professionals other than physician Lab tests, X-rays Hospital room and services Care in convalescent or nursing home Other medical services

total consumer units

129 46 130 176 145 123 21

121

108 104 83

90

115 116 123 103 126 114 127 5 72

45 to 54

138 88 126 97 69 249 63

127

141 159 149

148

141 142 134 154 136 173 150 39 154

55 to 64

89 351 96 117 239 73 299

128

119 152 185

170

109 82 137 119 88 69 54 444 127

total

114 250 101 55 217 57 256

127

126 162 198

183

117 97 162 120 92 85 52 201 168

65 to 74

aged 65 or older 75+

62 462 89 185 263 90 347

128

111 139 170

157

100 64 109 119 85 51 55 711 82

COVERAGE AND COST

AMERICAN HEALTH

157

158 AMERICAN HEALTH

Out-of-Pocket Spending on Health Care, 2008: Total Spending by Age of Householder

4,042,172

Commercial Medicare supplement 32,808,378 40,834,752 6,988,960 15,662,661 10,782,346 4,880,316 7,254,654

Health maintenance plans (HMOs)

Medicare payments

Medicare prescription drug premium

Commercial Medicare supplements/ other health insurance

Commercial Medicare supplement (not BCBS)

Other health insurance (not BCBS)

Long term care insurance

826,067

17,160,209

57,558,982

Blue Cross, Blue Shield

Health maintenance organization

27,988,448

Preferred-provider health plan (not BCBS) 9,657,977

10,580,660

Traditional fee-for-service health plan (not BCBS)

25,872,557

38,569,107

Commercial health insurance

Preferred-provider health plan

199,677,495

HEALTH INSURANCE

Traditional fee-for-service health plan

359,397,028

Other BCBS health insurance

8,227

under 25

20,208

25 to 34

22,834

35 to 44

25,614

45 to 54

19,826

55 to 64

24,062

total

12,580

65 to 74

aged 65 or older 75+

11,481

14,809

64,253

324,144

388,314

4,936

178,526

771,693

35,376

26,491

474,862

526,117

129,658

1,192,504

491,152

161,743

652,895

3,203,676

5,609,662

217,236

523,589

827,720

1,351,309

115,590

531,672

4,267,121

81,034

272,202

2,982,095

3,827,395

725,871

7,888,597

4,087,876

1,399,606

5,487,482

19,859,008

35,097,456

310,771

941,217

675,886

1,617,104

216,923

1,343,324

7,864,715

166,917

460,105

3,763,500

5,432,209

1,592,900

11,415,858

6,014,247

1,830,602

7,844,849

30,613,315

57,064,906

1,040,441

1,450,009

1,100,890

2,550,898

410,080

2,428,463

8,070,459

157,782

217,975

4,010,384

6,979,815

2,286,050

13,652,006

8,177,782

2,676,407

10,854,189

39,006,536

75,049,276

2,213,375

848,355

847,958

1,696,313

832,494

4,600,822

6,719,824

244,851

426,259

4,118,852

6,528,504

2,683,449

14,001,716

6,490,239

1,998,659

8,488,898

38,553,441

3,458,431

1,052,713

7,006,373

8,059,086

5,408,897

31,752,215

5,114,619

140,281

2,638,880

1,811,147

2,578,484

2,240,413

9,409,204

2,727,428

2,513,998

5,241,185

68,443,637

75,827,907 110,798,773

2,084,506

660,576

3,134,433

3,795,009

2,598,022

16,336,891

3,356,596

99,256

1,135,722

1,044,014

1,800,450

1,111,946

5,191,389

1,916,186

1,212,460

3,128,646

36,491,183

60,120,701

1,373,587

391,961

3,871,738

4,263,699

2,810,549

15,414,046

1,757,856

40,987

1,503,093

767,160

777,838

1,128,238

4,217,316

811,018

1,301,371

2,112,389

31,949,671

50,667,720

$6,097,154,366 $241,252,991 $973,197,880 $1,342,827,581 $1,567,029,429 $1,086,122,207 $886,539,125 $521,228,398 $363,856,426

120,770

Health care, total spending

Total spending of all consumer units

Number of consumer units

total consumer units

(total annual out-of-pocket spending on health care, by consumer unit age groups, 2008; numbers in thousands)

Table 6.26

12,208,639 2,201,637 2,433,516 58,223,217 10,461,097 4,800,608 42,961,512 13,741,211 7,234,123 1,559,141 3,729,378

Hospital room and services

Care in convalescent or nursing home

Other medical services

DRUGS

Nonprescription drugs

Nonprescription vitamins

Prescription drugs

MEDICAL SUPPLIES

Eyeglasses and contact lenses

Hearing aids

Topicals and dressings

167,870

–

823

1,399

2,715

135,581

5,841

124,639

270,997

547,918

76,100

334,428

958,446

20,485

3,373

167,995

124,886

75,688

76,429

292,634

415,134

$1,176,543

under 25

35 to 44

45 to 54

55 to 64

total

65 to 74

aged 65 or older

6,062

5,456

11,923

81,236

444,374

4,648

799,631

1,353,532

2,985,126

355,257

1,005,954

4,346,539

321,105

28,493

1,758,096

960,486

862,882

541,574

2,007,867

3,058,077

36,534

30,369

22,606

34,708

639,580

78,777

1,397,441

2,240,244

5,524,915

629,990

1,823,752

7,978,428

491,159

57,998

2,671,121

1,101,284

1,330,309

655,564

5,249,993

4,429,796

7,428

50,203

106,810

190,568

1,031,988

152,916

1,985,597

3,525,511

7,594,295

1,055,553

2,406,435

11,056,027

370,891

25,102

3,300,620

1,568,089

1,828,583

944,644

8,027,940

5,395,333

17,447

78,907

39,255

81,088

773,809

226,016

1,642,386

2,858,909

10,478,636

1,252,805

2,428,090

14,159,333

616,192

139,575

3,009,190

1,836,284

1,525,412

1,095,981

6,785,250

5,121,056

100,098

27,912

165,787

118,626

711,273

1,091,452

1,284,430

3,499,818

15,830,871

1,450,457

2,484,161

19,765,730

614,062

1,947,819

1,301,514

887,166

1,202,138

1,030,816

8,377,185

3,573,929

44,785

11,448

78,751

29,060

393,377

406,208

859,843

1,823,219

8,881,857

811,410

1,376,504

11,069,771

425,204

460,554

660,953

573,145

651,770

541,317

5,196,043

2,227,541

$9,538,378 $16,232,691 $21,460,946 $20,256,026 $19,089,588 $10,736,401

25 to 34

Note: Numbers may not add to total because of rounding. “–” means sample is too small to make a reliable estimate. Source: Calculations by New Strategist based on the Bureau of Labor Statistics’ 2008 Consumer Expenditure Survey

Rental of supportive, convalescent medical equipment

193,232

6,478,103

Lab tests, X-rays

Rental of medical equipment

6,824,713

Service by professionals other than physician

347,818

4,345,305

Eye care services

Supportive, convalescent medical equipment

30,740,796

509,649

21,993,425

Physician’s services

Dental services

Medical equipment for general use

$87,756,313

MEDICAL SERVICES

total consumer units

75+

55,453

16,533

87,026

89,552

316,072

685,301

424,682

1,674,619

6,948,416

634,899

1,101,372

8,684,688

188,862

1,487,249

640,525

313,891

550,514

489,550

3,180,926

1,346,262

$8,358,857

COVERAGE AND COST

AMERICAN HEALTH

159

160 AMERICAN HEALTH

Out-of-Pocket Spending on Health Care, 2008: Market Shares by Age of Householder

1.6 1.7 1.5 1.8 2.1 1.3 2.0 2.8 0.7 4.3 2.4 0.4 0.1 2.5 3.0 1.3 0.2

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

HEALTH INSURANCE Commercial health insurance Traditional fee-for-service health plan (not BCBS) Preferred-provider health plan (not BCBS) Blue Cross, Blue Shield Traditional fee-for-service health plan Preferred-provider health plan Health maintenance organization Commercial Medicare supplement Other BCBS health insurance Health maintenance plans (HMOs) Medicare payments Medicare prescription drug premium Commercial Medicare supplements/ other health insurance Commercial Medicare supplement (not BCBS) Other health insurance (not BCBS) Long-term care insurance

1.6

100.0

Health care, share of spending

6.8% 4.0

100.0% 100.0

under 25

Share of total consumer units Share of total spending

total consumer units

8.6 7.7 10.7 3.0

9.9 14.2 13.2 14.6 13.7 7.5 14.8 17.4 6.7 9.8 13.0 1.3 1.7

9.8

16.7% 16.0

25 to 34

10.3 6.3 19.3 4.3

15.3 20.3 17.3 21.5 19.8 16.5 21.0 21.9 11.4 20.2 24.0 3.3 3.1

15.9

18.9% 22.0

35 to 44

16.3 10.2 29.7 14.3

19.5 28.1 25.3 29.2 23.7 23.7 27.0 23.4 5.4 19.1 24.6 5.9 5.9

20.9

21.2% 25.7

45 to 54

10.8 7.9 17.4 30.5

19.3 22.0 18.9 23.2 24.3 27.8 25.2 24.0 10.5 29.6 20.5 11.3 11.9

21.1

16.4% 17.8

55 to 64

(percentage of total annual out-of-pocket spending on health care accounted for by consumer unit age groups, 2008)

Table 6.27

51.5 65.0 21.6 47.7

34.3 13.6 23.8 9.7 16.3 23.2 10.0 10.6 65.3 17.0 15.6 77.8 77.4

30.8

24.2 29.1 13.5 28.7

18.3 8.1 11.5 6.8 9.0 11.5 7.0 6.1 28.1 12.0 10.2 40.0 37.2

16.7

10.4% 8.5

65 to 74

aged 65 or older

19.9% 14.5

total

75+

27.2 35.9 8.0 18.9

16.0 5.5 12.3 2.9 7.3 11.7 3.0 4.5 37.2 5.0 5.4 37.7 40.2

14.1

9.5% 6.0

100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

Nonprescription drugs Nonprescription vitamins Prescription drugs

MEDICAL SUPPLIES

Eyeglasses and contact lenses Hearing aids Topicals and dressings Medical equipment for general use Supportive, convalescent medical equipment Rental of medical equipment Rental of supportive, convalescent medical equipment

1.7 0.4 3.6 0.5 0.4 0.4 –

2.0

3.2 1.6 1.3

1.6

1.3% 1.9 1.0 1.8 1.1 1.9 1.4 0.2 0.8

under 25

11.1 0.3 11.9 15.9 3.4 2.8 3.6

9.9

9.6 7.4 6.9

7.5

10.9% 13.9 6.5 12.5 12.6 14.8 14.4 1.3 13.2

25 to 34

19.3 5.1 17.1 6.8 6.5 15.7 21.8

16.3

17.4 13.1 12.9

13.7

18.5% 20.1 17.1 15.1 19.5 17.0 21.9 2.6 20.2

35 to 44

Note: Numbers may not add to total because of rounding. “–” means sample is too small to make a reliable estimate. Source: Calculations by New Strategist based on the Bureau of Labor Statistics’ 2008 Consumer Expenditure Survey

100.0

100.0 100.0 100.0

DRUGS

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

MEDICAL SERVICES Physician’s services Dental services Eye care services Service by professionals other than physician Lab tests, X-rays Hospital room and services Care in convalescent or nursing home Other medical services

total consumer units

27.4 9.8 27.7 37.4 30.7 26.0 4.4

25.7

23.0 22.0 17.7

19.0

24.5% 24.5 26.1 21.7 26.8 24.2 27.0 1.1 15.2

45 to 54

22.7 14.5 20.7 15.9 11.3 40.8 10.4

20.8

23.2 26.1 24.4

24.3

23.1% 23.3 22.1 25.2 22.4 28.3 24.6 6.3 25.3

55 to 64

33.9

17.8 70.0 19.1 23.3 47.7 14.4 59.6

25.5

23.7 30.2 36.8

11.9 26.1 10.5 5.7 22.6 5.9 26.7

13.3

13.2 16.9 20.7

19.0

12.2% 10.1 16.9 12.5 9.6 8.8 5.4 20.9 17.5

65 to 74

aged 65 or older

21.8% 16.2 27.3 23.7 17.6 13.7 10.7 88.5 25.2

total

75+

5.9 44.0 8.5 17.6 25.0 8.6 33.0

12.2

10.5 13.2 16.2

14.9

9.5% 6.1 10.3 11.3 8.1 4.8 5.2 67.6 7.8

COVERAGE AND COST

AMERICAN HEALTH

161

Sixteen Percent of Health Care Costs Are Paid for Out-of-Pocket The out-of-pocket share is lowest among the elderly. Eighty-ﬁve percent of Americans had health care expenses in 2007, a median of $1,206 per person, according to the federal government’s Medical Expenditure Panel Survey. Average per person spending on health care was far higher than the median, at $4,404. The large difference between the median and the average indicates great variability in individual health care costs. Not surprisingly, as people get older, the cost of health care rises sharply. For the 86 percent of children under age 18 with expenses, the median expenditure was just $464 in 2007. For the 97 percent of people aged 65 or older with expenses, the median was a much higher $4,447. Overall, only 16 percent of health care spending is paid for out-of-pocket. Private insurance covers 42 percent of costs, Medicare (the federal government’s health insurance program for people aged 65 or older and for the disabled) covers 25 percent, and Medicaid (the federal government’s health insurance program for the poor) covers 9 percent. ■ The uninsured pay only 38 percent of their health care expenses out-of-pocket. The rest of their cost is shouldered by society as a whole. 60

Government insurance programs pay for nearly one-third of health care expenses (percent distribution of total health care expenses, by source of payment, 2007)

40

42% 40%

25%

20

0

20%

0%

16%

out-of-pocket a

162 AMERICAN HEALTH

privateb insurance

Medicare c

9%

8%

Medicaid d

other e

COVERAGE AND COST

Table 6.28

Total Spending on All Health Services by Selected Characteristics, 2007

(total number of people, percent with health care expense, median and average expense per person with expense, total health care expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007)

total (thousands)

percent with expense

spending per person with expense median

average

total expenses (millions)

percent distribution of total expenses by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

All health services TOTAL PEOPLE

301,309

84.9% $1,206

$4,404 $1,126,056

100.0%

16.2%

42.4%

24.8%

8.7%

7.9%

Age Under age 65

262,616

83.1

927

3,499

764,019

100.0

17.5

56.8

5.8

11.7

Under age 18

73,909

85.6

464

1,620

102,444

100.0

18.2

44.6

0.3

28.4

8.2 8.6

Aged 18 to 24

28,169

72.2

567

2,012

40,906

100.0

19.2

46.1

–

23.1

10.3

Aged 25 to 34

41,140

77.1

823

2,780

88,236

100.0

19.7

52.5

–

16.0

8.9

Aged 35 to 44

41,733

80.9

1,040

3,177

107,313

100.0

18.7

60.3

4.9

9.1

7.0

Aged 45 to 54

42,927

87.4

1,665

5,044

189,325

100.0

17.1

58.6

8.3

6.7

9.2

Aged 55 to 64

34,738

91.3

2,817

7,432

235,796

100.0

15.7

62.6

8.5

6.1

7.1

Aged 65 or older

38,694

96.5

4,447

9,696

362,037

100.0

13.6

11.9

65.0

2.3

7.2

Male

147,629

80.6

953

4,118

489,997

100.0

15.3

43.3

23.8

7.4

10.1

Female

153,680

88.9

1,452

4,653

636,059

100.0

16.9

41.6

25.6

9.7

6.1

Sex

Race and Hispanic origin Asian

14,026

80.5

814

3,802

42,951

100.0

14.2

63.5

12.4

–

–

Black

36,704

79.0

810

4,295

124,566

100.0

10.0

33.3

24.7

22.4

9.6

Hispanic Non-Hispanic white

46,390

71.5

593

2,885

95,685

100.0

15.5

31.7

23.4

20.1

9.3

197,611

89.4

1,478

4,752

839,810

100.0

17.4

43.8

25.8

5.5

7.5

3.6

Health insurance under age 65 Any private

181,422

88.7

1,091

3,648

587,156

100.0

18.2

73.9

2.3

1.9

Public only

41,312

83.6

596

3,760

129,899

100.0

6.7

–

23.6

60.4

9.3

Uninsured

39,882

57.2

487

2,057

46,965

100.0

37.8

–

–

–

62.2

Health insurance aged 65 or older Medicare only

13,333

94.4

3,943

9,178

115,486

100.0

15.2

–

70.3

–

14.5

Medicare/private

20,473

98.3

4,499

9,311

187,355

100.0

15.4

22.9

57.9

–

3.5

4,618

96.9

5,855

13,177

58,945

100.0

4.5

–

77.5

13.2

4.7

Poor

38,158

78.6

868

4,974

149,103

100.0

10.7

17.4

33.9

27.7

10.2

Near poor

13,290

78.6

1,055

5,343

55,807

100.0

11.2

15.2

46.3

18.5

8.7

Low income

40,482

78.1

1,055

5,156

162,911

100.0

12.3

25.0

38.8

15.3

8.6

93,234

83.6

1,046

3,982

310,234

100.0

16.8

45.6

22.3

5.9

9.4

116,145

91.1

1,445

4,236

448,001

100.0

19.7

58.1

15.8

0.7

5.7

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

163

Insurance Covers Most of the Cost of Physician Visits Older Americans pay the least out-of-pocket to see a doctor. Two out of three Americans went to the doctor in 2007, spending a median of $312 per person on physician visits. Only 13 percent of the cost of physician visits is paid for out-of-pocket. Private insurance covers 51 percent of the cost, while Medicare’s share is 20 percent and Medicaid’s is 6 percent. The oldest Americans are most likely to visit the doctor. Eighty-nine percent of people aged 65 or older visited a physician in 2007, spending a median of $635 per person on doctor visits during the year. Older Americans paid only 8 percent of the cost of their doctor visits out-of-pocket. This compares with a 15 percent share paid for out-of-pocket by people under age 65. Private health insurance covers 63 percent of the cost of physician visits for people under age 65, while Medicaid accounts for a 7 percent share. Among people aged 65 or older, Medicare covers 63 percent of the cost of their physician visits, while private health insurance accounts for an 18 percent share. ■ Health insurance covers a much greater share of the cost of physician visits than of prescription drugs. 120

People aged 18 to 44 are least likely to see a doctor (percent of people with expenses for visiting a physician, by age, 2007)

8080%

4040%

00%

under a 18

164 AMERICAN HEALTH

18 to b24

25 c to 34

35 to d44

45 to e54

55 tof 64

65 org older

COVERAGE AND COST

Table 6.29

Spending on Physician Visits by Selected Characteristics, 2007

(total number of people, percent with physician visit expense, median and average expense per person with expense, total physician visit expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007)

total (thousands)

percent with expense

spending per person with expense median

average

total expenses (millions)

percent distribution of total expenses by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

Physician visits TOTAL PEOPLE

301,309

65.8% $312

$904 $179,090

100.0%

13.3%

50.9%

19.8%

5.9%

10.1% 10.3

Age Under age 65

262,616

62.4

270

807

132,133

100.0

15.2

62.6

4.5

7.4

Under age 18

73,909

65.7

202

404

19,625

100.0

14.5

56.9

0.4

19.3

8.9

Aged 18 to 24

28,169

45.9

200

628

8,114

100.0

14.9

60.5

–

16.4

7.1

Aged 25 to 34

41,140

53.9

250

765

16,965

100.0

17.5

65.4

0.6

7.9

8.6

Aged 35 to 44

41,733

58.4

289

807

19,662

100.0

16.4

64.1

2.7

6.0

10.8

Aged 45 to 54

42,927

67.5

325

1,078

31,236

100.0

15.0

62.7

6.3

3.6

12.3

Aged 55 to 64

34,738

77.1

478

1,363

36,530

100.0

14.0

63.9

8.7

2.7

10.7

Aged 65 or older

38,694

88.9

635

1,365

46,957

100.0

7.8

18.0

63.0

1.7

9.6

Male

147,629

59.3

269

814

71,237

100.0

12.4

46.5

20.9

5.7

14.5

Female

153,680

72.0

346

975

107,853

100.0

13.8

53.8

19.1

6.0

7.2

Sex

Race and Hispanic origin Asian

14,026

59.6

256

822

6,872

100.0

13.5

65.9

10.7

2.2

–

Black

36,704

58.8

235

798

17,202

100.0

8.6

47.1

16.7

16.2

11.5

Hispanic Non-Hispanic white

46,390

53.2

219

661

16,322

100.0

11.3

40.1

16.6

17.9

14.1

197,611

70.5

353

969

135,082

100.0

14.2

52.2

20.8

3.2

9.6

Health insurance under age 65 Any private

181,422

68.1

301

885

109,369

100.0

15.2

75.6

2.0

0.5

6.7

Public only

41,312

65.2

202

595

16,035

100.0

4.9

–

23.6

57.2

14.4

Uninsured

39,882

33.1

195

510

6,728

100.0

39.4

–

–

–

60.6

Health insurance aged 65 or older Medicare only

13,333

85.1

550

1,206

13,680

100.0

9.0

–

74.0

–

17.0

Medicare/private

20,473

92.2

730

1,512

28,549

100.0

8.0

29.6

55.9

–

6.4

4,618

88.8

539

1,144

4,689

100.0

3.1

–

74.3

15.9

6.7

Poor

38,158

58.9

244

671

15,075

100.0

8.8

15.7

28.2

32.2

15.1

Near poor

13,290

60.0

282

940

7,492

100.0

7.0

20.9

35.4

21.0

15.8

Low income

40,482

59.0

275

844

20,150

100.0

11.6

34.2

34.1

9.8

10.3

93,234

63.8

299

927

55,143

100.0

13.3

57.0

15.4

3.4

10.8

116,145

72.6

360

963

81,229

100.0

15.0

60.2

16.2

0.3

8.2

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

165

Insurance Payments Cover Nearly All Hospital Inpatient Expenses Few Americans could afford a hospital stay if they had to foot the bill. Overall, 7 percent of the population had expenses for hospital inpatient stays in 2007, spending a median of $8,612 on the service. One of the primary purposes of health insurance is to cover potentially catastrophic costs that can arise from serious accidents or illnesses, typically the types of events associated with an inpatient hospital stay. Health insurance generally does its job well in these cases. Individuals pay only 3 percent of the costs of inpatient hospital stays out-of-pocket, with some form of insurance covering the remainder. Even those without health insurance do not pay the full costs of inpatient hospitalization. Their out-of-pocket share is just 7 percent. Fifteen percent of the population used hospital outpatient services in 2007, spending a median of $682 on them. Individuals paid 7 percent of the costs of their hospital outpatient services out-ofpocket. The uninsured paid an 18 percent share out-of-pocket. Twelve percent of the population used emergency room services during 2007, spending a median of $498 on them. Twelve percent of emergency room costs were paid for out-of-pocket, with the uninsured paying a 45 percent share of their emergency room costs out-of-pocket. ■ Affordable hospitalization-only health insurance policies could protect the uninsured from devastating medical bills and also protect hospitals from losses when the uninsured are unable to pay.

The uninsured pay little out-of-pocket for hospital care

60 (percent of hospital inpatient, outpatient, and emergency room services paid for out-of-pocket by the uninsured, 2007)

45% 40

40%

20

20%

18% 7%

0

0%

166 AMERICAN HEALTH

a inpatient

b outpatient

c room emergency

COVERAGE AND COST

Table 6.30

Spending on Hospital Inpatient Services by Selected Characteristics, 2007

(total number of people, percent with hospital inpatient expense, median and average expense per person with expense, total hospital inpatient expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007)

total (thousands)

percent with expense

spending per person with expense median

average

total expenses (millions)

percent distribution of total expenses by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

Hospital inpatient services TOTAL PEOPLE

301,309

7.4% $8,612

$15,754 $352,995

100.0%

3.1%

39.7%

38.4%

10.2%

8.6%

Age Under age 65

262,616

5.5

6,955

14,499

209,536

100.0

3.6

61.7

8.6

16.0

Under age 18

73,909

2.9

3,996

10,241

21,913

100.0

3.7

42.5

–

35.0

10.1 –

Aged 18 to 24

28,169

5.3

5,020

7,748

11,523

100.0

2.4

45.5

–

37.4

–

Aged 25 to 34

41,140

6.8

6,013

10,068

28,237

100.0

5.8

49.1

–

28.0

–

Aged 35 to 44

41,733

5.2

7,607

10,830

23,380

100.0

4.9

69.7

–

–

7.8

Aged 45 to 54

42,927

6.3

10,136

20,292

54,875

100.0

–

67.9

–

7.5

–

Aged 55 to 64

34,738

9.1

11,013

22,044

69,608

100.0

2.9

67.9

13.3

–

6.5

Aged 65 or older

38,694

20.6

12,053

18,034

143,459

100.0

–

7.6

82.0

1.7

6.5

Male

147,629

5.6

10,671

19,790

164,934

100.0

–

40.8

36.2

8.5

11.0

Female

153,680

9.2

7,888

13,363

188,061

100.0

2.7

38.7

40.4

11.6

6.6

Sex

Race and Hispanic origin Asian

14,026

5.6

–

–

–

100.0

–

–

–

–

–

Black

36,704

8.3

7,510

15,227

46,606

100.0

1.5

24.0

33.9

28.9

11.8

Hispanic Non-Hispanic white

46,390

5.6

5,945

12,313

32,010

100.0

2.8

28.6

32.5

26.4

9.6

197,611

7.7

9,469

16,305

249,137

100.0

3.5

40.9

42.6

5.0

7.9

Health insurance under age 65 Any private

181,422

5.1

8,448

16,240

149,944

100.0

4.1

86.2

–

–

–

Public only

41,312

9.6

5,413

11,141

44,293

100.0

0.6

–

26.7

63.8

9.0

Uninsured

39,882

3.1

5,017

12,303

15,299

100.0

7.1

–

–

–

92.9

Health insurance aged 65 or older Medicare only

13,333

22.6

12,005

16,830

50,659

100.0

–

–

81.4

–

14.0

Medicare/private

20,473

17.4

11,898

17,700

63,159

100.0

1.1

17.3

79.5

–

–

4,618

29.5

12,253

21,728

29,565

100.0

–

–

88.4

8.1

–

Poor

38,158

11.4

6,572

16,167

70,364

100.0

–

–

40.6

22.7

11.3

Near poor

13,290

11.6

8,297

14,476

22,367

100.0

–

–

58.9

18.9

–

Low income

40,482

10.0

9,307

16,264

65,678

100.0

1.8

25.6

52.3

12.7

7.6

93,234

6.4

8,651

14,780

87,540

100.0

3.0

41.9

35.9

–

11.6

116,145

5.6

9,518

16,347

107,045

100.0

3.9

63.9

26.2

–

5.4

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

167

Table 6.31

Spending on Hospital Outpatient Services by Selected Characteristics, 2007

(total number of people, percent with hospital outpatient service expense, median and average expense per person with expense, total hospital outpatient service expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007) spending per person with expense median

average

total expenses (millions)

301,309

14.9% $682

$2,130

$95,604

total (thousands)

percent with expense

percent distribution of total expenses by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

Hospital outpatient services TOTAL PEOPLE

100.0%

7.4%

59.7%

19.1%

3.7%

10.1% 10.4

Age Under age 65

262,616

12.3

683

2,216

71,588

100.0

8.7

73.5

3.1

4.4

Under age 18

73,909

6.2

427

1,679

7,726

100.0

7.0

66.3

–

12.7

–

Aged 18 to 24

28,169

6.0

255

1,340

2,258

100.0

5.6

69.0

–

–

–

Aged 25 to 34

41,140

8.2

726

1,989

6,722

100.0

8.6

71.1

–

6.1

–

Aged 35 to 44

41,733

13.0

637

1,981

10,788

100.0

10.0

71.4

–

–

7.4

Aged 45 to 54

42,927

18.9

771

2,461

19,998

100.0

9.0

73.0

3.1

2.4

12.5

Aged 55 to 64

34,738

26.1

941

2,656

24,096

100.0

8.5

78.1

3.7

–

7.7

Aged 65 or older

38,694

32.5

680

1,909

24,016

100.0

3.6

18.5

67.0

–

9.2

Sex Male

147,629

11.7

772

2,462

42,427

100.0

6.7

59.3

18.1

3.1

12.8

Female

153,680

18.0

638

1,923

53,177

100.0

7.9

60.0

20.0

4.2

7.9

Race and Hispanic origin Asian

14,026

9.8

–

1,699

2,343

100.0

5.8

77.4

–

–

–

Black

36,704

11.2

489

2,131

8,768

100.0

3.8

49.1

19.9

11.3

–

Hispanic

46,390

7.0

431

1,905

6,156

100.0

–

46.1

19.9

9.8

–

197,611

17.9

735

2,161

76,586

100.0

7.6

61.7

19.3

2.4

9.1

Non-Hispanic white

Health insurance under age 65 Any private

181,422

14.1

850

2,443

62,377

100.0

8.7

84.3

1.2

–

5.2

Public only

41,312

11.1

330

1,178

5,401

100.0

2.2

–

26.8

51.6

19.5

Uninsured

39,882

5.5

430

1,739

3,810

100.0

17.7

–

–

–

82.3

Health insurance aged 65 or older Medicare only

13,333

29.8

620

2,023

8,032

100.0

4.1

–

81.2

–

14.8

Medicare/private

20,473

35.7

734

1,847

13,487

100.0

3.9

33.0

56.5

–

–

4,618

28.4

577

1,906

2,497

100.0

0.6

–

77.9

15.4

–

Poor

38,158

12.3

390

1,391

6,540

100.0

3.3

29.2

27.5

23.7

16.3

Near poor

13,290

13.9

657

2,185

4,029

100.0

2.8

–

42.0

–

–

Low income

40,482

11.9

704

1,836

8,863

100.0

5.3

34.1

36.1

6.8

17.6

93,234

13.9

656

2,003

25,877

100.0

7.7

59.2

18.4

2.6

12.1

116,145

17.7

827

2,442

50,294

100.0

8.5

70.7

13.6

–

6.9

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

168 AMERICAN HEALTH

COVERAGE AND COST

Table 6.32

Spending on Emergency Room Services by Selected Characteristics, 2007

(total number of people, percent with emergency room services expense, median and average expense per person with expense, total emergency room service expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007) spending per person with expense median

average

total expenses (millions)

301,309

12.2% $498

$1,038

$38,115

total (thousands)

percent with expense

percent distribution of total expenses by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

Emergency room services TOTAL PEOPLE

100.0%

12.0%

52.5%

14.6%

9.4%

11.5%

Age Under age 65

262,616

11.2

517

1,090

32,170

100.0

13.5

59.2

4.7

10.4

Under age 18

73,909

11.3

376

686

5,718

100.0

16.9

56.3

–

20.2

12.3 6.5

Aged 18 to 24

28,169

11.6

486

973

3,185

100.0

16.7

45.1

–

17.6

20.3

Aged 25 to 34

41,140

11.2

546

1,004

4,638

100.0

17.9

49.9

–

15.1

15.4

Aged 35 to 44

41,733

9.7

572

1,091

4,437

100.0

13.6

67.1

–

7.6

–

Aged 45 to 54

42,927

12.0

655

1,356

6,991

100.0

12.4

61.1

–

4.7

14.5

Aged 55 to 64

34,738

11.7

724

1,771

7,202

100.0

7.6

66.8

11.0

3.5

11.1

Aged 65 or older

38,694

18.6

418

827

5,945

100.0

3.5

16.4

68.4

4.3

7.4

Sex Male

147,629

11.2

499

1,118

18,451

100.0

14.1

51.4

14.8

5.8

13.9

Female

153,680

13.1

494

973

19,664

100.0

9.9

53.5

14.4

12.8

9.3

Race and Hispanic origin Asian

14,026

6.5

619

1,466

–

100.0

11.6

72.8

–

–

–

Black

36,704

15.9

429

856

4,986

100.0

12.3

40.4

15.6

19.5

12.3

Hispanic Non-Hispanic white

46,390

10.0

446

962

4,444

100.0

13.5

50.8

9.9

14.4

11.3

197,611

12.3

537

1,082

26,366

100.0

11.7

54.5

16.0

6.6

11.1

Health insurance under age 65 Any private

181,422

10.3

638

1,289

24,038

100.0

10.6

79.2

–

–

5.8

Public only

41,312

17.8

320

634

4,658

100.0

5.3

–

18.9

61.9

13.9

Uninsured

39,882

8.8

440

986

3,474

100.0

44.7

–

–

–

55.3

Health insurance aged 65 or older Medicare only

13,333

18.2

383

789

1,913

100.0

4.0

–

83.3

–

12.6

Medicare/private

20,473

17.8

483

891

3,238

100.0

–

30.0

61.6

–

–

4,618

24.5

336

701

793

100.0

–

–

60.2

31.0

–

Poor

38,158

17.5

357

817

5,458

100.0

10.8

19.6

21.9

33.3

14.4

Near poor

13,290

15.7

350

677

1,413

100.0

–

26.5

36.9

16.2

–

Low income

40,482

13.5

466

890

4,860

100.0

10.2

37.6

18.4

19.0

14.9

93,234

11.9

497

1,041

11,500

100.0

12.7

54.4

13.8

4.0

15.0

116,145

9.8

640

1,302

14,883

100.0

12.6

70.4

9.2

–

6.7

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

169

Older Adults Are Most Likely to Buy Prescription Drugs Medicare covers 55 percent of their cost. Sixty-two percent of Americans had prescription drug expenses in 2007, with a median cost of $345 per person with the expense. Individuals paid 28 percent of prescription drug costs out-of-pocket, while private insurance covered another 36 percent. In most age groups, the majority of Americans had prescription drug expenses in 2007. The ﬁgure ranged from a low of 46 percent among 18-to-24-year-olds to a high of 90 percent among people aged 65 or older. Among people aged 65 or older with prescription drug costs, their median expense was a hefty $1,449, 28 percent of which was paid out-of-pocket and 55 percent by Medicare. The uninsured pay 71 percent of their prescription drug costs out-of-pocket. Median prescription drug expenses for the uninsured were $119 in 2007 versus $256 for those under age 65 with private insurance. This suggests that many uninsured people are foregoing medication because they cannot afford it. ■ Prescription medications are increasingly central to the treatment of many health conditions, yet prescription drug coverage can be spotty.

Medicare covers one-quarter of the nation’s spending on prescription drugs

45

(percent distribution of spending on prescription drugs, by source of payment, 2007)

36% 30

30%

15

15%

28% 25%

8% 4% 0

0%

out-of-pocket a

170 AMERICAN HEALTH

private b insurance

Medicare c

Medicaid d

other e

COVERAGE AND COST

Table 6.33

Spending on Prescription Drugs by Selected Characteristics, 2007

(total number of people, percent with prescription drug expense, median and average expense per person with expense, total prescription drug expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007)

total (thousands)

percent with expense

spending per person with expense median

average

total expenses (millions)

percent distribution of total expenses by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

Prescription drugs TOTAL PEOPLE

301,309

61.7% $345

$1,251 $232,641

100.0%

27.7%

35.5%

24.7%

7.8%

4.3%

Age Under age 65

262,616

57.5

228

996

150,540

100.0

27.4

49.0

8.5

11.7

3.4

Under age 18

73,909

46.7

62

364

12,558

100.0

23.7

37.8

–

34.9

2.8

Aged 18 to 24

28,169

45.7

90

435

5,606

100.0

30.8

35.5

–

23.6

–

Aged 25 to 34

41,140

52.9

162

633

13,772

100.0

36.2

43.6

–

14.3

1.8

Aged 35 to 44

41,733

57.9

219

918

22,165

100.0

27.4

49.8

11.0

10.1

1.8

Aged 45 to 54

42,927

69.6

484

1,432

42,792

100.0

25.8

48.3

12.2

10.2

3.4

Aged 55 to 64

34,738

80.3

873

1,922

53,647

100.0

26.8

54.8

7.7

6.2

4.4

Aged 65 or older

38,694

90.0

1,449

2,357

82,101

100.0

28.4

10.7

54.6

0.5

5.8

Male

147,629

55.7

302

1,177

96,751

100.0

26.9

38.2

21.6

7.0

6.3

Female

153,680

67.5

374

1,310

135,890

100.0

28.3

33.6

27.0

8.3

2.8

Sex

Race and Hispanic origin Asian

14,026

47.6

234

914

6,101

100.0

27.5

40.5

28.1

2.6

–

Black

36,704

55.0

254

1,167

23,563

100.0

23.6

27.3

25.9

19.1

4.2

Hispanic Non-Hispanic white

46,390

46.2

126

814

17,420

100.0

27.4

26.8

27.5

15.2

3.0

197,611

67.7

426

1,347

180,208

100.0

28.5

37.4

24.1

5.5

4.5

1.0

Health insurance under age 65 Any private

181,422

62.5

256

963

109,274

100.0

28.0

67.6

1.9

1.6

Public only

41,312

55.9

173

1,409

32,564

100.0

13.8

–

32.7

48.9

4.6

Uninsured

39,882

36.4

119

599

8,701

100.0

70.5

–

–

–

29.5

Health insurance aged 65 or older Medicare only

13,333

86.8

1,207

2,077

24,020

100.0

34.6

–

51.1

–

14.3

Medicare/private

20,473

92.5

1,522

2,450

46,404

100.0

28.8

18.9

49.7

–

2.4

4,618

91.1

1,783

2,756

11,589

100.0

13.2

–

81.8

3.4

1.6

Poor

38,158

56.5

254

1,372

29,558

100.0

23.4

9.0

34.6

28.8

4.2

Near poor

13,290

57.7

375

1,487

11,414

100.0

25.3

12.6

41.4

14.8

5.8

Low income

40,482

57.1

370

1,398

32,305

100.0

27.3

19.2

35.3

13.3

4.9

93,234

59.5

313

1,214

67,353

100.0

29.5

36.4

24.5

4.7

4.9

116,145

67.3

392

1,177

92,011

100.0

28.2

51.9

16.0

0.5

3.4

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

171

Eyeglasses and Contact Lenses Are Not Covered by Much Insurance Most of these expenses are paid for out-of-pocket. Just as dental care is considered separate from general medical care—and is much less likely to be covered by insurance—vision care is largely omitted from most insurance plans. In 2007, nearly half (46 percent) of the total expense for optometrist ofﬁce visits was paid for out-of-pocket. The out-ofpocket proportion was 49 percent for people under age 65 and a smaller 32 percent for those aged 65 or older. Overall, 6.5 percent of Americans visited an optometrist in 2007, spending a median of $91 doing so. Fifteen percent of the population spent on vision aids in 2007, a category dominated by eyeglasses and contact lenses. The median expense for those buying vision aids was $210. More than 72 percent of the cost was paid for out-of-pocket. ■ Vision aids are not part of most health insurance plans because the out-of-pocket costs for these items are relatively modest.

Seventy-one percent of the cost of glasses and contact lenses is paid for out-of-pocket 90 of total expenses for optometrist ofﬁce visits and vision aids paid for out-of-pocket, 2007) (percent

72.5% 60

60%

46.0% 30

30%

0

0%

172 AMERICAN HEALTH

optometrist a visits

vision baids

COVERAGE AND COST

Table 6.34

Spending on Optometrist Ofﬁce Visits by Selected Characteristics, 2007

(total number of people, percent with optometrist visit expense, median and average expense per person with expense, total optometrist visit expenses, and percent of total expenses paid out-of-pocket, by selected characteristics, 2007)

total (thousands)

percent with expense

spending per person with expense median

average

total expenses (millions)

$91

$160

$3,123

percent distribution by source of payment out-ofpocket

private insurance

total

100.0%

46.0%

40.5%

Medicare

Medicaid

Optometrist ofﬁce visits TOTAL PEOPLE

301,309

6.5%

3.7%

5.8%

Age Under age 65

262,616

6.3

90

156

2,589

100.0

48.8

42.2

–

5.8

Under age 18

73,909

4.9

70

149

539

100.0

39.8

41.7

–

–

Aged 18 to 24

28,169

6.6

100

138

256

100.0

56.4

38.5

–

–

Aged 25 to 34

41,140

5.7

97

160

373

100.0

57.9

31.0

–

–

Aged 35 to 44

41,733

5.8

90

106

257

100.0

48.7

45.3

–

–

Aged 45 to 54

42,927

8.5

90

163

595

100.0

55.0

41.4

–

–

Aged 55 to 64

34,738

7.7

95

212

570

100.0

41.6

51.4

–

–

Aged 65 or older

38,694

7.5

109

183

535

100.0

32.1

32.0

19.9

–

Male

147,629

5.5

93

165

1,339

100.0

47.9

39.3

3.5

–

Female

153,680

7.4

90

157

1,784

100.0

44.5

41.4

3.8

6.8

Sex

Race and Hispanic origin Asian

14,026

7.0

120

191

187

100.0

34.9

40.0

–

–

Black

36,704

3.4

90

174

219

100.0

43.7

40.1

–

7.1

Hispanic Non-Hispanic white

46,390

3.5

85

186

300

100.0

49.5

28.3

–

–

197,611

7.8

90

155

2,392

100.0

46.8

42.1

3.8

3.3

Health insurance under age 65 Any private

181,422

7.6

95

160

2,217

100.0

48.2

49.3

–

1.0

Public only

41,312

4.1

55

114

192

100.0

16.4

–

–

66.2

20,473

9.4

100

178

342

100.0

32.3

50.1

16.3

–

Poor

38,158

4.2

63

133

211

100.0

30.3

–

–

33.0

Low income

40,482

4.6

79

149

277

100.0

36.7

32.3

–

–

Middle income

93,234

5.7

90

170

913

100.0

46.3

41.4

3.3

–

116,145

8.6

100

162

1,625

100.0

50.5

43.9

2.7

–

Health insurance aged 65 or older Medicare/private Income status

High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

173

Table 6.35

Spending on Vision Aids by Selected Characteristics, 2007

(total number of people, percent with vision aid expense, median and average expense per person with expense, total vision aid expenses, and percent of total expenses paid out-of-pocket, by selected characteristics, 2007)

Vision aids TOTAL PEOPLE

spending per person with expense median

average

total expenses (millions)

301,309

14.8% $210

$260

$11,620

total (thousands)

percent with expense

percent distribution by source of payment total

out-ofpocket

private insurance

100.0%

72.5%

18.7%

Medicare

1.0%

Medicaid

other

5.0%

2.9%

Age Under age 65

262,616

14.3

205

256

9,618

100.0

71.2

20.8

–

5.3

2.7

Under age 18

73,909

8.8

172

208

1,358

100.0

60.6

18.1

–

15.7

5.6

Aged 18 to 24

28,169

14.1

175

213

846

100.0

68.8

21.5

–

7.7

–

Aged 25 to 34

41,140

14.8

185

229

1,398

100.0

73.6

19.8

–

3.6

–

Aged 35 to 44

41,733

14.1

200

241

1,422

100.0

75.2

21.2

–

2.3

–

Aged 45 to 54

42,927

19.6

250

293

2,467

100.0

73.6

21.5

–

3.3

1.5

Aged 55 to 64

34,738

19.3

269

318

2,128

100.0

72.0

21.9

–

2.8

3.2

Aged 65 or older

38,694

18.2

240

284

2,001

100.0

78.3

8.8

5.6

3.6

3.7

Male

147,629

12.1

210

258

4,616

100.0

71.5

19.6

–

3.7

4.5

Female

153,680

17.4

211

261

7,003

100.0

73.1

18.2

1.1

5.8

1.8

Sex

Race and Hispanic origin Asian

14,026

15.8

201

256

570

100.0

70.1

22.1

–

–

–

Black

36,704

11.3

210

258

1,074

100.0

59.0

19.8

–

14.5

5.4

Hispanic Non-Hispanic white

46,390

10.6

200

234

1,153

100.0

69.4

15.0

–

10.4

–

197,611

16.5

220

266

8,648

100.0

74.9

18.9

0.9

2.8

2.4

1.4

Health insurance under age 65 Any private

181,422

16.5

224

265

7,949

100.0

72.5

25.2

–

0.9

Public only

41,312

10.1

149

197

827

100.0

43.8

–

–

52.2

3.8

Uninsured

39,882

8.7

198

243

843

100.0

86.2

–

–

–

13.8

Health insurance aged 65 or older Medicare only

13,333

15.7

250

285

595

100.0

84.4

–

8.9

–

6.7

Medicare/private

20,473

20.3

246

284

1,182

100.0

79.6

15.0

–

–

–

4,618

17.1

200

283

223

100.0

55.2

–

8.6

31.0

–

Poor

38,158

10.9

157

212

881

100.0

60.0

4.6

–

29.7

4.3

Near poor

13,290

12.6

200

250

418

100.0

67.0

–

–

18.5

–

Low income

40,482

11.5

200

236

1,103

100.0

70.8

11.6

–

11.1

–

93,234

14.2

200

246

3,254

100.0

71.6

21.0

–

3.2

3.1

116,145

18.0

246

285

5,964

100.0

75.4

21.9

–

–

1.8

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

174 AMERICAN HEALTH

COVERAGE AND COST

Nearly Half the Cost of Dental Visits Is Paid for Out-of-Pocket People aged 65 or older are especially likely to pay out-of-pocket for dental care. Most Americans have health insurance, but a much smaller share has dental insurance. This is readily apparent in the fact that 47 percent of expenditures for dental ofﬁce visits in 2007 were paid for out-of-pocket. Among people under age 65, a smaller 42 percent of dental expenses were paid out of pocket. Among people aged 65 or older, the proportion was a much larger 70 percent. Overall, 40 percent of Americans had dental visit expenses in 2007, with a median cost of $200 per person. Twelve percent of children aged 12 to 17 visited an orthodontist in 2007. They spent a median of $1,080 on the service. More than half of orthodontic care is paid for out-of-pocket. Private insurance pays about one-third of the cost. ■ With escalating health care costs cutting into company proﬁts, it is unlikely that employers will be adding more generous dental beneﬁts to their health care plans anytime soon. 90

Children pay the least out-of-pocket for dental care (percent of total spending on general dentist ofﬁce visits paid for out-of-pocket, by age, 2007)

6060%

3030%

00%

under a 18

18 to b24

25 c to 34

35 d to 44

45 to e54

55 tof 64

65 org older

AMERICAN HEALTH

175

Table 6.36

Spending on Visits to General Dentists by Selected Characteristics, 2007

(total number of people, percent with general dentist ofﬁce visit expenses, median and average expense per person with expense, total general dentist ofﬁce visit expenses, and percent distribution of total expenses by source of payment, by selected characteristics, 2007) spending per person with expense median

average

total expenses (millions)

301,309

39.8% $200

$499

$59,896

total (thousands)

percent with expense

percent distribution by source of payment total

out-ofpocket

private insurance

Medicare

Medicaid

other

General dentist visits TOTAL PEOPLE

100.0%

47.1%

44.8%

1.0%

4.0%

3.2% 3.0

Age Under age 65

262,616

39.7

197

471

49,103

100.0

42.1

50.1

–

4.7

Under age 18

73,909

41.7

156

284

8,747

100.0

23.9

55.4

–

17.3

3.5

Aged 18 to 24

28,169

30.6

162

344

2,971

100.0

41.9

48.3

–

4.3

5.5

Aged 25 to 34

41,140

31.6

200

436

5,673

100.0

42.4

50.8

–

2.6

–

Aged 35 to 44

41,733

39.4

220

479

7,889

100.0

39.8

55.6

–

2.0

–

Aged 45 to 54

42,927

43.8

229

601

11,296

100.0

45.4

50.6

–

1.9

2.1

Aged 55 to 64

34,738

47.2

265

764

12,527

100.0

53.1

42.8

–

–

2.8

Aged 65 or older

38,694

41.0

250

680

10,793

100.0

69.7

20.4

5.3

–

3.8

Male

147,629

36.6

200

485

26,208

100.0

45.4

45.7

–

3.9

3.7

Female

153,680

42.9

200

510

33,689

100.0

48.4

44.1

0.7

4.1

2.7

–

Sex

Race and Hispanic origin Asian

14,026

36.5

226

502

2,575

100.0

38.2

55.3

–

–

Black

36,704

28.1

160

467

4,819

100.0

31.1

50.5

–

10.5

–

Hispanic

46,390

25.5

150

388

4,590

100.0

44.4

38.2

–

11.8

4.7

197,611

45.9

210

518

46,986

100.0

49.8

44.0

0.7

2.6

2.9

1.0

Non-Hispanic white

Health insurance under age 65 Any private

181,422

47.0

210

503

42,849

100.0

41.0

57.5

–

0.4

Public only

41,312

29.2

101

261

3,139

100.0

22.6

–

–

68.0

9.1

Uninsured

39,882

17.3

190

452

3,115

100.0

75.9

–

–

–

24.1

Health insurance aged 65 or older Medicare only

13,333

34.0

270

593

2,682

100.0

76.6

–

11.2

–

12.1

Medicare/private

20,473

50.9

250

750

7,820

100.0

67.9

28.1

–

–

–

4,618

19.1

162

321

284

100.0

54.5

–

–

28.1

–

Poor

38,158

24.6

130

333

3,128

100.0

45.6

16.0

–

32.5

4.8

Near poor

13,290

22.2

186

416

1,229

100.0

41.5

26.6

–

21.6

–

Low income

40,482

28.2

182

466

5,330

100.0

46.7

32.9

–

10.4

7.2

93,234

37.3

188

459

15,959

100.0

44.3

48.8

–

3.2

2.9

116,145

52.9

226

557

34,249

100.0

48.7

48.1

–

–

2.4

Medicare/other public Income status

Middle income High income

Note: “Uninsured” refers to people uninsured for the entire year. Tricare (armed-forces related coverage) is considered private insurance in these data. “Other” insurance includes Department of Veterans Affairs (except Tricare), American Indian Health Service, state and local clinics, worker’s compensation, homeowner’s and automobile insurance, etc. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

176 AMERICAN HEALTH

COVERAGE AND COST

Table 6.37

Spending on Orthodontic Ofﬁce Visits by Selected Characteristics, 2007

(total number of people, percent with orthodontic ofﬁce visit expense, median and average expense per person with expense, total orthodontic visit expenses, and percent of expenses paid out-of-pocket, by selected characteristics, 2007)

total people (thousands)

percent with expense

spending per person with expense

median

average

total expenses (millions)

$950

$1,959

$11,998

percent distribution by source of payment

out-ofpocket

total

private insurance

Orthodontic ofﬁce visits TOTAL PEOPLE

301,309

2.0%

100.0%

56.0%

34.6%

Age Aged 12 to 17

25,505

12.3

1,080

2,288

7,185

100.0

55.5

33.3

227,400

0.9

674

1,483

2,940

100.0

59.8

33.5

Male

147,629

1.7

800

1,648

4,235

100.0

58.1

35.1

Female

153,680

2.3

1,075

2,184

7,763

100.0

54.8

34.3

46,390

2.0

669

1,586

1,463

100.0

56.5

34.1

197,611

2.0

975

2,027

8,147

100.0

59.8

33.3

Aged 18 or older Sex

Race and Hispanic origin Hispanic Non-Hispanic white

Health insurance under age 65 Any private

181,422

2.6

1,075

2,075

9,952

100.0

56.3

41.3

Public only

41,312

1.9

669

1,579

1,239

100.0

41.9

–

93,234

1.9

960

2,280

4,042

100.0

50.1

40.6

116,145

2.6

1,020

1,975

5,872

100.0

59.8

37.4

Income status Middle income High income

Note: “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

177

Few Americans Visit Chiropractors Only 4 percent of the population visited a chiropractor in the past year. Visits to nurse practitioners are more common than visits to chiropractors, with 9 percent of the population visiting a nurse practitioner in 2007. Only 2 percent received home health care during the year, but among people aged 65 a substantial 10 percent received home health care services. Going to a nurse practitioner rather than a doctor might be cost effective. The median expense for those visiting a nurse or nurse practitioner in 2007 was just $95. Those visiting chiropractors paid a median of $244. Home health care cost a median of $2,984 for each person aged 65 or older with the expense. ■ Home health care is a less expensive alternative to nursing home care for the nation’s elderly.

The elderly with Medicare and other public insurance are most likely to have had a home health care expense in 2007

24 (percent of people aged 65 or older with home health care expenses, by type of insurance, 2007)

19% 16

16%

10% 8

8%

0

0%

7%

Medicare a only

178 AMERICAN HEALTH

Medicare b and private

Medicare and cother public

COVERAGE AND COST

Table 6.38

Spending on Visits to Nurses or Nurse Practitioners by Selected Characteristics, 2007

(total number of people, percent with nurse or nurse practitioner visit expense, and median expense per person with expense, by selected characteristics, 2007) total (thousands)

percent with expense

median expense per person

Nurse or nurse practitioner visits TOTAL PEOPLE Age Under age 65 Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

301,309

9.1%

$95

262,616 73,909 28,169 41,140 41,733 42,927 34,738 38,694

8.2 8.1 6.6 7.1 8.0 8.0 11.2 15.5

94 81 89 99 99 111 110 98

Sex Male Female

147,629 153,680

6.8 11.3

85 100

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

14,026 36,704 46,390 197,611

4.1 5.4 4.1 11.3

93 74 98

Health insurance under age 65 Any private 181,422 Public only 41,312 Uninsured 39,882

9.4 6.2 4.6

95 108 77

Health insurance aged 65 or older Medicare only 13,333 Medicare/private 20,473

16.2 16.5

75 112

Income status Poor Near poor Low income Middle income High income

6.8 6.8 7.5 9.2 10.5

104 82 109 93 92

38,158 13,290 40,482 93,234 116,145

Note: “Uninsured” refers to people uninsured for the entire year. “Poor” refers to incomes below poverty level. “Near poor” encompasses incomes from poverty level through 125 percent of poverty level. “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

179

Table 6.39

Spending on Chiropractic Ofﬁce Visits by Selected Characteristics, 2007

(total number of people, percent with chiropractic visit expense, and median expense per person with expense, by selected characteristics, 2007) total people (thousands)

percent with expense

median expense per person

Chiropractic ofﬁce visits TOTAL PEOPLE Age Under age 65 Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

301,309

4.2%

262,616 73,909 28,169 41,140 41,733 42,927 34,738 38,694

4.0 1.3 2.7 4.9 5.0 6.1 5.6 6.0

232 – – 240 262 281 267 285

Sex Male Female

147,629 153,680

3.7 4.8

210 280

Race and Hispanic origin Non-Hispanic white

197,611

5.6

240

Health insurance under age 65 Any private 181,422

4.7

261

Health insurance aged 65 or older Medicare/private 20,473

6.5

270

Income status Low income Middle income High income

3.4 4.6 5.4

232 210 266

40,482 93,234 116,145

$244

Note: “Low income” is more than 125 percent of poverty level through 200 percent of poverty level. “Middle income” is more than 200 percent of poverty level through 400 percent of poverty level. “High income” is more than 400 percent of poverty level. “–” means not applicable or sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

180 AMERICAN HEALTH

COVERAGE AND COST

Table 6.40

Spending on Home Health Care Services by Selected Characteristics, 2007

(total number of people, percent with home health care expense, and expense per person with expense, by selected characteristics, 2007) total people (thousands)

percent with expense

median expense per person

Home health care TOTAL PEOPLE Age Under age 65 Aged 65 or older

301,309

2.1%

$2,406

262,616 38,694

1.0 9.6

1,692 2,984

Sex Male Female

147,629 153,680

1.5 2.6

2,169 2,449

Race and Hispanic origin Black Hispanic Non-Hispanic white

36,704 46,390 197,611

2.1 1.3 2.4

4,451 4,349 1,955

Health insurance aged 65 or older Medicare only 13,333 Medicare/private 20,473 Medicare/other public 4,618

10.4 7.2 18.6

2,400 2,682 4,890

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

181

Medicaid Rolls Are Growing The program now covers more than 30 percent of children. Medicare and Medicaid are government programs providing health insurance to the elderly (Medicare), the disabled (Medicare), and the poor (Medicaid). Both programs are becoming increasingly large and important components of the health care system. Medicaid covered 14 percent of the population in 2008, including more than 30 percent of children under age 18. The percentage of people covered by Medicaid grew in most age groups between 2000 and 2008. Females are slightly more likely than males to be covered by Medicaid. Just over 45 million Americans were enrolled in Medicare in 2007, most of them eligible for coverage because they were aged 65 or older. Seventeen percent of Medicare enrollees are in the program because of a disability. Nearly one in ﬁve men enrolled in Medicare is disabled. ■ The number of Medicare enrollees will expand rapidly as boomers enter the eligible age group.

Women outnumber men among Medicare enrollees (percent distribution of Medicare enrollees, by sex, 2008)

45% men

55% women

b a

182 AMERICAN HEALTH

a b

COVERAGE AND COST

Table 6.41

Medicaid Coverage by Selected Characteristics, 2000 and 2008

(percent of people covered by Medicaid by selected characteristics, 2000 and 2008; percentage point change, 2000–08) 2008

2000

percentage point change

Percent covered by Medicaid

14.1%

10.6%

3.5

Age Under age 18 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

30.3 13.2 9.2 7.6 7.5 7.7 9.1

20.9 9.4 6.4 5.4 5.2 7.0 9.9

9.4 3.8 2.8 2.2 2.3 0.7 –0.8

Sex Female Male

15.1 13.1

11.5 9.6

3.6 3.5

Source: Bureau of the Census, Historical Health Insurance Tables, Internet site http://www.census.gov/hhes/www/hlthins/ historic/index.html; calculations by New Strategist

AMERICAN HEALTH

183

Table 6.42

Medicare Enrollees by Selected Characteristics, 2007

(number and percent distribution of people enrolled in Medicare, by age and sex, 2007; numbers in thousands) total

female

male

Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

45,412 37,896 19,884 12,744 5,268

25,200 21,642 10,605 7,446 3,591

20,212 16,254 9,280 5,298 1,677

Disabled Under age 45 Aged 45 to 54 Aged 55 or older

7,516 1,825 2,352 3,338

3,559 840 1,115 1,604

3,957 985 1,238 1,734

Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

100.0% 83.4 43.8 28.1 11.6

100.0% 85.9 42.1 29.5 14.3

100.0% 80.4 45.9 26.2 8.3

Disabled Under age 45 Aged 45 to 54 Aged 55 or older

16.6 4.0 5.2 7.4

14.1 3.3 4.4 6.4

19.6 4.9 6.1 8.6

TOTAL COVERED

Percent distribution by characteristic TOTAL COVERED

Percent distribution by sex Aged 65 or older Aged 65 to 74 Aged 75 to 84 Aged 85 or older

100.0% 100.0 100.0 100.0 100.0

55.5% 57.1 53.3 58.4 68.2

44.5% 42.9 46.7 41.6 31.8

Disabled Under age 45 Aged 45 to 54 Aged 55 or older

100.0 100.0 100.0 100.0

47.4 46.0 47.4 48.1

52.6 54.0 52.6 51.9

TOTAL COVERED

Source: Centers for Medicare and Medicaid Services, Data Compendium 2009, Internet site http://www.cms.hhs.gov/ DataCompendium/

184 AMERICAN HEALTH

DEATHS CHAPTER

7

Deaths ■ Heart disease and cancer are the leading killers. These two causes of death accounted for 49 percent of all deaths in 2006. The third leading cause of death, cerebrovascular disease, accounted for just 6 percent of the total.

■ Most deaths occur to people aged 75 or older. Eighty-four percent of deaths occur in the 55-or-older age group, and 56 percent are among people aged 75 or older.

■ Accidents are the primary cause of death among the young. Homicide is the second-leading cause of death among 15-to-24-year-olds, while suicide ranks third.

■ Accidental death becomes less common with age. Accidents drop behind cancer and heart disease in the 45-to-54 age group.

■ Life expectancy continues to increase. Life expectancy reached a record 77.9 years in 2007, up from 68.2 years in 1950.

AMERICAN HEALTH

185

Hospice Care Is Expanding Home health care is growing much more slowly. Hospice services are provided to people who are terminally ill. The primary goal of hospice is to make the individual as comfortable as possible and to provide support to the patient and family in a variety of ways. Hospice care can take place in a person’s home or in a specialized facility. According to the federal government’s National Home and Hospice Care Survey, 1 million people were discharged from hospice care in 2007, 68 percent more than in 2000. Most (83 percent) were aged 65 or older. Home health care has increased much more slowly than hospice care, primarily because Medicare provides only temporary coverage. The 1 million people aged 65 or older who received home health care in 2007 was just 5 percent more than in 2000.

■ Home health and hospice care can save money by allowing the frail or ailing to remain at home. 1500000

More than one million are in hospice care (number of hospice discharges, 2000 and 2007)

1000000

1,045,100 1,000,000

621,100

500000

500,000

0

0

186 AMERICAN HEALTH

2000

2007

DEATHS

Table 7.1

Home Health and Hospice Care Agencies, Patients, and Discharges, 2000 and 2007

(number of home health and hospice care agencies, patients, and discharges, 2000 and 2007 percent change

2007

2000

14,500

11,400

Number of home health care patients Under age 65 Aged 65 or older

1,459,900 456,600 1,003,400

1,355,300 400,100 955,200

7.7 14.1 5.0

Number of hospice care discharges Under age 65 Aged 65 or older

1,045,100 177,000 868,100

621,100 126,900 494,300

68.3 39.5 75.6

Number of agencies

27.2%

Source: National Center for Health Statistics, National Home and Hospice Care Survey, Internet site http://www.cdc.gov/nchs/ nhhcs/nhhcs_patient_trends.htm

AMERICAN HEALTH

187

Leading Causes of Death Differ by Sex, Race, and Hispanic Origin But heart disease and cancer claim the largest share regardless of demographics. Two diseases account nearly half of deaths in the U.S.—heart disease and cancer. Combined, they accounted for 49 percent of all deaths in 2006. In contrast, the third leading cause of death, cerebrovascular disease, accounts for just 6 percent of the total. Heart disease and cancer rank ﬁrst and second as a cause of death for both men and women. But there are differences by sex in the percentage of deaths attributable to other causes. For men, the third-leading cause is accidents, accounting for 7 percent of total male deaths in 2006. Accidents rank sixth among causes of death for females, accounting for only 3 percent of the total. Among Asians, blacks, Hispanics, and non-Hispanic whites, heart disease and cancer account for the largest share of deaths. Beyond that however, differences emerge. For example, homicide is the sixth-and seventh leading cause of death among blacks and Hispanics, respectively, but among Asians and non-Hispanic whites homicide does not even rank in the top ten. Hispanics are more likely than any other racial or ethnic group to die in an accident. Blacks are more likely to die of HIV. ■ Accidents rank high as a cause of death among males because teen boys and young men are the biggest risk takers.

Half of males and nearly half of females die of heart disease or cancer (percent of deaths due to heart disease or cancer, by sex, 2006)

60

48% 40

40%

20

20%

0

0%

188 AMERICAN HEALTH

females

50%

males

DEATHS

Table 7.2

Leading Causes of Death, 2006

(number and percent distribution of deaths accounted for by the 15 leading causes of death, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Total deaths Diseases of the heart Malignant neoplasms (cancer) Cerebrovascular diseases Chronic lower respiratory disease Accidents (unintentional injuries) Diabetes mellitus Alzheimer’s Inﬂuenza and pneumonia Nephritis, nephrotic syndrome, nephrosis Septicemia Suicide Chronic liver disease and cirrhosis Essential hypertension Parkinson’s disease Homicide All other causes

2,426,264 631,636 559,888 137,119 124,583 121,599 72,449 72,432 56,326 45,344 34,234 33,300 27,555 23,855 19,566 18,573 447,805

percent distribution

100.0% 26.0 23.1 5.7 5.1 5.0 3.0 3.0 2.3 1.9 1.4 1.4 1.1 1.0 0.8 0.8 18.5

Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

AMERICAN HEALTH

189

Table 7.3

Leading Causes of Death among Females, 2006

(number and percent distribution of deaths to females accounted for by the 10 leading causes of death among females, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes 1,224,322 Diseases of the heart (1) 315,930 Malignant neoplasms (cancer) (2) 269,819 Cerebrovascular diseases (3) 82,595 Chronic lower respiratory disease (4) 65,323 Alzheimer’s disease (7) 51,281 Accidents (5) 42,658 Diabetes mellitus (6) 36,443 Inﬂuenza and pneumonia (8) 30,676 Nephritis, nephrotic syndrome, nephrosis (9) 23,250 Septicemia (10) 18,712 All other causes 287,635

percent distribution

100.0% 25.8 22.0 6.7 5.3 4.2 3.5 3.0 2.5 1.9 1.5 23.5

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15 in the speciﬁed year. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.4

Leading Causes of Death among Males, 2006

(number and percent distribution of deaths to males accounted for by the 10 leading causes of death among males, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes 1,201,942 Diseases of the heart (1) 315,706 Malignant neoplasms (cancer) (2) 290,069 Accidents (5) 78,941 Chronic lower respiratory disease (4) 59,260 Cerebrovascular diseases (3) 54,524 Diabetes mellitus (6) 36,006 Suicide (11) 26,308 Inﬂuenza and pneumonia (8) 25,650 Nephritis, nephrotic syndrome, nephrosis (9) 22,094 Alzheimer’s disease (7) 21,151 All other causes 272,233

percent distribution

100.0% 26.3 24.1 6.6 4.9 4.5 3.0 2.2 2.1 1.8 1.8 22.6

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15 in the speciﬁed year. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

190 AMERICAN HEALTH

DEATHS

Table 7.5

Leading Causes of Death among Asians, 2006

(number and percent distribution of deaths to Asians accounted for by the 10 leading causes of death among Asians, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10

All causes Malignant neoplasms (cancer) (2) Diseases of the heart (1) Cerebrovascular diseases (3) Accidents (5) Diabetes mellitus (6) Chronic lower respiratory disease (4) Inﬂuenza and pneumonia (8) Nephritis, nephrotic syndrome, nephrosis (9) Suicide (11) Alzheimer’s disease (7) All other causes

44,707 11,784 10,673 3,662 2,125 1,621 1,352 1,347 866 813 720 9,744

percent distribution

100.0% 26.4 23.9 8.2 4.8 3.6 3.0 3.0 1.9 1.8 1.6 21.8

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15 in the speciﬁed year. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.6

Leading Causes of Death among Blacks, 2006

(number and percent distribution of deaths to blacks accounted for by the 10 leading causes of death among blacks, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Diseases of the heart (1) Malignant neoplasms (cancer) (2) Cerebrovascular diseases (3) Accidents (5) Diabetes mellitus (6) Homicide (15) Nephritis, nephrotic syndrome, nephrosis (9) Chronic lower respiratory disease (4) Human immunodeﬁciency virus infection Septicemia (10) All other causes

289,971 72,253 63,082 17,045 13,917 12,813 9,032 8,397 7,730 6,854 6,108 72,740

percent distribution

100.0% 24.9 21.8 5.9 4.8 4.4 3.1 2.9 2.7 2.4 2.1 25.1

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15 in the speciﬁed year. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

AMERICAN HEALTH

191

Table 7.7

Leading Causes of Death among Hispanics, 2006

(number and percent distribution of deaths to Hispanics accounted for by the 10 leading causes of death among Hispanics, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Diseases of the heart (1) Malignant neoplasms (cancer) (2) Accidents (5) Cerebrovascular diseases (3) Diabetes mellitus (6) Chronic liver disease and cirrhosis (12) Homicide (15) Chronic lower respiratory diseases (4) Inﬂuenza and pneumonia (8) Certain conditions originating in the perinatal period All other causes

percent distribution

133,004 28,921 26,633 12,052 7,005 6,287 3,592 3,524 3,310 2,966

100.0% 21.7 20.0 9.1 5.3 4.7 2.7 2.6 2.5 2.2

2,804 35,910

2.1 27.0

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15 in the speciﬁed year. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.8

Leading Causes of Death among Non-Hispanic Whites, 2006

(number and percent distribution of deaths to non-Hispanic whites accounted for by the 10 leading causes of death among non-Hispanic whites, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes 1,944,617 Diseases of the heart (1) 516,883 Malignant neoplasms (cancer) (2) 455,978 Chronic lower respiratory diseases (4) 111,559 Cerebrovascular diseases (3) 108,886 Accidents (5) 91,830 Alzheimer’s disease (7) 64,660 Diabetes mellitus (6) 50,950 Inﬂuenza and pneumonia (8) 46,419 Nephritis, nephrotic syndrome, nephrosis (9) 33,208 Suicide (11) 27,952 All other causes 436,292

percent distribution

100.0% 26.6 23.4 5.7 5.6 4.7 3.3 2.6 2.4 1.7 1.4 22.4

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15 in the speciﬁed year. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

192 AMERICAN HEALTH

DEATHS

Heart Disease Is the Leading Killer of the Oldest Adults Cancer claims more lives among those aged 55 to 74, however. The majority of deaths in any given year occur among people aged 75 or older, as might be expected. In 2006, 84 percent of deaths occurred in the 55-or-older age group; 56 percent were among people aged 75 or older. People aged 55 or older account for the great majority of deaths for most of the 15 leading causes of death. They account for 96 percent of deaths from chronic lower respiratory disease and nearly 100 percent of deaths from Alzheimer’s. In fact 62 percent of deaths from Alzheimer’s disease are among people aged 85 or older. Only three of the leading causes of death are more likely to claim people under age 55—accidents, suicide, and homicide. Only 40 percent of people who die in accidents are aged 55 or older, as are 30 percent of those who commit suicide and just 10 percent of homicide victims. As people age, the likelihood of dying from a particular disease changes. Among 55-to-64year-olds who died in 2006, the largest share died of cancer. This was also true in the 65-to-74 age group. Among older adults, however, heart disease causes a larger share of deaths than cancer. The percentage of deaths due to cancer falls from 36 percent in the 55-to-64 age group to just 12 percent among those aged 85 or older. ■ As the Baby-Boom generation reaches the older age groups, leading causes of death may change thanks to advances in treatments for heart disease and cancer.

The majority of deaths occur among people aged 75 or older (percent distribution of deaths by age, 2006) 30

20 20%

28%

29%

16%

16% 12%

10 10%

0 0%

under 55

55 to 64

65 to 74

75 to 84

85 or older

AMERICAN HEALTH

193

Table 7.9

Deaths from the 15 Leading Causes of Death, 2006: Number of Deaths

(number of deaths from the 15 leading causes of death, by age, 2006; ranked by total number of deaths) aged 55 or older total

55 to 64

65 to 74

75 to 84

85 or older

Total deaths 2,426,264 2,040,824 Diseases of the heart 631,636 576,019 Malignant neoplasms (cancer) 559,888 488,969 Cerebrovascular diseases 137,119 127,528 Chronic lower respiratory disease 124,583 119,220 Accidents (unintentional injuries) 121,599 48,135 Diabetes mellitus 72,449 63,783 Alzheimer’s 72,432 72,315 Inﬂuenza and pneumonia 56,326 52,500 Nephritis, nephrotic syndrome, nephrosis 45,344 41,745 Septicemia 34,234 30,233 Suicide 33,300 9,882 Chronic liver disease and cirrhosis 27,555 16,938 Essential hypertension 23,855 22,036 Parkinson’s disease 19,566 19,477 Homicide 18,573 1,791

total

281,401 65,477 101,454 10,518 12,375 11,446 11,432 655 3,154 4,368 4,032 4,583 7,217 2,178 397 1,012

390,093 92,752 137,554 18,223 28,236 8,420 15,483 3,812 6,061 7,453 6,064 2,384 4,917 3,174 2,310 398

667,338 180,451 164,889 43,719 47,406 13,708 21,763 22,915 16,668 14,536 10,745 2,075 3,778 6,654 9,101 279

701,992 237,339 85,072 55,068 31,203 14,561 15,105 44,933 26,617 15,388 9,392 840 1,026 10,030 7,669 102

Note: Numbers will not add to total because “age not stated” is not shown. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.10

Deaths from the 15 Leading Causes of Death, 2006: Distribution by Age

(percent distribution of deaths by age for total people and people aged 55 or older, 2006; ranked by total number of deaths) aged 55 or older

Total deaths Heart disease Malignant neoplasms Cerebrovascular diseases Chronic lower respiratory disease Accidents (unintentional injuries) Diabetes mellitus Alzheimer’s Inﬂuenza and pneumonia Nephritis Septicemia Suicide Chronic liver disease Essential hypertension Parkinson’s disease Homicide

total

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

total

84.1% 91.2 87.3 93.0 95.7 39.6 88.0 99.8 93.2 92.1 88.3 29.7 61.5 92.4 99.5 9.6

55 to 64

11.6% 10.4 18.1 7.7 9.9 9.4 15.8 0.9 5.6 9.6 11.8 13.8 26.2 9.1 2.0 5.4

65 to 74

16.1% 14.7 24.6 13.3 22.7 6.9 21.4 5.3 10.8 16.4 17.7 7.2 17.8 13.3 11.8 2.1

75 to 84

27.5% 28.6 29.5 31.9 38.1 11.3 30.0 31.6 29.6 32.1 31.4 6.2 13.7 27.9 46.5 1.5

85 or older

28.9% 37.6 15.2 40.2 25.0 12.0 20.8 62.0 47.3 33.9 27.4 2.5 3.7 42.0 39.2 0.5

Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

194 AMERICAN HEALTH

DEATHS

Table 7.11

Deaths from the 15 Leading Causes of Death, 2006: Distribution by Cause

(percent distribution of deaths by cause for total people and people aged 55 or older, 2006; ranked by total number of deaths) aged 55 or older

Total deaths Diseases of the heart Malignant neoplasms (cancer) Cerebrovascular diseases Chronic lower respiratory disease Accidents (unintentional injuries) Diabetes mellitus Alzheimer’s Inﬂuenza and pneumonia Nephritis, nephrotic syndrome, nephrosis Septicemia Suicide Chronic liver disease and cirrhosis Essential hypertension Parkinson’s disease Homicide

total

total

100.0% 26.0 23.1 5.7 5.1 5.0 3.0 3.0 2.3 1.9 1.4 1.4 1.1 1.0 0.8 0.8

100.0% 28.2 24.0 6.2 5.8 2.4 3.1 3.5 2.6 2.0 1.5 0.5 0.8 1.1 1.0 0.1

55 to 64

65 to 74

75 to 84

100.0% 23.3 36.1 3.7 4.4 4.1 4.1 0.2 1.1 1.6 1.4 1.6 2.6 0.8 0.1 0.4

100.0% 23.8 35.3 4.7 7.2 2.2 4.0 1.0 1.6 1.9 1.6 0.6 1.3 0.8 0.6 0.1

100.0% 27.0 24.7 6.6 7.1 2.1 3.3 3.4 2.5 2.2 1.6 0.3 0.6 1.0 1.4 0.0

85 or older

100.0% 33.8 12.1 7.8 4.4 2.1 2.2 6.4 3.8 2.2 1.3 0.1 0.1 1.4 1.1 0.0

Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

AMERICAN HEALTH

195

Accidents Are the Primary Cause of Death among Children Homicide accounts for a sizable share of deaths, as well. The leading causes of death vary signiﬁcantly by age. The majority of deaths among infants are the result of congenital malformations (conditions that are present at birth), being born prematurely, sudden infant death syndrome, or complications of pregnancy or delivery. After the ﬁrst year of life, accidents become the leading cause of death among children and young adults. Accidents account for 35 percent of deaths among children aged 1 to 4, 37 percent of deaths among children aged 5 to 14, and 47 percent of deaths among people aged 15 to 24. One of the more disturbing facts revealed by these statistics is the relatively large number of children who are murdered or commit suicide. Homicide accounted for 8 percent of deaths among children aged 1 to 4 in 2006 and for 6 percent of deaths among children aged 5 to 14. In the15-to-24 age group, homicide is the second-leading cause of death, accounting for 16 percent of the total. Suicide accounts for another 12 percent of deaths, placing it third among causes of death in the age group. ■ Many of the deaths of children and young adults could be prevented if parents were more vigilant and teenagers more cautious.

Nearly half of deaths to 15-to-24-year-olds are due to accidents

60

(percent of deaths due to accidents, by age, 2006)

47% 40 40%

35%

37%

20 20%

4% 0

0%

196 AMERICAN HEALTH

under 1

1 to 4

c14 5 to

d24 15 to

DEATHS

Table 7.12

Leading Causes of Death for Infants, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for children under age 1, 2006) number

All causes Congenital malformations Disorders related to short gestation and low birth weight 3. Sudden infant death syndrome 4. Newborn affected by maternal complications of pregnancy 5. Accidents (5) 6. Newborn affected by complications of placenta, cord and membranes 7. Respiratory distress of newborn 8. Bacterial sepsis of newborn 9. Neonatal hemorrhage 10. Diseases of circulatory system All other causes 1. 2.

percent distribution

28,527 5,819

100.0% 20.4

4,841 2,323

17.0 8.1

1,683 1,147

5.9 4.0

1,140 825 807 618 543 8,781

4.0 2.9 2.8 2.2 1.9 30.8

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.13

Leading Causes of Death for Children Aged 1 to 4, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for children aged 1 to 4, 2006) number

All causes Accidents (5) Congenital malformations Malignant neoplasms (cancer) (2) Homicide (15) Diseases of the heart (1) Inﬂuenza and pneumonia (8) Septicemia (10) Certain conditions originating in the perinatal period 9. In situ neoplasms, benign neoplasms 10. Cerebrovascular diseases (3) All other causes 1. 2. 3. 4. 5. 6. 7. 8.

percent distribution

4,631 1,610 515 377 366 161 125 88

100.0% 34.8 11.1 8.1 7.9 3.5 2.7 1.9

65 60 54 1,210

1.4 1.3 1.2 26.1

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

AMERICAN HEALTH

197

Table 7.14

Leading Causes of Death for Children Aged 5 to 14, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for children aged 5 to 14, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Accidents (5) Malignant neoplasms (cancer) (2) Homicide (15) Congenital malformations Diseases of the heart (1) Suicide (11) Chronic lower respiratory diseases (4) Cerebrovascular diseases (3) Septicemia (10) In situ neoplasms, benign neoplasms All other causes

6,149 2,258 907 390 344 253 216 115 95 84 76 1,371

percent distribution

100.0% 36.7 14.8 6.3 5.6 4.1 3.5 1.9 1.5 1.4 1.2 22.3

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.15

Leading Causes of Death for People Aged 15 to 24, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 15 to 24, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Accidents (unintentional injuries) (5) Homicide (15) Suicide (11) Malignant neoplasms (cancer) (2) Diseases of the heart (1) Congenital malformations, deformations Cerebrovascular diseases (3) Human immunodeﬁciency virus infection Inﬂuenza and pneumonia (8) Pregnancy and childbirth All other causes

34,887 16,229 5,717 4,189 1,644 1,076 460 210 206 184 179 4,793

percent distribution

100.0% 46.5 16.4 12.0 4.7 3.1 1.3 0.6 0.6 0.5 0.5 13.7

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

198 AMERICAN HEALTH

DEATHS

Accidental Deaths Become Less Common with Age Cancer and heart disease account for a larger share of deaths as people get older. Among people aged 25 to 44, accidents are the leading cause of death. There are two reasons for this. One, people aged 25 to 44 often still engage in activities that put them at risk—although they are generally not as reckless as teenagers and young adults. Two, accidents are an important cause of death simply because diseases, such as cancer and heart disease, are relatively rare. Accidents drop to third place as a cause of death among people aged 45 to 54, and they fall to fourth place among people aged 55 to 64. Not only are people more careful at these ages, but they are also more vulnerable to life-threatening illnesses. Among people aged 45 to 64, cancer is the leading cause of death followed by heart disease. ■ Among people aged 55 to 64, accidents cause only 4 percent of deaths

45

Few deaths in the 55-to-64 age group are caused by accidents (percent of deaths due to accidents, by age, 2006)

35% 30 30%

21% 15 15%

11% 4%

0 0%

25 to 34

35 to 44

45 to c 54

55 to d64

AMERICAN HEALTH

199

Table 7.16

Leading Causes of Death for People Aged 25 to 34, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 25 to 34, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Accidents (unintentional injuries) (5) Suicide (11) Homicide (15) Malignant neoplasms (cancer) (2) Diseases of the heart (1) Human immunodeﬁciency virus infection Diabetes mellitus (6) Cerebrovascular diseases (3) Congenital malformations, deformations Inﬂuenza and pneumonia (8) All other causes

42,952 14,954 4,985 4,725 3,656 3,307 1,182 673 527 437 335 8,171

percent distribution

100.0% 34.8 11.6 11.0 8.5 7.7 2.8 1.6 1.2 1.0 0.8 19.0

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.17

Leading Causes of Death for People Aged 35 to 44, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 35 to 44, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Accidents (unintentional injuries) (5) Malignant neoplasms (cancer) (2) Diseases of the heart (1) Suicide (11) Human immunodeﬁciency virus infection Homicide (15) Chronic liver disease and cirrhosis (12) Cerebrovascular diseases (3) Diabetes mellitus (6) Septicemia (10) All other causes

83,043 17,534 13,917 12,339 6,591 4,010 3,020 2,551 2,221 2,094 870 17,896

percent distribution

100.0% 21.1 16.8 14.9 7.9 4.8 3.6 3.1 2.7 2.5 1.0 21.6

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

200 AMERICAN HEALTH

DEATHS

Table 7.18

Leading Causes of Death for People Aged 45 to 54, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 45 to 54, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Malignant neoplasms (cancer) (2) Diseases of heart (1) Accidents (unintentional injuries) (5) Chronic liver disease and cirrhosis (12) Suicide (11) Cerebrovascular diseases (3) Diabetes mellitus (6) Human immunodeﬁciency virus infection Chronic lower respiratory disease (4) Viral hepatitis All other causes

185,031 50,334 38,095 19,675 7,712 7,426 6,341 5,692 4,377 3,924 2,911 38,544

percent distribution

100.0% 27.2 20.6 10.6 4.2 4.0 3.4 3.1 2.4 2.1 1.6 20.8

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.19

Leading Causes of Death for People Aged 55 to 64, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 55 to 64, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Malignant neoplasms (cancer) (2) Diseases of heart (1) Chronic lower respiratory disease (4) Accidents (unintentional injuries) (5) Diabetes mellitus (6) Cerebrovascular diseases (3) Chronic liver disease and cirrhosis (12) Suicide (11) Nephritis, nephrotic syndrome, nephrosis (9) Septicemia (10) All other causes

281,401 101,454 65,477 12,375 11,446 11,432 10,518 7,217 4,583 4,368 4,032 48,499

percent distribution

100.0% 36.1 23.3 4.4 4.1 4.1 3.7 2.6 1.6 1.6 1.4 17.2

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

AMERICAN HEALTH

201

The Oldest Adults Die from a Wide Variety of Causes Most of those aged 65 to 84 die from cancer or heart disease. Although medical research and lifestyle changes have reduced the death rates from cancer and heart disease, these two causes still account for the majority of deaths among people aged 65 to 84, and for nearly half of deaths among those aged 85 or older. If both cancer and heart disease were eradicated, however, something else would emerge to take their place since there is no means for prolonging life indeﬁnitely. In fact, this is what happens among those aged 85 or older. This group might be considered survivors in that they have not yet succumbed to any of the myriad causes of death among younger people. While heart disease and cancer remain the most common causes of death in this group, other diseases claim a larger share of the oldest adults. For example, 8 percent of people aged 85 or older die of cerebrovascular disease compared with only 5 percent of those aged 65 to 74. Twenty-four percent of the oldest adults die from a variety of causes that do not make it into their top 10 list. ■ Alzheimer’s is the fourth leading cause of death among people aged 85 or older.

Cancer accounts for only 12 percent of deaths to people aged 85 or older

45

(percent of deaths from heart disease or cancer, by age, 2006)

35%

30

cancer

34%

30%

27%

25%

24%

15

heart

15%

12% 100000

0

all disease heart

cancer dual

75000

0%

65 to 74

75 to 84

85 orcolder

50000

25000

0

202 AMERICAN HEALTH

with

w/out

DEATHS

Table 7.20

Leading Causes of Death for People Aged 65 or Older, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 65 or older, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Diseases of the heart (1) Malignant neoplasms (cancer) (2) Cerebrovascular diseases (3) Chronic lower respiratory diseases (4) Alzheimer’s disease (7) Diabetes mellitus (6) Inﬂuenza and pneumonia (8) Nephritis, nephrotic syndrome nephrosis (9) Accidents (5) Septicemia (10) All other causes

1,759,423 510,542 387,515 117,010 106,845 71,660 52,351 49,346 37,377 36,689 26,201 363,887

percent distribution

100.0% 29.0 22.0 6.7 6.1 4.1 3.0 2.8 2.1 2.1 1.5 20.7

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.21

Leading Causes of Death for People Aged 65 to 74, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 65 to 74, 2006) number

1. 2. 3. 4. 5. 6. 7. 9. 8. 10.

All causes Malignant neoplasms (cancer) (2) Diseases of the heart (1) Chronic lower respiratory disease (4) Cerebrovascular diseases (3) Diabetes mellitus (6) Accidents (unintentional injuries) (5) Nephritis, nephrotic syndrome, nephrosis (9) Septicemia (10) Inﬂuenza and pneumonia (8) Chronic liver disease and cirrhosis (12) All other causes

390,093 137,554 92,752 28,236 18,223 15,483 8,420 7,453 6,064 6,061 4,917 64,930

percent distribution

100.0% 35.3 23.8 7.2 4.7 4.0 2.2 1.9 1.6 1.6 1.3 16.6

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

AMERICAN HEALTH

203

Table 7.22

Leading Causes of Death for People Aged 75 to 84, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 75 to 84, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Diseases of the heart (1) Malignant neoplasms (cancer) (2) Chronic lower respiratory disease (4) Cerebrovascular diseases (3) Alzheimer’s disease (7) Diabetes mellitus (6) Inﬂuenza and pneumonia (8) Nephritis, nephrotic syndrome, nephrosis (9) Accidents (unintentional injuries) (5) Septicemia (10) All other causes

667,338 180,451 164,889 47,406 43,719 22,915 21,763 16,668 14,536 13,708 10,745 130,538

percent distribution

100.0% 27.0 24.7 7.1 6.6 3.4 3.3 2.5 2.2 2.1 1.6 19.6

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

Table 7.23

Leading Causes of Death for People Aged 85 or Older, 2006

(number and percent distribution of deaths accounted for by the 10 leading causes of death for people aged 85 or older, 2006) number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

All causes Diseases of the heart (1) Malignant neoplasms (cancer) (2) Cerebrovascular diseases (3) Alzheimer’s disease (7) Chronic lower respiratory disease (4) Inﬂuenza and pneumonia (8) Nephritis, nephrotic syndrome, nephrosis (9) Diabetes mellitus (6) Accidents (unintentional injuries) (5) Essential hypertension (13) All other causes

701,992 237,339 85,072 55,068 44,933 31,203 26,617 15,388 15,105 14,561 10,030 166,676

percent distribution

100.0% 33.8 12.1 7.8 6.4 4.4 3.8 2.2 2.2 2.1 1.4 23.7

Note: Number in parentheses shows rank for all Americans if the cause of death is among top 15. Source: National Center for Health Statistics, Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57; calculations by New Strategist

204 AMERICAN HEALTH

DEATHS

Americans Are Living Longer Life expectancy continues to increase. Life expectancy has increased signiﬁcantly over the past six decades. In 1950, a newborn could expect to live 68.2 years, on average. By 2007, life expectancy had increased to 77.9 years, a gain of 9.7 years. Much of the increase was due to reduced infant mortality, but some was caused by lower mortality among the elderly. Between 1950 and 2007, life expectancy at age 65 increased 4.7 years. Life expectancy increases with advancing age. The older you get, the longer you can expect to live. A child born in 2007 could expect to live 77.9 years, on average. But a person reaching age 65 in 2007 could expect to live another 18.6 years, on average—almost to age 84. Someone aged 85 in 2007 could expect to live another 6.4 years, on average. Women have longer life expectancies than men at every age. A girl born in 2007 could expect to live to age 80.4. Her male counterpart could expect to live to age 75.3. At age 65, women can expect to live an additional 19.8 years compared with 17.1 years for men. By age 90, however, the difference in life expectancy between men and women is measured in months rather than years. ■ Although life expectancy has increased substantially, the United States ranks well below many other developed nations in expected length of life.

Life expectancy at birth reached 77.9 years in 2007 (years of life remaining at birth for selected years, 2007)

90

68.2

69.7

70.8

1950

1960

1970

73.7

75.4

76.8

77.9

1980 d

1990 e

2000 f

2007 g

6060 yrs.

3030 yrs.

00 yrs.

AMERICAN HEALTH

205

Table 7.24

Life Expectancy by Age, 1950 to 2007

(years of life remaining at birth and age 65, 1950 to 2007; change in years of life remaining for selected years) 2007 2006 2005 2004 2003 2002 2001 2000 1990 1980 1970 1960 1950 Change 2000 to 2007 1950 to 2007

at birth

age 65

77.9 77.7 77.4 77.5 77.1 76.9 76.9 76.8 75.4 73.7 70.8 69.7 68.2

18.6 18.5 18.2 18.2 17.9 17.8 17.7 17.6 17.2 16.4 15.2 14.3 13.9

1.1 9.7

1.0 4.7

Source: National Center for Health Statistics, Deaths: Preliminary Data for 2007, National Vital Statistics Report, Vol. 58, No. 1, 2009, Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol58, and Health, United States, 2008, Internet site http:// www.cdc.gov/nchs/hus/updatedtables.htm; calculations by New Strategist

206 AMERICAN HEALTH

DEATHS

Table 7.25

Life Expectancy by Age and Sex, 2007

(years of life remaining at selected ages, by sex, 2007) At birth Aged 1 Aged 5 Aged 10 Aged 15 Aged 20 Aged 25 Aged 30 Aged 35 Aged 40 Aged 45 Aged 50 Aged 55 Aged 60 Aged 65 Aged 70 Aged 75 Aged 80 Aged 85 Aged 90 Aged 95 Aged 100

total

females

males

77.9 77.4 73.5 68.6 63.6 58.8 54.1 49.3 44.6 39.9 35.3 30.9 26.6 22.5 18.6 14.9 11.6 8.8 6.4 4.6 3.2 2.2

80.4 79.9 75.9 71.0 66.0 61.2 56.3 51.4 46.6 41.9 37.2 32.6 28.2 23.9 19.8 15.9 12.4 9.3 6.8 4.8 3.3 2.3

75.3 74.9 71.0 66.0 61.1 56.3 51.7 47.1 42.4 37.8 33.3 28.9 24.8 20.8 17.1 13.6 10.5 7.9 5.7 4.1 2.9 2.0

Source: National Center for Health Statistics, Deaths: Preliminary Data for 2007, National Vital Statistics Report, Vol. 58, No. 1, 2009, Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol58; calculations by New Strategist

AMERICAN HEALTH

207

Table 7.26

Life Expectancy by Sex, Age, and Race, 2007

(years of life remaining at birth and age 65 by sex and race, and difference between white and black life expectancy, 2007) white

black

difference between white and black

Total At birth Aged 65

78.3 18.6

73.7 17.3

4.6 1.3

Female At birth Aged 65

80.7 19.8

77.0 18.7

3.7 1.1

Male At birth Aged 65

75.8 17.2

70.2 15.3

5.6 1.9

Source: National Center for Health Statistics, Deaths: Preliminary Data for 2007, National Vital Statistics Report, Vol. 58, No. 1, 2009, Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol58; calculations by New Strategist

208 AMERICAN HEALTH

DISABILITY CHAPTER

8

Disability ■ Millions of Americans have disabilities. The 52 percent majority of people aged 65 or older have some sort of disability, with 32 percent having difﬁculty walking.

■ Disability rates vary by income and education. The disability rate falls with rising education, from 30 percent of people who did not graduate from high school to just 8 percent of college graduates.

■ Eighteen percent of older Americans use canes, crutches, or walkers. Only 5 percent of people aged 65 or older use a wheelchair.

■ Eleven million need personal assistance to function. Fully 63 percent receive help solely from a spouse, children, or other relative. Only 13 percent must pay for the help they receive.

■ Work limitations are common among those in low-income households. A substantial 21 percent of people living in households with incomes below $35,000 had a health problem that limited their work.

AMERICAN HEALTH

209

Most Older Americans Have a Disability Five million people aged 65 or older need personal assistance. According to the 2005 Survey of Income and Program Participation supplement on disability, 49 million people aged 15 or older—21 percent of the population—have a disability of some type. Most likely to be disabled are those aged 65 or older, 52 percent of whom have some form of disability. Among people aged 65 or older, the most common problem is walking. Nearly one in three people aged 65 or older has difﬁculty walking, and 30 percent have problems using stairs. A much smaller 11 percent have hearing problems. Five million people aged 65 or older—16 percent— need assistance for daily functioning. From 2 to 4 percent of children under age 6 are disabled. Among the school-aged population aged 6 to 14, a larger 13 percent have a disability. The largest share (7 percent) has difﬁculty doing schoolwork. Only 236,000 need personal assistance for daily functioning. ■ As the overweight baby-boom generation ages into the oldest age groups, the number of disabled Americans will increase sharply.

Among people aged 65 or older, the disabled slightly outnumber those without a disability (number of people aged 65 or older by disability status, 2005) 20

16.9 million 15

15 million

10

10 million

5

5 million

0

0

210 AMERICAN HEALTH

a no disability

18.1 million

with a b disability

DISABILITY

Table 8.1

Disability Status of People Aged 15 or Older, 2005

(total number of people aged 15 or older, and number and percent with selected disabilities and need for assistance, by type of disability and age, 2005; numbers in thousands) total number

Total aged 15 or older No disability With a disability

aged 65 or older percent

number

percent

share of total

230,391 181,317 49,073

100.0 % 78.7 21.3

35,028 16,895 18,133

100.0% 48.2 51.8

SEEING/HEARING/SPEAKING With a disability Difﬁculty seeing words/letters Difﬁculty hearing conversation Difﬁculty with speech Uses hearing aid

14,650 7,794 7,809 2,534 4,316

6.4 3.4 3.4 1.1 1.9

6,508 3,534 3,915 753 3,209

18.6 10.1 11.2 2.1 9.2

44.4 45.3 50.1 29.7 74.4

WALKING/USING STAIRS With a disability Difﬁculty walking Difﬁculty using stairs Uses wheelchair or similar device Uses cane, crutches, or walker

27,360 22,585 21,768 3,311 10,229

11.9 9.8 9.4 1.4 4.4

13,346 11,098 10,576 1,823 6,256

38.1 31.7 30.2 5.2 17.9

48.8 49.1 48.6 55.1 61.2

PHYSICAL TASKS With a disability Difﬁculty lifting/carrying 10 pounds Difﬁculty grasping objects Difﬁculty moving large chair Difﬁculty standing one hour Difﬁculty sitting one hour Difﬁculty crouching Difﬁculty reaching overhead

18,996 15,934 7,087 22,500 23,893 9,869 27,436 11,662

8.2 6.9 3.1 9.8 10.4 4.3 11.9 5.1

8,725 7,622 2,860 10,255 11,175 3,209 12,367 5,309

24.9 21.8 8.2 29.3 31.9 9.2 35.3 15.2

45.9 47.8 40.4 45.6 46.8 32.5 45.1 45.5

8,529 4,062 5,309 5,074 3,729 1,491 2,374

3.7 1.8 2.3 2.2 1.6 0.6 1.0

4,361 2,247 2,633 2,780 1,864 728 1,275

12.5 6.4 7.5 7.9 5.3 2.1 3.6

51.1 55.3 49.6 54.8 50.0 48.8 53.7

ACTIVITIES OF DAILY LIVING (ADL) Total with any ADL limitation Difﬁculty getting around Difﬁculty getting into bed Difﬁculty taking a bath Difﬁculty dressing Difﬁculty eating Difﬁculty toileting

15.2% 9.3 37.0

(continued)

AMERICAN HEALTH

211

total number

aged 65 or older percent

number

percent

share of total

INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) Total with any IADL limitation Difﬁculty going out Difﬁculty managing money Difﬁculty preparing meals Difﬁulty doing housework Difﬁculty taking prescriptions Difﬁculty using the phone

13,666 8,808 5,133 5,115 6,931 4,174 2,754

5.9% 3.8 2.2 2.2 3.0 1.8 1.2

6,676 4,809 2,579 2,786 3,485 2,183 1,620

19.1% 13.7 7.4 8.0 9.9 6.2 4.6

48.9% 54.6 50.2 54.5 50.3 52.3 58.8

NEED FOR ASSISTANCE Need assistance with one or more ADL or IADL

10,763

4.7

5,464

15.6

50.8

MENTAL With a disability With one or more conditions Learning disability Mental retardation Alzheimer’s, senility, or dementia Other mental/emotional condition With one or more symptoms Frequently depressed or anxious Trouble getting along with others Trouble concentrating Trouble coping with stress Difﬁculty managing money/bills

16,050 9,635 3,648 1,307 2,115 4,451 8,359 6,821 2,306 4,734 5,551 5,133

7.0 4.2 1.6 0.6 0.9 1.9 3.6 3.0 1.0 2.1 2.4 2.2

4,006 1,884 226 96 1,328 485 1,761 1,188 279 1,065 927 2,579

11.4 5.4 0.6 0.3 3.8 1.4 5.0 3.4 0.8 3.0 2.6 7.4

25.0 19.6 6.2 7.3 62.8 10.9 21.1 17.4 12.1 22.5 16.7 50.2

Source: Bureau of the Census, Americans with Disabilities: 2005, detailed tables, Internet site http://www.census.gov/hhes/ www/disability/sipp/disable05.html; calculations by New Strategist

212 AMERICAN HEALTH

DISABILITY

Table 8.2

Disability Status of Children under Age 15, 2005

(total number of people under aged 15, and number and percent with selected disabilities, by type of disability, 2005; numbers in thousands) number

percent distribution

UNDER AGE 3 No disability With a disability With a developmental delay Difﬁculty moving arms or legs

12,008 11,779 228 206 60

100.0% 98.1 1.9 1.7 0.5

AGED 3 to 5 No disability With a disability With a developmental delay Difﬁculty walking, running, or playing

12,339 11,864 475 387 227

100.0% 96.2 3.8 3.1 1.8

AGED 6 to 14 No disability With a disability Severe Not severe

36,361 31,708 4,654 1,584 3,069

100.0% 87.2 12.8 4.4 8.4

2,528 672 2,116 1,024 195 347 1,066 1,325 278 44 234 244 16 228 719 138 581 748 83 60 49 263 236 27

7.0 1.8 5.8 2.8 0.5 1.0 2.9 3.6 0.8 0.1 0.6 0.7 0.0 0.6 2.0 0.4 1.6 2.1 0.2 0.2 0.1 0.7 0.6 0.1

Type of disability among children aged 6 to 14 Difﬁculty doing regular schoolwork Difﬁculty getting along with others With one or more selected conditions A learning disability Mental retardation Other developmental disability Other developmental condition With a developmental disability or condition Difﬁculty seeing words or letters Severe Not severe Difﬁculty hearing conversation Severe Not severe Difﬁculty with speech Severe Not severe Difﬁculty walking or running Used wheelchair or similar device Used cane, crutches, or walker Has used for six months or more With an activity of daily living (ADL) limitation Needs personal assistance Does not need personal assistance

Note: “Other developmental disability” includes autism and cerebral palsy. “Other developmental condition” includes conditions for which the child received therapy or diagnostic services. Source: Bureau of the Census, Americans with Disabilities: 2005, detailed tables, Internet site http://www.census.gov/hhes/ www/disability/sipp/disable05.html; calculations by New Strategist

AMERICAN HEALTH

213

Many Have Difﬁculties in Physical Functioning Age makes a big difference in physical functioning, and so do race, income, and education. Disability is a concept with as many different deﬁnitions as there are surveys to measure it. A 2008 survey by the National Center for Health Statistics found 15 percent of adults aged 18 or older with some type of physical difﬁculty. The rate rises with age from 5 percent of 18-to-44-year-olds to 45 percent of people aged 75 or older. The share of people with physical difﬁculties also varies by race and Hispanic origin, income, and education. Non-Hispanic whites and blacks are more likely than Asians and Hispanics to have physical difﬁculties. The share of people with disabilities declines with rising income, from 25 percent of those with the lowest incomes to 6 percent of those with the highest incomes. The more education people have, the less likely they are to be disabled. ■ As the baby-boom generation enters the older age groups, the share of the elderly with disabilities may decline because of boomers’ higher level of education.

42

Physical difﬁculties are less common among the educated

(percent of people aged 18 or older with any type of difﬁculty in physical functioning, by education, 2008)

30%

28

28%

21%

14

14%

14%

8%

0

0%

lessa than high school

214 AMERICAN HEALTH

high b school graduate

someccollege

colleged graduate

DISABILITY

Table 8.3

Difﬁculties in Physical Functioning among Adults by Age, 2008

(number of people aged 18 or older with difﬁculties in physical functioning, by type of difﬁculty and age, 2008; numbers in thousands) aged 65 or older

Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

total

18 to 44

45 to 64

total

65 to 74

75 or older

225,227 33,131 16,010 11,334 19,938 6,921 19,512 5,044 3,722 9,295 13,222

110,615 5,587 1,908 1,197 3,126 1,754 2,876 534 524 1,304 2,205

77,335 13,986 6,552 4,718 8,105 3,421 8,275 2,129 1,595 3,745 5,599

37,278 13,557 7,550 5,418 8,706 1,745 8,361 2,381 1,603 4,247 5,418

19,869 5,676 2,791 1,960 3,543 833 3,734 833 605 1,405 2,137

17,409 7,881 4,759 3,458 5,163 912 4,627 1,548 998 2,842 3,281

PERCENT WITH PHYSICAL DIFFICULTY Total people 100.0% Total with any physical difﬁculty 14.7 Walk quarter of a mile 7.1 Climb up 10 steps without resting 5.0 Stand for two hours 8.9 Sit for two hours 3.1 Stoop, bend, or kneel 8.7 Reach over head 2.2 Grasp or handle small objects 1.7 Lift or carry 10 pounds 4.1 Push or pull large objects 5.9 PERCENT DISTRIBUTION BY AGE Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0% 5.1 1.7 1.1 2.8 1.6 2.6 0.5 0.5 1.2 2.0

100.0% 18.1 8.5 6.1 10.5 4.4 10.7 2.8 2.1 4.8 7.2

100.0% 36.4 20.3 14.5 23.4 4.7 22.4 6.4 4.3 11.4 14.5

100.0% 28.6 14.0 9.9 17.8 4.2 18.8 4.2 3.0 7.1 10.8

100.0% 45.3 27.3 19.9 29.7 5.2 26.6 8.9 5.7 16.3 18.8

49.1% 16.9 11.9 10.6 15.7 25.3 14.7 10.6 14.1 14.0 16.7

34.3% 42.2 40.9 41.6 40.7 49.4 42.4 42.2 42.9 40.3 42.3

16.6% 40.9 47.2 47.8 43.7 25.2 42.9 47.2 43.1 45.7 41.0

8.8% 17.1 17.4 17.3 17.8 12.0 19.1 16.5 16.3 15.1 16.2

7.7% 23.8 29.7 30.5 25.9 13.2 23.7 30.7 26.8 30.6 24.8

Note: Respondents were classiﬁed as having difﬁculties if they responded “very difﬁcult” or “can’t do at all.” Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

215

Table 8.4

Difﬁculties in Physical Functioning among Adults by Sex, 2008

(number of people aged 18 or older with difﬁculties in physical functioning, by type of difﬁculty and sex, 2008; numbers in thousands) Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

total

men

women

225,227 33,131 16,010 11,334 19,938 6,921 19,512 5,044 3,722 9,295 13,222

108,755 12,101 5,844 4,018 7,408 2,866 7,244 2,114 1,516 2,704 4,292

116,472 21,029 10,165 7,316 12,529 4,055 12,267 2,930 2,206 6,591 8,930

PERCENT WITH PHYSICAL DIFFICULTY Total people 100.0% Total with any physical difﬁculty 14.7 Walk quarter of a mile 7.1 Climb up 10 steps without resting 5.0 Stand for two hours 8.9 Sit for two hours 3.1 Stoop, bend, or kneel 8.7 Reach over head 2.2 Grasp or handle small objects 1.7 Lift or carry 10 pounds 4.1 Push or pull large objects 5.9 PERCENT DISTRIBUTION BY SEX Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0% 11.1 5.4 3.7 6.8 2.6 6.7 1.9 1.4 2.5 3.9

100.0% 18.1 8.7 6.3 10.8 3.5 10.5 2.5 1.9 5.7 7.7

48.3% 36.5 36.5 35.5 37.2 41.4 37.1 41.9 40.7 29.1 32.5

51.7% 63.5 63.5 64.5 62.8 58.6 62.9 58.1 59.3 70.9 67.5

Note: Respondents were classiﬁed as having difﬁculties if they responded “very difﬁcult” or “can’t do at all.” Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

216 AMERICAN HEALTH

DISABILITY

Table 8.5

Difﬁculties in Physical Functioning among Adults by Race and Hispanic Origin, 2008

(number of people aged 18 or older with difﬁculties in physical functioning, by type of difﬁculty, race, and Hispanic origin, 2008; numbers in thousands)

Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

total

Asian

black

Hispanic

non-Hispanic white

225,227 33,131 16,010 11,334 19,938 6,921 19,512 5,044 3,722 9,295 13,222

10,501 664 354 201 394 157 314 126 70 195 334

26,765 4,121 2,232 1,840 2,597 976 2,390 694 421 1,436 1,760

30,583 3,358 1,355 1,085 1,836 908 1,883 582 406 1,053 1,495

154,483 24,404 11,769 8,013 14,701 4,765 14,571 3,583 2,716 6,413 9,394

PERCENT WITH PHYSICAL DIFFICULTY Total people 100.0% Total with any physical difﬁculty 14.7 Walk quarter of a mile 7.1 Climb up 10 steps without resting 5.0 Stand for two hours 8.9 Sit for two hours 3.1 Stoop, bend, or kneel 8.7 Reach over head 2.2 Grasp or handle small objects 1.7 Lift or carry 10 pounds 4.1 Push or pull large objects 5.9

100.0% 6.3 3.4 1.9 3.8 1.5 3.0 1.2 0.7 1.9 3.2

PERCENT DISTRIBUTION BY RACE AND HISPANIC ORIGIN Total people 100.0% 4.7% Total with any physical difﬁculty 100.0 2.0 Walk quarter of a mile 100.0 2.2 Climb up 10 steps without resting 100.0 1.8 Stand for two hours 100.0 2.0 Sit for two hours 100.0 2.3 Stoop, bend, or kneel 100.0 1.6 Reach over head 100.0 2.5 Grasp or handle small objects 100.0 1.9 Lift or carry 10 pounds 100.0 2.1 Push or pull large objects 100.0 2.5

100.0% 15.4 8.3 6.9 9.7 3.6 8.9 2.6 1.6 5.4 6.6

100.0% 11.0 4.4 3.5 6.0 3.0 6.2 1.9 1.3 3.4 4.9

100.0% 15.8 7.6 5.2 9.5 3.1 9.4 2.3 1.8 4.2 6.1

11.9% 12.4 13.9 16.2 13.0 14.1 12.2 13.8 11.3 15.4 13.3

13.6% 10.1 8.5 9.6 9.2 13.1 9.7 11.5 10.9 11.3 11.3

68.6% 73.7 73.5 70.7 73.7 68.8 74.7 71.0 73.0 69.0 71.0

Note: Respondents were classiﬁed as having difﬁculties if they responded “very difﬁcult” or “can’t do at all.” Numbers by race and Hispanic origin do not sum to total because not all races are shown and Hispanics may be of any race. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

217

Table 8.6

Difﬁculties in Physical Functioning among Adults by Household Income, 2008

(number of people aged 18 or older with difﬁculties in physical functioning, by type of difﬁculty and household income, 2008; numbers in thousands)

Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

total

< $35,000

$35,000– $54,999

$55,000– –$74,999

$75,000– $99,999

$100,000 or more

225,227 33,131 16,010 11,334 19,938 6,921 19,512 5,044 3,722 9,295 13,222

68,352 17,346 9,240 6,977 11,299 4,208 10,303 2,974 2,146 5,919 7,677

31,715 4,993 2,314 1,718 2,923 840 3,073 671 534 1,215 1,915

38,300 4,178 1,747 1,099 2,215 837 2,516 566 360 937 1,305

25,842 1,799 681 356 901 245 1,003 254 193 164 607

43,165 2,544 967 566 1,310 476 1,377 285 255 451 877

PERCENT WITH PHYSICAL DIFFICULTY Total people 100.0% Total with any physical difﬁculty 14.7 Walk quarter of a mile 7.1 Climb up 10 steps without resting 5.0 Stand for two hours 8.9 Sit for two hours 3.1 Stoop, bend, or kneel 8.7 Reach over head 2.2 Grasp or handle small objects 1.7 Lift or carry 10 pounds 4.1 Push or pull large objects 5.9

100.0% 25.4 13.5 10.2 16.5 6.2 15.1 4.4 3.1 8.7 11.2

100.0% 15.7 7.3 5.4 9.2 2.6 9.7 2.1 1.7 3.8 6.0

100.0% 10.9 4.6 2.9 5.8 2.2 6.6 1.5 0.9 2.4 3.4

100.0% 7.0 2.6 1.4 3.5 0.9 3.9 1.0 0.7 0.6 2.3

100.0% 5.9 2.2 1.3 3.0 1.1 3.2 0.7 0.6 1.0 2.0

PERCENT DISTRIBUTION BY HOUSEHOLD INCOME Total people 100.0% 30.3% Total with any physical difﬁculty 100.0 52.4 Walk quarter of a mile 100.0 57.7 Climb up 10 steps without resting 100.0 61.6 Stand for two hours 100.0 56.7 Sit for two hours 100.0 60.8 Stoop, bend, or kneel 100.0 52.8 Reach over head 100.0 59.0 Grasp or handle small objects 100.0 57.7 Lift or carry 10 pounds 100.0 63.7 Push or pull large objects 100.0 58.1

14.1% 15.1 14.5 15.2 14.7 12.1 15.7 13.3 14.3 13.1 14.5

17.0% 12.6 10.9 9.7 11.1 12.1 12.9 11.2 9.7 10.1 9.9

11.5% 5.4 4.3 3.1 4.5 3.5 5.1 5.0 5.2 1.8 4.6

19.2% 7.7 6.0 5.0 6.6 6.9 7.1 5.7 6.9 4.9 6.6

Note: Respondents were classiﬁed as having difﬁculties if they responded “very difﬁcult” or “can’t do at all.” Numbers may not add to total because those not reporting income are not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

218 AMERICAN HEALTH

DISABILITY

Table 8.7

Difﬁculties in Physical Functioning among Adults by Educational Attainment, 2008

(number of people aged 18 or older with difﬁculties in physical functioning, by type of difﬁculty and educational attainment, 2008; numbers in thousands)

Total people Total with any physical difﬁculty Walk quarter of a mile Climb up 10 steps without resting Stand for two hours Sit for two hours Stoop, bend, or kneel Reach over head Grasp or handle small objects Lift or carry 10 pounds Push or pull large objects

total

less than high school

high school graduate

some college

bachelor’s degree or more

225,227 33,131 16,010 11,334 19,938 6,921 19,512 5,044 3,722 9,295 13,222

29,013 8,712 5,003 4,017 5,624 1,975 5,345 1,701 1,178 3,243 4,046

53,874 11,073 5,304 3,718 6,623 2,202 6,441 1,582 1,118 2,936 4,229

55,174 7,943 3,610 2,439 4,706 1,829 4,814 1,080 935 1,970 2,992

56,681 4,303 1,688 933 2,359 562 2,424 562 385 933 1,562

PERCENT WITH PHYSICAL DIFFICULTY Total people 100.0% Total with any physical difﬁculty 14.7 Walk quarter of a mile 7.1 Climb up 10 steps without resting 5.0 Stand for two hours 8.9 Sit for two hours 3.1 Stoop, bend, or kneel 8.7 Reach over head 2.2 Grasp or handle small objects 1.7 Lift or carry 10 pounds 4.1 Push or pull large objects 5.9

100.0% 30.0 17.2 13.8 19.4 6.8 18.4 5.9 4.1 11.2 13.9

100.0% 20.6 9.8 6.9 12.3 4.1 12.0 2.9 2.1 5.4 7.8

100.0% 14.4 6.5 4.4 8.5 3.3 8.7 2.0 1.7 3.6 5.4

100.0% 7.6 3.0 1.6 4.2 1.0 4.3 1.0 0.7 1.6 2.8

PERCENT DISTRIBUTION BY EDUCATION Total people 100.0% Total with any physical difﬁculty 100.0 Walk quarter of a mile 100.0 Climb up 10 steps without resting 100.0 Stand for two hours 100.0 Sit for two hours 100.0 Stoop, bend, or kneel 100.0 Reach over head 100.0 Grasp or handle small objects 100.0 Lift or carry 10 pounds 100.0 Push or pull large objects 100.0

12.9% 26.3 31.2 35.4 28.2 28.5 27.4 33.7 31.6 34.9 30.6

23.9% 33.4 33.1 32.8 33.2 31.8 33.0 31.4 30.0 31.6 32.0

24.5% 24.0 22.5 21.5 23.6 26.4 24.7 21.4 25.1 21.2 22.6

25.2% 13.0 10.5 8.2 11.8 8.1 12.4 11.1 10.3 10.0 11.8

Note: Respondents were classiﬁed as having difﬁculties if they responded “very difﬁcult” or “can’t do at all.” Educational categories are shown only for people aged 25 or older. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

219

Nearly 11 Million Need Personal Assistance to Function Most get help from their relatives. Eleven million Americans need help with one or more of the following: getting around inside their house, getting in or out of bed or a chair, bathing, eating, dressing, using the toilet, managing money, preparing meals, doing light housework, taking prescriptions, going outside, or walking. Of the 11 million who need help, fully 63 percent receive help solely from spouses, children, or other relatives. Only 13 percent of those who have people helping them must pay for the help they receive. ■ The number of people needing personal assistance will expand as boomers enter the 65-or-older age group.

Most of those who need personal assistance get help from relatives 45(percent distribution of people who need personal assistance with daily living, by type of person assisting, 2005) 37%

30

30%

26% 18%

15

15%

10% 6% 3%

0

0%

one a helper, related

220 AMERICAN HEALTH

two helpers, b both related

two helpers, c one related

one d helper, not related

two helpers, e not related

no helpers f

DISABILITY

Table 8.8

Need for Assistance, 2005

(total number of people aged 15 or older who need personal assistance with daily living, by type of person assisting, 2005; numbers in thousands) number

Total who need assistance Person has no helper Person has one or more helpers

percent

10,656 277 10,380

100.0% 2.6 97.4

Person needing assistance has one helper Relative Child Spouse Parent Other relative Nonrelative Friend or neighbor Paid help Other nonrelative

4,970 3,936 1,134 1,887 380 535 1,034 339 397 298

46.6 36.9 10.6 17.7 3.6 5.0 9.7 3.2 3.7 2.8

Person needing assistance has two helpers Both related One related, one nonrelated Neither related

5,410 2,804 1,929 676

50.8 26.3 18.1 6.3

Duration of needing assistance Less than one year One to ﬁve years More than ﬁve years

2,012 4,507 3,861

18.9 42.3 36.2

10,380 9,041 423 375 540

100.0% 87.1 4.1 3.6 5.2

Amount paid for help per month Person has one or more helpers $0 $1 to $99 $100 to $249 $250 or more

Note: People were asked wether they required help from another person with one or more of the following activities: getting around inside, getting in/out of bed/chair, bathing, eating, dressing, getting on/off the toilet, managing money, preparing meals, doing light housework, taking prescriptions, going outside alone, and walking. Source: Bureau of the Census, Americans with Disabilities: 2005, detailed tables, Internet site http://www.census.gov/hhes/ www/disability/sipp/disable05.html; calculations by New Strategist

AMERICAN HEALTH

221

Many Children Have a Learning Disability Attention deﬁcit hyperactivity disorder is also common among children. Of the 62 million children aged 3 to 17 in the United States in 2008, just over 5 million had been diagnosed with a learning disability, according to the National Center for Health Statistics. Five million had been diagnosed with attention deﬁcit hyperactivity disorder (ADHD). Boys are more likely than girls to have a learning disability (10 versus 6 percent) and to have ADHD (5 versus 11 percent). Six percent of children under age 18 received special education or early intervention services in 2008. Boys are about twice as likely as girls to receive these services—8 versus 4 percent. By race and Hispanic origin, Asian children are least likely to receive special education services, at 2 percent. Non-Hispanic white children are most likely to receive special education services, at 7 percent. ■ More than 9 percent of children on Medicaid—the government’s health insurance program for the poor—receive special education or early intervention services.

Receipt of special education services varies by race and Hispanic origin (percent of children under age 18 who receive special education or early intervention services, by race and Hispanic origin, 2008)

9

7.3%

6

6.2% 6%

4.3%

3

3%

1.9%

0

0%

222 AMERICAN HEALTH

a Asian

b black

c Hispanic

d white non-Hispanic

DISABILITY

Table 8.9

Children with a Learning Disability or Attention Deﬁcit Hyperactivity Disorder, 2008

(total number of children aged 3 to 17 and number and percent who have been told they have a learning disability or attention deﬁcit hyperactivity disorder, by selected characteristics, 2008; numbers in thousands) attention deﬁcit hyperactivity disorder

learning disability total

number

61,907

5,012

30,183 31,724

1,839 3,174

6.2 10.1

1,459 3,508

4.9 11.2

Age Aged 3 to 4 Aged 5 to 11 Aged 12 to 17

8,848 28,250 24,809

206 2,485 2,321

2.3 8.8 9.4

171 2,059 2,738

1.9 7.3 11.1

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

2,491 9,596 12,922 34,836

30 860 750 3,158

1.2 9.2 5.9 9.1

– 792 535 3,425

– 8.3 4.2 9.8

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

42,931 14,715 2,256 2,006

2,930 1,585 189 308

6.9 11.0 8.3 15.9

2,907 1,422 298 341

6.9 9.7 12.6 18.0

Parent’s education Less than high school diploma High school diploma More than high school

7,666 12,767 39,240

703 1,265 2,736

9.6 10.0 7.0

458 1,126 3,038

6.3 8.9 7.8

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

16,954 8,821 10,920 7,555 13,461

1,907 782 833 546 743

11.7 9.0 7.6 7.3 5.5

1,759 746 741 569 960

10.7 8.7 6.8 7.6 6.9

Health insurance coverage Private Medicaid/other public Other Uninsured

36,461 17,815 1,479 5,896

2,081 2,442 144 339

5.6 14.3 9.7 6.1

2,448 2,120 111 283

6.6 12.4 7.7 4.8

TOTAL CHILDREN Sex Female Male

percent

8.1%

number

4,968

percent

8.0%

Note: “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

223

Table 8.10

Children Receiving Special Education or Early Intervention Services by Selected Characteristics, 2008

(number of people under age 18, and number and percent receiving special education or early intervention services, by selected characteristics, 2008; numbers in thousands) receiving services total

number

percent

TOTAL CHILDREN Sex Female Male

73,858

4,672

6.3%

36,108 37,749

1,539 3,133

4.3 8.3

Age Under age 12 Aged 12 to 17

49,087 24,771

2,810 1,863

5.7 7.5

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

2,979 11,415 15,802 41,323

58 707 669 3,029

1.9 6.2 4.3 7.3

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

20,277 9,832 12,472 8,351 14,741

1,717 682 710 577 735

8.7 6.9 5.7 6.9 4.9

Health insurance coverage Private Medicaid/other public Other Uninsured

42,845 22,082 1,762 6,634

2,239 1,958 125 318

5.2 9.3 7.1 4.7

Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 243, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

224 AMERICAN HEALTH

DISABILITY

Chronic Health Conditions Often Limit Activities Older adults are especially likely to be limited in their usual activities. A sizable 13 percent of the population has some kind of activity limitation because of health problems. Most have one or more chronic conditions that limit what they can do. The incidence of activity limitations due to health problems increases sharply beginning in the 45-to-64 age group. From 6 to 9 percent of people under age 45 have activity limitations, but among those aged 45 to 64 the share is 17 percent. Twenty-seven percent of people aged 65 to 74 are limited, with the ﬁgure rising to 43 percent among those aged 75 or older. Ten percent of people aged 18 to 69 have a work limitation because of a health condition, and 6 percent are unable to work. The share of people with a work limitation rises with age, from 5 percent of 18-to-44-year-olds to 21 percent of 65-to-69-year-olds. Not surprisingly, work limitations are greater for people in low-income households (under $35,000). Twenty-one percent had a health problem that limited their work. The ﬁgure falls to just 3 percent among those with household incomes of $100,000 or more. ■ Only 6 percent of people with private health insurance have an activity limitation compared with 22 percent of those on Medicaid, the government’s health insurance program for the poor.

Limitations are greater for those with less education (percent of people who have an activity limitation due to a health problem, by education, 2008)

30

20

29%

19%

20%

15% 10

10%

0

0%

8%

not a high aschool graduate

highb school graduate

somec college

bachelor’s d degree or more

AMERICAN HEALTH

225

Table 8.11

Limitations in Usual Activities due to Health Problems by Selected Characteristics, 2008

(total number of people, and percent distribution by limitation status in usual activities, by selected characteristics, 2008; numbers in thousands) limitations total number

TOTAL PEOPLE Sex Female Male

percent

not limited

total

due to one or more chronic conditions

299,082

100.0%

86.9%

12.9%

12.5%

152,579 146,503

100.0 100.0

86.4 87.5

13.5 12.4

12.9 12.0

Age Under age 12 Aged 12 to 17 Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

49,087 24,771 110,613 77,489 19,858 17,264

100.0 100.0 100.0 100.0 100.0 100.0

92.9 90.8 93.6 82.6 73.2 56.7

6.9 8.9 6.3 17.2 26.7 43.3

6.6 8.7 5.9 16.7 26.0 41.8

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

13,554 38,247 46,385 196,018

100.0 100.0 100.0 100.0

94.7 86.0 92.2 85.5

5.3 13.8 7.7 14.3

5.2 13.3 7.4 13.8

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

82,233 39,912 48,526 32,762 56,639

100.0 100.0 100.0 100.0 100.0

76.4 86.0 91.0 92.1 94.3

23.5 13.9 8.9 7.9 5.7

22.7 13.7 8.7 7.5 5.5

Education Not a high school graduate High school graduate Some college Bachelor’s degree or more

28,879 55,405 51,574 54,951

100.0 100.0 100.0 100.0

70.8 81.1 84.8 92.0

29.0 18.9 15.1 7.9

28.3 18.2 14.7 7.6

170,213 36,678 8,767 43,675

100.0 100.0 100.0 100.0

93.4 78.3 62.8 91.7

6.5 21.6 36.9 8.2

6.2 20.7 36.0 7.8

Health insurance coverage among people under age 65 Private Medicaid Other Uninsured

Note: Limitation in usual activities is based on a series of questions concerning limitations in a person’s ability to engage in work, school, play, or other activities for health reasons, the speciﬁc conditions causing the limitation, and the duration of the conditions. Conditions lasting more than three months are classiﬁed as chronic. Selected conditions (such as arthritis, diabetes, cancer, heart conditions, etc.) are considered chronic regardless of duration. Numbers by race and Hispanic origin do not sum to total because not all races are shown and Hispanics may be of any race. Numbers by income do not sum to total because “not reported” is not shown. Numbers by education do not sum to total because education categories are shown only for people aged 25 or older. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 243, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

226 AMERICAN HEALTH

DISABILITY

Table 8.12

Limitations in Work Activity due to Health Problems by Selected Characteristics, 2008

(total number of people aged 18 to 69, and percent distribution by work limitation status, by selected characteristics, 2008; numbers in thousands) limited total number

TOTAL PEOPLE Sex Female Male

percent

not limited in work

199,520

100.0%

90.3%

101,245 98,275

100.0 100.0

90.0 90.7

110,613 77,489 11,417

100.0 100.0 100.0

Race and Hispanic origin Asian 9,674 Black 24,760 Hispanic 28,861 Non-Hispanic white 133,856 Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more Education Not a high school graduate High school graduate Some college Bachelor’s degree or more

total

unable to work

3.5%

6.2%

10.0 9.3

3.5 3.4

6.4 5.9

94.9 85.4 79.2

5.1 14.6 20.8

1.9 4.9 8.7

3.2 9.5 12.0

100.0 100.0 100.0 100.0

96.6 88.0 93.9 89.8

3.4 12.0 6.1 10.2

1.3 3.3 2.0 3.8

2.1 8.6 4.1 6.3

50,343 26,198 33,237 23,091 40,193

100.0 100.0 100.0 100.0 100.0

79.3 89.5 93.7 95.3 96.7

20.7 10.5 6.3 4.7 3.3

5.8 4.4 2.8 2.2 1.9

14.8 6.1 3.4 2.5 1.5

22,209 46,735 46,599 50,402

100.0 100.0 100.0 100.0

79.8 86.7 89.3 95.6

20.2 13.3 10.7 4.4

5.6 4.4 4.0 2.5

14.5 8.9 6.7 1.9

Health insurance coverage among people under age 65 Private 127,369 Medicaid 14,597 Other 7,004 Uninsured 37,042

100.0 100.0 100.0 100.0

95.2 65.3 59.4 92.7

4.8 34.7 40.6 7.3

2.4 5.7 9.1 3.4

2.4 28.8 31.4 3.8

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 69

9.7%

limited in work

Note: “Unable to work” is based on the question, “Does a physical, mental, or emotional problem now keep (respondent or family member aged 18 or older) from working at a job or business?” “Limited in work” is based on the question, “Is (respondent or family member aged 18 or older) limited in the kind or amount of work they can do because of a physical, mental, or emotional problem?” Numbers by race and Hispanic origin do not sum to total because not all races are shown and Hispanics may be of any race. Numbers by education do not sum to total because education categories are shown only for people aged 25 or older. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 243, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

227

DISEASES AND CONDITIONS CHAPTER

9

Diseases and Conditions ■ Twenty-seven million Americans have heart disease. Among people with heart disease, 45 percent are aged 65 or older.

■ Thirty-two percent of adults have high blood pressure. The proportion of the population with high blood pressure is rising, thanks in part to increased awareness of the condition.

■ Cholesterol levels are declining. Changing diets and cholesterol-lowering medications are helping to combat the problem of high cholesterol.

■ Ten percent of adults have diabetes. The proportion of people with diabetes is rising as obesity becomes a growing problem.

■ Forty-seven percent of adults have taken at least one prescription drug in the past month. Thirteen percent of children have taken prescription medications regularly for at least three months.

■ Some health conditions are more costly than others. The four most expensive health conditions are cancer, trauma, heart conditions, and mental illness.

AMERICAN HEALTH

229

Serious Diseases Are More Common among the Elderly The incidence of heart disease rises sharply with age. More than 26 million adults have some form of heart disease. Many more are at risk of developing heart disease because of other conditions. For example, 56 million have high blood pressure (hypertension) and nearly 19 million have diabetes—both of which can contribute to heart disease. Among people with heart disease, 45 percent are aged 65 or older. The 65-plus age group accounts for nearly half of adults with cancer and 37 percent of those with diabetes. People aged 18 to 44 account for the largest share of those with some health conditions, however. Nearly half of adults who have ever had asthma are in the 18-to-44 age group, as are 61 percent of people with migraines. In general, serious conditions tend to develop later in life. While the share of people who have hay fever, a relatively benign condition, peaks among those aged 45 to 64, the likelihood of having heart disease, hypertension, or cancer increases with age. Only 5 percent of people aged 18 to 44 have heart disease compared with more than one-third of those aged 75 or older. ■ Medical advances in treating heart disease have reduced death rates and increased life expectancy.

More than one-third of people aged 75 or older have heart disease (percent of people aged 18 or older with heart disease, by age, 2008)

45

39%

30

30%

15

15%

0

0%

27%

12% 5% 18 a to 44

230 AMERICAN HEALTH

45 b to 64

65 c to 74

75 ordolder

DISEASES AND CONDITIONS

Table 9.1

Number of Health Conditions among Adults by Age, 2008

(number of people aged 18 or older with selected health conditions, by type of condition and age, 2008; numbers in thousands) aged 65 or older total

18 to 44

45 to 64

total

65 to 74

75 or older

225,227

110,615

77,335

37,278

19,869

17,409

26,628 14,428 56,159 6,460

5,067 1,258 9,643 714

9,469 5,205 25,126 2,260

12,092 7,965 21,390 3,486

5,287 3,337 10,774 1,248

6,805 4,628 10,616 2,238

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

3,789 28,260 16,380 18,022 30,621 9,832

222 14,888 7,949 7,379 12,850 3,486

1,573 9,265 5,768 7,823 12,072 4,251

1,994 4,107 2,664 2,820 5,699 2,094

1,124 2,376 1,548 1,537 3,362 1,172

870 1,731 1,116 1,283 2,337 922

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

17,866 3,134 1,637 2,160

2,521 120 699 –

6,838 1,233 725 620

8,507 1,782 213 1,516

3,814 877 141 707

4,693 905 72 809

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

18,651 19,321 3,731 3,262 51,233 61,656 30,262 31,447 61,719 9,753

2,553 6,065 795 1,060 8,306 18,481 18,352 14,017 27,136 5,092

9,223 8,045 1,372 1,680 23,900 27,067 10,260 12,744 22,778 3,523

6,875 5,212 1,564 522 19,028 16,106 1,650 4,686 11,806 1,138

3,940 2,719 601 330 9,574 8,533 1,121 2,618 6,359 649

2,935 2,493 963 192 9,454 7,573 529 2,068 5,447 489

Selected sensory problems Hearing Vision Absence of all natural teeth

34,750 25,150 19,134

7,637 7,980 3,097

14,190 10,673 6,558

12,923 6,498 9,479

5,499 2,831 4,028

7,424 3,667 5,451

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

231

Table 9.2

Percent Distribution of Health Conditions among Adults by Age, 2008

(percent distribution of people aged 18 or older with selected health conditions, by type of condition and age, 2008) aged 65 or older

34.3%

total

16.6%

65 to 74

75 or older

19.0 8.7 17.2 11.1

35.6 36.1 44.7 35.0

45.4 55.2 38.1 54.0

19.9 23.1 19.2 19.3

25.6 32.1 18.9 34.6

100.0 100.0 100.0 100.0 100.0

5.9 48.5 40.9 42.0 35.5

41.5 35.2 43.4 39.4 43.2

52.6 16.3 15.6 18.6 21.3

29.7 9.5 8.5 11.0 11.9

23.0 6.8 7.1 7.6 9.4

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

100.0 100.0 100.0 100.0

14.1 3.8 42.7 –

38.3 39.3 44.3 28.7

47.6 56.9 13.0 70.2

21.3 28.0 8.6 32.7

26.3 28.9 4.4 37.5

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

13.7 31.4 21.3 32.5 16.2 30.0 60.6 44.6 44.0 52.2

49.5 41.6 36.8 51.5 46.6 43.9 33.9 40.5 36.9 36.1

36.9 27.0 41.9 16.0 37.1 26.1 5.5 14.9 19.1 11.7

21.1 14.1 16.1 10.1 18.7 13.8 3.7 8.3 10.3 6.7

15.7 12.9 25.8 5.9 18.5 12.3 1.7 6.6 8.8 5.0

Selected sensory problems Hearing Vision Absence of all natural teeth

100.0 100.0 100.0 100.0

22.0 31.7 16.2 12.2

40.8 42.4 34.3 30.9

37.2 25.8 49.5 56.9

15.8 11.3 21.1 24.0

21.4 14.6 28.5 32.9

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

total

18 to 44

45 to 64

100.0 100.0 100.0 100.0

100.0%

49.1%

8.8%

7.7%

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

232 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.3

Percent of Adults with Health Conditions by Age, 2008

(percent of people aged 18 or older with selected health conditions, by type of condition and age, 2008) 18 to 44

45 to 64

65 to 74

100.0%

total

100.0%

100.0%

100.0%

100.0%

11.8 6.4 25.0 2.9

4.6 1.1 8.7 0.6

12.3 6.7 32.5 2.9

26.7 16.9 54.4 6.3

39.2 26.7 61.1 12.9

1.7 12.6 7.3 8.0 13.6 4.4

0.2 13.5 7.2 6.7 11.6 3.2

2.0 12.0 7.5 10.1 15.6 5.5

5.7 12.0 7.8 7.7 16.9 5.9

5.0 10.0 6.4 7.4 13.4 5.3

7.9 1.4 1.4 2.0

2.3 0.1 1.3 –

8.9 1.6 1.8 1.7

19.2 4.4 1.3 7.7

27.0 5.2 0.7 11.8

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

8.4 8.6 1.7 1.4 22.8 27.4 13.4 14.0 27.4 4.3

2.3 5.5 0.7 1.0 7.5 16.7 16.6 12.7 24.5 4.6

12.1 10.4 1.8 2.2 30.9 35.0 13.3 16.5 29.5 4.6

20.4 13.7 3.0 1.7 48.3 43.0 5.7 13.2 32.1 3.3

17.3 14.4 5.5 1.1 54.4 43.6 3.0 11.9 31.3 2.8

Selected sensory problems Hearing Vision Absence of all natural teeth

15.4 11.2 8.5

6.9 7.2 2.8

18.4 13.8 8.5

27.8 14.3 20.4

42.7 21.1 31.5

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

75 or older

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

233

Biological Differences between Men and Women Are behind Disease Patterns The incidence of many conditions differs by sex. There are more women than men in the American population. This means that if the prevalence of a health condition is roughly the same for men and women, women will account for a larger number of those with the condition. This can be seen in heart disease statistics. The number of women with heart disease exceeds the number of men with heart disease by 287,000, although the prevalence of heart disease is slightly higher among men (13 percent of men versus 11 percent of women). For some health conditions, there are even larger differences by sex in disease prevalence. Men are much more likely than women to have hearing problems, for example (18 versus 12 percent). Women are more likely than men to have arthritis (25 versus 18.5 percent) and migraines (19 versus 8 percent). Some differences in the prevalence of health problems may be rooted in biology. Age differences between the male and female populations also contribute to differences in disease patterns. The female population is older, on average, than the male population. The older age of women means a higher incidence of conditions related to aging, such as arthritis. ■ As medical researchers develop a better understanding of the differences between men and women, individualized treatments that take gender into consideration are likely to become more common.

Women are more likely than men to have arthritis 30

(percent of people aged 18 or older with selected health conditions, by sex, 2008)

men

25.0% 20

20%

women

18.5%

18.2% 12.4%

10

10% 100000

0

0%

all men

women dual

75000

hear hearing problems

arthr arthritis

50000

25000

234 AMERICAN HEALTH

0

with

w/out

DISEASES AND CONDITIONS

Table 9.4

Number of Health Conditions among Adults by Sex, 2008

(number of people aged 18 or older with selected health conditions, by type of condition and sex, 2008; numbers in thousands) total

men

women

225,227

108,755

116,472

26,628 14,428 56,159 6,460

13,170 8,439 26,031 2,965

13,457 5,989 30,128 3,495

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

3,789 28,260 16,380 18,022 30,621 9,832

1,769 11,705 6,136 7,463 10,080 3,121

2,020 16,555 10,244 10,559 20,541 6,711

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

17,866 3,134 1,637 2,160

6,900 – – 2,160

10,966 3,128 1,637 –

Other selected diseases and conditions Diabetes 18,651 Ulcers 19,321 Kidney disease 3,731 Liver disease 3,262 Arthritis 51,233 Chronic joint symptoms 61,656 Migraines or severe headaches 30,262 Pain in neck 31,447 Pain in lower back 61,719 Pain in face or jaw 9,753

8,934 8,481 1,769 1,591 20,136 27,733 8,886 12,385 27,342 3,051

9,717 10,840 1,962 1,671 31,097 33,922 21,376 19,062 34,377 6,701

Selected sensory problems Hearing Vision Absence of all natural teeth

19,547 10,068 8,461

15,202 15,082 10,674

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

34,750 25,150 19,134

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

235

Table 9.5

Percent Distribution of Health Conditions among Adults by Sex, 2008

(percent distribution of people aged 18 or older with selected health conditions, by type of condition and sex, 2008) TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

100.0%

total

48.3%

men

women

100.0 100.0 100.0 100.0

49.5 58.5 46.4 45.9

50.5 41.5 53.6 54.1

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

100.0 100.0 100.0 100.0 100.0 100.0

46.7 41.4 37.5 41.4 32.9 31.7

53.3 58.6 62.5 58.6 67.1 68.3

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

100.0 100.0 100.0 100.0

38.6 – – 100.0

61.4 99.8 100.0 –

Other selected diseases and conditions Diabetes 100.0 Ulcers 100.0 Kidney disease 100.0 Liver disease 100.0 Arthritis 100.0 Chronic joint symptoms 100.0 Migraines or severe headaches 100.0 Pain in neck 100.0 Pain in lower back 100.0 Pain in face or jaw 100.0

47.9 43.9 47.4 48.8 39.3 45.0 29.4 39.4 44.3 31.3

52.1 56.1 52.6 51.2 60.7 55.0 70.6 60.6 55.7 68.7

Selected sensory problems Hearing Vision Absence of all natural teeth

56.3 40.0 44.2 43.4

43.7 60.0 55.8 56.6

100.0 100.0 100.0 100.0

51.7%

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

236 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.6

Percent of Adults with Health Conditions by Sex, 2008

(percent of people aged 18 or older with selected health conditions, by type of condition and sex, 2008) TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

total

men

women

100.0%

100.0%

100.0%

11.8 6.4 25.0 2.9

12.6 8.2 23.9 2.9

11.0 4.8 24.3 2.8

1.7 12.6 7.3 8.0 13.6 4.4

1.7 10.8 5.7 6.7 9.2 2.8

1.6 14.3 8.8 8.9 17.4 5.6

7.9 1.4 1.4 2.0

6.7 – – 2.2

8.9 2.5 1.4 –

Other selected diseases and conditions Diabetes 8.4 Ulcers 8.6 Kidney disease 1.7 Liver disease 1.4 Arthritis 22.8 Chronic joint symptoms 27.4 Migraines or severe headaches 13.4 Pain in neck 14.0 Pain in lower back 27.4 Pain in face or jaw 4.3

8.3 7.9 1.7 1.4 18.5 25.3 8.1 11.2 25.0 2.8

7.9 9.0 1.6 1.4 25.0 27.9 18.8 16.2 29.3 5.8

Selected sensory problems Hearing Vision Absence of all natural teeth

18.2 9.3 8.1

12.4 12.5 8.6

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

15.4 11.2 8.5

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

237

Prevalence of Many Diseases Is Highest among Non-Hispanic Whites and Blacks Asians have low prevalence rates for many health problems. Non-Hispanic whites are the largest segment of the U.S. population, which is why they account for the largest share of adults with various health problems. More than 40 million non-Hispanic whites have hypertension, for example, accounting for 73 of all those with hypertension. But non-Hispanic whites are actually less likely than blacks to have hypertension (24 percent of non-Hispanic whites versus 32 percent of blacks). For most of the health conditions considered here, blacks and non-Hispanic whites have higher prevalence rates than Asians and Hispanics. A large proportion of Asians and Hispanics are immigrants, while nearly all non-Hispanic whites and blacks are native-born. This suggests that cultural differences could be a factor in the prevalence of many health problems. Differences in diet, for example, can affect the likelihood of developing high blood pressure. Population characteristics also inﬂuence disease prevalence. In general, Asians and Hispanics are younger than non-Hispanic whites and blacks. With fewer older adults, the prevalence of agerelated health conditions among Hispanics and Asians is often below average. ■ Many immigrants adhere to traditional diets that are healthier than the average American diet of fast food and soft drinks. As immigrants become more acculturated, the prevalence of health problems may rise. 15

Blacks and Hispanics are most likely to have diabetes (percent of people aged 18 or older with diabetes, by race and Hispanic origin, 2008)

11% 10

11%

10%

8% 7% 5

5%

0

0%

a Asian

238 AMERICAN HEALTH

b black

c Hispanic

d white non-Hispanic

DISEASES AND CONDITIONS

Table 9.7

Number of Health Conditions among Adults by Race and Hispanic Origin, 2008

(number of people aged 18 or older with selected health conditions, by type of condition, race, and Hispanic origin, 2008; numbers in thousands) total

Asian

black

Hispanic

non-Hispanic white

225,227

10,501

26,765

30,583

154,483

26,233 14,210 55,482 6,360

472 261 1,985 153

2,436 1,307 7,900 832

1,817 1,217 4,913 562

21,396 11,409 40,506 4,804

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

3,708 27,538 15,881 17,709 30,237 9,649

– 966 506 723 740 124

217 3,627 2,163 1,699 3,645 1,020

191 2,950 1,639 1,554 2,693 631

3,258 19,951 11,542 13,647 23,112 7,834

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

17,866 3,134 1,637 2,160

324 102 – 57

1,016 216 88 191

865 183 112 133

15,371 2,556 1,421 1,745

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

18,651 19,321 3,731 3,262 51,233 61,656 30,262 31,447 61,719 9,753

741 523 153 156 1,132 1,358 844 929 1,822 196

2,756 1,866 501 253 5,370 6,365 3,524 2,789 6,272 904

2,524 1,857 483 531 3,726 5,483 4,050 4,082 7,453 1,033

12,193 14,732 2,543 2,266 40,216 47,469 21,309 23,025 45,183 7,494

Selected sensory problems Hearing Vision Absence of all natural teeth

34,750 25,150 19,134

787 886 537

2,145 3,006 2,089

2,303 2,780 1,415

28,957 18,034 14,715

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Numbers do not sum to total because not all races are shown and Hispanics may be of any race. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

239

Table 9.8

Percent Distribution of Health Conditions among Adults by Race and Hispanic Origin, 2008

(percent distribution of people aged 18 or older with selected health conditions, by type of condition, race, and Hispanic origin, 2008) total

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

Asian

black

Hispanic

13.6%

non-Hispanic white

100.0%

4.7%

11.9%

68.6%

100.0 100.0 100.0 100.0

1.8 1.8 3.6 2.4

9.3 9.2 14.2 13.1

6.9 8.6 8.9 8.8

81.6 80.3 73.0 75.5

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

100.0 100.0 100.0 100.0 100.0 100.0

– 3.5 3.2 4.1 2.4 1.3

5.9 13.2 13.6 9.6 12.1 10.6

5.2 10.7 10.3 8.8 8.9 6.5

87.9 72.4 72.7 77.1 76.4 81.2

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

100.0 100.0 100.0 100.0

1.8 3.3 – 2.6

5.7 6.9 5.4 8.8

4.8 5.8 6.8 6.2

86.0 81.6 86.8 80.8

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

4.0 2.7 4.1 4.8 2.2 2.2 2.8 3.0 3.0 2.0

14.8 9.7 13.4 7.8 10.5 10.3 11.6 8.9 10.2 9.3

13.5 9.6 12.9 16.3 7.3 8.9 13.4 13.0 12.1 10.6

65.4 76.2 68.2 69.5 78.5 77.0 70.4 73.2 73.2 76.8

Selected sensory problems Hearing Vision Absence of all natural teeth

100.0 100.0 100.0

2.3 3.5 2.8

6.2 12.0 10.9

6.6 11.1 7.4

83.3 71.7 76.9

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Numbers do not sum to total because not all races are shown and Hispanics may be of any race. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

240 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.9

Percent of Adults with Health Conditions by Race and Hispanic Origin, 2008

(percent of people aged 18 or older with selected health conditions, by type of condition, race, and Hispanic origin, 2008) Asian

black

100.0%

100.0%

100.0%

100.0%

100.0%

11.8 6.4 25.0 2.9

5.2 2.9 21.0 1.8

10.2 5.6 31.8 3.6

8.1 5.7 21.0 2.6

12.7 6.6 23.7 2.8

1.7 12.6 7.3 8.0 13.6 4.4

– 9.5 4.8 6.9 7.0 1.2

0.9 13.5 8.1 6.4 13.8 3.8

1.0 9.8 5.6 5.4 9.3 2.3

1.8 13.2 7.6 8.6 14.7 4.9

7.9 1.4 1.4 2.0

3.5 1.1 – 1.3

4.3 1.0 0.6 2.3

4.1 1.0 0.8 1.8

9.0 1.4 1.8 2.2

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

8.4 8.6 1.7 1.4 22.8 27.4 13.4 14.0 27.4 4.3

8.0 5.4 1.7 1.7 11.9 13.7 7.8 9.0 17.7 1.8

11.4 7.3 2.0 0.9 21.8 24.9 12.7 10.4 23.6 3.3

11.0 6.8 2.1 1.7 16.6 20.7 12.5 14.4 25.3 3.6

7.1 9.1 1.5 1.4 23.5 29.0 14.4 14.8 28.9 5.0

Selected sensory problems Hearing Vision Absence of all natural teeth

15.4 11.2 8.5

8.5 8.9 5.9

8.9 11.7 9.5

9.5 10.4 6.8

17.3 11.1 8.7

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

Hispanic

non-Hispanic white

total

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

241

Low Incomes Are Related to Health Problems But other factors also play a role in differences. Income is linked to many different health problems. There are both direct and indirect relationships between income and health. People with lower incomes generally have less access to health care, and poor health can make it difﬁcult for people to earn a good living. But people with lower incomes are also more likely to be older, and aging leads to more health problems. People with household incomes below $35,000 are more likely to experience most of the health problems examined here. Fifty-four percent of those who have had a stroke, for example, have a household income below $35,000, although this income group accounts for only 30 percent of the adult population. Health differences are also apparent in the percentage of adults with various health problems by income. While 1.7 percent of all adults have been diagnosed with emphysema, among those with incomes below $35,000 the ﬁgure is a larger 3.2 percent. ■ Because older adults are likely to have low incomes, many health differences by income are related to aging rather than economics. 12

People with lower incomes are more likely to have had a heart attack (percent of people aged 18 or older who have had a coronary, by household income, 2008)

8.8%

8

8%

5.9%

5.9% 5.1%

4

4%

0

0%

4.1%

under a $35,000

242 AMERICAN HEALTH

$35,000– b $49,999

$50,000– c $74,999

$75,000– d $99,999

$100,000 e or more

DISEASES AND CONDITIONS

Table 9.10

Number of Health Conditions among Adults by Household Income, 2008

(number of people aged 18 or older with selected health conditions, by type of condition and household income, 2008; numbers in thousands) household income total

under $35,000

$35,000– $49,999

$50,000– $74,999

$75,000– $99,999

$100,000 or more

225,227

68,352

31,715

38,300

25,842

43,165

26,628 14,428 56,159 6,460

11,234 6,920 21,105 3,463

3,898 1,968 7,983 1,105

3,681 1,879 8,887 507

2,246 1,074 5,130 280

3,295 1,216 8,301 596

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

3,789 28,260 16,380 18,022 30,621 9,832

2,374 10,040 6,218 4,371 9,352 4,324

542 3,727 2,027 2,177 4,064 1,282

269 4,478 2,594 3,155 5,181 1,502

214 3,324 1,768 2,363 3,753 1,009

131 4,889 2,522 4,623 5,858 1,093

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

17,866 3,134 1,637 2,160

6,592 1,181 795 719

2,454 440 262 249

2,506 451 209 269

1,658 164 108 328

3,044 523 164 391

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

18,651 19,321 3,731 3,262 51,233 61,656 30,262 31,447 61,719 9,753

8,002 7,557 1,861 1,488 18,751 21,470 11,495 11,481 22,274 3,691

2,545 2,924 535 586 7,249 8,683 3,805 4,327 8,926 1,270

2,933 3,162 368 463 8,362 10,265 4,827 5,088 10,151 1,480

1,471 1,756 272 328 5,015 6,811 3,584 3,487 6,439 1,048

2,133 2,753 467 260 7,694 10,072 5,182 5,104 10,211 1,719

Selected sensory problems Hearing Vision Absence of all natural teeth

34,750 25,150 19,134

12,714 10,391 10,080

4,703 4,158 2,606

5,405 3,600 2,473

3,416 2,137 1,223

5,922 3,179 1,356

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Numbers do not sum to total because “unknown income” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

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243

Table 9.11

Percent Distribution of Health Conditions among Adults by Household Income, 2008

(percent distribution of people aged 18 or older with selected health conditions, by type of condition and household income, 2008) household income total

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

under $35,000

$35,000– $49,999

$50,000– $74,999

$75,000– $99,999

11.5%

$100,000 or more

100.0%

30.3%

14.1%

17.0%

19.2%

100.0 100.0 100.0 100.0

42.2 48.0 37.6 53.6

14.6 13.6 14.2 17.1

13.8 13.0 15.8 7.8

8.4 7.4 9.1 4.3

12.4 8.4 14.8 9.2

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

100.0 100.0 100.0 100.0 100.0 100.0

62.7 35.5 38.0 24.3 30.5 44.0

14.3 13.2 12.4 12.1 13.3 13.0

7.1 15.8 15.8 17.5 16.9 15.3

5.6 11.8 10.8 13.1 12.3 10.3

3.5 17.3 15.4 25.7 19.1 11.1

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

100.0 100.0 100.0 100.0

36.9 37.7 48.6 33.3

13.7 14.0 16.0 11.5

14.0 14.4 12.8 12.5

9.3 5.2 6.6 15.2

17.0 16.7 10.0 18.1

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

42.9 39.1 49.9 45.6 36.6 34.8 38.0 36.5 36.1 37.8

13.6 15.1 14.3 18.0 14.1 14.1 12.6 13.8 14.5 13.0

15.7 16.4 9.9 14.2 16.3 16.6 16.0 16.2 16.4 15.2

7.9 9.1 7.3 10.1 9.8 11.0 11.8 11.1 10.4 10.7

11.4 14.2 12.5 8.0 15.0 16.3 17.1 16.2 16.5 17.6

Selected sensory problems Hearing Vision Absence of all natural teeth

100.0 100.0 100.0

36.6 41.3 52.7

13.5 16.5 13.6

15.6 14.3 12.9

9.8 8.5 6.4

17.0 12.6 7.1

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Numbers do not sum to total because “unknown income” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

244 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.12

Percent of Adults with Health Conditions by Household Income, 2008

(percent of people aged 18 or older with selected health conditions, by type of condition and household income, 2008) household income total

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

under $35,000

$35,000– $49,999

$50,000– $74,999

$75,000– $99,999

$100,000 or more

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

11.8 6.4 25.0 2.9

14.7 8.8 28.3 4.4

11.8 5.9 24.2 3.3

11.0 5.9 24.5 1.6

10.4 5.1 21.5 1.6

9.3 4.1 20.6 1.5

1.7 12.6 7.3 8.0 13.6 4.4

3.2 15.1 9.3 6.5 13.6 6.4

1.6 11.8 6.4 6.8 12.7 4.0

0.9 11.6 6.8 8.3 13.4 3.9

1.1 12.7 6.6 9.0 14.4 3.9

0.4 11.6 6.0 10.7 13.1 2.4

7.9 1.4 1.4 2.0

8.4 1.5 2.3 2.0

7.4 1.3 1.6 1.7

7.5 1.4 1.1 1.8

7.8 0.8 0.8 4.0

8.5 1.5 0.7 2.8

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

8.4 8.6 1.7 1.4 22.8 27.4 13.4 14.0 27.4 4.3

11.1 10.8 2.5 2.2 25.1 30.3 18.0 17.2 32.6 5.6

7.9 9.0 1.6 1.8 21.9 26.7 12.2 13.6 28.1 4.0

7.5 8.6 1.1 1.2 22.6 27.1 12.1 12.9 26.6 3.8

6.1 7.0 1.6 1.3 20.8 27.0 13.2 13.2 25.8 3.8

4.8 6.4 1.3 0.5 18.3 22.7 11.6 11.9 24.3 4.0

Selected sensory problems Hearing Vision Absence of all natural teeth

15.4 11.2 8.5

16.8 14.8 12.9

14.3 12.9 7.9

15.2 9.7 7.1

14.2 8.7 5.6

15.0 7.5 3.8

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

245

Higher Education Is Linked to Better Health But the relationship is complicated by other factors. People with higher levels of education tend to be in better health. The relationship between education and health is complicated, however. Older adults, who have the most health problems, also have the lowest levels of education. The higher prevalence of heart disease among people without a high school diploma, then, is mostly due to the older age of high school dropouts. People with more education also have higher incomes, on average, and are more likely to have health insurance coverage and greater access to medical care. Greater access to care generally results in better health. The poor and uninsured are less likely to seek health care until their condition has become serious—and the prognosis poor. Education also directly affects health. The educated are more likely to seek information about health conditions and use that information to improve their health. They are more likely to make lifestyle changes, for example, to reduce the likelihood of getting certain diseases. ■ The rising educational level of the population suggests that the incidence of some health problems may decline in the future.

Many health problems vary by educational attainment (percent of people aged 18 or older with diabetes, by educational attainment, 2008)

15

12% 10

10%

10%

8%

5

5%

0

0%

5%

not a a high school graduate

246 AMERICAN HEALTH

highb school graduate

somec college

d college graduate

DISEASES AND CONDITIONS

Table 9.13

Number of Health Conditions among Adults by Education, 2008

(number of people aged 18 or older with selected health conditions, by type of condition and educational attainment, 2008; numbers in thousands)

total

not a high school graduate

high school graduate

some college

bachelor’s degree or more

225,227

29,013

53,874

55,174

56,681

26,628 14,428 56,159 6,460

5,351 3,639 10,436 1,831

7,552 4,516 17,250 2,218

7,271 3,683 15,176 1,565

5,258 2,335 11,991 712

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

3,789 28,260 16,380 18,022 30,621 9,832

1,279 3,269 2,301 1,637 3,895 2,040

1,251 5,928 3,504 3,603 7,047 2,548

785 7,233 4,149 5,389 9,115 2,767

365 6,516 3,527 6,105 8,206 1,618

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

17,866 3,134 1,637 2,160

2,762 422 260 302

4,888 1,106 491 481

4,720 696 514 646

5,055 888 206 724

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

18,651 19,321 3,731 3,262 51,233 61,656 30,262 31,447 61,719 9,753

4,448 3,518 880 665 8,863 9,650 4,338 4,791 9,519 1,226

6,127 5,445 1,224 971 16,513 17,627 6,793 8,033 16,472 2,371

4,665 5,504 886 931 14,129 17,048 7,971 8,725 16,484 2,929

3,017 3,738 576 552 10,655 13,639 6,343 7,241 12,894 2,052

Selected sensory problems Hearing Vision Absence of all natural teeth

34,750 25,150 19,134

5,865 5,035 6,231

10,264 6,342 6,472

9,508 6,487 3,807

7,568 4,808 1,641

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Numbers by education do not sum to total because education categories are shown only for people aged 25 or older. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

247

Table 9.14

Percent Distribution of Health Conditions among Adults by Education, 2008

(percent distribution of people aged 18 or older with selected health conditions, by type of condition and educational attainment, 2008)

total

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

not a high school graduate

high school graduate

some college

college graduate

100.0%

12.9%

23.9%

24.5%

25.2%

100.0 100.0 100.0 100.0

20.1 25.2 18.6 28.3

28.4 31.3 30.7 34.3

27.3 25.5 27.0 24.2

19.7 16.2 21.4 11.0

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis

100.0 100.0 100.0 100.0 100.0 100.0

33.8 11.6 14.0 9.1 12.7 20.7

33.0 21.0 21.4 20.0 23.0 25.9

20.7 25.6 25.3 29.9 29.8 28.1

9.6 23.1 21.5 33.9 26.8 16.5

Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

100.0 100.0 100.0 100.0

15.5 13.5 15.9 14.0

27.4 35.3 30.0 22.3

26.4 22.2 31.4 29.9

28.3 28.3 12.6 33.5

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

23.8 18.2 23.6 20.4 17.3 15.7 14.3 15.2 15.4 12.6

32.9 28.2 32.8 29.8 32.2 28.6 22.4 25.5 26.7 24.3

25.0 28.5 23.7 28.5 27.6 27.7 26.3 27.7 26.7 30.0

16.2 19.3 15.4 16.9 20.8 22.1 21.0 23.0 20.9 21.0

Selected sensory problems Hearing Vision Absence of all natural teeth

100.0 100.0 100.0

16.9 20.0 32.6

29.5 25.2 33.8

27.4 25.8 19.9

21.8 19.1 8.6

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Numbers by education do not sum to total because education categories are shown only for people aged 25 or older. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

248 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.15

Percent of Adults with Health Conditions by Education, 2008

(percent of people aged 18 or older with selected health conditions, by type of condition and educational attainment, 2008)

total

TOTAL PEOPLE Selected circulatory diseases Heart disease, all types Coronary Hypertension Stroke

not a high school graduate

high school graduate

some college

college graduate

100.0%

100.0%

100.0%

100.0%

100.0%

11.8 6.4 25.0 2.9

13.7 9.0 28.3 4.4

12.1 6.9 27.4 3.4

13.1 6.6 26.0 2.8

9.9 4.6 21.0 1.4

1.7 12.6 7.3 8.0 13.6 4.4

3.4 11.0 7.6 5.4 12.5 6.4

1.8 11.2 6.5 6.4 12.8 4.4

1.4 13.0 7.4 9.5 16.2 4.8

0.8 11.5 6.2 10.4 14.2 2.9

7.9 1.4 1.4 2.0

7.0 0.9 2.1 1.6

7.4 1.6 1.9 1.7

8.4 1.2 1.7 2.7

9.3 1.6 0.7 2.9

Other selected diseases and conditions Diabetes Ulcers Kidney disease Liver disease Arthritis Chronic joint symptoms Migraines or severe headaches Pain in neck Pain in lower back Pain in face or jaw

8.4 8.6 1.7 1.4 22.8 27.4 13.4 14.0 27.4 4.3

12.3 10.7 2.6 2.1 23.3 28.5 16.7 15.9 31.3 4.0

9.7 9.4 2.0 1.7 26.0 29.9 14.1 14.8 30.5 4.8

7.8 9.7 1.6 1.5 24.1 29.6 14.4 15.3 29.6 5.3

5.3 6.5 1.1 0.9 18.4 23.3 11.3 12.7 22.7 3.7

Selected sensory problems Hearing Vision Absence of all natural teeth

15.4 11.2 8.5

15.2 15.0 15.8

16.8 10.7 9.8

16.7 11.3 6.9

13.7 8.5 3.2

Selected respiratory conditions Emphysema Asthma, ever Asthma, still Hay fever Sinusitis Chronic bronchitis Cancer Any cancer Breast cancer Cervical cancer Prostate cancer

Note: The conditions shown are those that have ever been diagnosed by a doctor, except as noted. Hay fever, sinusitis, and chronic bronchitis have been diagnosed in the past 12 months. Kidney and liver disease have been diagnosed in the past 12 months and exclude kidney stones, bladder infections, and incontinence. Chronic joint symptoms are shown if respondent had pain, aching, or stiffness in or around a joint (excluding back and neck) and the condition began more than three months ago. Migraines, pain in neck, lower back, face, or jaw are shown only if pain lasted a whole day or more. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

249

Hypertension Rate Has Risen Increased monitoring may be behind the rise. There has been considerable progress in alleviating many health conditions in recent years. Nevertheless, hypertension rates increased between 1988–94 and 2003–06, perhaps because of increased monitoring for the disease. Overall, the share of adults with high blood pressure rose from 24 to 32 percent during those years. The biggest percentage point increase has been among older women. Mexican Americans are much less likely than non-Hispanic whites or blacks to have hypertension. They also experienced the smallest percentage point increase in the prevalence of hypertension between 1988–94 and 2003–06. Age structure may explain this difference. Many Mexican Americans are young adults who have come to the United States in search of jobs. The prevalence of high blood pressure falls as education rises. Only 23 percent of college graduates have high blood pressure versus 35 percent of high school dropouts. The older age of less-educated adults explains much of the difference. ■ As more Americans become aware of having high blood pressure, the rate of heart disease may decline in the future.

Women are slightly more likely than men to have hypertension

45

(percent of people aged 20 or older who have hypertension, by sex, 1988–94 and 2003–06)

30

30%

23.8%

15

24.4%

15% 100000

0

wome

32.9%

31.3%

0%

all men

women dual

75000

1988–94 eighth-eight

2003–06 oh-three

50000

25000

0

250 AMERICAN HEALTH

with

w/out

men

DISEASES AND CONDITIONS

Table 9.16

Hypertension by Sex and Age, 1988–94 and 2003–06

(percent of people aged 20 or older who have hypertension or take antihypertensive medication, by sex and age, 1988–94 and 2003–06; percentage point change, 1988–94 to 2003–06)

TOTAL PEOPLE Total men Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older Total women Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2003–06

1988–94

percentage point change

32.9 2.2 12.6 36.2 54.4 70.8 80.2

24.4 2.9 11.2 23.9 42.6 56.2 73.6

8.5 –0.7 1.4 12.3 11.8 14.6 6.6

32.1% 31.3 9.2 21.1 36.2 50.2 64.1 65.0

24.1% 23.8 7.1 17.1 29.2 40.6 54.4 60.4

8.0 7.5 2.1 4.0 7.0 9.6 9.7 4.6

Note: People by deﬁnition have hypertension if they have a systolic pressure of at least 140 mmHg or a diastolic pressure of at least 90 mmHg or take antihypertensive medication. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

Table 9.17

Hypertension by Sex, Race, and Hispanic Origin, 1988–94 and 2003–06

(percent of people aged 20 or older who have hypertension or take antihypertensive medication, by sex, race, and Hispanic origin, 1988–94 and 2003–06; percentage point change, 1988–94 to 2003–06)

TOTAL PEOPLE Men, total Black, non-Hispanic Hispanic (Mexican) White, non-Hispanic Women, total Black, non-Hispanic Hispanic (Mexican) White, non-Hispanic

2003–06

1988–94

percentage point change

32.9 42.8 20.0 33.4

24.4 32.5 15.9 24.6

8.5 10.3 4.1 8.8

32.1% 31.3 38.8 16.6 32.4

24.1% 23.8 31.1 16.4 24.3

8.0 7.5 7.7 0.2 8.1

Note: People by deﬁnition have hypertension if they have a systolic pressure of at least 140 mmHg or a diastolic pressure of at least 90 mmHg or take antihypertensive medication. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

251

Table 9.18

People with High Blood Pressure by Selected Characteristics, 2007

(percent distribution of people aged 18 or older by whether they have been told by a doctor that they have high blood pressure, by selected characteristics, 2007) yes

no

27.8%

72.2%

28.1 26.4

71.9 73.6

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

6.0 9.4 16.0 28.6 44.3 57.9

94.0 90.6 84.0 71.4 55.7 42.1

Race and Hispanic origin Black Hispanic White Multiracial Other

36.9 17.1 27.9 25.4 20.6

63.1 83.0 72.1 74.6 79.4

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

38.7 35.4 31.4 27.8 21.8

61.3 64.7 68.6 72.2 78.2

Education Not a high school graduate High school graduate Some college College graduate

35.4 31.8 27.6 23.2

64.7 68.2 72.4 76.8

TOTAL PEOPLE Sex Men Women

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

252 AMERICAN HEALTH

DISEASES AND CONDITIONS

Prevalence of High Cholesterol Is Declining Greater awareness of potential health problems has encouraged people to seek treatment. The prevalence of high cholesterol fell between 1988–94 and 2003–06. The largest percentage point declines were among older adults. Among men and women aged 55 or older, the incidence of high cholesterol fell by at least 10 percentage points. High cholesterol rates also fell in most racial and ethnic group between 1988–94 and 2003–06. Black women experienced the greatest decline, down nearly 6 percentage points. Cholesterol levels may be declining because more people are having their cholesterol checked and treated. Seventy-ﬁve percent of people aged 18 or older have had their cholesterol checked in the past ﬁve years. ■ Only 21 percent of adults have never had their cholesterol checked. The ﬁgure rises to 43 percent among Hispanics, however.

Older men and women have seen cholesterol levels decline 45

(percent of people aged 75 or older with high cholesterol, by sex, 1988–94 and 2003–06)

ninety

38%

oh-six 30

30%

20%

15

19%

15%

10% 100000

0

0%

men men

all 1988–94

2003–06 dual

75000

women women

50000

25000

0

with

w/out

AMERICAN HEALTH

253

Table 9.19

High Cholesterol by Sex and Age, 1988–94 and 2003–06

(percent of people aged 20 or older who have high serum cholesterol, by sex and age, 1988–94 and 2003–06; percentage point change, 1988–94 to 2003–06)

TOTAL PEOPLE Total men Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older Total women Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2003–06

1988–94

percentage point change

17.5 10.3 12.7 19.7 30.5 24.2 18.6

21.3 7.3 12.3 26.7 40.9 41.3 38.2

–3.8 3.0 0.4 –7.0 –10.4 –17.1 –19.6

16.4% 15.2 9.5 20.5 20.8 16.0 10.9 9.6

19.6% 17.7 8.2 19.4 26.6 28.0 21.9 20.4

–3.2 –2.5 1.3 1.1 –5.8 –12.0 –11.0 –10.8

Note: High cholesterol is deﬁned as 240 mg/dL or more. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

Table 9.20

High Cholesterol by Race, Hispanic Origin, and Sex, 1988–94 and 2003–06

(percent of people aged 20 or older who have high serum cholesterol, by race, Hispanic origin, and sex, 1988–94 and 2003–06; percentage point change, 1988–94 to 2003–06)

TOTAL PEOPLE Men, total Black, non-Hispanic Hispanic (Mexican) White, non-Hispanic Women, total Black, non-Hispanic Hispanic (Mexican) White, non-Hispanic

2003–06

1988–94

percentage point change

17.5 12.5 12.6 18.9

21.3 18.2 14.3 22.5

–3.8 –5.7 –1.7 –3.6

16.4% 15.2 10.8 15.7 15.7

19.6% 17.7 14.7 15.4 18.0

–3.2 –2.5 –3.9 0.3 –2.3

Note: High cholesterol is deﬁned as 240 mg/dL or more. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

254 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.21

Cholesterol Status by Selected Characteristics, 2007

(percent distribution of people aged 18 or older by whether they have had their blood cholesterol checked in the past ﬁve years, and whether they have been told by a doctor that their cholesterol is high, by selected characteristics, 2007) never had cholesterol checked

cholesterol checked in past ﬁve years

21.3%

total

74.8%

cholesterol is high

23.3 18.8

72.4 77.6

39.0 35.7

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

60.9 37.8 19.6 10.9 5.3 4.2

35.6 58.7 75.2 84.6 91.7 93.7

9.8 18.3 27.8 38.6 51.3 53.7

Race and Hispanic origin Black Hispanic White Multiracial Other

21.6 43.3 17.4 14.9 20.7

76.3 55.0 78.1 78.5 76.1

33.4 31.7 39.0 31.4 31.6

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

30.2 28.4 24.2 20.5 13.8

66.2 68.4 71.6 76.4 81.8

47.8 42.7 39.5 37.2 34.1

Education Not a high school graduate High school graduate Some college College graduate

33.4 25.9 20.8 11.5

63.4 71.2 74.9 83.8

44.8 40.2 36.4 34.5

TOTAL PEOPLE Sex Men Women

37.6%

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

AMERICAN HEALTH

255

Diabetes Is Increasingly Common Rates are likely to rise as the ranks of the obese grow. One in 10 American adults has been diagnosed with diabetes, making it one of the nation’s more important health problems. Between 1988–94 and 2003–06, the percentage of people aged 20 or older with diabetes increased from 7.8 to 10.3 percent. Among non-Hispanic blacks, the percentage rose from 10 to 14 percent. Of great concern is the fact that these ﬁgures include only people who have been diagnosed by a doctor. The National Center for Health Statistics estimates that many diabetics have yet to be diagnosed. The likelihood of having diabetes rises with age. In 2008, only 1 percent of people aged 18 to 24 had diabetes. Among those aged 65 or older, the proportion was a much higher 19 percent. People with low incomes and low levels of education are also more likely to have diabetes—in large part because older adults are overrepresented in those groups. ■ The prevalence of diabetes has grown in recent years, a rise that is likely to accelerate as Americans continue to put on weight.

Nearly one in ﬁve older Americans has diabetes

24

(percent of people aged 18 or older who have been diagnosed with diabetes, by age, 2008)

19.1%

16

16%

8

8%

13.9%

8.7% 4.3% 1.2%

0

0%

18 a to 24

256 AMERICAN HEALTH

2.0% 25 b to 34

35 c to 44

45d to 54

55 e to 64

65 orfolder

DISEASES AND CONDITIONS

Table 9.22

Diabetes by Selected Characteristics, 1988–94 and 2003–06

(percent of people aged 20 or older with diabetes, by sex, race, Hispanic origin, and age, 1988–94 and 2003–06, and percentage point change 1988–94 to 2003–06) 2003–06

1988–94

percentage point change

9.7 10.9

7.8 7.9

1.9 3.0

Race and Hispanic origin Black, non-Hispanic Hispanic, Mexican White, non-Hispanic

14.4 10.9 9.5

10.4 9.0 7.5

4.0 1.9 2.0

Age Aged 20 to 39 Aged 40 to 59 Aged 60 or older

2.5 10.6 22.9

1.6 8.9 18.9

0.9 1.7 4.0

TOTAL PEOPLE Sex Female Male

10.3%

7.8%

2.5

Note: People with diabetes include those diagnosed by a physician and those who have not been diagnosed but who have a fasting blood glucose of at least 126 mg/dL. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

257

Table 9.23

People with Diabetes by Selected Characteristics, 2008

(percent distribution of people aged 18 or older by whether they have been told by a doctor that they have diabetes, by selected characteristics, 2008) yes

TOTAL PEOPLE Sex Men Women

no

8.3%

90.0%

8.4 7.9

90.3 89.1

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

1.2 2.0 4.3 8.7 13.9 19.1

98.0 96.1 93.3 89.4 83.3 78.6

Race and Hispanic origin Black Hispanic White Multiracial Other

13.1 7.5 7.5 9.2 8.2

85.1 89.9 90.7 88.7 89.5

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

15.2 12.3 10.2 8.6 5.4

82.1 85.1 87.7 89.3 92.9

Education Not a high school graduate High school graduate Some college College graduate

13.3 9.5 8.8 5.8

84.6 88.6 89.4 92.4

Note: Numbers do not add to 100 percent because pregnancy-related diabetes and prediabetes are not shown. Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

258 AMERICAN HEALTH

DISEASES AND CONDITIONS

Many Americans Report Health Problems Most people aged 65 or older say they have been diagnosed with arthritis. Four percent of adults have been diagnosed with heart disease, according to the Behavioral Risk Factor Surveillance System, an annual survey of the health status of the population. Nine percent currently have asthma. More than one in four have been diagnosed with arthritis. Millions of Americans report health problems. Advances in medicine have made it easier to treat a variety of conditions, which has lowered death rates for afﬂictions such as heart disease and cancer. The ﬁve-year survival rate has increased for every type of cancer over the past few decades. The percentage of whites who survive for at least ﬁve years after a cancer diagnosis has grown from 51 percent in 1975–77 to 69 percent in the 1999–2005 time period. For blacks the survival rate grew from 40 to 59 percent during those years. The percentage of people with asthma is greatest among young adults. Eleven percent of 18to-24-year-olds reported having asthma in 2008. Not surprisingly, the percentage of adults with heart disease is highest in the 65-or-older age group, at 14 percent. Arthritis rises with age from 6 percent among 18-to-24-year-olds to 57 percent among people aged 65 or older. ■ As death rates from heart disease and cancer fall, more people are living with health conditions that require monitoring and treatment.

Arthritis increases with age

75

(percent of people aged 18 or older who report that they have been told by a doctor that they have arthritis, by age, 2007)

57% 50

50%

46%

30% 25

25%

17% 6%

0

0%

a24 18 to

10%

25 b to 34

35 c to 44

45 d to 54

55 e to 64

65 orf older

AMERICAN HEALTH

259

Table 9.24

People with Asthma by Selected Characteristics, 2008

(percent of people aged 18 or older who currently have asthma, by selected characteristics, 2008) yes

8.8%

no

TOTAL PEOPLE Sex Men Women

91.2%

6.7 10.7

93.3 89.3

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

10.8 9.1 8.2 8.6 9.1 7.9

89.2 90.9 91.8 91.4 90.9 92.1

Race and Hispanic origin Black Hispanic White Multiracial Other

10.1 6.6 8.7 10.7 7.4

89.9 93.4 91.3 89.3 92.6

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

15.2 10.7 8.5 8.3 7.4

84.8 89.3 91.5 91.7 92.6

Education Not a high school graduate High school graduate Some college College graduate

11.9 8.7 9.5 7.8

88.1 91.3 90.7 92.2

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

260 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.25

People with Arthritis by Selected Characteristics, 2007

(percent of people aged 18 or older who have been told by a doctor that they have arthritis, by selected characteristics, 2007) yes

no

27.5%

72.5%

23.5 31.3

76.5 68.7

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

5.6 9.6 16.9 29.8 45.8 57.0

94.4 90.4 83.1 70.2 54.2 43.0

Race and Hispanic origin Black Hispanic White Multiracial Other

26.2 15.0 29.3 28.9 19.5

73.8 85.0 70.7 71.1 80.5

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

41.1 33.9 30.6 28.6 22.9

59.0 66.2 69.4 71.4 77.1

Education Not a high school graduate High school graduate Some college College graduate

34.2 30.9 28.3 23.0

65.8 69.1 71.7 77.0

TOTAL PEOPLE Sex Men Women

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

AMERICAN HEALTH

261

Table 9.26

People with Heart Disease by Selected Characteristics, 2008

(percent of people aged 18 or older who have been told by a doctor that they have angina or heart disease, by selected characteristics, 2008) yes

TOTAL PEOPLE Sex Men Women

no

4.3%

95.7%

5.3 3.4

94.7 96.6

0.6 0.4 1.1 2.9 7.1 13.8

100.0 99.6 98.9 97.1 92.9 86.2

Race and Hispanic origin Black Hispanic White Multiracial Other

3.4 3.4 4.6 4.7 3.3

96.6 96.6 95.4 95.3 96.7

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

7.8 6.8 5.5 4.3 2.7

92.2 93.2 94.5 95.7 97.3

Education Not a high school graduate High school graduate Some college College graduate

6.7 4.8 4.3 3.3

93.3 95.2 95.7 96.7

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

262 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.27

Cancer Survival Rates, 1975–77 to 1999–2005

(percent of people surviving cancer for ﬁve or more years by selected cancer site and race, 1975–77 to 1999– 2005) 1999–2005

1975–77

percentage point change

WHITES All sites Oral cavity and pharynx Esophagus Stomach Colon Rectum Pancreas Lung and bronchus Urinary bladder Non-Hodgkin’s lymphoma Leukemia

69.1% 64.4 19.8 25.3 67.4 69.4 5.7 16.6 82.6 70.1 54.8

51.0% 54.6 5.6 14.8 51.7 49.4 2.6 12.8 74.5 48.4 36.0

18.1 9.8 14.2 10.5 15.7 20.0 3.1 3.8 8.1 21.7 18.8

BLACKS All sites Oral cavity and pharynx Esophagus Stomach Colon Rectum Pancreas Lung and bronchus Urinary bladder Non-Hodgkin’s lymphoma Leukemia

59.4 46.1 12.5 26.1 55.6 61.0 5.3 12.9 67.8 59.9 46.3

39.7 36.2 3.1 16.3 46.4 45.0 2.3 11.5 50.6 49.0 33.5

19.7 9.9 9.4 9.8 9.2 16.0 3.0 1.4 17.2 10.9 12.8

Note: Rates are based on a followup of patients through 2006. The rate is the ratio of the observed survival rate for the patient group to the expected survival rate for persons in the general population similar to the patient group with respect to age, sex, race, and calendar year of observation. It estimates the chance of surviving the effects of cancer. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

263

Most Have Been Tested for Health Problems Testing is most likely among college graduates. Among all Americans aged 50 or older, the 62 percent majority has had a colonoscopy—as recommended by the medical community. College graduates are most likely to have had a colonoscopy—69 percent of college graduates have had the exam compared with 53 percent of people who had not graduated from high school. Among men, college graduates are much more likely than those with less education to have had a PSA test for prostate cancer recently. Sixty-one percent of college graduates have had the test in the past two years compared with only 43 percent of men who did not graduate from high school. Among women, education also plays an important role in medical testing. More than 90 percent of college graduates have had a pap test in the past three years versus 74 percent of women who had not graduated from high school. Among women aged 40 or older, 81 percent of college graduates had a mammogram in the past two years versus 66 percent of women who do not have a high school diploma. ■ Some in the medical community are questioning the value of medical testing, but they face stiff resistance from an educated population that has long believed in the value of tests.

Medical tests are popular (percent of adults who have had selected tests, by age, 2008)

90

83% 76%

60

60%

30

30%

0

0%

62% 55%

everahad colonoscopy (50 or older)

264 AMERICAN HEALTH

PSAb test in past two years (men 40 or older)

papc test in past three years (women 18 or older)

d in mammogram past two years (women 40 or older)

DISEASES AND CONDITIONS

Table 9.28

People Aged 50 or Older Who Have Ever Had a Colonoscopy by Selected Characteristics, 2008

(percent of people aged 50 or older who have ever had a sigmoidoscopy or colonoscopy, by selected characteristics, 2008) yes

no

Total people aged 50 or older

62.2%

37.8%

Sex Men Women

61.9 61.9

38.1 38.1

Age Aged 50 to 59 Aged 60 to 64 Aged 65 or older

51.4 67.3 71.0

48.6 32.7 29.0

Race and Hispanic origin Black Hispanic White Multiracial Other

58.6 49.5 64.0 57.2 48.6

41.4 50.5 36.0 42.8 51.4

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

52.2 56.2 61.8 62.6 66.7

47.8 43.8 38.2 37.4 33.3

Education Not a high school graduate High school graduate Some college College graduate

52.5 59.2 62.6 69.0

47.5 40.8 37.4 31.0

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

AMERICAN HEALTH

265

Table 9.29

Men Who Have Had Prostate Cancer Screening by Selected Characteristics, 2008

(percent of men aged 40 or older who have had a PSA test for prostate cancer in the past two years, by selected characteristics, 2008) yes

no

Total men aged 40 or older

54.8%

45.2%

Age Aged 40 to 49 Aged 50 to 59 Aged 60 to 64 Aged 65 or older

26.0 58.0 75.4 78.4

74.0 42.0 24.6 21.6

Race and Hispanic origin Black Hispanic White Multiracial Other

58.9 41.0 57.0 47.8 39.7

41.1 59.0 43.0 52.2 60.3

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

40.2 50.9 55.3 55.2 57.8

59.8 49.1 44.7 44.8 42.2

Education Not a high school graduate High school graduate Some college College graduate

43.1 49.6 54.9 61.2

56.9 50.4 45.1 38.8

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

266 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.30

Women Who Have Had a Pap Test by Selected Characteristics, 2008

(percent of women aged 18 or older who have had a pap test in the past three years, by selected characteristics, 2008) yes

no

Total women aged 18 or older

82.9%

17.1%

Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

73.8 91.3 89.5 86.2 84.3 65.8

26.2 8.7 10.5 13.8 15.7 34.2

Race and Hispanic origin Black Hispanic White Multiracial Other

86.5 85.5 83.0 81.1 83.0

13.5 14.5 17.0 18.9 17.0

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

71.6 76.1 81.3 84.4 90.7

28.4 23.9 18.7 15.6 9.3

Education Not a high school graduate High school graduate Some college College graduate

73.8 77.0 83.2 90.4

26.2 23.0 16.8 9.6

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

AMERICAN HEALTH

267

Table 9.31

Women Who Have Had a Mammogram by Selected Characteristics, 2008

(percent of women aged 40 or older who have had a mammogram in the past two years, by selected characteristics, 2008) yes

no

Total women aged 40 or older

76.0%

24.0%

Age Aged 40 to 49 Aged 50 to 59 Aged 60 to 64 Aged 65 or older

68.8 80.0 81.0 78.6

31.2 20.0 19.0 21.4

Race and Hispanic origin Black Hispanic White Multiracial Other

79.4 73.5 76.1 65.1 74.8

20.6 26.5 23.9 34.9 25.2

Household income Under $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 or more

63.3 69.3 73.8 77.4 81.1

36.7 30.7 26.2 22.6 18.9

Education Not a high school graduate High school graduate Some college College graduate

65.6 74.3 75.8 80.6

34.4 25.7 24.2 19.4

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp

268 AMERICAN HEALTH

DISEASES AND CONDITIONS

AIDS Hits Minorities Hard Among AIDS cases, blacks outnumber whites. The emergence of AIDS in the 1980s presented a new and serious challenge to medical science. Since then, deaths from AIDS (or HIV disease as it is now known) have been dramatically reduced by the development of new treatments, primarily pharmaceuticals. None of the treatments are a cure, however. Sexual contact or needle sharing are the primary HIV transmission routes. This is why most AIDS cases are diagnosed among people who are relatively young; they are at the age when people are most likely to have multiple sex partners or to use intravenous drugs. By the end of 2007, of the more than 1 million diagnosed with AIDS, a substantial 41 percent were aged 30 to 39 at the time of diagnosis. The lag time between infection and diagnosis means that people were considerably younger when infected with the virus. Most AIDS cases are among men (80 percent). The number of blacks with AIDS exceeds the number of non-Hispanic whites with the disease. ■ The development of drugs that can arrest the progression of HIV disease and allow people to live relatively normal lives is one of the great medical successes of the past century. 60

Hispanics account for a small share of AIDS cases

(percent distribution of AIDS cases among people aged 13 or older, by race and Hispanic origin, through 2007)

42%

40

40%

20

20%

0

0%

40%

17%

non-Hispanic a black

non-Hispanic b white

Hispanic c

AMERICAN HEALTH

269

Table 9.32

Cumulative AIDS Cases by Age, Sex, Race, and Hispanic Origin, through 2007

(cumulative number and percent distribution of AIDS cases by age at diagnosis, sex, race, and Hispanic origin, through 2007) number

TOTAL CASES Age Under age 13 Aged 13 to 14 Aged 15 to 19 Aged 20 to 24 Aged 25 to 29 Aged 30 to 34 Aged 35 to 39 Aged 40 to 44 Aged 45 to 49 Aged 50 to 54 Aged 55 to 59 Aged 60 to 64 Aged 65 or older Sex Male, aged 13 or older Female, aged 13 or older Children (under age 13 at diagnosis) Race and Hispanic origin American Indian Asian Black, non-Hispanic Hispanic White, non-Hispanic

1,018,428

percent distribution

100.0%

9,209 1,169 6,089 38,175 120,464 201,906 219,601 177,250 112,896 63,408 34,160 18,249 15,853

0.9 0.1 0.6 3.7 11.8 19.8 21.6 17.4 11.1 6.2 3.4 1.8 1.6

810,676 198,544

79.6 19.5

9,209

0.9

3,492 7,511 426,003 169,138 404,465

0.3 0.7 41.8 16.6 39.7

Source: Centers for Disease Control and Prevention, Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2007, HIV/AIDS Surveillance Report, Vol. 19, 2009, Internet site http://www.cdc.gov/hiv/topics/surveillance/resources/ reports/2007report/default.htm

270 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.33

Cumulative AIDS Cases by Sex and Transmission Category, through 2007

(cumulative number and percent distribution of AIDS cases by sex and transmission category, through 2007) number

TOTAL CASES

percent distribution

1,018,428

100.0%

Males aged 13 or older Male-to-male sexual contact Injection drug use Male-to-male sexual contact, injection drug use High-risk heterosexual contact Other

810,676 487,695 175,704 71,242 63,927 12,108

100.0% 60.2 21.7 8.8 7.9 1.5

Females aged 13 or older Injection drug use High-risk heterosexual contact Other

198,544 80,155 112,230 6,158

100.0% 40.4 56.5 3.1

9,209 8,434 775

100.0% 91.6 0.1

Children under age 13 Perinatal Other

Source: Centers for Disease Control and Prevention, Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2007, HIV/AIDS Surveillance Report, Vol. 19, 2009, Internet site http://www.cdc.gov/hiv/topics/surveillance/resources/ reports/2007report/default.htm

AMERICAN HEALTH

271

Flu Shots Have Become Increasingly Popular Most of the elderly get a ﬂu shot each year. The percentage of Americans who get vaccinated against the ﬂu has tripled over the past two decades. In 1989, only 9 percent of people aged 18 or older had gotten a ﬂu shot in the past 12 months. By 2007, the proportion had grown to nearly 30 percent. Older Americans are much more likely than younger adults to get a ﬂu shot. In 2007, nearly 67 percent of people aged 65 or older had received the ﬂu vaccine during the past 12 months. This compares with just 17.5 percent of people aged 18 to 49. ■ In every age group, getting a ﬂu shot is becoming more common.

The percentage of people aged 65 or older who get a ﬂu shot has more than doubled 90 (percent of people aged 65 or older who got a ﬂu shot in the past 12 months, 1989 and 2007)

66.7%

60

60%

30

30%

0

0%

272 AMERICAN HEALTH

30.4%

a 1989

b 2007

DISEASES AND CONDITIONS

Table 9.34

Inﬂuenza Vaccination among Adults by Age, 1989 to 2007

(percent of people aged 18 or older who received the inﬂuenza vaccination in the past 12 months, by age, 1989 to 2007; percentage point change, 1989 to 2007)

Total, aged 18 or older Aged 18 to 49 Aged 50 to 64 Aged 65 or older

2007

29.9% 17.5 36.2 66.7

2000

28.4% 17.1 34.6 64.4

1989

9.1% 3.4 10.6 30.4

percentage point change, 1989 to 2007

20.8 14.1 25.6 36.3

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

273

Children’s Health Problems Vary by Age, Sex, and Race Boys are more likely than girls to have problems. Prescription drugs are popular with children as well as adults. In 2008, more than 9 million children under age 18 had been taking prescription medication for at least three months. Among children taking medication, boys account for the 60 percent majority. Fourteen percent of the nation’s children have had asthma at some point in their lives, and 9 percent still have it. Boys are more likely than girls to have asthma and hay fever. The prevalence of some health conditions varies sharply by race and Hispanic origin. Sixteen percent of black children currently have asthma compared with 4 percent of Asian children, 7 percent of Hispanic children, and 9 percent of non-Hispanic white children. ■ The percentage of children with asthma has been increasing for years, but the reason for the increase is unknown.

Non-Hispanic white children are most likely to be taking prescription medication (percent 18 of children taking prescription medication regularly for at least three months, by race and Hispanic origin, 2008)

15% 12

12%

12%

8% 6

6%

0

0%

a Asian

274 AMERICAN HEALTH

8%

b black

c Hispanic

d white non-Hispanic

DISEASES AND CONDITIONS

Table 9.35

Health Conditions among Children by Selected Characteristics, 2008

(number of people under age 18 with selected health conditions, by selected characteristics and type of condition, 2008; numbers in thousands)

in last 12 months

asthma

prescription medication taken regularly other at least allergies 3 months

total children

ever had

still have

hay fever

respiratory allergies

73,859

10,190

6,953

7,069

8,254

10,514

9,449

Female

36,109

4,006

2,660

3,027

3,667

5,149

3,747

Male

37,750

6,184

4,293

4,042

4,587

5,365

5,702

Aged 0 to 4

20,800

1,499

1,276

957

1,713

3,173

1,490

Aged 5 to 11

28,250

4,573

3,159

3,198

3,400

4,220

4,005

Aged 12 to 17

24,809

4,118

2,518

2,915

3,141

3,121

3,954

TOTAL CHILDREN Sex

Age

Race and Hispanic origin Asian

2,911

191

107

143

232

401

224

Black

11,337

2,384

1,753

881

1,215

1,900

1,360

Hispanic

15,803

1,725

1,055

1,039

1,161

1,954

1,191

Non-Hispanic white

41,294

5,356

3,638

4,685

5,314

5,756

6,282

Mother and father

52,026

6,193

4,204

5,282

5,967

7,085

6,440

Mother, no father

17,287

3,255

2,262

1,506

1,961

2,984

2,355

Father, no mother

2,377

256

138

125

115

167

237

Neither mother nor father

2,169

486

349

157

211

278

417

Family structure

Parent’s education Less than high school diploma

9,255

929

688

423

555

918

797

High school diploma

15,437

2,088

1,372

1,173

1,293

1,737

1,734

More than high school

46,749

6,667

4,535

5,288

6,196

7,573

6,497

Less than $35,000

21,285

3,913

2,696

1,642

2,095

3,161

2,845

$35,000 to $54,999

10,230

1,148

809

711

943

1,382

1,239

$55,000 to $74,999

12,980

1,401

939

1,361

1,453

1,598

1,538

$75,000 to $99,999

8,719

1,324

849

996

1,200

1,242

1,048

15,555

1,955

1,357

2,020

2,239

2,444

2,342

Household income

$100,000 or more

Note: “Mother and father” can include biological, adoptive, step, in-law, or foster relationships. Legal guardians are classiﬁed as “neither mother nor father.” Parent’s education is the education level of the parent with the higher level of education. Other allergies include food or digestive allergies, eczema, and other skin allergies. Numbers of education and income may not add to total because “unknown” is not shown. Numbers by race do not add to total because not all races are shown and Hispanics may be of any race. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

275

Table 9.36

Distribution of Health Conditions by Selected Characteristics of Children, 2008

(percent distribution of people under age 18 with health condition by selected characteristics, 2008)

in last 12 months

asthma

TOTAL CHILDREN

total children

ever had

still have

100.0%

100.0%

100.0%

hay fever

100.0%

respiratory allergies

100.0%

prescription medication taken regularly other at least allergies 3 months

100.0%

100.0%

Sex Female

48.9

39.3

38.3

42.8

44.4

49.0

39.7

Male

51.1

60.7

61.7

57.2

55.6

51.0

60.3

Aged 0 to 4

28.2

14.7

18.4

13.5

20.8

30.2

15.8

Aged 5 to 11

38.2

44.9

45.4

45.2

41.2

40.1

42.4

Aged 12 to 17

33.6

40.4

36.2

41.2

38.1

29.7

41.8

Age

Race and Hispanic origin Asian

3.9

1.9

1.5

2.0

2.8

3.8

2.4

Black

15.3

23.4

25.2

12.5

14.7

18.1

14.4

Hispanic

21.4

16.9

15.2

14.7

14.1

18.6

12.6

Non-Hispanic white

55.9

52.6

52.3

66.3

64.4

54.7

66.5

Mother and father

70.4

60.8

60.5

74.7

72.3

67.4

68.2

Mother, no father

23.4

31.9

32.5

21.3

23.8

28.4

24.9

Father, no mother

3.2

2.5

2.0

1.8

1.4

1.6

2.5

Neither mother nor father

2.9

4.8

5.0

2.2

2.6

2.6

4.4

Family structure

Parent’s education Less than high school diploma

12.5

9.1

9.9

6.0

6.7

8.7

8.4

High school diploma

20.9

20.5

19.7

16.6

15.7

16.5

18.4

More than high school

63.3

65.4

65.2

74.8

75.1

72.0

68.8

Less than $35,000

28.8

38.4

38.8

23.2

25.4

30.1

30.1

$35,000 to $54,999

13.9

11.3

11.6

10.1

11.4

13.1

13.1

$55,000 to $74,999

17.6

13.7

13.5

19.3

17.6

15.2

16.3

$75,000 to $99,999

11.8

13.0

12.2

14.1

14.5

11.8

11.1

$100,000 or more

21.1

19.2

19.5

28.6

27.1

23.2

24.8

Household income

Note: “Mother and father” can include biological, adoptive, step, in-law, or foster relationships. Legal guardians are classiﬁed as “neither mother nor father.” Parent’s education is the education level of the parent with the higher level of education. Other allergies include food or digestive allergies, eczema, and other skin allergies. Numbers of education and income may not add to total because “unknown” is not shown. Numbers by race do not add to total because not all races are shown and Hispanics may be of any race. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

276 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.37

Percent of Children with Health Conditions by Selected Characteristics, 2008

(percent of people under age 18 with selected health conditions, by type of condition and selected characteristics, 2008)

in last 12 months

asthma total children

TOTAL CHILDREN

100.0%

ever had

13.8%

still have

9.4%

hay fever

9.6%

respiratory allergies

11.2%

prescription medication taken regularly other at least allergies 3 months

14.2%

12.8%

Sex Female

100.0

11.2

7.4

8.5

10.2

14.3

10.4

Male

100.0

16.5

11.5

10.9

12.2

14.2

15.2

Age Aged 0 to 4

100.0

7.2

6.2

4.6

8.2

15.3

7.2

Aged 5 to 11

100.0

16.2

11.2

11.4

12.1

14.9

14.2

Aged 12 to 17

100.0

16.6

10.2

11.8

12.7

12.6

15.9

Race and Hispanic origin Asian

100.0

6.5

3.6

4.8

7.9

13.7

7.6

Black

100.0

21.2

15.6

7.9

10.8

16.8

12.1

Hispanic

100.0

11.2

6.8

6.7

7.4

12.3

7.6

Non-Hispanic white

100.0

13.0

8.8

11.4

12.9

14.0

15.2

Mother and father

100.0

12.2

8.2

10.4

11.7

13.6

12.6

Mother, no father

100.0

19.1

13.3

8.8

11.3

17.4

13.6

Father, no mother

100.0

8.7

5.0

4.1

5.4

8.0

9.6

Neither mother nor father

100.0

21.3

15.7

7.8

10.8

13.9

18.1

Family structure

Parent’s education Less than high school diploma

100.0

10.4

7.7

4.6

6.0

9.9

8.9

High school diploma

100.0

13.7

8.9

7.7

8.4

11.3

11.3

More than high school

100.0

14.4

9.8

11.4

13.3

16.2

14.0

Less than $35,000

100.0

19.3

13.2

8.2

10.1

14.9

13.9

$35,000 to $54,999

100.0

11.2

7.9

6.9

9.3

13.5

12.1

$55,000 to $74,999

100.0

10.7

7.2

10.5

11.2

12.3

11.8

$75,000 to $99,999

100.0

14.9

9.6

11.3

13.8

14.3

11.9

$100,000 or more

100.0

12.5

8.7

12.8

14.2

15.7

14.6

Household income

Note: “Mother and father” can include biological, adoptive, step, in-law, or foster relationships. Legal guardians are classiﬁed as “neither mother nor father.” Parent’s education is the education level of the parent with the higher level of education. Other allergies include food or digestive allergies, eczema, and other skin allergies. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

277

Prescription Drug Use Is Increasing More Americans are using a growing number of prescriptions. The use of prescription drugs to treat a variety of illnesses, particularly chronic conditions, increased between 1988–94 and 2003–06. The percentage of people who took at least one drug in the past month rose from 38 to 47 percent during those years. The percentage using three or more prescription drugs in the past month climbed from 11 to 21 percent. The increase in prescription drug use was greatest among people aged 65 or older. The share of people aged 65 or older taking at least one prescription drug in the past month rose from 74 to 89 percent between 1988–94 and 2003–06. The percentage using three or more drugs grew from 35 to 63 percent. Women are more likely than men to have taken at least one prescription medication in the past month (53 versus 41 percent). Non-Hispanic whites are more likely to have used prescription drugs in the past month than are blacks or Mexican Americans (53.5 percent versus 39 and 25 percent, respectively). ■ Behind the increase in the use of prescriptions is the introduction and marketing of new drugs to treat chronic health problems.

90

60

Most Americans aged 65 or older take multiple prescription medications (percent of people aged 65 or older who took three or more prescription drugs in the past month, by sex, 1988–94 and 2003–06)

oh-six

65%

61%

60%

ninety-

38% 30

30%

31% 100000

0

0%

men men

all 1988–94

2003–06 dual

75000

women women

50000

25000

0

278 AMERICAN HEALTH

with

w/out

DISEASES AND CONDITIONS

Table 9.38

Prescription Drug Use by Sex and Age, 1988–94 and 2003–06

(percent of people aged 18 or older taking at least one or three or more prescription drugs in the past month, by sex and age, 1988–94 and 2003–06; percentage point change, 1988–94 to 2003–06) at least one 2003–06

1988–94

three or more percentage point change

2003–06

1988–94

percentage point change

Total people Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

47.3% 24.7 37.5 65.2 89.4

37.8% 20.5 31.3 54.8 73.6

9.5 4.2 6.2 10.4 15.8

21.4% 4.0 10.6 35.4 63.1

11.0% 2.4 5.7 20.0 35.3

10.4 1.6 4.9 15.4 27.8

Female Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

53.2 24.0 46.6 71.6 90.3

44.6 20.6 40.7 62.0 78.3

8.6 3.4 5.9 9.6 12.0

25.1 4.0 14.3 40.6 64.8

13.6 2.3 7.6 24.7 38.2

11.5 1.7 6.7 15.9 26.6

Male Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

41.2 25.3 28.1 58.4 88.2

30.6 20.4 21.5 47.2 67.2

10.6 4.9 6.6 11.2 21.0

17.5 4.0 6.9 30.0 60.8

8.3 2.6 3.6 15.1 31.3

9.2 1.4 3.3 14.9 29.5

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calclulations by New Strategist

AMERICAN HEALTH

279

Table 9.39

Prescription Drug Use by Race, Hispanic Origin, and Age, 1988–94 and 2003–06

(percent of people aged 18 or older taking at least one or three or more prescription drugs in the past month, by race, Hispanic origin, and age, 1988–94 and 2003–06; percentage point change, 1988–94 to 2003–06) at least one 2003–06

1988–94

three or more percentage point change

2003–06

1988–94

percentage point change

Total people Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

47.3% 24.7 37.5 65.2 89.4

37.8% 20.5 31.3 54.8 73.6

9.5 4.2 6.2 10.4 15.8

21.4% 4.0 10.6 35.4 63.1

11.0% 2.4 5.7 20.0 35.3

10.4 1.6 4.9 15.4 27.8

Black, non-Hispanic Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

38.7 19.4 29.9 63.3 87.4

31.2 14.8 27.8 57.5 74.5

7.5 4.6 2.1 5.8 12.9

16.6 3.4 8.1 33.8 60.7

12.6 1.5 5.4 21.9 41.2

4.0 1.9 2.7 11.9 19.5

Hispanic, Mexican Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

25.2 16.3 19.8 53.3 74.5

24.0 16.1 21.1 48.1 67.7

1.2 0.2 -1.3 5.2 6.8

8.5 2.2 4.4 27.8 49.0

4.8 1.2 3.0 16.0 31.3

3.7 1.0 1.4 11.8 17.7

White, non-Hispanic Under age 18 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

53.5 28.5 43.3 67.3 90.6

41.4 22.9 34.3 55.5 74.0

12.1 5.6 9.0 11.8 16.6

25.3 4.9 12.9 37.0 64.8

12.4 3.2 6.3 20.9 35.0

12.9 1.7 6.6 16.1 29.8

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calclulations by New Strategist

280 AMERICAN HEALTH

DISEASES AND CONDITIONS

Some Health Conditions Are More Costly than Others The top four are cancer, trauma, heart conditions, and mental illness. Fifty million Americans were treated for hypertension in 2007, making it the single most common condition for which medical treatment was received. Trauma was the number-one reason for an emergency room visit, with 12 million visiting an emergency room for this reason. Normal childbirth produced the largest number of hospital stays—more than 3 million. Forty-eight million people got prescription medication for hypertension in 2007. The nation spent more than $98 billion on cancer treatments in 2007, another $83 billion on trauma-related disorders, $82 billion on heart conditions, and $61 billion on mental disorders. On a per event basis, though, the highest average expenditure is for the treatment of gallbladder, pancreatic, and liver disease ($1,477 per event). Appendicitis ranks ﬁrst in expenditures on a per-person basis, costing $8,270 per person with the condition in 2007 because many end up with a hospital stay. ■ Reducing the incidence of trauma would have a noticeable impact on health care spending in the United States.

Cancer is the most expensive health condition (total amount spent on selected health conditions, 2007)

120

$98 billion $83 billion

80$80 billion

$82 billion $61 billion

40$40 billion

0

$0

a cancer

b trauma-related disorders

c heart conditions

mentald disorders

AMERICAN HEALTH

281

Table 9.40

Number of Health Events by Condition and Type of Service, 2007

(number of health events by condition and type of service, 2007; numbers in thousands) hospital outpatient or total ofﬁce-based events provider

Cancer Trauma-related disorders Heart conditions Mental disorders Chronic obstructive pulmonary disease, asthma Diabetes mellitus Hypertension Osteoarthritis and other nontraumatic joint disorders Normal birth, live born Hyperlipidemia Back problems Disorders of the upper gastrointestinal tract Cerebrovascular disease Kidney disease Skin disorders Gallbladder, pancreatic, and liver disease Systemic lupus and connective tissues disorders Infectious diseases Pneumonia Female genital disorders and contraception Hereditary, degenerative, and other nervous system disorders Acute bronchitis and upper respiratory infections Congenital anomalies Epilepsy and convulsions Headache Hernias Thyroid disease Cataracts Nonmalignant neoplasm Urinary tract infections Anemia and other deﬁciencies Male genital disorders Glaucoma Intestinal infections Otitis media (ear infections) Appendicitis Paralysis Allergic reactions Complications of surgery or device Poisoning by medical and nonmedical substances Complications of pregnancy and birth Hemorrhagic, coagulation, white blood cell disorders Nonmalignant breast disease Tonsillitis Disorders of teeth and jaws Inﬂuenza Disorders of mouth and esophagus

hospital inpatient stay

emergency room visit

prescribed medicines

home health care

91,293 178,157 128,956 235,601 200,712 158,009 251,796 140,420 48,277 136,348 148,285 64,192 20,123 44,983 73,697 11,926 69,828 46,350 13,242 37,399

75,150 135,608 60,059 130,000 80,267 64,303 76,391 92,864 38,950 51,943 122,842 21,031 10,600 36,621 41,329 7,899 50,881 26,404 5,963 15,125

2,139 2,254 3,315 946 1,599 703 695 675 3,255 – 560 541 1,421 750 655 953 209 513 1,029 328

765 13,855 3,369 1,384 3,900 563 825 783 979 – 1,256 1,471 867 1,104 1,752 988 715 1,470 1,295 646

10,933 23,422 56,242 91,753 111,956 88,131 169,580 39,680 4,939 83,371 23,627 40,802 4,414 5,631 28,510 2,086 16,246 17,963 4,955 21,300

2,306 3,018 5,971 11,518 2,990 4,309 4,305 6,418 154 1,034 – 347 2,821 877 1,451 – 1,777 – – –

17,449 83,716 6,618 10,310 32,585 7,457 50,010 17,804 9,902 22,009 11,215 14,781 18,328 14,901 32,746 999 3,123 19,383 3,137 5,532 4,570 3,491 4,477 3,788 12,503 5,060

8,225 42,320 5,220 3,297 17,097 5,093 18,073 14,571 8,628 10,894 8,279 6,693 8,424 7,670 17,758 – 1,524 9,633 1,840 2,882 2,651 2,359 4,138 2,243 2,325 2,678

– 170 – 397 – 314 – – 275 395 – – – 374 – 308 – – – 159 188 – – – – –

– 1,803 – 703 1,524 – – – – 1,028 – – – 1,373 879 285 – 748 258 853 465 – – – – –

7,792 39,423 1,398 5,913 13,964 2,050 31,937 3,233 999 9,692 2,936 8,088 9,904 5,484 14,109 406 – 9,002 1,039 1,638 1,266 1,132 339 1,545 10,178 2,382

1,432 – – – – – – – – – – – – – – – 1,599 – – – – – – – – –

1,701

619

–

–

1,082

–

Note: “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

282 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.41

Number of People Experiencing Health Events by Condition and Type of Service, 2007

(number of people experiencing health events by condition and type of service, 2007; people in thousands) hospital outpatient or total ofﬁce-based events provider

Cancer Trauma-related disorders Heart conditions Mental disorders Chronic obstructive pulmonary disease, asthma Diabetes mellitus Hypertension Osteoarthritis and other nontraumatic joint disorders Normal birth, live born Hyperlipidemia Back problems Disorders of the upper gastrointestinal tract Cerebrovascular disease Kidney disease Skin disorders Gallbladder, pancreatic, and liver disease Systemic lupus and connective tissues disorders Infectious diseases Pneumonia Female genital disorders and contraception Hereditary, degenerative, and other nervous system disorders Acute bronchitis and upper respiratory infections Congenital anomalies Epilepsy and convulsions Headache Hernias Thyroid disease Cataracts Nonmalignant neoplasm Urinary tract infections Anemia and other deﬁciencies Male genital disorders Glaucoma Intestinal infections Otitis media (ear infections) Appendicitis Paralysis Allergic reactions Perinatal conditions Complications of surgery or device Poisoning by medical and nonmedical substances Complications of pregnancy and birth Central nervous system infections Hemorrhagic, coagulation, white blood cell disorders Nonmalignant breast disease Tonsillitis Disorders of teeth and jaws Inﬂuenza Disorders of mouth and esophagus

hospital inpatient stay

emergency room visit

prescribed medicines

home health care

12,738 34,778 20,823 36,166 45,900 19,468 50,471 27,622 6,280 36,673 19,743 21,514 3,331 4,031 23,084 2,948 14,489 16,555 3,834 14,339

11,866 26,358 14,532 19,911 27,035 15,046 26,867 20,381 5,850 19,988 16,656 8,506 2,255 2,886 17,275 2,354 11,744 12,164 2,758 5,416

1,564 1,970 2,603 809 1,172 479 590 552 3,125 – 511 503 1,073 604 587 844 209 499 875 259

499 12,230 2,785 1,088 2,948 440 661 647 703 – 1,125 995 772 863 1,392 802 677 1,287 995 488

4,511 13,718 15,305 30,888 39,335 18,322 48,431 17,095 2,783 33,407 10,040 19,155 1,845 2,376 15,078 1,094 7,826 10,600 2,773 11,551

669 790 1,161 1,932 663 697 758 1,213 – 250 472 124 571 176 349 – 388 127 179 –

2,567 31,940 1,600 2,274 8,203 2,513 14,312 4,463 4,549 7,828 2,702 4,431 4,006 7,553 10,432 379 378 6,206 196 1,013 2,198 1,340 195 975 2,098 1,241 7,132 2,507 1,026

1,396 26,647 1,413 1,105 4,796 1,852 6,918 4,384 4,372 5,629 1,683 2,500 3,243 5,606 8,468 – 290 4,396 – 575 1,314 751 – 627 2,015 1,102 968 2,141 472

– 162 – 331 – 305 – – 247 364 – – – 360 – 308 – – – – – 186 – – – – – – –

– 1,672 – 514 964 168 – – – 870 – – – 1,239 816 277 – 635 – 202 654 357 – – – – 344 – –

2,235 24,755 650 2,028 5,864 1,177 13,420 1,575 701 6,542 1,602 3,741 3,076 4,132 9,014 271 189 4,685 – 553 1,136 786 – 604 262 910 6,542 1,642 766

224 – – – – – – – – – – – – – – – 164 – – – – – – – – – – – –

Note: “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

283

Table 9.42

Cost of Health Events by Condition and Type of Service, 2007

(amount spent on health events by condition and type of service, 2007; in millions of dollars) total hospital spent on outpatient or health ofﬁce-based events provider

Cancer Trauma-related disorders Heart conditions Mental disorders Chronic obstructive pulmonary disease, asthma Diabetes mellitus Hypertension Osteoarthritis, other nontraumatic joint disorders Normal birth, live born Hyperlipidemia Back problems Disorders of the upper gastrointestinal tract Cerebrovascular disease Kidney disease Skin disorders Gallbladder, pancreatic, and liver disease Systemic lupus and connective tissues disorders Infectious diseases Pneumonia Female genital disorders and contraception Hereditary, degenerative, and other nervous system disorders Acute bronchitis and upper respiratory infections Epilepsy and convulsions Headache Hernias Thyroid disease Cataracts Nonmalignant neoplasm Urinary tract infections Anemia and other deﬁciencies Male genital disorders Glaucoma Intestinal infections Otitis media (ear infections) Allergic reactions Poisoning by medical and nonmedical substances Complications of pregnancy and birth Hemorrhagic, coagulation, white blood cell disorders Nonmalignant breast disease Tonsillitis Disorders of teeth and jaws Inﬂuenza

hospital inpatient stay

emergency room visit

prescribed medicines

home health care

$97,917 83,178 82,167 61,348 51,085 41,182 40,678 40,175 33,353 31,476 30,467 25,273 25,155 24,132 22,296 17,609 16,037 15,912 14,919 12,034

$43,588 31,268 13,707 13,528 10,788 9,887 9,781 16,865 9,378 7,328 18,470 5,162 – 11,493 8,365 4,374 9,874 4,741 935 6,143

$41,330 37,267 49,778 10,468 16,243 – 6,168 10,375 23,149 – 5,749 5,031 17,869 8,977 6,903 11,523 – 5,589 12,214 –

– $9,970 3,869 957 1,854 469 641 298 507 – 856 1,038 582 1,464 792 956 384 734 808 504

$9,371 1,658 8,479 26,144 19,414 19,214 20,436 7,920 252 22,148 4,455 13,719 1,333 1,326 4,562 – 1,946 4,505 262 2,807

$2,851 3,015 6,333 10,250 2,786 3,731 3,651 4,718 – 798 – – 2,881 – 1,674 – 951 – – –

11,033 10,466 9,569 8,303 7,292 6,263 6,164 5,878 5,786 4,914 4,796 3,959 3,596 3,366 2,807 2,467 2,381 – 1,759 1,331 1,018

– 5,678 – 2,883 2,993 2,671 5,847 3,020 1,447 1,736 – 1,815 869 2,574 1,348 400 – 379 1,504 912 578

– – – – 3,311 – – – 2,424 – – – 1,594 – – – – – – – –

– 674 – 1,195 – – – – 778 – – – 701 261 299 517 358 – – – –

5,663 1,797 2,268 3,350 650 1,979 246 65 765 – 1,582 1,803 – 506 705 101 – – – – 247

– – – – – – – – – – – – – – – – – – – – –

479

307

–

–

112

–

Note: “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp”

284 AMERICAN HEALTH

DISEASES AND CONDITIONS

Table 9.43

Average Expense Per Health Event, by Condition and Type of Service, 2007

(average expense per health event by condition and type of service, 2007; in dollars) hospital average outpatient or expense ofﬁce-based per event provider

Cancer $1,073 Trauma-related disorders 467 Heart conditions 637 Mental disorders 260 Chronic obstructive pulmonary disease, asthma 255 Diabetes mellitus 261 Hypertension 162 Osteoarthritis and other nontraumatic joint disorders 286 Normal birth, live born 691 Hyperlipidemia 231 Back problems 205 Disorders of the upper gastrointestinal tract 394 Cerebrovascular disease 1,250 Kidney disease 536 Skin disorders 303 Gallbladder, pancreatic, and liver disease 1,477 Systemic lupus and connective tissues disorders 230 Infectious diseases 343 Pneumonia 1,127 Female genital disorders and contraception 322 Hereditary, degenerative, other nervous system disorders 632 Acute bronchitis and upper respiratory infections 125 Epilepsy and convulsions 928 Headache 255 Hernias 978 Thyroid disease 125 Cataracts 346 Nonmalignant neoplasm 594 Urinary tract infections 263 Anemia and other deﬁciencies 438 Male genital disorders 324 Glaucoma 216 Intestinal infections 241 Otitis media (ear infections) 103 Allergic reactions 145 Poisoning by medical and nonmedical substances 446 Complications of pregnancy and birth 521 Hemorrhagic, coagulation, white blood cell disorders – Nonmalignant breast disease 393 Tonsillitis 351 Disorders of teeth and jaws 81 Inﬂuenza 95

$580 231 228 104 134 154 128 182 241 141 150 245 – 314 202 554 194 180 157 406 – 134 – 169 588 148 401 350 133 210 – 215 113 145 140 139 – 161 363 407 248 115

hospital inpatient stay

emergency room visit

prescribed medicines

home health care

$19,322 16,534 15,016 11,065 10,158 – 8,875 15,371 7,112 – 10,266 9,299 12,575 11,969 10,539 12,092 – 10,896 11,870 – – – – – 10,543 – – – 6,138 – – – 4,263 – – – – – – – – –

– $720 1,148 692 475 833 777 380 518 – 682 705 671 1,326 452 967 537 500 624 781 – 374 – 784 – – – – 757 – – – 511 297 399 606 771 – – – – –

$857 71 151 285 173 218 121 200 51 266 189 336 302 235 160 – 120 251 53 132 727 46 384 240 317 62 76 65 79 – 196 182 – 36 78 61 – – – – 24 47

$1,236 999 1,061 890 932 866 848 735 – 772 – – 1,021 – 1,154 – 535 – – – – – – – – – – – – – – – – – – – – – – – – –

Note: “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps. ahrq.gov/mepsweb/survey_comp/household.jsp

AMERICAN HEALTH

285

Table 9.44

Average Expense Per Person Experiencing Health Event, by Condition and Type of Service, 2007

(average expense per person experiencing health event by condition and type of service, 2007; in dollars) average hospital expense outpatient or per person ofﬁce-based with event provider

Cancer Trauma-related disorders Heart conditions Mental disorders Chronic obstructive pulmonary disease, asthma Diabetes mellitus Hypertension Osteoarthritis and other nontraumatic joint disorders Normal birth, live born Hyperlipidemia Back problems Disorders of the upper gastrointestinal tract Cerebrovascular disease Kidney disease Skin disorders Gallbladder, pancreatic, and liver disease Systemic lupus and connective tissues disorders Infectious diseases Pneumonia Female genital disorders and contraception Hereditary, degenerative, and other nervous system disorders Acute bronchitis and upper respiratory infections Congenital anomalies Epilepsy and convulsions Headache Hernias Thyroid disease Cataracts Nonmalignant neoplasm Urinary tract infections Anemia and other deﬁciencies Male genital disorders Glaucoma Intestinal infections Otitis media (ear infections) Appendicitis Paralysis Allergic reactions Complications of surgery or device Poisoning by medical and nonmedical substances Complications of pregnancy and birth Hemorrhagic, coagulation, white blood cell disorders Nonmalignant breast disease Tonsillitis Disorders of teeth and jaws Coma, brain damage Inﬂuenza Disorders of mouth and esophagus

hospital inpatient stay

emergency room visit

prescribed medicines

home health care

$7,687 2,392 3,949 1,706 1,113 2,116 806 1,456 5,311 858 1,544 1,175 7,657 5,996 966 5,985 1,107 961 3,892 840

$3,673 1,186 945 679 399 657 364 827 1,603 367 1,109 607 – 3,982 484 1,858 841 390 339 1,135

$26,419 18,916 19,123 12,940 13,862 – 10,448 18,783 7,407 16,174 11,251 10,007 16,646 14,862 11,751 13,656 – 11,195 13,957 9,939

– $815 1,389 880 629 1,067 971 460 722 – 761 1,043 754 1,695 569 1,191 566 571 812 1,034

$2,077 121 554 846 494 1,049 422 463 91 663 444 716 722 558 303 – 249 425 94 243

$4,928 4,450 6,175 6,879 4,818 5,936 5,272 4,669 – 3,406 – – 6,166 5,148 5,316 – 2,724 3,311 4,227 –

4,311 328 – 4,208 1,012 2,902 438 1,381 1,292 739 1,818 1,082 988 476 323 8,270 7,903 452 – 1,127 1,777 – 839 $1,073 143 – 191 –

– 213 – – 601 1,616 386 1,334 691 257 1,031 – 560 155 304 – 819 307 863 305 1,045 604 746 $828 597 – 143 –

– – 15,344 12,568 – 10,852 – – 10,954 6,668 – 11,037 -4,428 – 8,183 7,938 7,256 – 9,848 5,719 – 8,425 $4,396 – – – –

210 403 – 1,056 1,239 – – – 804 894 791 484 – 566 320 – – 471 – 791 1,003 – – – $309 1,429 309 –

2,534 73 – 1,118 571 553 147 156 93 117 – 423 586 – 56 – – 150 – 89 – – – $50 38 – 68 78

3,513 – – – 2,441 – 4,595 – – – 4,758 – – – – – 16,336 – 2,088 – – – – – – – – –

Note: “–” means sample is too small to make a reliable estimate. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp

286 AMERICAN HEALTH

HEALTH CARE VISITS CHAPTER

10 Health Care Visits ■ Physician visits are declining as American incomes shrink. The number of physician ofﬁce visits fell 6 percent between 2005 and 2006.

■ Most adults have been to a doctor in the past year. Eighty percent of people aged 18 or older have seen a doctor in the past year, as have nearly 90 percent of children.

■ Only 19 percent of physician ofﬁce visits are for preventive care. New health problems bring the largest share of people to the doctor (35 percent). Routine visits for chronic health problems rank second at 29 percent.

■ Most doctor visits last less than 15 minutes. The median amount of time people spend with the doctor is just 14.9 minutes.

■ Drugs are prescribed in 71 percent of physician ofﬁce visits. The average person ﬁlled or reﬁlled a prescription 16.5 times in 2006.

■ Fifty-nine percent of adults have been to a dentist in the past year. Only 41 percent of people in households with incomes below $35,000 have been to a dentist in the past year.

AMERICAN HEALTH

287

Physician Visits Have Declined The number of visits peaked in 2005, then fell in 2006. Americans made more than 1 billion visits to doctors’ ofﬁces, hospital outpatient departments, and hospital emergency rooms in 2006. Physician ofﬁce visits account for 80 percent of the total. The number of visits to physicians fell by 6 percent between 2005 and 2006 as health care costs soared and Americans tightened their belts. In contrast, visits to hospital outpatient departments and emergency rooms continued to rise and are at an all-time high. A growing percentage of the public—especially people aged 18 to 64—are reporting not getting medical care, delaying medical care, or not getting prescriptions ﬁlled because of the cost. Visits to hospital outpatient departments accounted for 9 percent of health care visits in 2006. A larger 11 percent were emergency room visits. The use of emergency rooms is highest among 15-to-24-year-olds, and ERs account for 19 percent of the health care visits made by the age group. Many young adults do not have health insurance, forcing them to go to the emergency room when problems occur. Twenty-one percent of health care visits by blacks are to emergency rooms. ■ Better access to health care clinics could lower health care costs by diverting emergency room visits to a less-expensive setting.

Physician visits have declined recently as people tighten their belts

1200

800 million 800

(number of physician visits, 1996 to 2006)

�

�

�

�

�

� � �

�

400 million 400

00

1996 a

288 AMERICAN HEALTH

2000 b

2001 c

2002 d

2003 e

2004 f

2005 g

2006 h

HEALTH CARE VISITS

Table 10.1

Health Care Visits, 1996 to 2006

(number of visits to physicians’ ofﬁces, hospital outpatient departments, and emergency rooms, and visits per 100 persons per year, 1996 to 2006; percent change in number of visits and rate, 1996–2006 and 2005–06; numbers in thousands) physician ofﬁce visits

2006 2005 2004 2003 2002 2001 2000 1996

hospital inpatient visits

emergency visits

all visits

number

rate

number

rate

number

rate

1,123,353 1,169,333 1,106,067 1,114,504 1,083,474 1,071,692 1,014,848 892,026

901,954 963,617 910,857 906,023 889,980 880,487 823,542 734,493

306.6 331.0 315.9 317.3 314.4 314.4 300.4 277.8

102,208 90,393 84,994 94,578 83,339 83,715 83,289 67,186

34.7 31.0 29.5 33.1 29.4 29.9 30.4 25.4

119,191 115,323 110,216 113,903 110,155 107,490 108,017 90,347

40.5 39.6 38.2 39.9 38.9 38.4 39.4 34.2

Percent change 2005 to 2006 –3.9% 1996 to 2006 25.9

–6.4% 22.8

–7.4% 10.4

13.1% 52.1

11.9% 36.6

3.4% 31.9

2.3% 18.4

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey, 1996 to 2006, Internet site http:// www.cdc.gov/nchs/ahcd/ahcd_reports.htm; calculations by New Strategist

AMERICAN HEALTH

289

Table 10.2

Delayed Medical Care, 1997 and 2007

(percent of people who did not get medical care or delayed medical care due to cost, by age and health insurance coverage status, 1997 and 2007; percentage point change, 1997–2007)

Did not get medical care due to cost TOTAL Under age 18 Aged 18 to 64 Aged 18 to 44 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 64 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

Insured continuously Uninsured any time during year Uninsured entire year

2007

1997

5.8% 2.3 7.8 7.9 7.1 8.6 7.9 7.7 8.3 6.9 2.5

4.5% 2.2 6.0 6.1 5.8 6.2 6.0 5.8 6.0 5.4 2.3

percentage point change

1.3 0.1 1.8 1.8 1.3 2.4 1.9 1.9 2.3 1.5 0.2

2.5 20.2 23.7

1.8 14.3 18.9

0.7 5.9 4.8

TOTAL Under age 18 Aged 18 to 64 Aged 18 to 44 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 64 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

7.8 3.3 10.3 10.4 9.3 11.0 10.5 10.3 10.8 9.6 3.8

7.3 3.7 9.5 9.7 8.8 10.2 9.8 9.0 9.6 8.2 3.9

0.5 –0.4 0.8 0.7 0.5 0.8 0.7 1.3 1.2 1.4 –0.1

Insured continuously Uninsured any time during year Uninsured entire year

4.0 24.7 27.8

3.9 22.5 23.9

0.1 2.2 3.9

Delayed medical care due to cost

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

290 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.3

Did Not Get Prescriptions, 1997 and 2007

(percent of people who did not get prescriptions due to cost, by age and health insurance coverage status, 1997 and 2007; percentage point change, 1997–2007) 2007

TOTAL Under age 18 Aged 18 to 64 Aged 18 to 44 Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 64 Aged 45 to 54 Aged 55 to 64 Aged 65 or older

7.2% 2.6 9.6 10.0 9.0 10.9 9.8 9.1 10.0 7.9 3.8

Insured continuously Uninsured any time during year Uninsured entire year

3.7 21.7 24.3

1997

percentage point change

2.2 14.9 16.7

1.5 6.8 7.6

4.8% 2.2 6.3 6.9 6.7 6.9 7.1 5.1 5.6 4.2 2.8

2.4 0.4 3.3 3.1 2.3 4.0 2.7 4.0 4.4 3.7 1.0

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

291

Table 10.4

Health Care Visits by Age, 2006

(number and percent distribution of visits to physicians’ ofﬁces, hospital outpatient departments, and emergency rooms, by age, 2006; numbers in thousands)

NUMBER Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older

total

physicians’ ofﬁces

hospital outpatient departments

hospital emergency departments

1,123,354 199,646 103,948 245,443 310,667 263,649

901,954 157,906 72,411 185,305 256,494 229,837

102,208 19,864 12,012 25,104 28,707 16,522

119,191 21,876 19,525 35,034 25,466 17,290

PERCENT DISTRIBUTION BY PLACE OF CARE Total visits 100.0% 80.3% Under age 15 100.0 79.1 Aged 15 to 24 100.0 69.7 Aged 25 to 44 100.0 75.5 Aged 45 to 64 100.0 82.6 Aged 65 to 74 100.0 87.2

9.1% 9.9 11.6 10.2 9.2 6.3

10.6% 11.0 18.8 14.3 8.2 6.6

Source: National Center for Health Statistics, Ambulatory Medical Care Utilization Estimates for 2006, National Health Statistics Reports, No. 8, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm; calculations by New Strategist

Table 10.5

Health Care Visits by Race and Hispanic Origin, 2006

(number and percent distribution of visits to physicians’ ofﬁces, hospital outpatient departments, and emergency rooms, by race and Hispanic origin, 2006; numbers in thousands)

NUMBER Total visits Asian Black Hispanic White

total

physicians’ ofﬁces

hospital outpatient departments

hospital emergency rooms

1,123,354 43,742 140,066 151,762 923,722

901,954 38,683 87,040 118,695 764,636

102,208 2,673 23,468 17,595 73,814

119,191 2,386 29,558 15,472 85,273

PERCENT DISTRIBUTION BY PLACE OF CARE Total visits 100.0% 80.3% Asian 100.0 88.4 Black 100.0 62.1 Hispanic 100.0 78.2 White 100.0 82.8

9.1% 6.1 16.8 11.6 8.0

10.6% 5.5 21.1 10.2 9.2

Note: Numbers by race do not add to total because Hispanics may be of any race and not all races are shown. Source: National Center for Health Statistics, Ambulatory Medical Care Utilization Estimates for 2006, National Health Statistics Reports, No. 8, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm; calculations by New Strategist

292 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.6

Health Care Visits by Sex, 2006

(number and percent distribution of visits to physicians’ ofﬁces, hospital outpatient departments, and emergency rooms, by sex, 2006; numbers in thousands)

NUMBER Total visits Female Male

total

physicians’ ofﬁces

hospital outpatient departments

hospital emergency rooms

1,123,354 660,205 463,148

901,954 533,292 368,662

102,208 61,952 40,256

119,191 64,962 54,230

PERCENT DISTRIBUTION BY PLACE OF CARE Total visits 100.0% 80.3% Female 100.0 80.8 Male 100.0 79.6

9.1% 9.4 8.7

10.6% 9.8 11.7

Source: National Center for Health Statistics, Ambulatory Medical Care Utilization Estimates for 2006, National Health Statistics Reports, No. 8, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm; calculations by New Strategist

AMERICAN HEALTH

293

Women Are More Likely than Men to Visit Health Care Providers Men are less likely to visit and wait longer between visits. Nearly 80 percent of adults visit the ofﬁce of a health care provider at least once a year. Men are less likely than women to go to the doctor. Twenty-ﬁve percent of men did not visit a health care provider at all in 2008 compared with only 12 percent of women. Among all demographic segments, Hispanics are least likely to have visited a health care provider in the past year, with 32 percent not going to the doctor at all. Most adults have seen a doctor within the past six months. But a substantial 9 million have not visited a doctor in at least ﬁve years—4 percent of the adult population. Among the uninsured, a larger 14 percent have not been to a doctor in at least ﬁve years. ■ With some important health problems presenting no symptoms, such as high cholesterol, many people would beneﬁt from some type of annual check-up.

Many men did not go to the doctor in 2008

60

(percent distribution of people aged 18 or older by number of ofﬁce visits to a health care professional in the past 12 months, by sex, 2008

men

wom

45%

40

40%

25%

20

25%

27%

30%

18%

20%

12%

14% 100000

0

0%

no a visits

75000

onebvisit

all men

women dual

two to three c visits

four or more d visits

50000

25000

0

294 AMERICAN HEALTH

with

w/out

HEALTH CARE VISITS

Table 10.7

Number of Ofﬁce Visits to a Health Care Professional by Selected Characteristics, 2008

(number of people aged 18 or older by number of ofﬁce visits to health care professionals in past 12 months, by selected characteristics, 2008; numbers in thousands) one or more visits two to three

four to nine

10 or more

TOTAL ADULTS Sex Men Women

225,227

41,056

179,614

36,572

58,779

54,163

30,100

108,755 116,472

27,304 13,752

79,191 100,423

19,819 16,753

27,146 31,633

21,526 32,637

10,700 19,400

Age Aged 18 to 44

110,615 77,335 19,869 17,409

27,487 11,392 1,375 802

81,214 64,414 18,012 15,975

20,895 12,176 2,269 1,232

28,326 21,578 4,974 3,901

20,249 19,766 7,184 6,965

11,744 10,894 3,585 3,877

Race and Hispanic origin Asian 10,501 Black 26,765 Hispanic 30,583 Non-Hispanic white 154,483

2,220 5,258 9,715 23,618

8,106 20,876 20,305 127,727

2,092 4,614 5,645 23,760

3,092 6,871 6,560 41,453

2,027 6,254 5,194 39,903

895 3,137 2,906 22,611

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

6,916 10,341 8,773 6,740

21,387 42,380 45,456 48,927

4,332 8,096 8,650 9,760

5,654 13,278 14,754 17,296

6,990 13,603 14,078 14,130

4,411 7,403 7,974 7,741

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

15,141 7,056 7,204 3,787 4,923

51,688 24,177 30,524 21,692 37,685

10,095 4,810 6,611 5,025 7,414

14,115 7,521 10,091 7,412 14,977

16,310 7,548 9,008 6,010 10,743

11,168 4,298 4,814 3,245 4,551

Health insurance coverage among adults under age 65 Private 127,168 Medicaid 15,447 Other 7,545 Uninsured 36,854

18,688 2,098 656 17,215

106,347 13,047 6,642 18,902

23,265 1,754 930 6,905

38,669 3,266 1,623 6,175

29,710 4,058 2,263 3,817

14,703 3,969 1,826 2,005

Aged 45 to 64 Aged 65 to 74 Aged 75 or older

total

none

total

one

Note: Ofﬁce visits include visits to physicians’ ofﬁces and clinics but exclude overnight hospitalizations, visits to hospital emergency rooms, home visits, and telephone calls. Numbers may not add to total because “not reported” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

295

Table 10.8

Percent Distribution of Ofﬁce Visits to Health Care Professionals by Selected Characteristics, 2008

(percent distribution of people aged 18 or older by number of ofﬁce visits to health care professionals in past 12 months, by selected characteristics, 2008) one or more visits total

none

total

one

100.0%

18.2%

79.7%

16.2%

26.1%

24.0%

13.4%

100.0 100.0

25.1 11.8

72.8 86.2

18.2 14.4

25.0 27.2

19.8 28.0

9.8 16.7

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

100.0 100.0 100.0 100.0

24.8 14.7 6.9 4.6

73.4 83.3 90.7 91.8

18.9 15.7 11.4 7.1

25.6 27.9 25.0 22.4

18.3 25.6 36.2 40.0

10.6 14.1 18.0 22.3

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

100.0 100.0 100.0 100.0

21.1 19.6 31.8 15.3

77.2 78.0 66.4 82.7

19.9 17.2 18.5 15.4

29.4 25.7 21.4 26.8

19.3 23.4 17.0 25.8

8.5 11.7 9.5 14.6

Education Less than high school High school graduate Some college College graduate

100.0 100.0 100.0 100.0

23.8 19.2 15.9 11.9

73.7 78.7 82.4 86.3

14.9 15.0 15.7 17.2

19.5 24.6 26.7 30.5

24.1 25.2 25.5 24.9

15.2 13.7 14.5 13.7

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

22.2 22.2 18.8 14.7 11.4

75.6 76.2 79.7 83.9 87.3

14.8 15.2 17.3 19.4 17.2

20.7 23.7 26.3 28.7 34.7

23.9 23.8 23.5 23.3 24.9

16.3 13.6 12.6 12.6 10.5

Health insurance coverage among adults under age 65 Private Medicaid Other Uninsured

100.0 100.0 100.0 100.0

14.7 13.6 8.7 46.7

83.6 84.5 88.0 51.3

18.3 11.4 12.3 18.7

30.4 21.1 21.5 16.8

23.4 26.3 30.0 10.4

11.6 25.7 24.2 5.4

TOTAL ADULTS Sex Men Women

two to three

four to nine

10 or more

Note: Ofﬁce visits include visits to physicians’ ofﬁces and clinics but exclude overnight hospitalizations, visits to hospital emergency rooms, home visits, and telephone calls. Numbers may not add to total because “not reported” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

296 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.9

Length of Time since Last Ofﬁce Visit to a Health Care Professional by Selected Characteristics, 2008

(total number of people aged 18 or older and distribution by length of time since last ofﬁce visit to a health care professional, by selected characteristics, 2008; numbers in thousands) time since last ofﬁce visit more than six months, not more than one year

more than one year, not more than two years

more than two years, not more than ﬁve years

more than ﬁve years (excl. never)

never

total

six months or less

TOTAL ADULTS Sex Men Women

225,227

151,901

31,164

16,954

12,009

6,501

2,889

108,755 116,472

65,678 86,223

15,455 15,709

10,455 6,499

8,356 3,653

5,076 1,425

1,771 1,118

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

110,615 77,335 19,869 17,409

64,486 55,379 16,613 15,423

18,618 10,088 1,458 999

11,510 4,502 638 304

8,218 3,348 273 170

3,997 2,006 389 108

1,960 659 216 54

Race and Hispanic origin Asian 10,501 Black 26,765 Hispanic 30,583 Non-Hispanic white 154,483

6,363 17,626 16,457 109,428

1,965 3,865 4,440 20,319

966 2,044 2,946 10,859

605 1,674 2,891 6,757

311 555 2,026 3,553

144 463 1,294 1,009

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

18,910 37,033 38,503 40,855

3,275 6,269 7,742 8,366

2,120 3,938 3,724 3,378

1,922 3,133 2,503 2,040

1,462 1,902 1,429 766

787 684 476 379

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

44,889 20,726 25,517 17,886 30,895

8,630 3,778 5,379 4,140 6,859

5,220 2,813 3,021 1,854 2,688

4,162 2,458 2,321 1,035 1,238

3,030 990 1,037 495 549

1,116 507 499 107 407

Health insurance coverage among adults under age 65 Private 127,168 Medicaid 15,447 Other 7,545 Uninsured 36,854

87,441 11,991 6,030 13,953

19,963 1,473 769 6,261

9,420 859 330 5,289

5,363 466 126 5,527

2,024 195 92 3,660

1,003 200 – 1,379

Note: Ofﬁce visits include visits to physicians’ ofﬁces and clinics but exclude overnight hospitalizations, visits to hospital emergency rooms, home visits, and telephone calls. Numbers may not add to total because “not reported” is not shown. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

297

Table 10.10

Percent Distribution by Length of Time since Last Ofﬁce Visit to a Health Care Professional, 2008

(percent distribution of people aged 18 or older by length of time since last ofﬁce visit to a health care professional, by selected characteristics, 2008) time since last ofﬁce visit more than six months, not more than one year

more than one year, not more than two years

more than two years, not more than ﬁve years

more than ﬁve years (excl. never)

never

TOTAL ADULTS Sex Men Women

total

six months or less

100.0 100.0

60.4 74.0

14.2 13.5

9.6 5.6

7.7 3.1

4.7 1.2

1.6 1.0

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

100.0 100.0 100.0 100.0

58.3 71.6 83.6 88.6

16.8 13.0 7.3 5.7

10.4 5.8 3.2 1.7

7.4 4.3 1.4 1.0

3.6 2.6 2.0 0.6

1.8 0.9 1.1 0.3

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

100.0 100.0 100.0 100.0

60.6 65.9 53.8 70.8

18.7 14.4 14.5 13.2

9.2 7.6 9.6 7.0

5.8 6.3 9.5 4.4

3.0 2.1 6.6 2.3

1.4 1.7 4.2 0.7

Education Less than high school High school graduate Some college College graduate

100.0 100.0 100.0 100.0

65.2 68.7 69.8 72.1

11.3 11.6 14.0 14.8

7.3 7.3 6.7 6.0

6.6 5.8 4.5 3.6

5.0 3.5 2.6 1.4

2.7 1.3 0.9 0.7

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

65.7 65.4 66.6 69.2 71.6

12.6 11.9 14.0 16.0 15.9

7.6 8.9 7.9 7.2 6.2

6.1 7.8 6.1 4.0 2.9

4.4 3.1 2.7 1.9 1.3

1.6 1.6 1.3 0.4 0.9

Health insurance coverage among adults under age 65 Private Medicaid Other Uninsured

100.0 100.0 100.0 100.0

68.8 77.6 79.9 37.9

15.7 9.5 10.2 17.0

7.4 5.6 4.4 14.4

4.2 3.0 1.7 15.0

1.6 1.3 1.2 9.9

0.8 1.3 – 3.7

100.0%

67.4%

13.8%

7.5%

5.3%

2.9%

1.3%

Note: Ofﬁce visits include visits to physicians’ ofﬁces and clinics but exclude overnight hospitalizations, visits to hospital emergency rooms, home visits, and telephone calls. Numbers may not add to total because “not reported” is not shown. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

298 AMERICAN HEALTH

HEALTH CARE VISITS

Teenagers Are Least Likely to Visit a Doctor Frequently The youngest children visit doctors the most. Most children see a doctor regularly. Seventy-four percent have seen a health care provider within the past six months. As children age, their ofﬁce visits become less frequent. Among children under age 5, fully 85 percent had been to a health care provider within the past six months. Among children aged 12 to 17, only 67 percent had made an ofﬁce visit that recently. Of the 74 million children under age 18, nearly 7 million had no health insurance in 2008. Lack of health insurance reduces the likelihood that children will get the health care they need, particularly well visits important for diagnosing conditions with no obvious symptoms. Hispanic children are nearly twice as likely as the average child to have no health insurance (17 versus 9 percent). Three percent of children were unable to get medical care and another 5 percent had to delay getting care due to cost during the past 12 months. These ﬁgures are highest among Hispanics (10 percent were unable to get or had to delay getting care), children living in households with low-tomiddle incomes (14 percent), and children without health insurance (34 percent). ■ Teenagers may not need to see a physician as often as toddlers, but many would beneﬁt from getting a check-up at least once a year. 24

Hispanic children are least likely to have health insurance

(percent of children who have no health insurance, by race and Hispanic origin, 2008)

17%

16

16%

8

8%

0

0%

6%

Asian a

7%

black b

7%

Hispanic c

non-Hispanic d white

AMERICAN HEALTH

299

Table 10.11

Problems with Health Care Access for Children by Selected Characteristics, 2008

(total number of people under age 18, and number with health care access problems, by selected characteristics, 2008; numbers in thousands) total

no health insurance

unmet medical need

delayed care due to cost

73,858

6,634

2,045

3,506

36,108 37,749

3,274 3,360

1,095 950

1,811 1,694

Age Aged 0 to 4 Aged 5 to 11 Aged 12 to 17

20,911 28,176 24,771

1,538 2,498 2,597

366 776 903

764 1,330 1,412

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

2,979 11,415 15,802 41,323

187 851 2,638 2,759

28 394 663 884

41 535 959 1,861

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

52,429 16,944 2,273 2,212

4,416 1,614 319 285

1,260 678 62 44

2,372 908 156 70

Parent’s education Less than high school diploma High school diploma More than high school

9,011 15,892 45,541

2,050 1,746 2,447

316 674 998

455 888 2,084

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

20,277 9,832 12,472 8,351 14,741

2,733 1,321 1,061 332 504

912 498 335 108 40

1,225 914 605 310 185

Health insurance status Private Medicaid/other public Other Uninsured

42,845 22,082 1,762 6,634

– – – 6,634

549 515 – 947

1,303 839 29 1,304

TOTAL CHILDREN Sex Female Male

Note: “Unmet medical need” is deﬁned as being unable to afford necessary medical care in the past 12 months. “Delayed care” is deﬁned as delaying medical care because of cost. Numbers may not add to total because “not reported” is not shown. “–” means not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

300 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.12

Percent of Children with Problems Accessing Health Care, 2008

(percent of people under age 18 with problems accessing health care, by selected characteristics, 2008) total

TOTAL CHILDREN Sex Female Male

no health insurance

unmet medical need

delayed care due to cost

100.0%

9.0%

2.8%

4.7%

100.0 100.0

9.1 8.9

3.0 2.5

5.0 4.5

Age Aged 0 to 4 Aged 5 to 11 Aged 12 to 17

100.0 100.0 100.0

7.4 8.9 10.5

1.8 2.8 3.6

3.7 4.7 5.7

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

100.0 100.0 100.0 100.0

6.3 7.5 16.7 6.7

0.9 3.5 4.2 2.1

1.4 4.7 6.1 4.5

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

100.0 100.0 100.0 100.0

8.4 9.5 14.0 12.9

2.4 4.0 2.7 2.0

4.5 5.4 6.9 3.2

Parent’s education Less than high school diploma High school diploma More than high school

100.0 100.0 100.0

22.7 11.0 5.4

3.5 4.2 2.2

5.0 5.6 4.6

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

13.5 13.4 8.5 4.0 3.4

4.5 5.1 2.7 1.3 0.3

6.0 9.3 4.9 3.7 1.3

Health insurance status Private Medicaid/other public Other Uninsured

100.0 100.0 100.0 100.0

– – – 100.0

1.3 2.3 – 14.3

3.0 3.8 1.6 19.7

Note: “Unmet medical need” is deﬁned as being unable to afford necessary medical care in the past 12 months. “Delayed care” is deﬁned as delaying medical care because of cost. Numbers may not add to total because “not reported” is not shown. “–” means not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

301

Table 10.13

Length of Time since Child’s Last Ofﬁce Visit to a Health Care Professional by Selected Characteristics, 2008

(total number of people under age 18 and distribution by length of time since last ofﬁce visit to a health care professional, by selected characteristics, 2008; numbers in thousands) time since last ofﬁce visit

total

six months or less

more than six months, not more than one year

73,859

54,482

11,608

4,332

1,232

1,488

36,109 37,750

26,824 27,658

5,599 6,009

2,068 2,264

457 775

804 684

Age Aged 0 to 4 Aged 5 to 11 Aged 12 to 17

20,800 28,250 24,809

17,704 20,143 16,635

2,087 5,155 4,366

396 1,724 2,211

– 491 672

406 470 613

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

2,911 11,337 15,803 41,294

1,999 8,091 10,837 31,483

522 2,059 2,476 6,290

220 601 1,293 2,116

32 156 429 558

105 215 549 635

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

52,026 17,287 2,377 2,169

38,994 12,476 1,509 1,502

7,941 2,856 456 355

2,887 1,113 215 117

764 317 81 71

1,073 329 42 45

Parent’s education Less than high school diploma High school diploma More than high school

9,255 15,437 46,749

5,915 11,256 35,681

1,554 2,248 7,406

953 973 2,277

242 373 526

495 393 544

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

21,285 10,230 12,980 8,719 15,555

15,433 7,171 9,758 6,437 12,262

3,044 1,754 2,063 1,446 2,544

1,465 676 666 589 511

399 229 263 111

596 318 198 80 113

Health insurance status Private Medicaid/other public Other Uninsured

42,600 22,515 1,784 6,625

32,628 17,428 1,381 2,870

6,699 3,013 273 1,561

2,019 1,132 94 1,052

464 151 – 588

525 503 – 432

TOTAL CHILDREN Sex Female Male

more than one year, not more than two years

more than two years, not more than ﬁve years

more than ﬁve years

Note: Numbers may not add to total because “not reported” is not shown. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

302 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.14

Percent Distribution of Children by Length of Time since Child’s Last Ofﬁce Visit to a Health Care Professional, 2008

(percent distribution of people under age 18 by length of time since last ofﬁce visit to a health care professional, by selected characteristics, 2008) time since last ofﬁce visit

total

six months or less

more than six months, not more than one year

100.0 100.0

74.3 73.3

15.5 15.9

5.7 6.0

1.3 2.1

2.2 1.8

Age Aged 0 to 4 Aged 5 to 11 Aged 12 to 17

100.0 100.0 100.0

85.1 71.3 67.1

10.0 18.2 17.6

1.9 6.1 8.9

– 1.7 2.7

2.0 1.7 2.5

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

100.0 100.0 100.0 100.0

68.7 71.4 68.6 76.2

17.9 18.2 15.7 15.2

7.6 5.3 8.2 5.1

1.1 1.4 2.7 1.4

3.6 1.9 3.5 1.5

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

100.0 100.0 100.0 100.0

75.0 72.2 63.5 69.2

15.3 16.5 19.2 16.4

5.5 6.4 9.0 5.4

1.5 1.8 3.4 3.3

2.1 1.9 1.8 2.1

Parent’s education Less than high school diploma High school diploma More than high school

100.0 100.0 100.0

63.9 72.9 76.3

16.8 14.6 15.8

10.3 6.3 4.9

2.6 2.4 1.1

5.3 2.5 1.2

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

72.5 70.1 75.2 73.8 78.8

14.3 17.1 15.9 16.6 16.4

6.9 6.6 5.1 6.8 3.3

1.9 2.2 2.0 1.3 -

2.8 3.1 1.5 0.9 0.7

Health insurance status Private Medicaid/other public Other Uninsured

100.0 100.0 100.0 100.0

76.6 77.4 77.4 43.3

15.7 13.4 15.3 23.6

4.7 5.0 5.3 15.9

1.1 0.7 – 8.9

1.2 2.2 – 6.5

TOTAL CHILDREN Sex Female Male

100.0%

73.8%

15.7%

more than one year, not more than two years

more than two years, not more than ﬁve years

more than ﬁve years

5.9%

1.7%

2.0%

Note: Numbers may not add to total because “not reported” is not shown. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

303

Women Seek Health Care More Often than Men Men average one fewer physician visit per year. On average, Americans made 3.1 visits to the doctor’s ofﬁce in 2006. Young adults—aged 15 to 24—visit the doctor much less frequently than older people, only 1.7 times a year on average. The oldest adults—aged 75 or older—visit the doctor most frequently, an average of 7.2 times a year. Women average 3.6 doctor visits a year compared with an average of 2.6 visits for men. Health care visits are about the same for boys and girls under age 15, but for most other age groups women go to the doctor more often than men. Behind this difference are frequent prenatal visits and also the fact that women are more willing than men to seek treatment for their problems. Whites visit doctors more often than blacks, regardless of age. The lower visit rate of blacks is primarily due to the fact that they are less likely to be covered by private health insurance, which reduces access to health care. ■ The growing number of Americans without health insurance could lower the average number of physician ofﬁce visits since the uninsured tend to forego medical care.

9

Older men and women visit doctors the most (average number of physician ofﬁce visits per person, by sex and age, 2006)

femal male

66 visits

33 visits 100000

00 visits

all males

females dual

75000

under a 15

15 b to 24

25 c to 44

45 d to 64

65 e to 74

75 orfolder

50000

25000

0

304 AMERICAN HEALTH

with

w/out

HEALTH CARE VISITS

Table 10.15

Physician Ofﬁce Visits by Sex and Age, 2006

(total number, percent distribution, and number of physician ofﬁce visits per person per year, by sex and age, 2006; numbers in thousands)

total

percent distribution

average visits per person per year

Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older Aged 65 to 74 Aged 75 or older

901,954 157,906 72,411 185,305 256,494 229,837 108,063 121,774

100.0% 17.5 8.0 20.5 28.4 25.5 12.0 13.5

3.1 2.6 1.7 2.3 3.5 6.5 5.8 7.2

Visits by females Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

533,292 76,300 49,641 122,261 149,778 60,699 74,613

59.1 8.5 5.5 13.6 16.6 6.7 8.3

3.6 2.6 2.4 3.0 3.9 6.0 7.3

Visits by males Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

368,662 81,607 22,770 63,044 106,716 47,364 47,161

40.9 9.0 2.5 7.0 11.8 5.3 5.2

2.6 2.6 1.1 1.6 3.0 5.5 7.1

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

305

Table 10.16

Physician Ofﬁce Visits by Race, Hispanic Origin, and Age, 2006

(total number, percent distribution, and number of physician ofﬁce visits per person per year, by race, Hispanic origin, and age, 2006; numbers in thousands)

total

percent distribution

average visits per person per year

Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

901,954 157,906 72,411 185,305 256,494 108,063 121,774

100.0% 17.5 8.0 20.5 28.4 12.0 13.5

3.1 2.6 1.7 2.3 3.5 5.8 7.2

Visits by blacks Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

87,040 18,279 8,183 20,857 24,481 7,980 7,260

9.7 2.0 0.9 2.3 2.7 0.9 0.8

2.4 2.0 1.3 2.0 3.0 4.6 5.7

Visits by whites Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

764,636 127,918 61,055 154,487 218,225 94,827 108,123

84.8 14.2 6.8 17.1 24.2 10.5 12.0

3.2 2.8 1.9 2.4 3.5 5.9 7.2

Visits by Asians

38,683

4.3

3.0

118,695

13.2

2.7

Visits by Hispanics

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

306 AMERICAN HEALTH

HEALTH CARE VISITS

Preventive Care Visits Are Most Common among the Young Chronic problems account for a large share of doctor visits. Preventive care ofﬁce visits may seem like a waste of time and money to many people, but check-ups are important in identifying illnesses that present few, if any symptoms. For children, particularly those under age 15, well visits are expected. This explains why children under age 15 accounted for the largest share—26 percent—of preventive care visits in 2006. New health problems—often colds, ﬂu, and accidents—bring the largest share of people to the doctor (35 percent). Ranking second are routine visits for chronic health problems (29 percent). Preventive care visits rank third, at 19 percent. Eight percent of visits are due to ﬂare-ups of chronic conditions, and 7 percent are pre- or postsurgery visits. ■ An examination of the speciﬁc diagnoses made by doctors reveals the many different reasons patients come in the door. Well-baby visits are the single biggest reason, followed by hypertension.

New health problems—such as colds, ﬂu, and injuries—account for the largest share of doctor visits

45

(percent distribution of physician ofﬁce visits by major reason for visit, 2006)

35%

30

29%

30%

19%

15

0

15%

0%

new a problem

chronicbproblem, routine

preventive c care

8%

7%

chronicd problem, ﬂare-up

pre- or postsurgery e

AMERICAN HEALTH

307

Table 10.17

Physician Ofﬁce Visits for Preventive Care, 2006

(total number and percent distribution of physician ofﬁce visits for preventive care, and number per person per year, by sex, age, race, and Hispanic origin, 2006; numbers in thousands)

total

percent distribution

average visits per person per year

Total preventive care visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

173,342 47,613 22,225 42,163 36,082 11,920 13,338

100.0% 26.3 12.8 24.3 20.8 6.9 7.7

0.6 0.8 0.5 0.5 0.5 0.6 0.8

Total females Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

114,696 23,266 17,879 34,185 23,602 7,433 8,331

66.2 13.4 10.3 19.7 13.6 4.3 4.8

0.8 0.8 0.9 0.8 0.6 0.7 0.8

Total males Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

58,646 24,347 4,346 7,978 12,480 4,487 5,008

33.8 14.0 2.5 4.6 7.2 2.6 2.9

0.4 0.8 0.2 0.2 0.3 0.5 0.8

Race Black White Other

18,949 143,579 10,814

10.9 82.8 6.2

0.5 0.6 0.5

Hispanic origin Hispanic Not Hispanic

29,733 143,609

17.2 82.8

0.7 0.6

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

308 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.18

Physician Ofﬁce Visits by Major Reason for Visit, 2006

(percent distribution of physician ofﬁce visits by sex, age, race, Hispanic origin, and major reason for visit, 2006; numbers in thousands)

total

TOTAL VISITS Sex Female Male

new problem

chronic problem, routine

preventive care

chronic problem, ﬂareup

pre- or postsurgery

100.0%

35.4%

29.1%

19.2%

7.9%

6.6%

100.0 100.0

34.9 36.2

27.3 31.7

21.5 15.9

8.2 7.6

6.4 6.8

Age Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

100.0 100.0 100.0 100.0 100.0 100.0

52.3 42.4 37.2 31.2 25.5 24.4

9.4 15.7 23.7 35.7 42.6 45.0

30.2 30.7 22.8 14.1 11.0 11.0

4.8 5.4 8.2 9.5 9.7 7.9

1.8 4.0 6.7 8.0 9.1 9.1

Race Black White Other

100.0 100.0 100.0

35.4 35.3 36.8

28.0 29.2 30.2

21.8 18.8 21.5

8.0 8.1 5.2

5.5 6.9 4.7

Hispanic origin Hispanic Not Hispanic

100.0 100.0

39.7 34.8

22.8 30.1

25.0 18.3

5.6 8.3

5.1 6.8

Note: Numbers do not add to total because “blank” and “unknown” are not shown. Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

309

Table 10.19

Physician Ofﬁce Visits by Detailed Reason for Visit, 2006

(number and percent distribution of physician ofﬁce visits by the 20 principal reasons most frequently mentioned by patients for visit, 2006; numbers in thousands) number

Total visits General medical exam Progress visit, not otherwise speciﬁed Cough Postoperative visit Prenatal exam, routine Gynecological examination Medication Stomach pain, cramps, and spasms Knee symptoms Well baby exam Back symptoms Symptoms referable to throat Unspeciﬁed test results Vision dysfunctions Fever Hypertension Earache or ear infection Headache, pain in head Skin rash Nasal congestion All other reasons

901,954 66,389 51,296 26,738 23,355 21,718 19,379 19,034 16,007 14,957 13,555 13,346 13,309 13,077 12,184 12,167 11,604 11,366 10,243 10,068 9,448 512,714

percent distribution

100.0% 7.4 5.7 3.0 2.6 2.4 2.1 2.1 1.8 1.7 1.5 1.5 1.5 1.4 1.4 1.3 1.3 1.3 1.1 1.1 1.0 56.8

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

310 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.20

Physician Ofﬁce Visits by Major Disease Category and Primary Diagnosis Group, 2006

(number and percent distribution of physician ofﬁce visits by major disease category and primary diagnosis group, 2006; numbers in thousands) number

percent distribution

MAJOR DISEASE CATEGORY Total visits Infectious and parasitic diseases Neoplasms Endocrine, nutritional, metabolic diseases, and immunity disorders Mental disorders Diseases of the nervous system and sense organs Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue Symptoms, signs, and ill-deﬁned conditions Injury and poisoning Supplementary classiﬁcation All other diagnoses Unknown

901,954 22,214 29,021 45,914 41,573 85,182 72,151 103,969 35,887 38,404 37,434 72,528 54,999 48,343 181,679 23,808 8,850

100.0% 2.5 3.2 5.1 4.6 9.4 8.0 11.5 4.0 4.3 4.2 8.0 6.1 5.4 20.1 2.6 1.0

PRIMARY DIAGNOSIS GROUP Total visits Routine infant or child health check Essential hypertension Acute upper respiratory infections, excluding pharyngitis Arthropathies and related disorders Diabetes mellitus Spinal disorders Speciﬁc procedures and aftercare Malignant neoplasms Normal pregnancy Rheumatism, excluding back Gynecological examination Otitis media and eustachian tube disorcers Follow-up exam General medical examination Heart disease, excluding ischemic Chronic sinusitis Allergic rhinitis Ischemic heart disease Asthma Cataract All other diagnoses

901,954 39,298 35,784 30,916 27,736 23,779 23,760 22,875 20,923 19,730 16,221 15,630 13,784 13,676 13,594 13,323 12,971 12,150 10,859 10,590 10,239 514,117

100.0% 4.4 4.0 3.4 3.1 2.6 2.6 2.5 2.3 2.2 1.8 1.7 1.5 1.5 1.5 1.5 1.4 1.3 1.2 1.2 1.1 57.0

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

311

Most Doctor Visits include a Blood Pressure Reading Other tests and procedures are less common. The most common measurement taken during a doctor visit is a person’s weight, done at 69 percent of all visits—in part to determine the appropriate dosage of prescription medication, since most patients come away from a doctor visit with a prescription in hand. The 58 percent majority of doctor visits include a blood pressure reading. All other tests and measurements are far less common. Among those who have their blood pressure measured, only 23 percent have a normal reading. It may be the stress of visiting the doctor that causes 46 percent of patients to have mildly high blood pressure. Twenty percent have moderately high blood pressure, and 6 percent have a severely high reading. Slightly more than one-third of doctor visits involve health education services, the most common being information about diet and nutrition. Sixteen percent of doctor visits include nonmedication treatments, physical therapy being most common. ■ Doctors are far more likely to prescribe drugs than to offer health education or nonmedication treatments.

Only 7 percent of physician ofﬁce visits include a cholesterol test

90

(percent of physician ofﬁce visits by selected services ordered or provided, 2006)

69%

60

60%

30

30%

58%

14%

0

0%

weight

312 AMERICAN HEALTH

blood pressure reading

any imaging c

7%

7%

cholesterol d test

urinalysis e

HEALTH CARE VISITS

Table 10.21

Physician Ofﬁce Visits by Services Provided, 2006

(total number and percent of physician ofﬁce visits by services ordered or provided, by sex, 2006; numbers in thousands) percent of visits number

total

Examinations Skin Pelvic Breast Rectal Depression screening

113,570 63,689 47,974 31,759 16,187

12.6 7.1 5.3 3.5 1.8

13.2 10.8 8.6 4.1 2.2

11.7 1.6 0.6 2.7 1.2

Vital signs Weight Blood pressure Height Temperature

618,802 523,634 367,682 339,697

68.6 58.1 40.8 37.7

69.4 60.6 41.4 35.8

67.4 54.4 39.8 40.3

97,920 63,689 53,671 45,494 27,096 14,738 85,730

10.9 7.1 6.0 5.0 3.0 1.6 9.5

10.8 6.6 5.8 4.7 2.8 – 9.7

11.0 7.7 6.1 5.5 3.3 4.0 9.3

Other tests Urinalysis Any pap test Sigmoidoscopy/colonoscopy Other scope procedure Cystoscopy EKG or ECG Biopsy Chlamydia test Spirometry or pulmonary function test HPV DNA test Other test or service

61,331 29,815 11,669 10,596 2,175 21,992 9,865 5,180 3,800 3,349 122,571

6.8 3.3 1.3 1.2 0.2 2.4 1.1 0.6 0.4 0.4 13.6

7.9 5.6 1.3 1.4 0.2 2.2 1.1 0.9 0.4 0.6 13.6

5.2 – 1.3 0.8 0.3 2.8 1.1 0.1 0.4 – 13.6

Imaging Any imaging X-ray Ultrasound MRI, CT, or PET Mammography Bone mineral density

129,164 56,541 28,411 26,661 17,016 5,529

14.3% 6.3 3.1 3.0 1.9 0.6

15.9% 5.8 4.0 2.9 3.2 1.0

12.1% 7.0 1.9 3.0 – 0.1

12,849

1.4

1.5

1.3

Other imaging

100.0% 85.9 11.8 2.3

male

901,954 771,126 110,130 20,699

Blood tests CBC Lipids or cholesterol Glucose Electrolytes HgbA1C PSA Other blood test

100.0% 85.5 12.2 2.3

female

Total visits One or more diagnostic or screening services No diagnostic or screening services provided Unknown

100.0% 84.8 12.8 2.3

Note: “–” means not applicable or sample is too small to make a reliable estimate, Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

313

Table 10.22

Blood Pressure Measurements by Selected Characteristics, 2006

(total number of people aged 18 or older who visited a physician’s ofﬁce and had their blood pressure taken and percent distribution by initial blood pressure measurement, by selected characteristics, 2006; numbers in thousands) initial blood pressure measurement

TOTAL VISITS Age Aged 18 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

number

total

23.4%

mildly high

46.0%

moderately high

severely high

low

normal

476,335

100.0%

4.5%

19.8%

6.3%

33,916 127,926 167,378 71,316 75,799

100.0 100.0 100.0 100.0 100.0

9.4 6.3 2.4 3.8 4.7

43.2 33.6 20.3 13.3 13.6

39.5 43.5 48.2 48.5 46.0

6.3 12.4 22.3 26.6 26.3

1.5 4.1 6.9 7.7 9.4

Sex Female Male

297,728 178,608

100.0 100.0

5.5 2.9

27.0 17.3

44.2 49.0

17.8 23.1

5.4 7.7

Race Asian Black White

18,455 47,367 404,852

100.0 100.0 100.0

4.8 4.8 4.5

26.5 21.3 23.5

40.3 42.5 46.7

18.7 22.3 19.6

9.7 9.1 5.8

Hispanic origin Hispanic Not Hispanic

58,351 417,985

100.0 100.0

6.0 4.3

28.1 22.7

41.6 46.6

17.6 20.1

6.6 6.2

Note: Severely high blood pressure is deﬁned as 160 mm Hg systolic or above, or 100 mm Hg diastolic or above. Moderately high blood pressure is deﬁned as 140–159 mm Hg systolic or 90–99 mm Hg diastolic. Mildly high blood pressure is deﬁned as 120–139 mm Hg systolic or 80–89 mm Hg diastolic. Low blood pressure is deﬁned as less than 100 mm Hg systolic or less than 60 mm Hg diastolic. Normal blood pressure is deﬁned as 100–119 mm Hg systolic and 60–79 mm Hg diastolic. Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

314 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.23

Physician Ofﬁce Visits by Education Services and Nonmedication Treatments Ordered or Provided, 2006

(number and percent distribution of physician ofﬁce visits by health education services and nonmedication therapy ordered or provided, 2006; numbers in thousands) number

TOTAL VISITS One or more health education services ordered or provided Diet and nutrition Exercise Growth and development Weight reduction Injury prevention Stress management Tobacco use or exposure Asthma education Other One or more nonmedication treatments ordered or provided Physical therapy Wound care Orthopedic care Psychotherapy Excision of tissue Other mental health counseling Complementary alternative medicine Durable medical equipment Home health care Speech or occupational therapy Radiation therapy

percent distribution

901,954

100.0%

328,792 121,694 85,362 37,595 32,951 26,661 24,663 22,875 10,166 164,146

36.5 13.5 9.5 4.2 3.7 3.0 2.7 2.5 1.1 18.2

145,148 20,760 18,484 18,043 15,004 14,806 11,337 6,219 5,765 2,136 1,904 1,082

16.1 2.3 2.0 2.0 1.7 1.6 1.3 0.7 0.6 0.2 0.2 0.1

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

315

Most Doctor Visits Last Less than 15 Minutes Some specialists spend more time with patients, however. On average, patients spend 21.8 minutes with the doctor during an ofﬁce visit. The median was just 14.9, meaning that half of patients saw a physician for less than 15 minutes. Psychiatrists spend the most time with their patients. But the average length of a visit to a psychiatrist— 32.6 minutes—suggests that the 50-minute hour has gotten even shorter. Neurologists also spend more time than average with patients, as do oncologists and cardiovascular specialists. Often these physicians treat patients with serious, ongoing illnesses that require careful examinations and a wider range of services. Of the 902 million physician ofﬁce visits in 2006, 88 percent were with established patients, most of whom had been to the doctor’s ofﬁce three or more times before. Primary care physicians are more likely than surgical or medical specialists to see established patients. ■ Although some ofﬁce visits require little time, hurried examinations can lead to missed problems and a sense on the patient’s part that he or she is not getting the best care.

Few patients spend more than half an hour with the doctor 45

(percent distribution of physician ofﬁce visits by time spent with physician, 2006)

35.5% 30

30%

15

15%

0

0%

37.8%

16.7% 9.9%

1 to a 10 min.

316 AMERICAN HEALTH

11 tob 15 min.

16 to c 30 min.

31 min.dor more

HEALTH CARE VISITS

Table 10.24

Physician Ofﬁce Visits by Time Spent with Physician, 2006

(number and percent distribution of physician ofﬁce visits by time spent with physician; mean and median amount of time spent with physician by specialty, 2006; numbers in thousands) percent distribution

number

PHYSICIAN SEEN Total visits No physician seen Physician seen

901,954 33,789 868,165

100.0% 3.7 96.3

Total visits with physician 1 to 5 minutes 6 to 10 minutes 11 to 15 minutes 16 to 30 minutes 31 to 60 minutes 61 minutes or more

868,165 15,140 130,401 308,445 328,427 73,756 11,996

100.0% 1.7 15.0 35.5 37.8 8.5 1.4 minutes

All visits with physician Psychiatry Neurology Oncology Cardiovascular diseases Internal medicine General surgery Otolaryngology Orthopedic surgery Obstetrics and gynecology General and family practice Urology Ophthalmology Dermatology Pediatrics All other specialties

mean

median

21.8 32.6 27.0 24.5 22.1 21.5 20.8 20.4 20.0 19.7 19.5 19.2 19.1 17.5 16.8 33.2

14.9 27.0 19.7 19.1 18.4 14.9 14.9 14.9 14.7 14.9 14.8 14.9 14.8 14.0 14.6 19.1

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

317

Table 10.25

Physician Ofﬁce Visits by Continuity of Care, 2006

(number and percent distribution of physician ofﬁce visits by continuity of care and specialty type, 2006; numbers in thousands) specialty type

Total visits Established patient No prior visits in past 12 months 1 to 2 visits 3 to 5 visits 6 or more visits New patient PERCENT DISTRIBUTION Total visits Established patient No prior visits 1 to 2 visits 3 to 5 visits 6 or more visits New patient

total

primary care

medical specialties

surgical specialties

901,954 791,499 62,336 275,827 244,500 208,836 110,455

525,607 478,673 33,225 155,274 153,620 136,554 46,934

198,654 168,633 13,755 59,272 48,011 47,595 30,021

177,693 144,193 15,356 61,281 42,869 24,686 33,500

100.0% 87.8 6.9 30.6 27.1 23.2 12.2

100.0% 91.1 6.3 29.5 29.2 26.0 8.9

100.0% 84.9 6.9 29.8 24.2 24.0 15.1

100.0% 81.1 8.6 34.5 24.1 13.9 18.9

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

318 AMERICAN HEALTH

HEALTH CARE VISITS

Most Patients Prefer to See a Doctor But highly trained nurses could handle more health problems. Although there has been increased reliance on nurse practitioners and other health care professionals to supplement physicians’ services, fully 96 percent of visits to physicians’ ofﬁces involved a doctor in 2006. Over the past few years, the nursing ﬁeld has developed a multi-tiered profession, with those at the top able to perform many services previously limited to physicians. Many patients are not convinced, however, and continue to prefer to see a physician. This accounts, in part, for the small number of ofﬁce visits in which patients see a nurse practitioner or physician assistant. Resistance by doctors to professional nursing is another factor behind the small showing for nurses. ■ Controlling health care costs may eventually require more visits to health care professionals other than physicians.

Nurses are seen on only 24 percent of doctor visits

120

(percent of physician ofﬁce visits in which patients see type of provider, 2006)

96%

80

80%

40

40%

24%

0

0%

physician a

R.N. orbL.P.N.

4%

2%

physician cassistant

nurse practitioner/ d midwife

AMERICAN HEALTH

319

Table 10.26

Physician Ofﬁce Visits by Providers Seen, 2006

(number and percent distribution of physician ofﬁce visits by providers seen, 2006; numbers in thousands) number

Total visits Physician Registered or licensed practical nurse Physician assistant Nurse practitioner or midwife Other provider

901,954 868,165 220,132 38,606 17,535 140,363

percent distribution

100.0% 96.3 24.4 4.3 1.9 15.6

Note: Numbers do not add to total because more than one provider may be seen. Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2004 Summary, Advance Data No. 374, 2006, Internet site http://www.cdc.gov/nchs/about/major/ahcd/adata.htm

320 AMERICAN HEALTH

HEALTH CARE VISITS

Drugs Are Prescribed at Most Doctor Visits The proportion climbed to 71 percent in 2006. Getting a prescription is the norm when visiting a doctor. Medications are prescribed in 71 percent of doctor visits, with the ﬁgure over 80 percent for those visiting cardiologists, internists, psychiatrists, and family doctors. Those who get prescriptions during a doctor visit get an average of three. On average, Americans ﬁll 16.5 prescriptions a year, most being reﬁlls. The average number of prescriptions ﬁlled increases steeply with age, from fewer than 10 a year for people under age 45 to more than 30 a year for people aged 65 or older. Analgesics (painkillers) are the most common class of prescription drugs prescribed, and account for 11 percent of the total. By brand name, households spent the most on Lipitor in 2007—nearly $10 billion. The thyroid medication levothyroxine had the largest number of people purchasing it in 2007—more than 13 million. ■ The pharmaceutical industry is reaping the rewards of an aging population that increasingly demands pills to solve its medical problems.

Cardiovascular physicians are most likely to prescribe drugs (percent of physician ofﬁce visits during which one or more drugs are provided or prescribed, by physician specialty, 2006)

120

92% 80

80%

40

40%

0

a

0%

87%

84%

d internal medicine

e psychiatry

81%

71%

totalb visits

c cardiovascular diseases

f and general family practice

AMERICAN HEALTH

321

Table 10.27

Physician Ofﬁce Visits by Drug Therapy and Physician Specialty, 2006

(total number of physician ofﬁce visits, and number and percent of physician ofﬁce visits at which one or more drugs were provided or prescribed, total number of drugs provided and number per visit, by physician specialty, 2006; numbers in thousands) number of drugs provided or prescribed

drug visits

Total visits General and family practice Internal medicine Pediatrics Obstetrics and gynecology Ophthalmology Orthopedic surgery Cardiovascular diseases Dermatology Psychiatry Urology Otolaryngology Oncology General surgery Neurology All other specialties

total

number

901,954 208,475 125,398 122,344 69,436 57,815 48,066 25,790 25,256 25,150 18,307 17,508 14,871 14,048 12,532 116,958

636,708 168,400 109,654 83,752 40,319 27,492 19,588 23,737 17,113 21,178 11,568 9,021 11,422 6,308 9,895 77,260

percent of total

70.6% 80.8 87.4 68.5 58.1 47.6 40.8 92.0 67.8 84.2 63.2 51.5 76.8 44.9 79.0 66.1

total

1,897,015

513,141 432,585 158,409 66,468 57,244 49,636 130,148 36,926 52,551 32,659 19,177 45,571 22,912 32,319 247,268

number per visit

3.0 3.0 3.9 1.9 1.6 2.1 2.5 5.5 2.2 2.5 2.8 2.1 4.0 3.6 3.3 3.2

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

322 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.28

Number of Unique Prescriptions and Reﬁlls Purchased by Selected Characteristics, 2006

(average number of total and unique prescription drug purchases per person among the population with prescription drug purchases by selected demographic characteristics, 2006) average number of prescriptions (including reﬁlls)

average number of unique prescriptions

16.5

4.0

17.6 15.1

4.2 3.7

Age Under age 5 Aged 5 to 17 Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 to 84 Aged 85 or older

3.9 5.9 9.3 21.6 31.6 33.4 33.7

2.2 2.2 2.9 4.7 6.3 6.7 6.3

Race and Hispanic origin Black, non-Hispanic Hispanic White, non-Hispanic Other, non-Hispanic

16.8 12.0 17.5 13.1

3.9 3.2 4.2 3.5

Health insurance status, people under age 65 Any private health insurance Public health insurance only Uninsured

12.0 18.4 10.6

3.4 4.1 2.9

Medicare and any private Medicare and public only Medicare only

30.8 41.2 32.8

6.5 7.1 6.1

Poverty status Poor Near poor or low income Middle income High income

19.6 19.7 15.5 15.1

4.3 4.3 3.8 3.9

TOTAL PEOPLE Sex Female Male

Health insurance status, people aged 65 or older

Note: The “poor” are people in families with incomes below the poverty line. The “near poor or low income” are those in families with incomes over the poverty line through 200 percent of the poverty line. The “middle income” are those in families with incomes of over 200 percent to 400 percent of the poverty line. The “high income” are those in families with incomes over 400 percent of the poverty line. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Average Number of Total (Including Reﬁlls) and Unique Prescriptions by Select Person Characteristics, 2006, May 2009, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp; calculations by New Strategist

AMERICAN HEALTH

323

Table 10.29

Medications Most Frequently Prescribed during Physician Ofﬁce Visits by Therapeutic Class, 2006

(number and percent distribution of drugs provided or prescribed during physician ofﬁce visits, for the 20 most frequently occurring therapeutic classes, 2006; numbers in thousands) number

Total drugs provided or prescribed Analgesics* Antihyperlipidemic agents Antidepressants Antidiabetic agents Anixiolytics, sedatives, and hypnotics Beta-adrenergic blocking agents Antiplatelet agents Bronchodilators Proton pump inhibitors Diuretics Dermatological agents Anticonvulsants Angiotensis converting enzyme inhibitors Antihistamines Opthalmic preparations Sex hormones Calcium channel blockers Adrenal corticosteroids Vitamin and mineral combinations Thyroid drugs

1,897,015 209,936 101,640 85,331 68,742 66,968 63,428 62,430 60,170 59,313 54,571 53,135 49,800 49,301 45,181 40,197 36,777 36,529 36,276 33,634 33,340

percent distribution

100.0% 11.1 5.4 4.5 3.6 3.5 3.3 3.3 3.2 3.1 2.9 2.8 2.6 2.6 2.4 2.1 1.9 1.9 1.9 1.8 1.8

* Includes narcotic and nonnarcotic analgesics and nonsteroidal anti-inﬂammatory drugs. Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

324 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.30

Twenty-Five Drug Brands on Which Households Spend the Most, 2007

(spending on the 25 prescribed drug brands on which households spend the most, number of people spending and annual expenditure per person buying the drug, 2007)

rank

brand name

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Lipitor Nexium Advair Simvastatin Plavix Actos Prevacid Singulair Diovan Vytorin Fosamax Protonix Lexapro Topamax Wellbutrin Effexor Crestor Seroquel Cymbalta Zyrtec Zetia Diabetic Supply Avandia Risperdal Coreg

total expenditures

number of people with expenditure

annual spending per purchaser

$9,918,362,341 6,070,139,154 4,756,807,892 4,305,977,736 3,838,822,665 3,716,176,724 3,605,033,636 2,990,336,754 2,838,168,196 2,613,322,139 2,497,608,591 2,455,821,476 2,421,862,328 2,180,186,533 2,091,478,445 2,071,039,539 1,985,112,900 1,978,962,685 1,891,091,174 1,714,506,251 1,684,596,797 1,660,227,499 1,610,937,764 1,580,394,853 1,549,786,412

12,846,809 5,362,642 4,792,616 10,918,449 3,872,272 2,717,938 4,123,884 5,485,037 4,514,247 3,892,770 3,987,987 3,388,722 4,780,388 1,197,650 2,117,814 2,576,809 3,106,510 1,325,548 1,944,008 5,629,997 2,894,155 3,050,962 1,532,329 829,827 1,906,653

$772.05 1,131.93 992.53 394.38 991.36 1,367.28 874.18 545.18 628.71 671.33 626.28 724.70 506.62 1,820.39 987.56 803.72 639.02 1,492.94 972.78 304.53 582.07 544.17 1,051.30 1,904.49 812.83

Note: Expenditures include out-of-pocket costs and amount paid by insurance. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp; calculations by New Strategist

AMERICAN HEALTH

325

Table 10.31

Ten Drug Brands Prescribed the Most by Number of Purchases, 2007

(purchases of the 10 prescribed drug brands most frequently purchased, number of people purchasing drug and annual purchases per person buying the drug, 2007)

rank

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

brand name

Levothyroxine Lisinopril Lipitor Simvastatin Metformin Hydrochlorothiazide Atenolol Metoprolol Furosemide Hydrocodone

total purchases

number of people purchasing

annual purchases per person

93,550,325 75,207,175 72,850,122 59,549,189 52,652,399 52,316,496 52,237,566 47,927,763 36,408,415 35,919,754

13,324,375 12,976,349 12,846,809 10,918,449 8,854,422 9,517,700 9,253,357 8,588,178 5,781,054 13,411,596

7.0 5.8 5.7 5.5 5.9 5.5 5.6 5.6 6.3 2.7

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2007, Internet site http://www.meps .ahrq.gov/mepsweb/survey_comp/household.jsp; calculations by New Strategist

326 AMERICAN HEALTH

HEALTH CARE VISITS

Most People See a Dentist Regularly Many uninsured children are not getting needed care, however. Americans visit a dentist less frequently than they go to the doctor. Only 42 percent of adults have seen a dentist in the past six months versus the 67 percent who have been to a doctor. Nearly four of 10 adults have not been to the dentist for more than a year. Hispanics are most likely to have skipped a dental visit for more than one year. Overall, 39 percent of people aged 18 or older have avoided the dentist for that long, but among Hispanics the share is 53 percent. Many Hispanics do not have health insurance, and an even larger proportion lack dental insurance. The majority of children aged 2 to 17 have seen a dentist within the past six months, and more than three-quarters had a dental visit within the past year. Children without health insurance are least likely to have seen a dentist in the past six months, and fully 28 percent have an unmet dental need. ■ Dental care often is not covered under standard health insurance policies, although dental problems can affect overall health.

More than one in four children without health insurance has an unmet dental need (percent of people aged 2 to 17 with an unmet dental need, by insurance status, 2008) 30

28%

20

20%

10

10%

4% 0

0%

a private insurance

6%

b Medicaid/other public insurance

c uninsured

AMERICAN HEALTH

327

Table 10.32

Length of Time since Last Dental Visit by Selected Characteristics, 2008

(total number of people aged 18 or older and distribution by length of time since last dental visit, by selected characteristics, 2008; numbers in thousands) time since last dental visit more than six months, not more than one year

more than one year, not more than two years

more than two years, not more than ﬁve years

more than ﬁve years (excl. never)

never

total

six months or less

TOTAL ADULTS Sex Men Women

225,227

94,519

38,038

28,412

27,425

29,862

2,800

108,755 116,472

42,320 52,199

17,763 20,275

14,941 13,471

13,789 13,636

16,151 13,711

1,604 1,196

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

110,615 77,335 19,869 17,409

41,537 36,769 9,403 6,809

21,273 11,946 2,519 2,300

16,726 8,577 1,624 1,486

14,951 8,624 2,014 1,836

12,125 9,486 3,814 4,437

2,043 495 161 102

Race and Hispanic origin Asian 10,501 Black 26,765 Hispanic 30,583 Non-Hispanic white 154,483

4,325 8,095 8,499 72,418

2,089 5,276 5,236 25,023

1,439 4,061 4,979 17,441

1,249 4,576 4,850 16,441

983 3,721 5,198 19,553

238 418 1,301 807

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

6,350 19,288 24,636 33,875

3,805 8,157 10,252 9,779

3,791 6,980 7,024 5,440

5,013 7,755 6,233 3,996

8,570 10,159 5,852 2,448

904 497 306 260

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

17,943 11,833 16,141 13,356 27,379

10,046 5,295 6,951 5,063 7,779

9,821 4,492 5,591 3,224 3,420

11,313 4,855 4,564 2,186 2,503

16,405 4,497 3,918 1,516 1,442

1,400 342 478 147 129

Health insurance coverage among adults under age 65 Private 127,168 Medicaid 15,447 Other 7,545 Uninsured 36,854

64,211 4,606 2,737 6,435

24,576 2,334 1,140 5,000

15,386 2,219 1,172 6,468

12,020 2,624 981 7,732

8,233 3,164 1,267 8,780

658 232 – 1,614

Note: Numbers may not add to total because “not reported” is not shown. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

328 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.33

Percent Distribution by Length of Time since Last Dental Visit by Selected Characteristics, 2008

(percent distribution of people aged 18 or older by length of time since last dental visit, by selected characteristics, 2008) time since last dental visit

total

six months or less

more than six months, not more than one year

more than one year, not more than two years

more than two years, not more than ﬁve years

more than ﬁve years (excl. never)

never

100.0 100.0

38.9 44.8

16.3 17.4

13.7 11.6

12.7 11.7

14.9 11.8

1.5 1.0

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

100.0 100.0 100.0 100.0

37.6 47.5 47.3 39.1

19.2 15.4 12.7 13.2

15.1 11.1 8.2 8.5

13.5 11.2 10.1 10.5

11.0 12.3 19.2 25.5

1.8 0.6 0.8 0.6

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

100.0 100.0 100.0 100.0

41.2 30.2 27.8 46.9

19.9 19.7 17.1 16.2

13.7 15.2 16.3 11.3

11.9 17.1 15.9 10.6

9.4 13.9 17.0 12.7

2.3 1.6 4.3 0.5

Education Less than high school High school graduate Some college College graduate

100.0 100.0 100.0 100.0

21.9 35.8 44.7 59.8

13.1 15.1 18.6 17.3

13.1 13.0 12.7 9.6

17.3 14.4 11.3 7.0

29.5 18.9 10.6 4.3

3.1 0.9 0.6 0.5

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

26.3 37.3 42.1 51.7 63.4

14.7 16.7 18.1 19.6 18.0

14.4 14.2 14.6 12.5 7.9

16.6 15.3 11.9 8.5 5.8

24.0 14.2 10.2 5.9 3.3

2.0 1.1 1.2 0.6 0.3

Health insurance coverage among adults under age 65 Private Medicaid Other Uninsured

100.0 100.0 100.0 100.0

50.5 29.8 36.3 17.5

19.3 15.1 15.1 13.6

12.1 14.4 15.5 17.6

9.5 17.0 13.0 21.0

6.5 20.5 16.8 23.8

0.5 1.5 – 4.4

TOTAL ADULTS Sex Men Women

100.0%

42.0%

16.9%

12.6%

12.2%

13.3%

1.2%

Note: Numbers may not add to total because “not reported” is not shown. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

329

Table 10.34

Dental Care Access and Length of Time since Last Dental Visit among Children, 2008

(total number of people aged 2 to 17 and distribution by access to dental care and length of time since last dental visit, by selected characteristics, 2008; numbers in thousands) time since last dental visit

unmet dental need

more than more than more than six months, one year, two years, six months not more than not more than not more than or less one year two years ﬁve years

more than ﬁve years

total

yes

no

Total children

66,184

4,626

61,429

39,025

11,689

4,506

2,173

8,199

Sex Female Male

32,304 33,880

2,210 2,416

30,050 31,379

19,709 19,316

5,259 6,429

2,207 2,299

901 1,271

3,983 4,216

Age Aged 2 to 4 Aged 5 to 11 Aged 12 to 17

13,125 28,250 24,809

512 2,125 1,989

12,592 26,032 22,805

5,156 18,144 15,725

1,483 5,391 4,815

403 2,007 2,096

68 888 1,216

5,941 1,574 683

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

2,645 10,184 13,974 37,164

74 761 1,501 2,093

2,570 9,382 12,402 35,057

1,576 5,343 7,320 23,622

390 2,543 2,331 5,979

200 787 1,267 1,941

100 308 754 988

364 1,058 2,136 4,375

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

46,131 15,672 2,325 2,055

2,790 1,509 198 131

43,270 14,117 2,127 1,914

28,772 7,885 1,261 1,107

7,538 3,278 393 480

2,671 1,409 215 211

1,170 756 176 71

5,665 2,156 236 142

Parent’s education Less than high school diploma High school diploma More than high school

8,194 13,743 41,956

862 1,229 2,390

7,313 12,468 39,512

3,630 6,918 27,285

1,506 2,701 6,946

984 1,279 2,003

513 610 976

1,509 2,002 4,529

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

18,337 9,390 11,562 8,006 14,272

1,898 1,114 874 246 310

16,391 8,242 10,662 7,748 13,962

8,857 4,646 6,823 5,136 10,855

3,750 2,026 2,009 1,425 1,692

1,816 758 835 428 449

908 494 387 166 113

2,821 1,372 1,413 823 1,112

Health insurance status Private Medicaid/other public Other

38,797 19,345 1,604

1,641 1,195 61

37,105 18,106 1,543

25,600 10,764 866

6,260 3,774 361

1,886 1,442 86

792 619 26

3,996 2,534 261

6,136

1,707

4,402

1,660

1,242

1,070

709

1,356

Uninsured

Note: “Unmet dental need” is deﬁned as being unable to afford necessary dental care including checkups in the past 12 months. Numbers may not add to total because “not reported” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

330 AMERICAN HEALTH

HEALTH CARE VISITS

Table 10.35

Percent Distribution of Children by Dental Care Access and Length of Time since Last Dental Visit, 2008

(percent distribution of people aged 2 to 17 by access to dental care and length of time since last dental visit, by selected characteristics, 2008) time since last dental visit

unmet dental need

TOTAL CHILDREN Sex Female Male

total

yes

no

100.0%

7.0%

92.8%

100.0 100.0

6.8 7.1

Age Aged 2 to 4 Aged 5 to 11 Aged 12 to 17

100.0 100.0 100.0

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

more than more than more than six months, one year, two years, six months not more than not more than not more than or less one year two years ﬁve years

more than ﬁve years

59.0%

17.7%

6.8%

3.3%

12.4%

93.0 92.6

61.0 57.0

16.3 19.0

6.8 6.8

2.8 3.8

12.3 12.4

3.9 7.5 8.0

95.9 92.1 91.9

39.3 64.2 63.4

11.3 19.1 19.4

3.1 7.1 8.4

0.5 3.1 4.9

45.3 5.6 2.8

100.0 100.0 100.0 100.0

2.8 7.5 10.7 5.6

97.2 92.1 88.8 94.3

59.6 52.5 52.4 63.6

14.7 25.0 16.7 16.1

7.6 7.7 9.1 5.2

3.8 3.0 5.4 2.7

13.8 10.4 15.3 11.8

Family structure Mother and father Mother, no father Father, no mother Neither mother nor father

100.0 100.0 100.0 100.0

6.0 9.6 8.5 6.4

93.8 90.1 91.5 93.1

62.4 50.3 54.2 53.9

16.3 20.9 16.9 23.4

5.8 9.0 9.2 10.3

2.5 4.8 7.6 3.5

12.3 13.8 10.2 6.9

Parent’s education Less than high school diploma High school diploma More than high school

100.0 100.0 100.0

10.5 8.9 5.7

89.2 90.7 94.2

44.3 50.3 65.0

18.4 19.7 16.6

12.0 9.3 4.8

6.3 4.4 2.3

18.4 14.6 10.8

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

100.0 100.0 100.0 100.0 100.0

10.4 11.9 7.6 3.1 2.2

89.4 87.8 92.2 96.8 97.8

48.3 49.5 59.0 64.2 76.1

20.5 21.6 17.4 17.8 11.9

9.9 8.1 7.2 5.3 3.1

5.0 5.3 3.3 2.1 0.8

15.4 14.6 12.2 10.3 7.8

Health insurance status Private Medicaid/other public Other Uninsured

100.0 100.0 100.0 100.0

4.2 6.2 3.8 27.8

95.6 93.6 96.2 71.7

66.0 55.6 54.0 27.1

16.1 19.5 22.5 20.2

4.9 7.5 5.4 17.4

2.0 3.2 1.6 11.6

10.3 13.1 16.3 22.1

Note: “Unmet dental need” is deﬁned as being unable to afford necessary dental care including checkups in the past 12 months. Numbers may not add to total because “not reported” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

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331

HOSPITAL CARE CHAPTER

11 Hospital Care ■ Acute problems account for the largest share of visits to hospital outpatient departments. Thirty-seven percent of visits to hospital outpatient departments are due to acute health problems such as headaches, stomach pain, or skin rashes.

■ The oldest Americans are most likely to use emergency rooms. People aged 15-to-24 have the second-highest emergency room visit rate.

■ Eight percent of Americans stayed overnight in a hospital in 2008. Among people aged 65 or older, a much larger 17 percent were hospitalized.

■ Heart disease is the most common reason for hospitalization. Diseases related to the circulatory system account for 18 percent of hospital discharges, while childbirth accounts for 12 percent.

■ The average length of hospital stays has shortened. In 1980, the average hospital stay was 7.3 days. By 2006, it had fallen to 4.8 days.

■ In 2006, the nation’s hospitals performed more than 46 million procedures. Sixteen percent of procedures are performed on the cardiovascular system, and another 15 percent are obstetrical.

AMERICAN HEALTH

333

Blacks Are Most Likely to Use Hospital Outpatient Services Middle-aged and older blacks have the highest use rates of all. Americans use hospital outpatient facilities for a variety of reasons—to see physicians, to undergo tests, or to receive care for chronic conditions. In 2006, there were 34.7 visits to hospital outpatient departments for every 100 people in the U.S. population. This does not mean 34.7 percent of Americans visited an outpatient department during the year because some visit outpatient departments more than once and others do not visit them at all. The use of outpatient departments is highest among people aged 65 or older, which is predictable since older adults tend to have more health problems. Women are more likely than men to visit hospital outpatient departments. In fact, women aged 25 to 64 accounted for one-third of all visits to outpatient departments in 2006. Among men, that age group accounts for a much smaller 20 percent of visits to these facilities. The use of hospital outpatient facilities is much higher among blacks than whites. One reason for the difference is that blacks have less access to private physicians because of their lower incomes. Many blacks use public hospitals for much of their medical care. Blacks aged 45 or older are especially likely to use hospital outpatient departments, with a rate of more than 80 visits per 100 people in 2006, about double the rate among their white counterparts. ■ The use of outpatient clinics has increased in recent years, while the number of visits to physicians has declined. 90

The black rate is more than double the white rate

(number of visits to hospital outpatient departments per 1,000 people, by race and Hispanic origin, 2006)

63.5 visits

6060 visits

40.2 visits 3030 visits

00 visits

334 AMERICAN HEALTH

31.3 visits 20.4 visits

Asian a

black b

Hispanic c

white d

HOSPITAL CARE

Table 11.1

Hospital Outpatient Department Visits by Sex and Age, 2006

(total number, percent distribution, and number of hospital outpatient department visits per 100 people per year, by sex and age, 2006; numbers in thousands)

total

percent distribution

number of visits per 100 people per year

Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older Aged 65 to 74 Aged 75 or older

102,208 19,864 12,012 25,104 28,707 16,522 8,931 7,591

100.0% 19.4 11.8 24.6 28.1 16.2 8.7 7.4

34.7 32.7 29.0 30.6 38.6 46.4 47.8 44.8

Visits by females Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

61,952 9,628 8,551 16,712 16,924 5,478 4,658

60.6 9.4 8.4 16.4 16.6 5.4 4.6

41.2 32.5 41.8 40.3 44.3 54.2 45.3

Visits by males Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

40,256 10,236 3,461 8,391 11,782 3,453 2,933

39.4 10.0 3.4 8.2 11.5 3.4 2.9

28.0 33.0 16.5 20.6 32.6 40.3 44.1

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

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335

Table 11.2

Hospital Outpatient Department Visits by Race, Hispanic Origin, and Age, 2006

(total number, percent distribution, and number of hospital outpatient department visits per 100 people per year, by race, Hispanic origin, and age, 2006; number of visits in thousands)

total

Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older Aged 65 to 74 Aged 75 or older

102,208 19,864 12,012 25,104 28,707 16,522 8,931 7,591

percent distribution

number of visits per 100 people per year

100.0% 19.4 11.8 24.6 28.1 16.2 8.7 7.4

34.7 32.7 29.0 30.6 38.6 46.4 47.8 44.8

Visits by Asians

2,673

2.6

20.4

Visits by blacks Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

23,468 4,587 3,223 6,250 6,921 1,463 1023

23.0 4.5 3.2 6.1 6.8 1.4 1.0

63.5 49.5 52.6 60.0 85.0 84.0 80.2

Visits by Hispanics

17,595

17.2

40.2

Visits by whites Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

73,814 14,093 8,241 17,583 20,649 7,058 6,191

72.2 13.8 8.1 17.2 20.2 6.9 6.1

31.3 30.5 25.7 27.1 33.4 44.2 41.3

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

336 AMERICAN HEALTH

HOSPITAL CARE

Acute Health Problems Are the Most Common Reason for Visiting Hospital Outpatient Departments But people receive many types of services from these facilities. Acute health problems account for the largest share (37 percent) of visits to hospital outpatient departments. This broad general category includes injuries and illnesses of relatively short duration, such as respiratory infections. Among children under age 15, acute illnesses account for nearly half of visits to outpatient facilities. The single most commonly cited detailed reason for an outpatient department visit is a progress visit, followed by a general medical exam. Respiratory illness is the single most common diagnosis (11 percent) among people visiting hospital outpatient facilities. More than three out of four patients see a physician during their visit, and nearly half see a nurse in addition to or in lieu of a doctor. Most patients have their weight and temperature taken and receive a blood pressure test. Among the therapeutic services provided, the most common is advice about diet and nutrition. ■ Hospital outpatient departments offer many of the same services as physicians in private practice.

Nearly half of children who visit hospital outpatient departments are there for acute health problems 60

(percent of hospital outpatient department visits due to acute health problems, by age, 2006)

4040%

2020%

00%

under a 15

15 to b24

25 c to 44

45 to d64

65 to e74

75 orfolder

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337

Table 11.3

Hospital Outpatient Department Visits by Major Reason for Visit, 2006

(number and percent distribution of hospital outpatient department visits by age, sex, race, and major reason for visit, 2006; numbers in thousands)

percent

acute problem

chronic problem, routine

chronic problem, ﬂare-up

pre- or postsurgery/injury follow-up

preventive care

19,864 12,012 25,104 28,707 16,522 8,931 7,591

100.0 100.0 100.0 100.0 100.0 100.0 100.0

48.9 38.9 37.3 32.2 27.4 27.5 27.4

17.6 16.0 27.2 41.4 46.2 45.7 46.8

3.7 4.7 7.0 8.4 8.8 8.2 9.4

2.0 3.5 4.3 5.4 5.9 5.8 5.9

24.8 34.8 22.6 11.5 10.3 11.2 9.2

Sex Female Male

61,952 40,256

100.0 100.0

35.3 38.9

28.7 34.9

6.7 6.9

4.3 4.4

23.4 13.2

Race and Hispanic origin Black Hispanic White

23,468 17,595 73,814

100.0 100.0 100.0

30.6 33.2 38.9

32.9 25.4 30.5

5.9 6.0 7.1

4.1 4.1 4.4

24.9 29.6 17.3

TOTAL VISITS Age Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older Aged 65 to 74 Aged 75 or older

total number

102,208

100.0%

36.7%

31.1%

6.8%

4.3%

19.4%

Note: Numbers do not add to total because “blank” and “unknown” are not shown. Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

338 AMERICAN HEALTH

HOSPITAL CARE

Table 11.4

Visits to Hospital Outpatient Departments by Detailed Reason for Visit, 2006

(number and percent distribution of hospital outpatient department visits by the 20 principal reasons most frequently mentioned by patients for visit, 2006; numbers in thousands) number

Total visits Progress visit General medical examination Prenatal examination, routine Cough Diabetes mellitus Medication Symptoms referable to throat Counseling, not otherwise speciﬁed Well-baby examination Postoperative visit Stomach pain, cramps, and spasms Hypertension Earache or ear infection Gynecological examination Fever Headache, pain in head Skin rash Knee symptoms Prophylactic inoculations Back symptoms All other reasons

102,208 7,542 5,105 3,519 3,137 2,416 2,306 2,291 1,720 1,551 1,528 1,508 1,387 1,373 1,306 1,278 1,124 1,120 1,062 1,055 1,053 58,826

percent distribution

100.0% 7.4 5.0 3.4 3.1 2.4 2.3 2.2 1.7 1.5 1.5 1.5 1.4 1.3 1.3 1.3 1.1 1.1 1.0 1.0 1.0 57.6

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

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339

Table 11.5

Hospital Outpatient Department Visits by Primary Diagnosis, 2006

(number and percent distribution of hospital outpatient department visits by primary diagnosis, 2006; numbers in thousands) percent distribution

number

Total visits Infectious and parasitic diseases Neoplasms Endocrine, nutritional, metabolic diseases and immunity disorders Mental disorders Diseases of the nervous system and sense organs Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue Symptoms, signs, and ill-deﬁned conditions Injury and poisoning Supplementary classiﬁcation All other diagnoses Unknown

102,208 3,892 4,311

100.0% 3.8 4.2

7,086 7,337 6,189 6,633 10,784 3,151 4,356 3,548

6.9 7.2 6.1 6.5 10.6 3.1 4.3 3.5

7,161

7.0

6,700 5,882 20,744 3,909 524

6.6 5.8 20.3 3.8 0.5

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ ahcd/ahcd_reports.htm

Table 11.6

Hospital Outpatient Department Visits by Provider Seen, 2006

(number and percent distribution of hospital outpatient department visits by providers seen, 2006; numbers in thousands) number

PROVIDER SEEN Total visits Any physician Registered nurse or L.P.N. Nurse practitioner or midwife Physician assistant Other provider

102,208 80,487 48,535 9,623 6,848 24,644

percent distribution

100.0% 78.7 47.5 9.4 6.7 24.1

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

340 AMERICAN HEALTH

HOSPITAL CARE

Table 11.7

Hospital Outpatient Department Visits by Services Ordered or Provided, 2006

(number and percent of hospital outpatient department visits by services ordered or provided, 2006; numbers in thousands) number

Total visits One or more diagnostic or screening services No diagnostic or screening services provided Unknown

percent

102,208

100.0%

91,786

89.8

8,604 1,818

8.4 1.8

Examinations Skin Pelvic Breast Rectal Depression screening

11,932 5,856 4,590 2,076 1,365

11.7 5.7 4.5 2.0 1.3

Vital signs Weight Blood pressure Temperature Height

73,586 68,387 54,739 45,121

72.0 66.9 53.6 44.1

Blood tests CBC Glucose Lipids or cholesterol Electrolytes HgbA1C PSA Other blood test

15,860 8,240 7,708 6,770 4,617 1,598 15,164

15.5 8.1 7.5 6.6 4.5 1.6 14.8

Other tests Urinalysis 9,837 EKG or ECG 3,733 Any Pap test 3,506 Chlamydia test 1,508 Biopsy 1,156 Spirometry, pulmonary function test 844 HPV DNA test 492 Other test or service 14,301

9.6 3.7 3.4 1.5 1.1 0.8 0.5 14.0

Imaging Any imaging X-ray Ultrasound MRI, CT, or PET Mammography Bone mineral density Other imaging

17.5 8.4 4.1 3.5 2.2 0.5 1.6

17,893 8,581 4,197 3,621 2,272 503 1,684

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008; Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

341

Table 11.8

Hospital Outpatient Department Visits by Therapeutic Services Ordered or Provided, 2006

(number and percent of hospital outpatient department visits by therapeutic services ordered or provided, 2006; numbers in thousands) number

Total visits No counseling, education, or therapeutic services provided One or more counseling, education, or therapeutic services provided Diet or nutrition Exercise Growth or development Tobacco use or exposure Stress management Weight reduction Injury prevention Asthma education Other

percent

102,208

100.0%

50,813

49.7

49,927 15,696 7,711

48.8 15.4 7.5 4.1 3.9 3.6 3.3 2.8 1.4 32.7

4,209 3,971 3,687 3,380 2,862 1,405 33,429

Source: National Center for Health Statistics, National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

342 AMERICAN HEALTH

HOSPITAL CARE

Emergency Room Visits Rise Sharply in the Oldest Age Group People aged 75 or older have the highest rate of emergency room visits. The oldest Americans have the highest rate of visits to hospital emergency rooms, with 60.2 visits per 100 people in the age group in 2006. This compares with a rate of 40.5 per 100 people among the total population. The second-highest emergency room visit rate (47.1 per 100) is found among people aged 15 to 24. At this age, many are prone to behavior that can lead to accidents and injuries, necessitating a trip to the local ER. People aged 75 or older accounted for only 9 percent of total ER visits in 2006 because they make up a relatively small share of the total population. Blacks are far more likely than the general population to visit a hospital emergency room, with 79.9 visits per 100 blacks in the population versus a rate of 36.1 per 100 among whites. The low incomes of blacks, which limit their access to private physicians, are a reason for their higher rate of emergency room use. ■ As the population ages, the need for emergency care will increase. 75

Emergency room visit rates are lowest among 45-to-64-year-olds (number of hospital emergency room visits per 100 people, by age, 2006)

50 visits 50

25 visits 25

00 visits

under a 15

15 b to 24

25 c to 44

45 d to 64

65 e to 74

75 orfolder

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343

Table 11.9

Hospital Emergency Department Visits by Sex and Age, 2006

(total number, percent distribution, and number of hospital emergency department visits per 100 persons per year, by sex and age, 2006; numbers in thousands)

total

percent distribution

number of visits per 100 people per year

Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older Aged 65 to 74 Aged 75 or older

119,191 21,876 19,525 35,034 25,466 17,290 7,095 10,195

100.0% 18.4 16.4 29.4 21.4 14.5 6.0 8.6

40.5 36.0 47.1 42.7 34.3 48.5 38.0 60.2

Visits by females Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

64,962 10,328 11,398 19,790 13,195 3,887 6,363

54.5 8.7 9.6 16.6 11.1 3.3 5.3

43.3 34.8 55.7 47.8 34.5 38.4 61.8

Visits by males Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

54,230 11,548 8,127 15,244 12,271 3,208 3,832

45.5 9.7 6.8 12.8 10.3 2.7 3.2

37.7 37.2 38.8 37.5 34.0 37.5 57.6

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

344 AMERICAN HEALTH

HOSPITAL CARE

Table 11.10

Hospital Emergency Department Visits by Race and Age, 2006

(total number, percent distribution, and number of hospital emergency department visits per 100 persons per year, by race and age, 2006; numbers in thousands)

total

Total visits Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 or older Aged 65 to 74 Aged 75 or older

119,191 21,876 19,525 35,034 25,466 17,290 7,095 10,195

percent distribution

number of visits per 100 people per year

100.0% 18.4 16.4 29.4 21.4 14.5 6.0 8.6

40.5 36.0 47.1 42.7 34.3 48.5 38.0 60.2

Visits by Asians

2,386

2.0

18.2

Visits by blacks Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

29,558 5,962 5,096 9,381 6,653 1,263 1,202

24.8 5.0 4.3 7.9 5.6 1.1 1.0

79.9 64.3 83.1 90.0 81.7 72.6 94.3

Visits by Hispanics

15,472

13.0

35.3

Visits by whites Under age 15 Aged 15 to 24 Aged 25 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

85,273 14,823 13,839 24,532 17,929 5,561 8,588

71.5 12.4 11.6 20.6 15.0 4.7 7.2

36.1 32.0 43.1 37.8 29.0 34.8 57.3

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

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345

Emergency Room Visits by Older Adults Are Most Likely to Be Emergencies The youngest patients are most likely to have less serious conditions. Only 5 percent of patients who visit an emergency room must be seen immediately. Another 47 percent need to be treated within an hour. The rest require less urgent care, including 12 percent that are not urgent. Visits by people aged 65 or older are most likely to fall into the category immediate, and another 57 percent are deemed emergent or urgent. The largest share of nonurgent visits is found among people under age 24. The principal reasons why people visit an ER vary widely. The most commonly given reason is abdominal pain, although this accounted for only 6.8 percent of ER visits in 2006. Among the speciﬁc diagnoses given to ER patients, injuries and poisonings account for the largest share (24 percent). Nearly all patients visiting an ER are seen by a physician. Most (77 percent) are given some kind of diagnostic or screening service, and more than one-third has some type of blood test. X-rays and other imaging techniques are also commonly used, and 44 percent of visits include these services. ■ The burden on hospital emergency rooms is growing because people without easy access to private physicians use them for basic medical care.

Many visits to emergency rooms are not for emergencies 45

(percent distribution of visits to emergency rooms by urgency of problem, 2006)

36.6% 30 30%

22.0% 15 15%

12.1%

10.8%

13.4%

5.1% 0 0%

immediate a

346 AMERICAN HEALTH

emergent b

urgent c

semi-urgent d

non-urgent e

unknown f

HOSPITAL CARE

Table 11.11

Emergency Department Visits by Selected Characteristics and Urgency of Problem, 2006

(number of visits to emergency rooms and percent distribution by urgency of problem, by age, sex, and race, 2006; numbers in thousands) percent distribution by urgency of problem number

TOTAL VISITS

119,191

total

immediate

100.0%

5.1%

emergent

10.8%

urgent

semiurgent

nonurgent

unknown

36.6%

22.0%

12.1%

13.4%

Age Under age 15

21,876

100.0

3.1

7.8

35.0

25.6

14.6

13.9

Aged 15 to 24

19,525

100.0

4.1

8.4

34.3

24.7

14.3

14.1

Aged 25 to 44

35,034

100.0

4.3

10.1

36.4

22.7

12.9

13.6

Aged 45 to 64

25,466

100.0

5.9

12.8

37.1

20.0

11.1

13.2

Aged 65 or older

17,290

100.0

9.2

15.4

41.3

15.5

6.7

11.9

Aged 65 to 74

7,095

100.0

9.1

14.2

39.7

17.2

7.5

12.4

10,195

100.0

9.3

16.2

42.3

14.4

6.1

11.6

Female

64,962

100.0

4.6

10.4

37.2

22.2

12.0

13.5

Male

54,230

100.0

5.7

11.1

36.0

21.7

12.3

13.3

Black

29,558

100.0

4.9

10.4

35.6

22.6

14.2

12.3

Hispanic

15,472

100.0

3.8

9.6

33.3

22.0

13.7

17.5

White

85,273

100.0

5.2

10.9

36.6

21.8

11.7

13.8

Aged 75 or older Sex

Race and Hispanic origin

Note: “Immediate” is a visit in which the patient should be seen immediately; “emergent” is a visit in which the patient should be seen in less than 15 minutes; “urgent” is a visit in which the patient should be seen within 15 to 60 minutes; “semiurgent” is a visit in which the patient should be seen within 61 to 120 minutes; “nonurgent” is a visit in which the patient should be seen within 121 minutes to 24 hours; “unknown” is a visit with no mention of immediacy or triage or the patient was dead on arrival. Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

347

Table 11.12

Hospital Emergency Department Visits by Reason for Visit, 2006

(number and percent distribution of hospital emergency department visits by the 20 principal reasons most frequently mentioned by patients for visit, 2006; numbers in thousands) number

All visits 119,191 Stomach and abdominal pain, cramps, spasms 8,057 Chest pain and related symptoms 6,392 Fever 4,485 Headache, pain in head 3,354 Back symptoms 3,304 Shortness of breath 3,007 Cough 2,956 Vomiting 2,635 Pain, site not referable to speciﬁc body system 2,512 Symptoms referable to throat 2,278 Lacerations and cuts, upper extremity 1,870 Nausea 1,804 Accident, not otherwise speciﬁed 1,737 Motor vehicle accident, type of injury unspeciﬁed 1,714 Earache or ear infection 1,677 Vertigo, dizziness 1,657 Leg symptoms 1,645 Skin rash 1,613 Injury, other and unspeciﬁed type (head, neck, face) 1,586 Low back symptoms 1,511 All other reasons 63,399

percent distribution

100.0% 6.8 5.4 3.8 2.8 2.8 2.5 2.5 2.2 2.1 1.9 1.6 1.5 1.5 1.4 1.4 1.4 1.4 1.4 1.3 1.3 53.2

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

348 AMERICAN HEALTH

HOSPITAL CARE

Table 11.13

Hospital Emergency Department Visits by Primary Diagnosis, 2006

(number and percent distribution of hospital emergency department visits by primary diagnosis, 2006; numbers in thousands) number

percent distribution

All visits Infectious and parasitic diseases Neoplasms Endocrine, nutritional, and metabolic diseases and immunity disorders Mental disorders Diseases of the nervous system and sense organs Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue

119,191 3,331 204

100.0% 2.8 0.2

1,936 4,279 5,718 4,378 11,943 7,239 5,775 4,450

1.6 3.6 4.8 3.7 10.0 6.1 4.8 3.7

7,402

Symptoms, signs, and ill-deﬁned conditions Injury and poisoning Fractures Sprains and strains Intracranial injury Open wounds Superﬁcial injury Contusions with intact skin surface Foreign body Burns Trauma complications and unspeciﬁed injuries Poisoning and toxic effects Surgical and medical complications Other injuries Supplementary classiﬁcation All other diagnoses Unknown

23,966 28,996 3,851 5,813 294 6,153 1,454 5,302 651 517 1,911 920 428 1,701 3,545 2,839 3,191

6.2 20.1 24.3 3.2 4.9 0.2 5.2 1.2 4.4 0.5 0.4 1.6 0.8 0.4 1.4 3.0 2.4 2.7

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

349

Table 11.14

Hospital Emergency Department Visits by Provider Seen, 2006

(number and percent distribution of hospital emergency department visits by provider seen, 2006; numbers in thousands) number

PROVIDER SEEN Total visits Any physician ED attending physician ED resident or intern On call attending physician or fellow Registered nurse or L.P.N. E.M.T. Physician assistant Nurse practitioner Other provider Blank

119,191 107,453 104,531 10,745 6,044 105,992 11,075 10,408 4,893 26,531 1,558

percent distribution

100.0% 90.2 87.7 9.0 5.1 88.9 9.3 8.7 4.1 22.3 1.3

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

350 AMERICAN HEALTH

HOSPITAL CARE

Table 11.15

Visits to Hospital Emergency Departments by Diagnostic and Screening Services Ordered or Provided, 2006

(number and percent of hospital emergency department visits by diagnostic and screening services ordered or provided, 2006; numbers in thousands) number

Total visits One or more diagnostic or screening services No diagnostic or screening services provided No services

percent

119,191 92,304 24,990 1,897

100.0% 77.4 21.0 1.6

Blood tests Any blood test listed Complete blood count Blood urea nitrogen or creatinine Glucose Electrolytes Cardiac enzymes Liver function tests Arterial blood gases Blood alcohol concentration HIV serology Other blood test

46,232 41,639 25,213 23,614 22,091 13,865 7,464 2,799 1932 249 22,956

38.8 34.9 21.2 19.8 18.5 11.6 6.3 2.3 1.6 0.2 19.3

Imaging Any imaging X-ray CT scan Ultrasound MRI scan Other imaging

52,690 41,589 13,770 3,675 621 1,581

44.2 34.9 11.6 3.1 0.5 1.3

Examinations and tests Pulse oximetry Urinalysis EKG or ECG Cardiac monitor Pregnancy test Other test or servcie

49,058 25,994 20,385 9,477 5,512 13,521

41.2 21.8 17.1 8.0 4.6 11.3

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm

AMERICAN HEALTH

351

Older Adults Are More Likely to Need Hospitalization The rate is lowest among children. In 2008, just 8 percent of Americans experienced an overnight hospital stay. The percentage hospitalized for at least one night during the year bottoms out at 2 percent among children aged 12 to 17. It peaks among people aged 65 or older at 17 percent. The rate of hospitalization increases with advancing age because health problems become more serious. Among people aged 65 or older, the hospital discharge rate per 10,000 population stood at 3,507.9 in 2006, more than nine times higher than the rate among children under age 15. Hospitalization rates also vary by sex. Among children under age 15, the rate is higher for males than females. Among people aged 45 or older, the rate for men and women is almost the same. Among those aged 15 to 44, women are far more likely to have a hospital stay. The primary reason is childbirth. On average, males have slightly longer hospital stays than females. This is especially true in the 15-to-44 age group where men were hospitalized for 5.0 days on average and women for 3.3 days. Behind women’s shorter length of stay is the brief time most women spend in the hospital following childbirth. ■ People under age 65 who lack health insurance are least likely to be hospitalized in a given year, with only 4.6 percent having a hospital stay in 2008.

Among older men and women, hospital stays are about the same length (average length of hospital stay for inpatients discharged from nonfederal short-stay hospitals, by sex and age, 2006)

6

4.7

5.0

4.9

44 days

4.9

5.1

5.5

fema

5.4

male

3.3

22 days 100000

00 days

a 15 under

all females

males dual

75000

15 b to 44

45 c to 64

65 ordolder

50000

25000

0

352 AMERICAN HEALTH

with

w/out

HOSPITAL CARE

Table 11.16

Overnight Hospital Stays by Selected Characteristics, 2008

(total number of people and percent distribution by experience of an overnight hospital stay in past 12 months, by selected characteristics, 2008; numbers in thousands) total number

TOTAL PEOPLE Sex Female Male

number of stays percent

none

one or more

299,082

100.0%

92.0%

8.0%

152,579 146,503

100.0 100.0

90.6 93.4

9.4 6.6

Age Under age 12 Aged 12 to 17 Aged 18 to 44 Aged 45 to 64 Aged 65 or older

49,087 24,771 110,613 77,489 19,858

100.0 100.0 100.0 100.0 100.0

92.3 97.6 93.6 92.2 82.6

7.7 2.4 6.4 7.8 17.4

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

13,554 38,247 46,385 196,018

100.0 100.0 100.0 100.0

94.5 90.8 92.7 92.0

5.5 9.2 7.3 8.0

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

82,233 39,912 48,526 32,762 56,639

100.0 100.0 100.0 100.0 100.0

89.6 92.3 92.2 92.5 93.4

10.4 7.7 7.8 7.5 6.6

Education Not a high school graduate High school graduate Some college Bachelor’s degree or more

28,879 55,405 51,574 54,951

100.0 100.0 100.0 100.0

89.0 90.4 91.0 91.9

11.0 9.6 9.0 8.1

170,213 36,678 8,767 43,675

100.0 100.0 100.0 100.0

94.2 86.0 89.3 95.4

5.8 14.0 10.7 4.6

Health insurance coverage among people under age 65 Private Medicaid Other Uninsured

Source: National Center for Health Statistics, Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 243, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm

AMERICAN HEALTH

353

Table 11.17

Hospital Discharges and Length of Stay, 2006

(number of hospital discharges, discharge rate per 10,000 population, and average length of stay in days, for inpatients from nonfederal short-stay hospitals by age and sex, 2006; excludes newborn infants) total

female

male

34,854 2,298 10,800 8,686 13,070

20,864 1,003 7,878 4,399 7,584

13,990 1,295 2,922 4,287 5,487

1,375.3 338.0 1,268.8 1,147.3 3,510.4

954.9 416.6 461.5 1,175.7 3,504.5

4.5 4.7 3.3 4.9 5.5

5.2 4.9 5.0 5.1 5.4

DISCHARGES (in 000s)

Total Under age 15 Aged 15 to 44 Aged 45 to 64 Aged 65 or older

DISCHARGE RATE (per 10,000 population)

Total Under age 15 Aged 15 to 44 Aged 45 to 64 Aged 65 or older

1,168.7 378.2 861.2 1,161.2 3,507.9

AVERAGE LENGTH OF STAY (days)

Total Under age 15 Aged 15 to 44 Aged 45 to 64 Aged 65 or older

4.8 4.8 3.7 5.0 5.5

Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

354 AMERICAN HEALTH

HOSPITAL CARE

The Oldest Account for the Largest Share of Hospitalizations Younger adults are most likely to be hospitalized for certain conditions, however. In 2006, hospitals discharged more than 34 million people. More than one-third of discharges are people aged 65 or older. For many conditions, older adults account for the majority of discharged patients. People aged 65 or older account for 53 percent of patients discharged with a diagnosis of malignant neoplasm (cancer) and 62 percent of patients with any type of heart disease. Among hospitalizations for pneumonia, 57 percent were among people aged 65 or older. People aged 15 to 44 account for the largest share of hospitalizations for some conditions, however. As would be expected, nearly everyone who gave birth was in this age group. But 15-to-44year-olds also made up more than half of those hospitalized for poisoning, appendicitis, and mental health conditions—including schizophrenia and depression. ■ As the baby-boom generation ages, people aged 65 or older will account for a growing share of hospital patients.

People aged 45 or older account for most hospital discharges (percent distribution of hospital discharges from nonfederal, short-stay hospitals, by age, 2006)

6.6% under 15 a

a b

37.5% 65 or older d

b 31.0%

15 to 44

24.9% 45 to 64

c d

c

AMERICAN HEALTH

355

Table 11.18

Number of Hospital Discharges by Diagnosis and Age, 2006

(number of hospital discharges from nonfederal short-stay hospitals by ﬁrst-listed diagnosis and age, 2006; numbers in thousands) total

under 15

15 to 44

45 to 64

65 or older

34,854

2,298

10,800

8,686

13,070

1,088

138

193

262

495

530

9

43

134

345

1,641

34

257

628

723

1,208

23

111

438

636

Malignant neoplasms of large intestine and rectum

154

–

8

46

101

Malignant neoplasms of trachea, bronchus, and lung

166

–

5

51

109

378

10

137

173

58

211

–

103

106

–

All conditions Infectious and parasitic diseases Septicemia Neoplasms Malignant neoplasms

Benign neoplasms Benign neoplasms of uterus Endocrine, nutritional, and metabolic diseases and immunity disorders

1,663

160

365

483

655

Diabetes mellitus

584

22

169

205

188

Volume depletion

480

112

46

81

240

451

55

98

102

196

315

22

75

65

152

2,419

–

1,332

717

239

1,747

–

952

522

191

Schizophrenic disorders

333

–

178

134

20

Major depressive disorder

459

–

256

140

42

615

83

134

151

246

6,161

29

452

1,880

3,801

293

–

45

122

125

4,202

16

277

1,285

2,624

Acute myocardial infarction

647

–

34

218

394

Coronary atherosclerosis

953

–

42

415

496

Other ischemic heart disease

160

–

17

67

76

Cardiac dysrhythmias

772

5

50

193

522

1,102

–

49

246

803

889

–

46

236

606

3,485

576

376

804

1,729

217

152

10

18

36

1,232

172

107

250

704 333

Diseases of the blood and blood-forming organs Anemias Mental disorders Psychoses

Diseases of the nervous system and sense organs Diseases of the circulatory system Essential hypertension Heart disease

Congestive heart failure Cerebrovascular disease Diseases of the respiratory system Acute bronchitis and bronchiolitis Pneumonia Chronic bronchitis

513

–

16

163

Asthma

444

145

89

121

88

3,517

219

858

1,111

1,329

Appendicitis

318

71

163

63

21

Noninfectious enteritis and colitis

356

44

95

91

126

Intestinal obstruction

323

15

38

103

167

Diverticula of intestine

314

–

42

99

174

Cholelithiasis

335

–

117

99

116

Acute pancreatitis

233

2

82

92

56

1,974

75

498

524

877

Diseases of the digestive system

Diseases of the genitourinary system Calculus of kidney and ureter

166

–

58

71

36

Urinary tract infection

479

27

32

77

343 (continued)

356 AMERICAN HEALTH

HOSPITAL CARE

total

under 15

15 to 44

45 to 64

Complications of pregnancy, childbirth, and the puerperium

519

–

517

–

–

Diseases of the skin and subcutaneous tissue

780

–

233

224

223 169

Cellulitis and abscess

65 or older

589

56

179

184

1,969

40

298

720

911

Osteoarthrosis and allied disorders

753

–

21

280

452

Intervertebral disc disorders

Diseases of the musculoskeletal system and connective tissue

324

–

102

148

73

Congenital anomalies

193

131

28

25

8

Certain conditions originating in the perinatal period

200

200

–

–

–

Symptoms, signs, and ill-deﬁned conditions

189

42

63

44

40

Injury and poisoning

2,968

211

846

764

1,147

Fractures, all sites

1,074

63

243

202

566

330

1

6

28

293

Poisonings

271

16

157

73

26

Certain complications of surgical and medical care

912

34

191

322

365

5,022

70

4,253

246

453

4,127

–

4,112

9

–

Fracture of neck of femur

Supplementary classiﬁcations Females with deliveries

Note: “–” means category is not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

AMERICAN HEALTH

357

Table 11.19

Percent Distribution of Hospital Discharges by Diagnosis and Age, 2006

(percent distribution of hospital discharges from nonfederal short-stay hospitals by ﬁrst-listed diagnosis and age, 2006) total

under 15

All conditions

100.0%

Infectious and parasitic diseases

100.0

12.7

100.0 100.0

15 to 44

45 to 64

65 or older

31.0%

24.9%

37.5%

17.7

24.1

45.5

1.7

8.1

25.3

65.1

2.1

15.7

38.3

44.1

100.0

1.9

9.2

36.3

52.6

Malignant neoplasms of large intestine and rectum

100.0

–

5.2

29.9

65.6

Malignant neoplasms of trachea, bronchus, and lung

100.0

–

3.0

30.7

65.7

100.0

2.6

36.2

45.8

15.3

100.0

–

48.8

50.2

–

Septicemia Neoplasms Malignant neoplasms

Benign neoplasms Benign neoplasms of uterus Endocrine, nutritional, and metabolic diseases and immunity disorders

6.6%

100.0

9.6

21.9

29.0

39.4

Diabetes mellitus

100.0

3.8

28.9

35.1

32.2

Volume depletion

100.0

23.3

9.6

16.9

50.0

100.0

12.2

21.7

22.6

43.5

100.0

7.0

23.8

20.6

48.3

100.0

–

55.1

29.6

9.9

100.0

–

54.5

29.9

10.9

Schizophrenic disorders

100.0

–

53.5

40.2

6.0

Major depressive disorder

100.0

–

55.8

30.5

9.2

Diseases of the nervous system and sense organs

100.0

13.5

21.8

24.6

40.0

Diseases of the circulatory system

Diseases of the blood and blood-forming organs Anemias Mental disorders Psychoses

100.0

0.5

7.3

30.5

61.7

Essential hypertension

100.0

–

15.4

41.6

42.7

Heart disease

100.0

0.4

6.6

30.6

62.4

Acute myocardial infarction

100.0

–

5.3

33.7

60.9

Coronary atherosclerosis

100.0

–

4.4

43.5

52.0

Other ischemic heart disease

100.0

–

10.6

41.9

47.5

Cardiac dysrhythmias

100.0

0.6

6.5

25.0

67.6

Congestive heart failure

100.0

–

4.4

22.3

72.9

100.0

–

5.2

26.5

68.2

100.0

16.5

10.8

23.1

49.6

Acute bronchitis and bronchiolitis

100.0

70.0

4.6

8.3

16.6

Pneumonia

100.0

14.0

8.7

20.3

57.1

Chronic bronchitis

100.0

–

3.1

31.8

64.9

Asthma

100.0

32.7

20.0

27.3

19.8

100.0

6.2

24.4

31.6

37.8

Appendicitis

100.0

22.3

51.3

19.8

6.6

Noninfectious enteritis and colitis

100.0

12.4

26.7

25.6

35.4

Intestinal obstruction

100.0

4.6

11.8

31.9

51.7

Diverticula of intestine

100.0

–

13.4

31.5

55.4

Cholelithiasis

100.0

–

34.9

29.6

34.6

Acute pancreatitis

100.0

0.9

35.2

39.5

24.0

100.0

3.8

25.2

26.5

44.4

Calculus of kidney and ureter

100.0

–

34.9

42.8

21.7

Urinary tract infection

100.0

5.6

6.7

16.1

Cerebrovascular disease Diseases of the respiratory system

Diseases of the digestive system

Diseases of the genitourinary system

71.6 (continued)

358 AMERICAN HEALTH

HOSPITAL CARE

total

under 15

15 to 44

Complications of pregnancy, childbirth, and the puerperium

100.0%

–

99.6%

Diseases of the skin and subcutaneous tissue

100.0

–

Cellulitis and abscess

45 to 64

65 or older

–

–

29.9

28.7%

28.6%

100.0

9.5%

30.4

31.2

28.7

Diseases of the musculoskeletal system and connective tissue

100.0

2.0

15.1

36.6

46.3

Osteoarthrosis and allied disorders

100.0

–

2.8

37.2

60.0

Intervertebral disc disorders

100.0

–

31.5

45.7

22.5 4.1

Congenital anomalies

100.0

67.9

14.5

13.0

Certain conditions originating in the perinatal period

100.0

100.0

–

–

–

Symptoms, signs, and ill-deﬁned conditions

100.0

22.2

33.3

23.3

21.2

Injury and poisoning

100.0

7.1

28.5

25.7

38.6

Fractures, all sites

100.0

5.9

22.6

18.8

52.7

Fracture of neck of femur

100.0

0.3

1.8

8.5

88.8

Poisonings

100.0

5.9

57.9

26.9

9.6

Certain complications of surgical and medical care

100.0

3.7

20.9

35.3

40.0

100.0

1.4

84.7

4.9

9.0

100.0

–

99.6

0.2

–

Supplementary classiﬁcations Females with deliveries

Note: “–” means category is not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

AMERICAN HEALTH

359

Heart Disease Is Most Likely to Lead to Hospitalization But heart patients do not stay in the hospital any longer than average. There are many different health conditions that can lead to a hospital stay. A few conditions account for a sizable share of hospitalizations. Based on the ﬁrst-listed (primary) diagnosis on discharge, the most common health problems among the hospitalized are related to the circulatory system, accounting for 18 percent. Most of these are heart disease cases (12 percent). Respiratory illnesses are also a major cause of hospitalization, accounting for 10 percent of the total. Diseases of the digestive system account for another 10 percent. The only other condition that accounts for at least 10 percent of hospital stays is childbirth. Among all discharges in 2006, 12 percent were women who had given birth. Although heart disease is a leading reason for hospitalization, it does not require as long a hospital stay as some other conditions. The average length of stay for all those with heart disease is 4.4 days, although those with acute myocardial infarction (heart attack) stayed a longer 5.4 days, on average. Regardless of diagnosis, the average hospital stay in 2006 was shorter than in 1980. There are two reasons for the decline—insurance limits and treatment protocols. Insurance companies have generally reduced the number of days of hospitalization for which they will pay, which effectively requires patients to be discharged more quickly. But treatments of diseases have also changed, often reducing the need for long hospital stays. ■ At ﬁrst, insurance curbs on hospital stays encouraged a treat ’em and street ’em approach. But protests from patients as well as health care providers resulted in more ﬂexibility from insurers.

Hospital stays have gotten shorter (average length of a hospital stay in days for discharges from short-stay hospitals, 1980 and 2006) 9

7.3 days 6

6 days

3

3 days

0

0 days

360 AMERICAN HEALTH

4.8 days

a 1980

b 2006

HOSPITAL CARE

Table 11.20

Number and Rate of Discharges from Hospitals by Diagnosis, 2006

(number and percent distribution of hospital discharges and discharge rate per 10,000 population by ﬁrst-listed diagnosis, 2006; excludes newborn infants; numbers in thousands)

number

All conditions Infectious and parasitic diseases Septicemia Neoplasms Malignant neoplasms Malignant neoplasms of large intestine and rectum Malignant neoplasms of trachea, bronchus, and lung Benign neoplasms Benign neoplasms of uterus Endocrine, nutritional, and metabolic diseases and immunity disorders Diabetes mellitus Volume depletion Diseases of the blood and blood-forming organs Anemias Mental disorders Psychoses Schizophrenic disorders Major depressive disorder Diseases of the nervous system and sense organs Diseases of the circulatory system Essential hypertension Heart disease Acute myocardial infarction Coronary atherosclerosis Other ischemic heart disease Cardiac dysrhythmias Congestive heart failure Cerebrovascular disease Diseases of the respiratory system Acute bronchitis and bronchiolitis Pneumonia Chronic bronchitis Asthma Diseases of the digestive system Appendicitis Noninfectious enteritis and colitis Intestinal obstruction Diverticula of intestine Cholelithiasis Acute pancreatitis Diseases of the genitourinary system Calculus of kidney and ureter Urinary tract infection

34,854 1,088 530 1,641 1,208 154 166 378 211 1,663 584 480 451 315 2,419 1,747 333 459 615 6,161 293 4,202 647 953 160 772 1,102 889 3,485 217 1,232 513 444 3,517 318 356 323 314 335 233 1,974 166 479

rate per 10,000 population

percent distribution

100.0% 3.1 1.5 4.7 3.5 0.4 0.5 1.1 0.6 4.8 1.7 1.4 1.3 0.9 6.9 5.0 1.0 1.3 1.8 17.7 0.8 12.1 1.9 2.7 0.5 2.2 3.2 2.6 10.0 0.6 3.5 1.5 1.3 10.1 0.9 1.0 0.9 0.9 1.0 0.7 5.7 0.5 1.4

1,168.7 36.5 17.8 55.0 40.5 5.2 5.6 12.7 7.1 55.8 19.6 16.1 15.1 10.6 81.1 58.6 11.2 15.4 20.6 206.6 9.8 140.9 21.7 32.0 5.4 25.9 36.9 29.8 116.9 7.3 41.3 17.2 14.9 117.9 10.7 11.9 10.8 10.5 11.2 7.8 66.2 5.6 16.0 (continued)

AMERICAN HEALTH

361

number

Complications of pregnancy, childbirth, and the puerperium Diseases of the skin and subcutaneous tissue Cellulitis and abscess Diseases of the musculoskeletal system and connective tissue Osteoarthrosis and allied disorders Intervertebral disc disorders Congenital anomalies Certain conditions originating in the perinatal period Symptoms, signs, and ill-deﬁned conditions Injury and poisoning Fractures, all sites Fracture of neck of femur Poisonings Certain complications of surgical and medical care Supplementary classiﬁcations Females with deliveries

percent distribution

rate per 10,000 population

519 780 589 1,969 753 324 193 200 189 2,968 1,074 330 271 912 5,022

1.5% 2.2 1.7 5.6 2.2 0.9 0.6 0.6 0.5 8.5 3.1 0.9 0.8 2.6 14.4

17.4 26.2 19.7 66.0 25.3 10.9 6.5 6.7 6.3 99.5 36.0 11.1 9.1 30.6 168.4

4,127

11.8

138.4

Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

362 AMERICAN HEALTH

HOSPITAL CARE

Table 11.21

Length of Hospital Stay by Diagnosis, 1980 and 2006

(average length of stay in days for discharges from short-stay hospitals by ﬁrst-listed diagnosis, 1980 and 2006, change in days, 1980–2006; excludes newborn infants) number of days

Total conditions Infectious and parasitic diseases Septicemia Neoplasms Malignant neoplasms Malignant neoplasms of large intestine and rectum Malignant neoplasms of trachea, bronchus, and lung Benign neoplasms Benign neoplasms of uterus Endocrine, nutritional, and metabolic diseases and immunity disorders Diabetes mellitus Volume depletion Diseases of the blood and blood-forming organs Anemias Mental disorders Psychoses Schizophrenic disorders Major depressive disorder Diseases of the nervous system and sense organs Diseases of the circulatory system Essential hypertension Heart disease Acute myocardial infarction Coronary atherosclerosis Other ischemic heart disease Cardiac dysrhythmias Congestive heart failure Cerebrovascular disease Diseases of the respiratory system Acute bronchitis and bronchiolitis Pneumonia Chronic bronchitis Asthma Diseases of the digestive system Appendicitis Noninfectious enteritis and colitis Intestinal obstruction Diverticula of intestine Cholelithiasis Acute pancreatitis Diseases of the genitourinary system Calculus of kidney and ureter Urinary tract infection

2006

1980

change, 1980–2006

4.8 6.7 8.7 5.8 6.5 7.8 7.2 3.3 2.4

7.3 6.9 14.3 10.5 11.9 15.7 12.8 6.2 –

–2.5 –0.2 –5.6 –4.7 –5.4 –7.9 –5.6 –3.8 –

3.9 4.7 3.5 4.3 4.0 7.0 7.7 11.7 6.7 5.7 4.5 2.2 4.4 5.4 3.2 2.5 3.4 5.1 4.9 5.1 3.2 5.1 4.7 3.2 4.6 3.1 4.2 6.2 4.8 3.8 5.2 3.9 2.4 4.6

9.6 10.5 8.9 7.2 – 11.6 14.8 – – 5.4 10.0 – 9.5 12.6 10.0 7.7 7.6 10.4 12.4 6.3 4.7 8.3 – 6.0 7.0 5.5 5.6 – – 9.3 – 5.6 5.0 –

–5.7 –5.8 –5.4 –2.9 – –4.6 –7.1 – – 0.3 –5.5 – –5.1 –7.2 –6.8 –5.2 –4.2 –5.3 –7.5 –1.2 –1.5 –3.2 – –2.8 –2.4 –2.4 –1.4 – – –5.5 – –1.7 –2.6 – (continued)

AMERICAN HEALTH

363

number of days

Complications of pregnancy, childbirth, and the puerperium Diseases of the skin and subcutaneous tissue Cellulitis and abscess Diseases of the musculoskeletal system and connective tissue Osteoarthrosis and allied disorders Intervertebral disc disorders Congenital anomalies Certain conditions originating in the perinatal period Symptoms, signs, and ill-deﬁned conditions Injury and poisoning Fractures, all sites Fracture of neck of femur Poisonings Certain complications of surgical and medical care Supplementary classiﬁcations Females with deliveries

2006

1980

change, 1980–2006

2.7 4.9 4.4 3.9 3.8 3.1 6.3 10.7 2.4 5.4 5.3 6.2 2.9 6.1 3.8

2.5 8.0 8.0 8.3 – 9.9 6.6 8.7 4.5 7.7 10.8 20.6 – – 3.7

0.2 –3.1 –3.6 –4.4 – –6.8 –0.3 2.0 –2.1 –2.3 –5.5 –14.4 – – 2.4

2.6

3.8

–1.2

Note: “–” means data not available. Source: National Center for Health Statistics, Trends in Hospital Utilization: United States, 1988–92, Vital and Health Statistics, Series 13, No. 124, 1996, Internet site http://www.cdc.gov/nchs/products/pubs/pubd/series/sr13/130-121/sr13_124.htm and 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc .gov/nchs/nhds.htm; calculations by New Strategist

364 AMERICAN HEALTH

HOSPITAL CARE

Hospitals Provide a Wide Variety of Services Surgeries account for a sizable share. Hospitals provide a wide variety of services, from basic support care to diagnostics to surgery and maternity services. In 2006, hospitals performed nearly 46 million procedures. The largest share (30 percent) is accounted for by the general category of miscellaneous diagnostic and therapeutic procedures. Operations on the cardiovascular system make up another 16 percent. Obstetrical procedures account for about 15 percent of the total. Twelve percent are operations on the digestive system. People aged 65 or older account for the largest share of procedures (35 percent), slightly greater than the 33 percent accounted for by people aged 15 to 44. The 65-or-older age group also makes up the largest share of hospital patients, so it is not surprising that they account for more procedures than younger age groups do. ■ Some medical procedures that once were performed only in a hospital setting have migrated to less expensive venues, including doctor’s ofﬁces.

More than one-third of procedures are performed on people aged 65 or older (percent distribution of procedures performed in nonfederal, short-stay hospitals, by age of patient, 2006)

4.7% under 15 a

a

35.3% 65 or older d

b b 32.7%

15 to 44

27.3% 45 to 64

c d

c

AMERICAN HEALTH

365

Table 11.22

Number of Hospital Discharges by Procedure and Age, 2006

(number of hospital discharges from nonfederal short-stay hospitals by procedure category and age, 2006; numbers in thousands) total

under 15

15 to 44

45 to 64

65 or older

45,963

2,159

15,012

12,555

16,238

1,155

184

343

304

324

315

124

77

64

50

101

–

33

37

29

Operations on the eye

76

–

19

19

26

Operations on the ear

53

–

11

8

–

298

67

89

74

67

1,167

73

188

362

544

282

–

44

88

132

Operations on the cardiovascular system

7,235

210

734

2,633

3,658

Balloon angioplasty of coronary artery or coronary atherectomy

661

–

33

301

327

Insertion of coronary artery stent(s)

652

–

33

294

324

Coronary artery bypass graft

444

–

15

191

237

1,115

12

87

487

529

Insertion, replacement, removal, revision of pacemaker

418

–

9

46

361

Hemodialysis

645

–

102

244

295

371

21

57

147

146

5,571

243

1,267

1,743

2,319

Total procedures Operations on the nervous system Spinal tap Operations on the endocrine system

Operations on the nose, mouth, and pharynx Operations on the respiratory system Bronchoscopy with or without biopsy

Cardiac catheterization

Operations on the hemic and lymphatic system Operations on the digestive system Endoscopy of small intestine with or without biopsy

1,045

–

151

307

570

Endoscopy of large intestine with or without biopsy

522

7

68

150

297

Partial excision of large intestine

252

–

30

83

135

Appendectomy, excluding incidental

341

74

178

66

24

Cholecystectomy

414

–

155

128

129

Lysis of peritoneal adhesions

344

7

120

117

101

1,025

26

203

355

442

Cystoscopy with or without biopsy

146

–

29

42

72

Operations on the male genital organs

250

28

16

82

123

Operations on the urinary system

Prostatectomy

168

–

–

65

103

1,957

9

1,073

638

237

Oophorectomy and salpingo-oophorectomy

418

–

147

207

61

Bilateral destruction or occlusion of Fallopian tubes

351

–

349

–

–

Hysterectomy

569

–

260

250

59 –

Operations on the female genital organs

Obstetrical procedures

7,076

9

7,049

17

Episiotomy with or without forceps or vacuum extraction

454

–

453

–

–

Artiﬁcial rupture of membranes

960

–

956

–

–

Medical induction of labor

653

–

650

–

–

Caesarean section

1,295

–

1,290

3

–

Repair of current obstetric laceration

1,308

–

1,304

–

–

Operations on the musculoskeletal system

4,254

166

909

1,513

1,666

Partial excision of bone

171

9

42

68

52

Reduction of fracture

672

43

196

159

273

439

14

130

113

183

Open reduction of fracture with internal ﬁxation

(continued)

366 AMERICAN HEALTH

HOSPITAL CARE

total

under 15

15 to 44

45 to 64

Excision or destruction of intervertebral disc

280

–

85

137

55

Total hip replacement

231

–

13

92

126

Total knee replacement Operations on the integumentary system Debridement of wound, infection, or burn Miscellaneous diagnostic and therapeutic procedures Computerized axial tomography Arteriography and angiocardiography using contrast material Diagnostic ultrasound Physical therapy procedures Respiratory therapy Insertion of endotracheal tube Transfusion of blood and blood components Injection or infusion of cancer chemotherapeutic substance

65 or older

542

–

11

204

328

1,598

–

510

473

417

402

–

124

121

122

13,775

885

2,511

4,150

6,230 312

740

35

174

219

1,698

18

188

701

790

888

34

149

273

432

386

–

33

95

249

1,088

165

159

288

476

476

49

74

132

221

1,968

66

224

487

1,191

221

42

36

88

55

Note: “–” means category is not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

AMERICAN HEALTH

367

Table 11.23

Percent Distribution of Hospital Discharges by Procedure and Age, 2006

(percent distribution of hospital discharges from nonfederal short-stay hospitals by procedure category and age, 2006) total

Total procedures

100.0%

Operations on the nervous system

100.0

Spinal tap

under 15

4.7%

15 to 44

45 to 64

65 or older

32.7%

27.3%

35.3%

15.9

29.7

26.3

28.1

100.0

39.4

24.4

20.3

15.9

Operations on the endocrine system

100.0

–

32.7

36.6

28.7

Operations on the eye

100.0

–

25.0

25.0

34.2

Operations on the ear

100.0

–

20.8

15.1

–

Operations on the nose, mouth, and pharynx

100.0

22.5

29.9

24.8

22.5

Operations on the respiratory system

100.0

6.3

16.1

31.0

46.6

Bronchoscopy with or without biopsy

100.0

–

15.6

31.2

46.8

Operations on the cardiovascular system

100.0

2.9

10.1

36.4

50.6

Balloon angioplasty of coronary artery or coronary atherectomy

100.0

–

5.0

45.5

49.5

Insertion of coronary artery stent(s)

100.0

–

5.1

45.1

49.7

Coronary artery bypass graft

100.0

–

3.4

43.0

53.4

Cardiac catheterization

100.0

1.1

7.8

43.7

47.4

Insertion, replacement, removal, revision of pacemaker

100.0

–

2.2

11.0

86.4

Hemodialysis

100.0

–

15.8

37.8

45.7

Operations on the hemic and lymphatic system

100.0

5.7

15.4

39.6

39.4

Operations on the digestive system

100.0

4.4

22.7

31.3

41.6

Endoscopy of small intestine with or without biopsy

100.0

–

14.4

29.4

54.5

Endoscopy of large intestine with or without biopsy

100.0

1.3

13.0

28.7

56.9

Partial excision of large intestine

100.0

–

11.9

32.9

53.6

Appendectomy, excluding incidental

100.0

21.7

52.2

19.4

7.0

Cholecystectomy

100.0

–

37.4

30.9

31.2

Lysis of peritoneal adhesions

100.0

2.0

34.9

34.0

29.4

Operations on the urinary system

100.0

2.5

19.8

34.6

43.1

Cystoscopy with or without biopsy

100.0

–

19.9

28.8

49.3

Operations on the male genital organs

100.0

11.2

6.4

32.8

49.2

100.0

–

–

38.7

61.3

100.0

0.5

54.8

32.6

12.1

Oophorectomy and salpingo-oophorectomy

100.0

–

35.2

49.5

14.6

Bilateral destruction or occlusion of Fallopian tubes

100.0

–

99.4

–

–

Hysterectomy

100.0

–

45.7

43.9

10.4 –

Prostatectomy Operations on the female genital organs

Obstetrical procedures

100.0

0.1

99.6

0.2

Episiotomy with or without forceps or vacuum extraction

100.0

–

99.8

–

–

Artiﬁcial rupture of membranes

100.0

–

99.6

–

–

Medical induction of labor

100.0

–

99.5

–

–

Caesarean section

100.0

–

99.6

0.2

–

Repair of current obstetric laceration

100.0

–

99.7

–

–

Operations on the musculoskeletal system

100.0

3.9

21.4

35.6

39.2

Partial excision of bone

100.0

5.3

24.6

39.8

30.4

Reduction of fracture

100.0

6.4

29.2

23.7

40.6

100.0

3.2

29.6

25.7

41.7

Open reduction of fracture with internal ﬁxation

(continued)

368 AMERICAN HEALTH

HOSPITAL CARE

total

under 15

15 to 44

Excision or destruction of intervertebral disc

100.0%

–

30.4%

Total hip replacement

100.0

–

Total knee replacement

100.0

Operations on the integumentary system Debridement of wound, infection, or burn Miscellaneous diagnostic and therapeutic procedures Computerized axial tomography

45 to 64

65 or older

48.9%

19.6%

5.6

39.8

54.5

–

2.0

37.6

60.5

100.0

–

31.9

29.6

26.1

100.0

–

30.8

30.1

30.3

100.0

6.4%

18.2

30.1

45.2

100.0

4.7

23.5

29.6

42.2

Arteriography and angiocardiography using contrast material

100.0

1.1

11.1

41.3

46.5

Diagnostic ultrasound

100.0

3.8

16.8

30.7

48.6

Physical therapy procedures

100.0

–

8.5

24.6

64.5

Respiratory therapy

100.0

15.2

14.6

26.5

43.8

Insertion of endotracheal tube

100.0

10.3

15.5

27.7

46.4

Transfusion of blood and blood components

100.0

3.4

11.4

24.7

60.5

Injection or infusion of cancer chemotherapeutic substance

100.0

19.0

16.3

39.8

24.9

Note: “–” means category is not applicable or sample is too small to make a reliable estimate. Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

AMERICAN HEALTH

369

Table 11.24

Discharges from Hospitals by Procedure, 2006

(number and percent distribution of hospital discharges and discharge rate per 10,000 population for all listed procedures, 2006; excludes newborn infants; numbers in thousands)

number

Total procedures

percent distribution

rate per 10,000 population

45,963

100.0%

1,155

2.5

38.7

315

0.7

10.6

101

0.2

3.4

Operations on the eye

76

0.2

2.6

Operations on the ear

53

0.1

1.8

298

0.6

10.0

1,167

2.5

39.1

282

0.6

9.4

7,235

15.7

242.6

Balloon angioplasty of coronary artery or coronary atherectomy

661

1.4

22.2

Insertion of coronary artery stent(s)

652

1.4

21.9

Coronary artery bypass graft

444

1.0

14.9

1,115

2.4

37.4

Insertion, replacement, removal, revision of pacemaker

418

0.9

14.0

Hemodialysis

645

1.4

21.6

371

0.8

12.4

5,571

12.1

186.8

Endoscopy of small intestine with or without biopsy

1,045

2.3

35.0

Endoscopy of large intestine with or without biopsy

522

1.1

17.5

Partial excision of large intestine

252

0.5

8.4

Appendectomy, excluding incidental

341

0.7

11.5

Cholecystectomy

414

0.9

13.9

Lysis of peritoneal adhesions

344

0.7

11.5

1,025

2.2

34.4

Cystoscopy with or without biopsy

146

0.3

4.9

Operations on the male genital organs

250

0.5

8.4

168

0.4

5.6

1,957

4.3

65.6

Oophorectomy and salpingo-oophorectomy

418

0.9

14.0

Bilateral destruction or occlusion of Fallopian tubes

351

0.8

11.8

Hysterectomy

569

1.2

19.1 237.3

Operations on the nervous system Spinal tap Operations on the endocrine system

Operations on the nose, mouth, and pharynx Operations on the respiratory system Bronchoscopy with or without biopsy Operations on the cardiovascular system

Cardiac catheterization

Operations on the hemic and lymphatic system Operations on the digestive system

Operations on the urinary system

Prostatectomy Operations on the female genital organs

Obstetrical procedures

1,541.3

7,076

15.4

Episiotomy with or without forceps or vacuum extraction

454

1.0

15.2

Artiﬁcial rupture of membranes

960

2.1

32.2

Medical induction of labor

653

1.4

21.9

Caesarean section

1,295

2.8

43.4

Repair of current obstetric laceration

1,308

2.8

43.9

Operations on the musculoskeletal system

4,254

9.3

142.6

Partial excision of bone

171

0.4

5.7

Reduction of fracture

672

1.5

22.5

439

1.0

14.7

Open reduction of fracture with internal ﬁxation

(continued)

370 AMERICAN HEALTH

HOSPITAL CARE

number

rate per 10,000 population

percent distribution

Excision or destruction of intervertebral disc

280

0.6%

Total hip replacement

231

0.5

7.7

Total knee replacement

542

1.2

18.2

1,598

3.5

53.6

402

0.9

13.5

13,775

30.0

461.9

Operations on the integumentary system Debridement of wound, infection, or burn Miscellaneous diagnostic and therapeutic procedures Computerized axial tomography

9.4

740

1.6

24.8

1,698

3.7

56.9

Diagnostic ultrasound

888

1.9

29.8

Physical therapy procedures

386

0.8

12.9

1,088

2.4

36.5

476

1.0

16.0

1,968

4.3

66.0

221

0.5

7.4

Arteriography and angiocardiography using contrast material

Respiratory therapy Insertion of endotracheal tube Transfusion of blood and blood components Injection or infusion of cancer chemotherapeutic substance

Source: National Center for Health Statistics, 2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm; calculations by New Strategist

AMERICAN HEALTH

371

MENTAL HEALTH CHAPTER

12 Mental Health ■ Twenty-six percent of adults have a diagnosable mental disorder in a given year. Among the most common are depressive disorders, which affect 7 percent of adults.

■ Seventeen percent say they have a history of depression. The ﬁgure rises to 30 percent among people in households with incomes below $24,000, according to Gallup.

■ Adults report an average of 3.4 days of poor mental health per month. The number of days of poor mental health declines with age from 4.0 per month in the 18-to-24 age group to just 2.0 per month among people aged 75 or older.

■ Mental health problems are greatest among those with low incomes. Ten percent of adults with household incomes below $35,000 feel like “everything is an effort” all or most of the time. Among those with household incomes of $100,000 or more, just 2 percent feel that way.

■ Many teenagers have suicidal thoughts. Nineteen percent of girls in 9th through 12th grades say they have considered suicide in the past year.

AMERICAN HEALTH

373

More than One in Four Adults Has a Diagnosable Mental Disorder These can range from phobias to serious mental illness. Twenty-six percent of adults have a diagnosable mental disorder in a given year, according to estimates by the National Institute of Mental Health. Among the most common are anxiety disorders such as panic attacks, which affect 18 percent. The mental health of Americans appears to be getting worse. People aged 18 or older report 3.4 days of poor mental health during the past month, according to the 2008 Behavioral Risk Factor Surveillance System survey. This ﬁgure is higher than the 2.9 days reported in the 1995 survey. More than 10 percent say their mental health was not good on at least 14 of the past 30 days, up from 8.7 percent in 1995. The percentage of people with poor mental health for at least two weeks during the past month increased in almost every age group, with the sharpest spike among 55-to-64-year-olds. The only ones who did not report an increase were people aged 65 or older. A 2009 Gallup survey asked Americans whether they had ever been told they had depression and found 17 percent with a history of the illness. According to a Pew survey, more than one in four Internet users has gone online to look for information about mental health. People under age 50 are more likely to have done so than those aged 65 or older (26 to 33 percent versus 12 percent). ■ Economic insecurity can lead to poor mental health, which is why mental health problems are growing among the middle aged.

Mental health is getting worse among the middle aged

15 (percent of people aged 18 or older with 14 or more days of poor mental health in past month, by age, 1995 and 2008)

nin

oh1010%

55% 100000

2008 dual

75000

25000

0

374 AMERICAN HEALTH

with

w/out

75 or older

75 +

65 to 74

65 to 74

50000

55 to 64

55 to 64

45 to 54

45 to 54

35 to 44

35 to 44

25 to 34

25 to 34

18 to 24

18 to 24

00%

all 1995

MENTAL HEALTH

Table 12.1

Prevalence of Mental Disorders, 2008

(percentage or number of people with selected mental disorders, 2008) prevalence in a given year

Adults aged 18 or older with any diagnosable mental disorder Adults aged 18 or older with any mood disorder With major depressive disorder With dysthymic disorder With bipolar disorder Adults aged 18 or older with schizophrenia Adults aged 18 or older with anxiety disorder With panic disorder With obsessive-compulsive disorder With posttraumatic stress disorder With generalized anxiety disorder With social phobia With agoraphobia With speciﬁc phobia Eating disorders Anorexia nervosa Bulimia Binge eating disorders Attention deﬁcit hyperactivity disorder Autism Alzheimer’s disease

26.2% 9.5 6.7 1.5 2.6 1.1 18.1 2.7 1.0 3.5 3.1 6.8 0.8 8.7

0.5 to 3.7 percent of females during lifetime 1.1 to 4.2 percent of females during lifetime 2 to 5 percent of population in 6-month period 4.1 percent of adults aged 18 to 44 in a given year 3.4 cases per 1,000 children aged 3 to 10 10 percent of people aged 65 or older

Source: National Institute of Mental Health, The Numbers Count: Mental Disorders in America, 2008, Internet Site http://www .nimh.nih.gov/publicat/numbers.cfm

AMERICAN HEALTH

375

Table 12.2

Mental Health Status in Past Month, 1995 to 2008 “Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

(average number of days during the past 30 days when mental health was not good among noninstitutionalized people aged 18 or older, by selected characteristics, 1995 to 2008; change in days, 1995–2008) average number of days

TOTAL PEOPLE Sex Female Male Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

2008

2000

1995

change in days, 1995 to 2008

3.4

3.2

2.9

0.5

4.0 2.9

3.8 2.5

3.5 2.4

0.5 0.5

4.0 3.7 3.6 3.9 3.4 2.2 2.0

4.1 3.4 3.5 3.5 2.7 2.0 2.0

3.6 3.1 3.3 3.0 2.4 2.1 2.0

0.4 0.6 0.3 0.9 1.0 0.1 0.0

Source: Centers for Disease Control and Prevention, Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/HRQOL/; calculations by New Strategist

Table 12.3

Frequent Mental Stress in Past Month, 1995 to 2008

(percentage of noninstitutionalized people aged 18 or older with 14 or more days in the past 30 days when mental health was not good, by selected characteristics, 1995 to 2008; percentage point change, 1995–2008) percent with 14 or more days of poor mental health

TOTAL PEOPLE Sex Female Male Age Aged 18 to 24 Aged 25 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74 Aged 75 or older

1995

percentage point change, 1995–2008

11.7 7.3

10.4 6.9

1.6 1.6

11.8 9.8 10.5 10.6 8.4 6.2 6.4

10.3 8.8 9.8 9.1 7.2 6.8 6.3

0.5 2.0 1.1 2.8 3.5 –0.1 –0.2

2008

2000

12.0 8.5 10.8 10.8 10.9 11.9 10.7 6.7 6.1

10.3%

9.6%

8.7%

1.6

Source: Centers for Disease Control and Prevention, Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/HRQOL/; calculations by New Strategist

376 AMERICAN HEALTH

MENTAL HEALTH

Table 12.4

Americans with a History of Depression by Selected Characteristics, 2009

“Have you ever been told by a physician or nurse that you have depression?” (percent distribution of people aged 18 or older who have ever been told by a physician or nurse that they have depression, by selected characteristics, 2009)

TOTAL PEOPLE Sex Men Women

history of depression

17% 13 22

Age Aged 18 to 44 Aged 45 to 64 Aged 65 or older

16 21 16

Race Asian Black Hispanic White

9 15 16 18

Household income Under $24,000 $24,000 to $59,999 $60,000 or more

30 16 13

Marital status Single/never married Married Separated or divorced

18 14 29

Source: Gallup, About One in Six Americans Report History of Depression, Brett W. Pelham, October 22, 2009, Internet site http://www.gallup.com/poll/123821/One-Six-Americans-Report-History-Depression.aspx

AMERICAN HEALTH

377

Table 12.5

Americans Who Have Looked Online for Mental Health Information, by Selected Characteristics, 2008

(percentage of Internet users aged 18 or older who have looked online for information about depression, anxiety, stress, or mental health issues, by selected characteristics, 2008)

TOTAL PEOPLE Sex Men Women

have looked online for mental health information

28% 22 35

Age Aged 18 to 29 Aged 30 to 49 Aged 50 to 64 Aged 65 or older

33 32 26 12

Race Black Hispanic Non-Hispanic white

27 30 28

Household income Under $30,000 $30,000 to $49,999 $50,000 to $74,999 $75,000 or more

33 31 30 27

Education Less than high school High school graduate Some college College graduate

26 24 31 32

Source: Pew Internet & American Life Project, The Social Life of Health Information, June 11, 2009, Internet site http://www .pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information.aspx

378 AMERICAN HEALTH

MENTAL HEALTH

Women Are More Likely to Experience Mental Health Problems The prevalence of mental health conditions also varies by race and Hispanic origin. From 2 to 6 percent of the population aged 18 or older experienced six mental health problems all or most of the time during the past 30 days, according to the National Health Interview Survey. The six problems are sadness, hopelessness, worthlessness, feeling like everything is an effort, nervousness, and restlessness. People aged 45 to 64 were more likely than those younger or older to have experienced four of the six problems. Women are more likely than men to report experiencing the six conditions. For example, 6 percent of women say they felt like everything was an effort all or most of the time compared with 4.7 percent of men. Some of the differences between the sexes may be due to women’s greater willingness to admit having problems. There are also differences by race and Hispanic origin in the likelihood of experiencing mental problems. Blacks are more likely than other groups to feel as though everything is an effort (7.9 percent). But non-Hispanic whites are more likely than other racial or ethnic groups to feel restless (6.2 percent). ■ Asians are least likely to report having mental health problems.

Blacks are most likely to feel like everything is an effort 9

(percent of people aged 18 or older who felt like everything was an effort all or most of the time during the past 30 days, by race and Hispanic origin, 2008)

7.9%

6

6%

3

3%

0

0%

5.5%

5.1%

2.4%

a Asian

b black

c Hispanic

d white non-Hispanic

AMERICAN HEALTH

379

Table 12.6

Mental Health Conditions among Adults by Age, 2008

(number and percent of people aged 18 or older with selected mental health conditions all or most of the time during the past 30 days, by type of condition and age, 2008; numbers in thousands) Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

total

18 to 44

45 to 64

65 to 74

75 or older

225,227 7,135 5,054 4,011 12,104 8,907 12,823

110,615 3,203 2,222 1,689 6,091 4,201 6,403

77,335 2,842 1,981 1,677 4,170 3,384 4,775

19,869 443 422 340 850 753 864

17,409 647 430 304 992 569 781

PERCENT WITH CONDITION ALL OR MOST OF THE TIME BY AGE

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 3.2 2.2 1.8 5.4 4.0 5.7

100.0% 2.9 2.0 1.5 5.5 3.8 5.8

100.0% 3.7 2.6 2.2 5.4 4.4 6.2

100.0% 2.2 2.1 1.7 4.3 3.8 4.3

100.0% 3.7 2.5 1.7 5.7 3.3 4.5

8.8% 6.2 8.3 8.5 7.0 8.5 6.7

7.7% 9.1 8.5 7.6 8.2 6.4 6.1

PERCENT DISTRIBUTION OF THOSE WITH CONDITION ALL OR MOST OF THE TIME BY AGE

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

49.1% 44.9 44.0 42.1 50.3 47.2 49.9

34.3% 39.8 39.2 41.8 34.5 38.0 37.2

Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

380 AMERICAN HEALTH

MENTAL HEALTH

Table 12.7

Mental Health Conditions among Adults by Sex, 2008

(number and percent of people aged 18 or older with selected mental health conditions all or most of the time during the past 30 days, by type of condition and sex, 2008; numbers in thousands) Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

total

men

women

225,227 7,135 5,054 4,011 12,104 8,907 12,823

108,755 2,887 2,105 1,659 5,161 3,239 5,902

116,472 4,248 2,948 2,352 6,943 5,667 6,921

PERCENT WITH CONDITION ALL OR MOST OF THE TIME BY SEX

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 3.2 2.2 1.8 5.4 4.0 5.7

100.0% 2.7 1.9 1.5 4.7 3.0 5.4

100.0% 3.6 2.5 2.0 6.0 4.9 5.9

PERCENT DISTRIBUTION OF THOSE WITH CONDITION ALL OR MOST OF THE TIME BY SEX

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

48.3% 40.5 41.7 41.4 42.6 36.4 46.0

51.7% 59.5 58.3 58.6 57.4 63.6 54.0

Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

381

Table 12.8

Mental Health Conditions among Adults by Race and Hispanic Origin, 2008

(number and percent of people aged 18 or older with selected mental health conditions all or most of the time during the past 30 days, by type of condition and race and Hispanic origin, 2008; numbers in thousands)

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

total

Asian

black

Hispanic

non-Hispanic white

225,227 7,135 5,054 4,011 12,104 8,907 12,823

10,501 162 60 – 247 130 132

26,765 1,131 737 470 2,127 1,034 1,526

30,583 1,388 882 652 1,696 1,182 1,426

154,483 4,401 3,317 2,794 7,897 6,461 9,619

PERCENT WITH CONDITION ALL OR MOST OF THE TIME BY RACE AND HISPANIC ORIGIN

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 3.2 2.2 1.8 5.4 4.0 5.7

100.0% 1.5 0.6 – 2.4 1.2 1.3

100.0% 4.2 2.8 1.8 7.9 3.9 5.7

100.0% 4.5 2.9 2.1 5.5 3.9 4.7

100.0% 2.8 2.1 1.8 5.1 4.2 6.2

13.6% 19.5 17.5 16.3 14.0 13.3 11.1

68.6% 61.7 65.6 69.7 65.2 72.5 75.0

PERCENT DISTRIBUTION OF THOSE WITH CONDITION ALL OR MOST OF THE TIME BY RACE AND HISPANIC ORIGIN

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

4.7% 2.3 1.2 – 2.0 1.5 1.0

11.9% 15.9 14.6 11.7 17.6 11.6 11.9

Note: Numbers by race and Hispanic origin do not sum to total because not all races are shown and Hispanics may be of any race. “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

382 AMERICAN HEALTH

MENTAL HEALTH

Income Is Strongly Linked to Mental Health Problems The prevalence of mental health conditions also varies by education. The lower the income, the more likely a person is to experience six mental health problems, according to the National Health Interview Survey. The problems are sadness, hopelessness, worthlessness, feeling like everything is an effort, nervousness, and restlessness. Ten percent of people with household incomes below $35,000 felt like everything was an effort all or most of the time during the past month. The proportion falls with rising income to a low of 2 percent among those with household incomes of $100,000 or more. It is not hard to explain the greater mental health problems of those with low incomes, since they are more likely to experience difﬁculties such as not being able to pay their bills. Economic problems can lead to mental health problems, particularly among those predisposed to mental problems. But people with pre-existing mental conditions may also have more difﬁculty holding down a job, which leads to lower incomes. Education is also linked to mental health conditions. Those with lower levels of education are more likely to report having each of the six conditions examined here. Fewer than 1 percent of people with a college degree report feeling hopeless or worthless compared with 4 to 5 percent of high school dropouts. Education affects mental health in part because the higher the education, the higher the income. ■ Socioeconomic status inﬂuences mental health, and mental health inﬂuences socioeconomic status.

Many low-income people feel like everything is an effort (percent of people aged 18 or older who felt like everything was an effort all or most of the time during the past 30 days, by household income, 2008)

12

9.6% 8

8%

6.3% 4

3.4%

4%

3.2% 2.2%

0 0%

under a $35,000

b to $35,000 $49,999

c to $50,000 $74,999

d to $75,000 $99,999

e $100,000 or more

AMERICAN HEALTH

383

Table 12.9

Mental Health Conditions among Adults by Household Income, 2008

(number and percent of people aged 18 or older with selected mental health conditions all or most of the time during the past 30 days, by type of condition and household income, 2008; numbers in thousands)

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

total

under $35,000

$35,000– $49,999

$50,000– $74,999

$75,000– $99,999

$100,000 or more

225,227 7,135 5,054 4,011 12,104 8,907 12,823

68,352 4,245 3,229 2,514 6,558 4,885 6,395

31,715 943 652 625 2,011 1,270 1,677

38,300 775 449 331 1,301 1,160 1,769

25,842 313 170 135 819 506 1,134

43,165 458 360 264 949 702 1,387

PERCENT WITH CONDITION ALL OR MOST OF THE TIME BY HOUSEHOLD INCOME

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 3.2 2.2 1.8 5.4 4.0 5.7

100.0% 6.2 4.7 3.7 9.6 7.1 9.4

100.0% 3.0 2.1 2.0 6.3 4.0 5.3

100.0% 2.0 1.2 0.9 3.4 3.0 4.6

100.0% 1.2 0.7 0.5 3.2 2.0 4.4

100.0% 1.1 0.8 0.6 2.2 1.6 3.2

11.5% 4.4 3.4 3.4 6.8 5.7 8.8

19.2% 6.4 7.1 6.6 7.8 7.9 10.8

PERCENT DISTRIBUTION OF THOSE WITH CONDITION ALL OR MOST OF THE TIME BY HOUSEHOLD INCOME

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

30.3% 59.5 63.9 62.7 54.2 54.8 49.9

14.1% 13.2 12.9 15.6 16.6 14.3 13.1

17.0% 10.9 8.9 8.3 10.7 13.0 13.8

Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

384 AMERICAN HEALTH

MENTAL HEALTH

Table 12.10

Mental Health Conditions among Adults by Education, 2008

(number and percent of people aged 18 or older with selected mental health conditions all or most of the time during the past 30 days, by type of condition and educational attainment, 2008; numbers in thousands)

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

total

not a high school graduate

high school graduate

some college

bachelor’s degree or more

225,227 7,135 5,054 4,011 12,104 8,907 12,823

29,013 2,006 1,396 1,183 2,525 2,295 2,793

53,874 2,096 1,357 1,025 3,339 2,328 3,492

55,174 1,595 1,244 1,130 3,081 1,832 2,967

56,681 633 403 299 1,339 1,051 1,507

PERCENT WITH CONDITION ALL OR MOST OF THE TIME BY EDUCATION

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 3.2 2.2 1.8 5.4 4.0 5.7

100.0% 6.9 4.8 4.1 8.7 7.9 9.6

100.0% 3.9 2.5 1.9 6.2 4.3 6.5

100.0% 2.9 2.3 2.0 5.6 3.3 5.4

100.0% 1.1 0.7 0.5 2.4 1.9 2.7

24.5% 22.4 24.6 28.2 25.5 20.6 23.1

25.2% 8.9 8.0 7.5 11.1 11.8 11.8

PERCENT DISTRIBUTION OF THOSE WITH CONDITION ALL OR MOST OF THE TIME BY EDUCATION

Total people Sadness Hopelessness Worthlessness Everything is an effort Nervousness Restlessness

100.0% 100.0 100.0 100.0 100.0 100.0 100.0

12.9% 28.1 27.6 29.5 20.9 25.8 21.8

23.9% 29.4 26.9 25.6 27.6 26.1 27.2

Note: Numbers do not sum to total because education categories include only people aged 25 or older. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

385

Many Teenagers Struggle with Mental Health Issues Nearly one in ﬁve high school girls has considered suicide. Teen angst is very real. Nearly 36 percent of high school girls have felt sad or hopeless almost every day for two or more weeks—so much so that they stopped doing some of their usual activities. Among boys, the proportion is a smaller but still substantial 21 percent, according to the Center for Disease Control’s latest Youth Risk Behavior Surveillance System survey. Hispanics are particularly likely to feel sad and hopeless for long periods of time. Forty-two percent of Hispanic girls and 30 percent of Hispanic boys report these feelings. Feeling sad can be life threatening. A substantial number of high school students, particularly girls, say they have seriously considered committing suicide. Nineteen percent of girls in grades nine through twelve have considered suicide in the past year, as have 10 percent of boys. Only about half as many say they have attempted suicide—9 percent of girls and 5 percent of boys. The percentage who report that their suicide attempt was treated by a doctor or nurse is smaller still at just 2.4 percent of girls and 1.5 percent of boys. ■ Although few high school students actually attempt suicide, the relatively large share of those who consider it indicates a need for more support services for teenagers.

Hispanic girls are most likely to seriously consider suicide

30

(percent of students in grades 9 through 12 who seriously considered suicide in the past year, by race, Hispanic origin, and sex, 2007)

black hisp

21.1%

20

20%

10

10%

18.0%

white

17.8%

10.7% 8.5%

30

10.2% blacknon-Hispanic black,

Hispanic hisp

0

0%

20

white, whitenon-Hispanic

females female

males male

10

0

386 AMERICAN HEALTH

female

male

MENTAL HEALTH

Table 12.11

High School Students Who Felt Sad or Hopeless, 2007

(percent of students in grades 9 through 12 who felt sad or hopeless almost every day for two or more weeks in a row so that they stopped doing some usual activities, by grade, race, Hispanic origin, and sex, 2007) total

female

male

Total 9th grade 10th grade 11th grade 12th grade

28.5% 28.2 28.9 27.1 29.4

35.8% 34.8 37.7 34.5 35.9

21.2% 22.1 20.3 19.5 22.6

Black, non-Hispanic Hispanic White, non-Hispanic

29.2 36.3 26.2

34.5 42.3 34.6

24.0 30.4 17.8

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance—United States, 2007, Morbidity and Mortality Weekly Report, Vol. 57, No. SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

AMERICAN HEALTH

387

Table 12.12

Suicidal Ideation among High School Students, 2007

(percent of students in grades 9 through 12 who seriously considered or attempted suicide or experienced a suicide attempt that required medical attention in the past 12 months, by grade, race, Hispanic origin, and sex, 2007) total

female

male

CONSIDERED SUICIDE

Total 9th grade 10th grade 11th grade 12th grade

14.5% 14.8 15.6 13.5 13.5

18.7% 19.0 22.0 16.3 16.3

10.3% 10.8 9.3 10.7 10.2

Black, non-Hispanic Hispanic White, non-Hispanic

13.2 15.9 14.0

18.0 21.1 17.8

8.5 10.7 10.2

6.9 7.9 8.0 5.8 5.4

9.3 10.5 11.2 7.8 6.5

4.6 5.3 4.9 3.7 4.2

7.7 10.2 5.6

9.9 14.0 7.7

5.5 6.3 3.4

Total 9th grade 10th grade 11th grade 12th grade

2.0 2.3 2.0 1.6 1.7

2.4 2.6 3.1 1.7 1.8

1.5 1.9 1.0 1.4 1.5

Black, non-Hispanic Hispanic White, non-Hispanic

2.3 2.9 1.5

2.1 3.9 2.1

2.5 1.8 0.9

ATTEMPTED SUICIDE

Total 9th grade 10th grade 11th grade 12th grade Black, non-Hispanic Hispanic White, non-Hispanic SUICIDE ATTEMPT TREATED BY DOCTOR OR NURSE

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance—United States, 2007, Morbidity and Mortality Weekly Report, Vol. 57, No. SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

388 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR CHAPTER

13 Sexual Attitudes and Behavior ■ Americans are increasingly liberal toward sexual behavior. Most favor sex education in the public schools, more than half (54 percent) say premarital sex is not wrong at all, and 38 percent say homosexuality is not wrong either.

■ Forty-six percent of 15-to-19-year-olds are sexually experienced. This is much lower than the 51 to 60 percent who were sexually experienced in 1988.

■ Most teens use birth control the ﬁrst time they have sex. Seventy-one percent of boys and 66 percent of girls used a condom at ﬁrst sexual intercourse.

■ Most adults have had only one sex partner in the past year. Fifteen percent have had two or more sex partners, however.

■ The birth control pill is the most widely used contraceptive. Thirty-one percent of women who use contraception are on the pill.

AMERICAN HEALTH

389

Americans Have Increasingly Liberal Attitudes toward Sexual Behavior Most say premarital sex is not wrong at all. Americans have long favored sex education in the public schools, worrying that if children are not adequately informed about sex it could lead to problems. In the late 1970s, as much as 21 percent of the public opposed sex education in the public schools. Today, fewer than 10 percent are against sex education in the public schools. Opinions about premarital sex have undergone a signiﬁcant transformation since the 1970s. In 1972 only 27 percent of adults felt that premarital sex was “not wrong at all.” By 2008, the share holding this view had grown to the 54 percent majority. The proportion believing premarital sex is “always wrong” fell from 37 to 24 percent during those years. Attitudes about homosexuality have also changed, although the shift has been more gradual. In 1973, only 11 percent of adults thought sex between two people of the same sex was not wrong at all. By 2008, the proportion had grown to 38 percent. At the same time, the proportion saying homosexual sex is always wrong fell from 73 to 52 percent. ■ Changing attitudes about sexual issues are largely the result of generational replacement. As older generations die, younger generations with different attitudes replace them.

Many people think premarital sex is OK (percent of people aged 18 or older who think premarital sex is “not wrong at all,” 1972 and 2008)

60

40

54%

40%

27% 20

20%

0

0%

390 AMERICAN HEALTH

1972 a

2008 b

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.1

Sex Education in Public Schools, 1974 to 2008 “Would you be for or against sex education in the public schools?”

(number of respondents aged 18 or older, and percent distribution by response, selected years, 1974–2008) 2008 2006 2004 2002 2000 1998 1996 1994 1993 1991 1990 1989 1988 1986 1985 1983 1982 1977 1975 1974

total

favor

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

90.9% 89.3 90.3 88.4 87.3 87.0 87.4 87.6 84.8 87.8 89.9 87.4 87.0 84.0 84.1 86.0 84.7 78.7 79.3 81.7

oppose

9.1% 10.7 9.7 11.6 12.7 13.0 12.6 12.4 15.2 12.2 10.1 12.6 13.0 16.0 15.9 14.0 15.3 21.3 20.7 17.7

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

AMERICAN HEALTH

391

Table 13.2

Premarital Sex, 1972 to 2008 “There’s been a lot of discussion about the way morals and attitudes about sex are changing in this country. If a man and woman have sex relations before marriage, do you think it is always wrong, almost always wrong, wrong only sometimes, or not wrong at all?”

(number of respondents aged 18 or older, and percent distribution by response, selected years, 1972–2008) total

2008 2006 2004 2002 2000 1998 1996 1994 1993 1991 1990 1989 1988 1986 1985 1983 1982 1978 1977 1975 1974 1972

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

always wrong

23.6% 26.3 27.0 27.3 28.0 26.4 23.8 26.0 27.0 27.6 25.6 28.0 26.3 27.8 28.5 27.4 29.0 29.3 31.0 30.9 33.0 36.6

almost always wrong

7.0% 8.6 8.9 8.2 8.8 9.2 9.7 10.1 10.1 9.9 11.5 8.7 10.7 8.9 8.3 9.9 8.5 11.7 9.5 12.3 12.7 11.8

sometimes wrong

15.9% 19.6 17.8 19.9 21.4 21.0 22.6 20.4 20.8 18.7 23.0 22.8 22.4 23.0 19.8 24.2 20.0 20.3 23.0 24.0 23.6 24.3

not wrong at all

53.5% 45.5 46.3 44.5 41.8 43.5 43.9 43.5 42.2 43.8 39.9 40.6 40.6 40.3 43.4 38.5 42.5 38.7 36.5 32.8 30.7 27.3

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

392 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.3

Homosexual Relations, 1973 to 2008

“What about sexual relations between two adults of the same sex—do you think it is always wrong, almost always wrong, wrong only sometimes, or not wrong at all?” (number of respondents aged 18 or older, and percent distribution by response, selected years, 1973–2008)

total

2008 2006 2004 2002 2000 1998 1996 1994 1993 1991 1990 1989 1988 1987 1985 1984 1982 1980 1977 1976 1974 1973

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

always wrong

51.5% 55.1 57.6 55.0 58.8 58.0 60.4 66.5 66.3 75.5 76.3 74.2 76.8 78.2 75.3 73.3 74.8 73.3 71.9 70.1 70.5 72.7

almost always wrong

3.4% 5.0 4.7 4.9 4.5 5.7 5.2 4.0 4.3 4.1 4.8 4.1 4.7 4.1 4.0 5.0 5.3 6.0 5.8 6.2 5.0 6.6

sometimes wrong

6.9% 7.1 6.9 7.1 8.0 6.9 6.2 6.2 7.3 4.4 6.1 6.0 5.7 5.8 7.0 7.4 6.5 6.1 7.5 7.9 7.9 7.6

not wrong at all

38.1% 32.7 30.8 33.0 28.8 29.4 28.2 23.3 22.0 16.0 12.8 15.7 12.8 11.9 13.7 14.3 13.4 14.6 14.9 15.9 13.0 11.0

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

AMERICAN HEALTH

393

Most Teenagers Think Anything Goes between Consenting Adults But most do not think unmarried 16-year-olds should have sex. Teenagers aged 15 to 19 have fairly liberal attitudes about many sexual issues. Nearly three-quarters agree that whatever consenting adults want to do in the bedroom is alright. Interestingly, teenagers make a distinction between 16-year-olds and 18-year-olds when it comes to premarital sex. The majority thinks it is all right for unmarried 18-year-olds to have sex, but most do not feel 16-yearolds should. Teenage boys and girls differ in their opinions on premarital childbearing, girls being considerably more likely to think it is OK for a woman to have a child out of wedlock (65 percent of girls versus 50 percent of boys). Surprisingly, boys are more likely than girls to think marriage is better than going through life single (69 percent of boys versus 55 percent of girls). Having a child out of wedlock might be OK in theory, but teens would clearly prefer not to do so. Among never-married girls aged 15 to 19, fully 60 percent say they would “very upset” if they got pregnant and another 27 percent would be “a little upset.” Boys are more likely than girls to say they would be a little or very pleased to get a girl pregnant—although most (85 percent) say a pregnancy would upset them. ■ Given the liberal sexual attitudes of teenagers, it is likely that American society will become even more tolerant of sexuality. 90

Teens’ tolerance of premarital sex has limits

female

(percent of people aged 15 to 19 who agree with selected questions, by sex, 2002)

60

30

60%

31%

30%

36%

100000

0

0%

all females

males dual

75000

OK for unmarried 16-year-olds to have sixteen sex if they have strong affection for one another 50000

OK for unmarried 18-year-olds to have eighteen sex if they have strong affection for one another

25000

0

394 AMERICAN HEALTH

males

65%

61%

with

w/out

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.4

Attitude of Teenagers toward Sexual Activity, Childbearing, and Cohabitation, 2002

(percent distribution of people aged 15 to 19 by agreement with selected statements, by sex, 2002) agree

Boys aged 15 to 19 Any sexual act between two consenting adults is all right It is all right for unmarried 18-year-olds to have sexual relations if they have strong affection for one another It is all right for unmarried 16-year-olds to have sexual relations if they have strong affection for one another It is OK for an unmarried female to have a child It is better for a person to get married than to go through life being single A young couple should not live together unless they are married Divorce is usually the best solution when a couple can’t seem to work out their marriage problems Girls aged 15 to 19 Any sexual act between two consenting adults is all right It is all right for unmarried 18-year-olds to have sexual relations if they have strong affection for one another It is all right for unmarried 16-year-olds to have sexual relations if they have strong affection for one another It is OK for an unmarried female to have a child It is better for a person to get married than to go through life being single A young couple should not live together unless they are married Divorce is usually the best solution when a couple can’t seem to work out their marriage problems

disagree

73.7%

24.1%

65.0

34.1

35.7 49.9 69.1 32.3

62.6 47.8 28.6 66.8

41.7

55.8

73.0

25.4

60.9

37.2

30.5 64.8 54.5 36.1

67.5 32.8 42.7 62.8

48.0

49.9

Note: Numbers may not add to 100 percent because “neither agree nor disagree” is not shown. Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

AMERICAN HEALTH

395

Table 13.5

Attitude of Boys Aged 15 to 19 toward Pregnancy, 2002 “If you got a female pregnant now, how would you feel?”

(percent distribution of never-married boys aged 15 to 19 by response, 2002) total

very upset

a little upset

a little pleased

very pleased

Total boys aged 15 to 19 Aged 15 to 17 Aged 18 to 19

100.0% 100.0 100.0

51.4% 58.9 41.8

33.4% 29.9 37.8

11.0% 8.1 14.6

3.7% 2.8 4.7

Black, non-Hispanic Hispanic White, non-Hispanic

100.0 100.0 100.0

35.9 38.2 59.0

43.1 35.1 30.6

14.0 17.0 8.5

6.3 9.7 1.3

Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

Table 13.6

Attitude of Girls Aged 15 to 19 toward Pregnancy, 2002 “If you got pregnant now, how would you feel?”

(percent distribution of never-married girls aged 15 to 19 by response, 2002) total

very upset

a little upset

Total girls aged 15 to 19 Aged 15 to 17 Aged 18 to 19

100.0% 100.0 100.0

60.2% 67.5 49.0

26.7% 21.2 35.1

Black, non-Hispanic Hispanic White, non-Hispanic

100.0 100.0 100.0

50.5 46.4 65.8

32.5 29.0 24.2

a little pleased

8.0% 8.2 7.8 11.7 14.9 5.5

very pleased

4.7% 2.8 7.6 5.0 9.8 3.8

Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

396 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Most Teenagers Have Sex before Reaching Age 18 Boys and girls are equally likely to have had sexual intercourse. Teenage sexual activity has declined signiﬁcantly over the past 12 years, according to the National Survey of Family Growth. In 2002, 46 percent of never-married boys aged 15 to 19 had ever had sexual intercourse, down from 60 percent in 1988. Among girls, the percentage ever having sexual intercourse fell from 51 to 46 percent. Despite the decline, most boys and girls have had sex by ages 18 to 19. A 2007 survey of high school students found that by 11th grade the majority of boys (57 percent) and girls (54 percent) are sexually experienced, although only 42 percent are currently sexually active. Teens aged 15 to 19 living in two-parent families are much less likely to have had sexual intercourse than those in other family situations. Only 39 to 40 percent of 15-to-19-year-olds in twoparent families have had sex compared with 57 percent of those in other types of families. Among 15-to-19-year-olds, Hispanic girls and non-Hispanic white boys are least likely to have had sexual intercourse (37 and 41 percent, respectively). ■ The decline in teen sexual activity may be due to concerns about sexually transmitted diseases. 75

Today’s teens are less likely than teens in 1988 to have had sex (percent of people aged 15 to 19 who have ever had intercourse, by sex, 1988 and 2002)

eighty-

60% 50

50%

25

25%

51%

oh-two

46%

46%

100000

0

0%

all 1988

2002 dual

75000

females females

males males

50000

25000

0

with

w/out

AMERICAN HEALTH

397

Table 13.7

Sexual Intercourse Experience of Boys Aged 15 to 19, 1988 and 2002

(percent of never-married boys aged 15 to 19 who have ever had sexual intercourse, by selected characteristics, 1988 and 2002; percentage point change, 1988–2002) percent who have ever had sexual intercourse

2002

1988

percentage point change, 1988–2002

Total never-married boys aged 15 to 19 Aged 15 to 17 Aged 18 to 19

45.7% 31.3 64.3

60.4% 50.0 77.3

–14.7 –18.7 –13.0

Race and Hispanic origin Black, non-Hispanic Hispanic White, non-Hispanic

63.3 54.8 40.8

80.6 59.7 56.8

–17.3 –4.9 –16.0

Family structure at age 14 Living with both parents Other

40.4 57.1

57.0 68.3

–16.6 –11.2

Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

Table 13.8

Sexual Intercourse Experience of Girls Aged 15 to 19, 1988 and 2002

(percent of never-married girls aged 15 to 19 who have ever had sexual intercourse, by selected characteristics, 1988 and 2002; percentage point change, 1988–2002) percent who have ever had sexual intercourse

2002

1988

percentage point change, 1988–2002

Total never-married girls aged 15 to 19 Aged 15 to 17 Aged 18 to 19

45.5% 30.3 68.8

51.1% 37.2 72.6

–5.6 –6.9 –3.8

Race and Hispanic origin Black, non-Hispanic Hispanic White, non-Hispanic

56.9 37.4 45.1

60.4 45.8 50.4

–3.5 –8.4 –5.3

Family structure at age 14 Living with both parents Other

38.7 57.2

44.9 62.2

–6.2 –5.0

Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

398 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.9

Sexual Behavior of 9th to 12th Graders by Sex, 2007

(percent of 9th to 12th graders engaging in selected sexual activities, by sex and grade, 2007) total

9th grade

10th grade

11th grade

12th grade

Boys Ever had sexual intercourse Currently sexually active* First sexual intercourse before age 13 Four or more sex partners during lifetime Condom use during last sexual intercourse Birth control pill use before last sexual intercourse

49.8% 34.3 10.1 17.9 68.5 13.1

38.1% 22.2 13.5 11.9 75.8 8.3

45.6% 29.4 9.1 16.7 73.2 9.5

57.3% 42.0 9.9 20.6 69.3 11.0

62.8% 48.3 6.7 24.7 59.6 20.8

Girls Ever had sexual intercourse Currently sexually active* First sexual intercourse before age 13 Four or more sex partners during lifetime Condom use during last sexual intercourse Birth control pill use before last sexual intercourse

45.9 35.6 4.0 11.8 54.9 18.7

27.4 18.0 4.9 5.5 61.0 9.2

41.9 31.8 4.7 10.2 59.5 13.7

53.6 41.5 3.4 13.1 55.1 18.9

66.2 56.7 2.4 20.1 49.9 25.6

* Sexual intercourse during the three months preceding the survey. Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance–United States, 2007, Mortality and Morbidity Weekly Report, Vol. 57/SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

AMERICAN HEALTH

399

Younger Teens Are Less Likely to Use Contraception Hispanic teenagers are least likely to use birth control. Among teenaged girls, the younger they were when they ﬁrst had sexual intercourse, the less likely they were to use a contraceptive method. More than one-third of girls aged 15 to 19 who ﬁrst had intercourse when they were 14 or younger did not use contraception. The share of girls who used a condom the ﬁrst time they had sex, which reduces the risk of pregnancy and sexually transmitted diseases, rises with age to a high of 71 percent among those ﬁrst having intercourse at ages 17 to 19. Boys show a different pattern of contraceptive use. As is true with girls, the boys who ﬁrst had intercourse at age 14 or younger were least likely to use contraception. But unlike the pattern with girls, boys who ﬁrst had intercourse at ages 15 to 16 were most likely to use birth control. When boys aged 17 to 19 ﬁrst had sex, they were less likely than those aged 15 to 16 to use contraception. Among both boys and girls, Hispanics were least likely to use birth control when they ﬁrst had sex. Not all teens are having sex, of course. Among sexually inexperienced 15-to-19-year-olds, the reason most commonly given for avoiding sex is that it is against their religion or morals. Fear of pregnancy and fear of sexually transmitted disease are also compelling reasons to delay having sex. The most commonly cited reason for not having sex among non-Hispanic black teenage girls is to avoid sexually transmitted diseases. For non-Hispanic black and Hispanic teen boys, it is fear of getting a girl pregnant. ■ The relatively large percentage of teenagers who do not use birth control when they ﬁrst have sex suggests more efforts are needed to prevent teens from having sex or to convince them to use contraception.

Many teens have unprotected sex (percent45 of 15-to-19-year-olds who did not use contraception at ﬁrst sexual intercourse, by age and sex, 2002)

35%

males

30 30%

24%

24% 17%

15 15%

20%

12% 100000

0 0%

females

14 less 14 orryounger

75000

all females

males dual

1515to to 1616

1717to to 1919

50000

25000

400 AMERICAN HEALTH 0

with

w/out

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.10

Contraceptive Use among People Aged 15 to 19, 2002

(number of people aged 15 to 19 who have ever had sexual intercourse and percent distribution by method of contraception used at ﬁrst sexual intercourse, by sex, age, race, and Hispanic origin, 2002; numbers in thousands) total number

BOYS AGED 15 TO 19 Age at ﬁrst sexual intercourse Aged 14 or younger Aged 15 to 16 Aged 17 to 19 Race and Hispanic origin Black, non-Hispanic Hispanic White, non-Hispanic GIRLS AGED 15 TO 19 Age at ﬁrst sexual intercourse Aged 14 or younger Aged 15 to 16 Aged 17 to 19 Race and Hispanic origin Black, non-Hispanic Hispanic White, non-Hispanic

any method percent

no method

total

condom

4,697

100.0%

18.0%

82.0%

70.9%

1,513 1,977 1,207

100.0 100.0 100.0

24.1 11.9 20.4

75.9 88.1 79.6

72.0 77.3 59.1

934 903 2,672

100.0 100.0 100.0

14.4 26.6 15.2

85.6 73.4 84.8

84.9 67.4 68.2

4,598

100.0

25.5

74.5

66.4

1,290 2,235 1,074

100.0 100.0 100.0

34.8 24.1 17.4

65.2 75.9 82.6

58.5 68.6 71.3

854 615 2,905

100.0 100.0 100.0

29.0 33.8 22.0

71.0 66.2 78.0

61.2 55.5 71.8

Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

AMERICAN HEALTH

401

Table 13.11

Reason People Aged 15 to 19 Have Never Had Sexual Intercourse, 2002

(percent distribution of people aged 15 to 19 who have never had sexual intercourse by primary reason for not having intercourse, by sex, age, race, and Hispanic origin, 2002) age 15 to 17

race and Hispanic origin 18 to 19

black, non-Hispanic

white, non-Hispanic

Hispanic

BOYS AGED 15 TO 19 Total without sexual intercourse Against religion or morals Does not want to get a girl pregnant Does not want to get a sexually transmitted disease Has not found the right person yet In a relationship, but waiting for the right time Other reason

100.0% 29.3 27.4 12.0 17.9 4.3 9.2

100.0% 36.9 19.5 – 28.2 5.9 4.7

100.0% 21.4 28.1 20.2 13.6 – 9.9

100.0% 35.9 23.1 9.0 19.4 4.5 8.2

100.0% 18.9 42.1 11.7 19.0 – 5.6

GIRLS AGED 15 TO 19 Total without sexual intercourse Against religion or morals Does not want to get pregnant Does not want to get a sexually transmitted disease Has not found the right person yet In a relationship, but waiting for the right time Other reason

100.0 37.5 19.1 9.1 15.9 6.1 12.3

100.0 38.7 17.3 – 21.8 8.0 12.7

100.0 19.2 14.0 25.9 18.6 5.1 17.2

100.0 42.1 18.3 3.7 19.3 4.9 11.6

100.0 29.8 24.2 8.6 13.5 11.4 12.4

Note: “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002; Vital and Health Statistics Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

402 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Nearly Everyone Has Had Sex by Age 22 Marital status has little impact on sexual activity. The percentage of men and women with sexual experience rises sharply with age, exceeding 90 percent among men and women in their early twenties. Martial status has little impact on sexual experience. Among unmarried women, 92 percent had sexual intercourse by age 23. Among unmarried men, the proportion exceeded 90 percent by age 21. Sexual activity is nearly universal, and monogamy is the norm. Most men and women are involved with only one sexual partner during a year’s time. In 2008, the 62 percent majority of adults aged 18 or older had had only one sexual partner in the past 12 months. Just 15 percent had more than one partner, according to the National Opinion Research Center’s General Social Survey. The proportion of people who had two or more sexual partners during the past year has not changed signiﬁcantly since this question was ﬁrst asked in 1988. Most sexual activity in the United States occurs in committed relationships, according to ﬁndings from the National Survey of Family Growth. Among men aged 15 to 44 who have had sex in the past three months, nearly 90 percent say their last sexual experience was with their wife, cohabiting partner, or steady girlfriend. The survey asked women about their relationship with their ﬁrst sexual partner, and 75 percent said they were going steady, engaged, or married to him. Only 11 percent said they had just met or were just friends. ■ Most Americans are sexually active, and most have only one sexual partner at a time.

Women no longer wait for marriage

120

(percent of total and unmarried women aged 20 to 23 who have had sexual intercourse, 2002)

90% 80 80%

78%

73%

79%

88%

95%

married

92%

unmarrie

75%

40 40% 100000

0 0%

a20 aged

all total

unmarried dual

75000

b 21 aged

c 22 aged

d23 aged

50000

25000

0

with

w/out

AMERICAN HEALTH

403

Table 13.12

Men Ever Having Had Sexual Intercourse by Age and Marital Status, 2002

(number of total and never-married men aged 15 to 44 and percent who have ever had sexual intercourse, by age at interview, 2002; numbers in thousands) total

number

Total men aged 15 to 44 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 to 29 Aged 30 to 44

never-married

percent ever having had sexual intercourse

61,147 1,930 1,998 1,820 2,392 2,067 1,942 1,978 2,289 1,747 1,926 9,226 31,830

87.1% 15.7 33.9 45.8 60.2 69.8 78.0 91.0 85.1 90.9 92.7 95.8 97.7

number

percent ever having had sexual intercourse

30,175 1,930 1,998 1,798 2,369 2,044 1,870 1,803 1,830 1,262 1,460 4,636 7,175

73.9% 15.7 33.9 45.1 59.8 69.4 77.1 90.1 81.3 87.4 90.4 91.6 89.7

Source: National Center for Health Statistics, Fertility, Contraception, and Fatherhood: Data on Men and Women from Cycle 6 of the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 26, 2006, Internet site http://www.cdc .gov/nchs/nsfg.htm

Table 13.13

Women Ever Having Had Sexual Intercourse by Age and Marital Status, 2002

(number of total and never-married women aged 15 to 44 and percent who have ever had sexual intercourse, by age at interview, 2002; numbers in thousands) total

number

Total women 15 to 44 Aged 15 Aged 16 Aged 17 Aged 18 Aged 19 Aged 20 Aged 21 Aged 22 Aged 23 Aged 24 Aged 25 to 29 Aged 30 to 44

61,561 1,819 1,927 2,073 2,035 1,980 1,958 2,047 2,147 1,895 1,793 9,249 32,638

never-married

percent ever having had sexual intercourse

88.0% 14.0 29.5 45.5 66.6 74.7 77.6 79.2 90.3 95.0 92.1 96.6 98.4

number

25,712 1,819 1,927 2,069 1,887 1,896 1,646 1,709 1,695 1,141 959 3,684 5,280

percent ever having had sexual intercourse

71.3% 14.0 29.5 45.4 64.0 73.5 73.3 75.1 87.7 91.7 85.2 91.6 90.3

Source: National Center for Health Statistics, Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 25, 2005, Internet site http://www.cdc .gov/nchs/nsfg.htm

404 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.14

People Aged 18 or Older by Number of Sex Partners in Past Year, 1988 to 2008 “How many sex partners have you had in the last 12 months?”

(number of respondents aged 18 or older and percent distribution by response, selected years 1988 to 2008) total

2008 2006 2004 2002 2000 1998 1996 1994 1993 1991 1990 1989 1988

100.0% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

no partners

23.5% 24.8 19.3 22.8 22.2 21.2 19.0 22.2 21.4 22.9 19.8 22.1 22.9

one partner

61.8% 61.9 66.5 62.3 64.1 65.6 65.9 65.2 67.1 65.6 66.0 64.9 62.9

more than one partner

14.7% 13.3 14.2 14.9 13.7 13.2 15.1 12.6 11.5 11.5 14.2 13.0 14.2

Source: Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley, General Social Surveys, 1972–2008 Cumulative Data Files, Internet site http://sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08; calculations by New Strategist

AMERICAN HEALTH

405

Table 13.15

Relationship between Men Aged 15 to 44 and Last Sexual Partner, 2002

(number of men aged 15 to 44 who have had sexual intercourse in the past three months and percent distribution by relationship with last sexual partner, by selected characteristics, 2002; numbers in thousands) total number

Men aged 15 to 44 who had sexual intercourse in past three months

43,599

percent

100.0%

just friends

5.2%

going out once in a while

going steady

4.3%

15.0%

cohabiting

17.2%

married

56.9%

other*

1.4%

Age Aged 15 to 19

3,234

100.0

14.1

9.1

61.8

9.6

1.3

4.2

Aged 20 to 24

6,828

100.0

8.6

6.5

31.6

28.9

22.7

1.8

Aged 25 to 29

7,292

100.0

3.4

3.5

10.9

26.1

54.7

1.4

Aged 30 to 34

8,634

100.0

4.7

3.5

6.7

14.8

69.3

1.0

Aged 35 to 39

8,713

100.0

1.8

2.8

5.7

13.6

75.4

0.8

Aged 40 to 44

8,898

100.0

4.8

4.0

6.9

9.8

73.6

1.0

Age at ﬁrst sexual intercourse Under age 16

14,880

100.0

8.1

4.6

16.1

22.8

46.3

2.1

Aged 16

7,636

100.0

5.9

5.3

16.8

18.0

53.2

0.9

Aged 17

6,988

100.0

3.1

6.0

16.9

16.7

56.1

1.2

Aged 18

4,676

100.0

3.6

4.5

18.7

15.5

56.8

–

Aged 19

2,158

100.0

5.6

3.4

12.2

16.6

61.5

–

Aged 20 or older

7,260

100.0

1.4

1.3

7.8

6.9

81.7

0.9

Black, non-Hispanic

5,221

100.0

8.6

3.8

23.2

21.8

40.9

1.7

Hispanic

7,549

100.0

4.7

6.2

11.4

22.4

53.0

2.3

27,552

100.0

4.8

4.1

14.7

14.7

60.7

1.0

Living with both parents

31,895

100.0

4.7

4.2

14.7

15.7

59.3

1.5

Other

11,704

100.0

6.5

4.7

15.9

21.6

50.1

1.1

None

3,511

100.0

8.2

3.8

22.6

18.3

46.2

–

Fundamentalist Protestant

1,950

100.0

8.1

5.5

14.0

18.0

52.5

1.9

Other Protestant

19,433

100.0

5.2

3.7

14.1

15.2

60.9

1.0

Catholic

15,823

100.0

4.1

4.9

14.9

19.7

54.5

1.9

2,775

100.0

5.7

5.8

12.5

15.6

59.4

–

Race and Hispanic origin

White, non-Hispanic Family structure at age 14

Religion raised

Other religion

* Includes “just met” and “other” relationships. Note: “–” means sample is too small to make a reliable estimate. Source: National Center for Health Statistics, Fertility, Contraception, and Fatherhood: Data on Men and Women from Cycle 6 of the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 26, 2006, Internet site http://www.cdc .gov/nchs/nsfg.htm

406 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.16

Relationship between Women Aged 15 to 44 and First Male Sexual Partner, 2002

(number of women aged 15 to 44 who have ever had sexual intercourse and percent distribution by relationship with ﬁrst male sexual intercourse partner, by selected characteristics, 2002; numbers in thousands) total number Women aged 15 to 44 who have ever had sexual intercourse 54,190

percent 100.0%

just met just friends 2.2%

8.9%

going out once in a while 7.2%

going steady cohabiting 61.2%

2.2%

engaged 4.5%

married 9.6%

other 3.8%

Age Aged 15 to 19

4,598

100.0

3.3

10.6

6.6

74.3

1.4

1.2

1.1

1.2

Aged 20 to 24

8,530

100.0

2.3

8.8

8.4

64.5

2.5

3.3

6.8

3.5

Aged 25 to 29

8,939

100.0

1.3

8.6

5.5

63.7

2.6

4.0

9.8

4.5

Aged 30 to 34

10,077

100.0

1.8

9.2

7.1

61.6

1.7

4.8

9.1

4.2

Aged 35 to 39

10,686

100.0

3.2

10.0

7.0

56.5

2.9

5.1

11.6

3.4

Aged 40 to 44

11,360

100.0

1.8

7.5

8.0

55.8

1.8

6.2

13.7

4.4

Age at ﬁrst sexual intercourse Under age 16

15,549

100.0

4.0

14.1

8.2

59.6

1.8

1.7

1.2

8.7

Aged 16

9,348

100.0

1.5

7.9

7.6

75.9

1.4

1.9

1.5

2.1

Aged 17

8,210

100.0

1.1

8.5

6.4

71.8

1.5

6.1

2.9

1.6

Aged 18

7,025

100.0

2.1

5.3

9.1

65.9

2.5

5.8

6.7

2.6

Aged 19

4,111

100.0

2.1

7.9

7.4

56.7

3.9

7.4

13.1

1.3

Aged 20 or older

9,646

100.0

1.2

5.2

4.4

39.9

3.3

7.8

36.6

1.3

Race and Hispanic origin Black, non-Hispanic

7,403

100.0

1.6

14.1

7.3

68.5

1.7

1.3

1.9

3.2

Hispanic

7,887

100.0

1.7

6.8

5.9

47.6

7.2

9.5

18.4

2.8

34,999

100.0

2.5

8.3

7.4

64.2

1.2

4.2

8.1

4.0

White, non-Hispanic Family structure at age 14 Living with both parents

38,480

100.0

2.0

8.1

7.4

60.1

1.9

5.2

11.8

3.2

Other

15,710

100.0

2.8

10.9

6.6

64.1

2.9

2.8

4.3

5.3

None

4,255

100.0

6.2

12.0

8.6

56.9

2.7

3.0

5.8

4.7

Fundamentalist Protestant

3,062

100.0

0.8

11.9

4.7

56.9

3.4

5.0

11.9

5.4

Other Protestant

24,898

100.0

1.9

10.1

7.2

63.6

1.0

4.0

7.9

4.1

Catholic

19,119

100.0

1.8

6.1

7.4

62.4

3.5

5.6

9.9

2.8

2,664

100.0

2.8

10.1

6.6

44.7

1.5

3.5

26.6

4.3

Religion raised

Other religion

Source: National Center for Health Statistics, Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 25, 2005, Internet site Internet site http:// www.cdc.gov/nchs/nsfg.htm

AMERICAN HEALTH

407

Most Women Use Contraception The pill is the most popular method. Among women aged 15 to 44, the 62 percent majority uses contraception. This ﬁgure was a lower 56 percent in 1982. Nineteen percent of women are on the pill, and 17 percent have been sterilized. Eleven percent of women use condoms, up from 7 percent in 1982. Fewer than 10 percent of women aged 15 to 44 are either pregnant or trying to get pregnant. Contraceptive choices vary by age. As would be expected, the share of women who have been sterilized, or whose partner has been sterilized, increases with age. Among women aged 35 to 39, the majority depends on female or male sterilization. Use of the pill declines with age, as does the use of condoms. Non-Hispanic white women are less likely than non-Hispanic black or Hispanic women to be sterilized and more likely to be on the pill. College educated women are more likely to be on the pill and less likely to be sterilized than women with less education. ■ A substantial 42 percent of women aged 15 to 44 have used family planning services in the past year.

Educational attainment inﬂuences birth control choices

60

42%

40

40%

20

20%

21%

19% 13%

0%

birth control a pill

13%

75000

all school grad. only high

college dual graduate

female sterilization b

condom c

50000

25000

0

408 AMERICAN HEALTH

colleg

42%

100000

0

h.s.

(percent of female contraceptive users aged 15 to 44 who use selected methods of contraception, by educational attainment, 2002)

with

w/out

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.17

Current Contraceptive Use Status of Women, 1982 and 2002

(total number of women aged 15 to 44 and percent distribution by current contraceptive use status and method, 1982 and 2002; numbers in thousands) 2002

Total women aged 15 to 44, number Total women aged 15 to 44, percent

1982

61,561 100.0%

54,099 100.0%

Using contraception Pill Female sterilization Condom Male sterilization Three-month injectable (Depo-Provera) Withdrawal Intrauterine device Implant, Lunelle, or patch Periodic abstinence—calendar rhythm method Diaphragm Periodic abstinence—natural family planning Other methods

61.9 18.9 16.7 11.1 5.7 3.3 2.5 1.3 0.8 0.7 0.2 0.2 0.6

55.7 15.6 12.9 6.7 6.1 – 1.1 4.0 – 1.8 4.5 0.3 2.7

Not using contraception Never had intercourse or no intercourse in past three months Pregnant or postpartum Seeking pregnancy Nonsurgically sterile, male or female Surgically sterile, female (noncontraceptive) All other

38.1

44.3

18.1 5.3 4.2 1.6 1.5 7.4

19.5 5.0 4.2 1.2 6.3 8.1

Note: “Other methods” includes Today Sponge, cervical cap, female condom, and other methods. “–” means method was unavailable in that year. Source: National Center for Health Statistics, Use of Contraception and Use of Family Planning Services in the United States: 1982–2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

AMERICAN HEALTH

409

Table 13.18

Current Method of Contraception among Women by Age, 2002

(percent distribution of women aged 15 to 44 using contraception by type of contraceptive used and age, 2002; numbers in thousands) 15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

100.0%

total

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

Pill

30.6

52.8

52.3

37.6

31.5

18.6

10.9

Female sterilization

27.0

0.0

3.6

15.1

27.5

41.2

50.3

Condom

18.0

27.0

23.1

20.5

17.1

15.7

11.5

9.2

0.0

0.8

4.2

9.2

14.2

18.4

Three-month injectable (Depo-Provera)

5.3

13.9

10.1

6.5

4.2

2.1

1.6

Other methods

9.9

6.3

10.1

16.2

10.7

8.2

7.3

Women aged 15 to 44 using contraception

Male sterilization

Source: National Center for Health Statistics, Use of Contraception and Use of Family Planning Services in the United States: 1982–2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

Table 13.19

Current Method of Contraception among Women by Marital Status, 2002

(percent distribution of women aged 15 to 44 using contraception by type of contraceptive used and marital status, 2002; numbers in thousands) total

Women aged 15 to 44 using contraception 100.0% Pill 30.6 Female sterilization 27.0 Condom 18.0 Male sterilization 9.2 Three-month injectable (Depo-Provera) 5.3 Other methods 9.9

currently married

100.0% 23.6 29.8 16.4 15.4 3.1 11.7

currently cohabiting

100.0% 33.2 25.4 18.1 3.1 9.3 11.0

never married

formerly married

100.0% 49.4 10.0 23.4 0.9 9.6 6.7

100.0% 19.1 54.9 12.5 3.3 2.7 7.5

Source: National Center for Health Statistics, Use of Contraception and Use of Family Planning Services in the United States: 1982–2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

410 AMERICAN HEALTH

SEXUAL ATTITUDES AND BEHAVIOR

Table 13.20

Current Method of Contraception among Women by Race and Hispanic Origin, 2002

(percent distribution of women aged 15 to 44 using contraception by type of contraceptive used, race, and Hispanic origin, 2002; numbers in thousands) black, non-Hispanic

total

Women aged 15 to 44 using contraception Pill Female sterilization Condom Male sterilization Three-month injectable (Depo-Provera) Other methods

100.0% 30.6 27.0 18.0 9.2 5.3 9.9

white, non-Hispanic

Hispanic

100.0% 22.5 38.9 20.0 2.4 9.8 6.5

100.0% 22.0 33.8 18.5 4.4 7.3 14.1

100.0% 34.4 24.0 16.6 11.6 4.3 9.2

Source: National Center for Health Statistics, Use of Contraception and Use of Family Planning Services in the United States: 1982–2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

Table 13.21

Current Method of Contraception among Women by Education, 2002

(percent distribution of women aged 15 to 44 using contraception by type of contraceptive used and education, 2002; numbers in thousands)

total

Women aged 15 to 44 using contraception 100.0% Pill 30.6 Female sterilization 27.0 Condom 18.0 Male sterilization 9.2 Three-month injectable (Depo-Provera) 5.3 Other methods 9.9

not a high school graduate

100.0% 10.6 55.3 13.2 2.8 7.4 10.7

high school graduate or GED

100.0% 19.0 41.5 13.1 10.8 4.9 10.8

some college, no degree

100.0% 27.6 28.7 17.9 12.1 3.2 10.4

bachelor’s degree or more

100.0% 41.8 12.8 20.8 12.8 1.9 10.0

Note: Education categories are shown only for people aged 22 to 44. Source: National Center for Health Statistics, Use of Contraception and Use of Family Planning Services in the United States: 1982–2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

AMERICAN HEALTH

411

Table 13.22

Use of Family Planning Services by Selected Characteristics, 2002

(number of women aged 15 to 44 and percent who have used family planning services, by selected characteristics and type of service, 2002; numbers in thousands) type of family planning service used used at least one type of family planning number service

Total women aged 15 to 44

61,561

birth control method

birth control counseling

birth control checkup or test

sterilization counseling

sterilization operation

41.7%

33.9%

18.6%

23.6%

4.4%

1.9%

Age Aged 15 to 17

5,819

31.8

22.2

19.0

15.8

1.1

0.0

Aged 18 to 19

4,016

51.6

43.9

26.5

31.0

0.9

0.0

Aged 20 to 24

9,840

63.3

54.0

30.6

35.7

1.4

1.2

Aged 25 to 29

9,249

55.4

46.3

23.8

30.2

3.6

2.2

Aged 30 to 34

10,272

47.0

39.1

18.3

27.2

7.1

2.6

Aged 35 to 39

10,853

30.5

23.9

12.7

18.6

6.6

3.0

Aged 40 to 44

11,512

19.5

14.0

7.0

10.8

5.2

2.0

Black, non-Hispanic

8,587

39.6

30.6

20.7

21.5

5.0

2.2

Hispanic

9,107

39.7

28.9

22.6

20.6

7.0

2.3

40,420

43.2

36.4

17.4

25.4

3.7

1.7

28,327

39.5

31.5

16.0

21.3

5.8

2.5

5,570

50.4

43.2

21.5

30.2

4.6

1.8

21,568

44.4

36.4

22.5

25.4

2.4

0.7

6,096

34.5

28.0

14.3

22.0

4.7

3.1

None

25,622

45.3

38.8

20.8

27.1

1.3

0.3

One

11,193

51.0

43.0

22.9

27.6

4.5

1.4

Two

13,402

38.1

29.3

16.5

21.4

6.3

3.7

Three or more

11,343

28.6

19.5

11.8

14.5

9.2

3.8

Race and Hispanic origin

White, non-Hispanic Marital or cohabiting status Currently married Currently cohabiting Never married, not cohabiting Formerly married, not cohabiting Number of children ever borne

Source: National Center for Health Statistics, Use of Contraception and Use of Family Planning Services in the United States: 1982–2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm

412 AMERICAN HEALTH

WEIGHT AND EXERCISE CHAPTER

14 Weight and Exercise ■ The average woman weighs 165 pounds. Between 1976–80 and 2003–06, the average woman gained 19 pounds.

■ Only 37 percent of women are at a healthy weight. Among men, the proportion is an even smaller 26 percent.

■ Most Americans are overweight. Seventy-three percent of men and 61 percent of women are overweight.

■ Only 15 percent of high school girls are overweight. A larger 34.5 percent of high school girls think they are overweight, however.

■ Most adults want to lose weight. Women say their ideal weight is 138 pounds, up from 129 pounds in 1990, according to Gallup.

■ Most Americans do not get enough exercise. Fifty-eight percent say they do not regularly engage in vigorous physical activity.

AMERICAN HEALTH

413

Shifts in Eating Habits Reﬂect Fads and Findings Some positive changes are apparent, but Americans still crave soft drinks. Between 2000 and 2007, Americans consumed less of some foods and more of others. During those years, the average person ate less beef but more chicken, fewer fresh fruits but more fresh vegetables, less regular soda but more diet soda. Ongoing efforts by nutritionists and public health professionals to get Americans to eat a better diet have yet to result in big changes. But they may account for the greater consumption of yogurt, fresh vegetables, and nuts. The advice of nutritionists hasn’t managed to lower consumption of potato chips, however. Carbonated soft drinks continue to be the most popular beverage, although consumption fell between 2000 and 2007. Coffee consumption rose slightly. The average person drank much more bottled water in 2007 (29 gallons) than in 2000 (18 gallons). He or she also drank more alcoholic beverages, with wine consumption growing by a signiﬁcant 23 percent. ■ The amount of food the average person consumes has grown during the past three decades, which explains Americans’ growing girth.

Carbonated beverages are more popular than any other

45

(number of gallons of beverages consumed per person, 2007)

34 29

30 gallons 30

25 22

21 15

15 gallons 15

13 8

8 2

00 gallons

carbonated a soft drinks, regular

bottled b water

414 AMERICAN HEALTH

coffee c

beer d

milk e

carbonated f soft drinks, diet

fruit g drinks

fruit h juice

tea

wine

1 distilled spirits

WEIGHT AND EXERCISE

Table 14.1

Food and Beverage Consumption, 2000 and 2007

(number of pounds of food and gallons of beverages consumed per person, 2000 and 2007; percent change in consumption, 2000–07)

Food (pounds) Red meat (boneless) Beef Veal Lamb and mutton Pork Poultry (boneless) Chicken Turkey Fish and shellﬁsh (boneless) Eggs (number) Shell Processed Yogurt, except frozen (1⁄2 pints) Cream (1⁄2 pints) Sour cream and dips (1⁄2 pints) Cheese American Cheddar Italian Mozzarella Other Swiss Cream, Neufchatel Cottage cheese, total Lowfat Frozen dairy products Ice cream Low-fat ice cream Sherbet Frozen yogurt Butter Margarine Shortening Salad and cooking oils Flour and cereal products Wheat ﬂour products Rice products Corn products Oat products

2007

2000

110.6 62.2 0.3 0.8 47.3 73.7 59.9 13.8 16.3 249 170 79 21.3 15.7 8.2 32.7 12.8 10.0 14.1 10.9 5.8 1.3 2.6 2.6 1.4 25.2 14.0 7.0 1.3 1.2 4.7 4.5 21.0 50.2 196.9 138.1 20.5 32.4 4.7

113.7 64.5 0.5 0.8 47.8 67.9 54.2 13.7 15.2 251 178 73 12.0 11.6 6.1 29.8 12.7 9.7 12.1 9.3 4.8 1.0 2.3 2.6 1.3 28.0 16.7 7.3 1.2 2.0 4.5 8.2 31.5 33.7 199.2 146.3 18.9 28.4 4.4

percent change, 2000–07

–2.7% –3.7 –40.1 1.5 –1.0 8.5 10.4 1.1 7.1 –0.9 –4.6 8.1 77.3 35.4 34.7 9.7 0.8 3.4 16.3 17.7 20.8 28.2 11.4 –0.4 7.3 –10.1 –16.0 –4.5 4.6 –39.6 5.7 –44.9 –33.5 49.0 –1.1 –5.6 8.9 14.1 7.9 (continued)

AMERICAN HEALTH

415

Caloric sweeteners Sugar Corn sweeteners High fructose corn syrup Peanuts (shelled) Tree nuts (shelled) Fresh fruits Noncitrus Apples Bananas Cantaloupes Grapes Peaches and nectarines Pears Pineapples Plums and prunes Strawberries Watermelons Other noncitrus fruits Citrus Oranges Grapefruit Other citrus fruit Processed fruits Frozen fruits Dried fruits Canned fruits Fresh vegetables Asparagus Broccoli Cabbage Carrots Cauliﬂower Celery Corn Cucumbers Head lettuce Mushrooms Onions Snap beans Bell peppers Potatoes Sweet potatoes Tomatoes Other fresh vegetables

2007

2000

136.3 62.0 72.9 56.2 6.3 3.3 126.2 108.1 16.4 26.0 9.9 8.0 4.5 3.1 5.0 1.0 6.4 16.3 11.5 18.1 7.5 2.8 7.8 136.9 4.4 9.6 15.9 202.2 1.1 6.0 8.6 9.0 1.7 6.4 9.1 6.3 20.3 2.6 21.7 2.2 6.8 39.2 5.2 20.3 35.6

148.8 65.5 81.8 62.6 5.9 2.6 128.5 105.0 17.5 28.4 11.1 7.4 5.3 3.4 3.2 1.2 4.9 13.8 8.7 23.5 11.7 5.1 6.7 157.1 4.2 10.4 17.5 199.2 1.0 5.9 8.9 9.2 1.7 6.3 9.0 6.4 23.5 2.6 18.9 2.0 7.0 47.1 4.2 19.0 26.7

percent change, 2000–07

–8.4% –5.4 –10.9 –10.3 7.0 28.1 –1.8 3.0 –5.8 –8.7 –11.4 7.8 –15.6 –9.0 56.0 –15.2 32.6 17.6 31.8 –23.2 –36.5 –44.1 15.9 –12.9 4.5 –7.8 –9.5 1.5 19.7 2.4 –3.5 –2.6 0.0 1.8 1.2 –0.6 –13.6 0.1 15.0 8.5 –2.9 –16.7 24.6 7.0 33.5 (continued)

416 AMERICAN HEALTH

WEIGHT AND EXERCISE

2007

2000

214.7 76.0 97.2 14.1 18.7

224.1 79.3 103.2 17.3 15.9

Beverages (gallons) Milk 20.7 Plain whole milk 6.1 Plain 2 percent milk 6.9 Plain 1 percent and skim milk 5.7 Flavored whole milk 0.3 Flavored milks other than whole 1.4 Buttermilk 0.2 Tea 8.4 Coffee 24.6 Bottled water 29.1 Carbonated soft drinks 48.8 Diet 14.9 Regular 33.9 Fruit juices 8.2 Fruit drinks, cocktails, and ades 12.9 Alcoholic beverages 25.7 Beer 21.8 Wine 2.5 Distilled spirits 1.4

22.5 7.7 7.1 6.1 0.4 1.0 0.3 8.2 24.2 18.2 52.9 13.9 39.0 9.2 14.7 25.0 21.8 2.0 1.3

Processed vegetables Frozen vegetables Canned vegetables Dehydrated vegetables Potato chips

percent change, 2000–07

–4.2% –4.1 –5.8 –18.2 17.8

–8.1 –20.1 –2.2 –5.9 –30.5 42.1 –23.5 2.9 1.5 59.8 –7.7 7.3 –13.1 –10.7 –11.9 2.7 0.2 23.2 12.9

Note: Alcoholic beverage consumption is per person aged 21 or older. Source: Bureau of the Census, Statistical Abstract of the United States: 2010, Internet site http://www.census.gov/compendia/ statab/cats/health_nutrition.html; calculations by New Strategist

AMERICAN HEALTH

417

Decades of Overeating Tip the Scales On average, men and women have gained 19 to 21 pounds. In 1976–80, the average man weighed 174 pounds. Twenty-ﬁve years later, the average man had put on an additional 21 pounds, bringing his weight up to 195 pounds. Women’s average weight increased from 145 to 165 pounds between 1976–80 and 2003–06. One factor behind the weight gain was an increase in food consumption. The average woman consumed 336 more calories per day in 2003–06 than her counterpart in 1976–80. Among men, food intake increased by 266 calories per day during those years. Among men, the heaviest are non-Hispanic whites aged 40 to 59, tipping the scales at nearly 204 pounds on average. Among women, blacks aged 40 to 59 are the heaviest, weighing an average of 190 pounds. ■ Because weight gain occurs slowly, many do not realize they are gaining weight until they no longer ﬁt into their clothes.

The average woman weighs more than 160 pounds 240

(average weight in pounds of people aged 20 to 74, by sex, 1976–80 and 2003–06)

eighty

195 lbs. 174 lbs. 160 160 lbs.

80

145 lbs.

80 lbs. 100000

0

oh-six

165 lbs.

0 lbs.

men men

all 1976–80

2003–06 dual

75000

women women

50000

25000

0

418 AMERICAN HEALTH

with

w/out

WEIGHT AND EXERCISE

Table 14.2

Average Measured Weight by Sex and Age, 1976–80 and 2003–06

(average weight in pounds of people aged 20 or older, by sex and age, 1976–80 and 2003–06; change in pounds 1976–80 to 2003–06) change in pounds

2003–06

1976–80

Men aged 20 or older Aged 20 to 29 Aged 30 to 39 Aged 40 to 49 Aged 50 to 59 Aged 60 to 69 Aged 70 to 79 Aged 80 or older

194.7 188.3 194.1 202.3 198.8 198.3 187.4 168.1

173.8* 167.9 175.5 179.7 176.0 167.5** – –

20.9 20.4 18.6 22.6 22.8 – – –

Women aged 20 or older Aged 20 to 29 Aged 30 to 39 Aged 40 to 49 Aged 50 to 59 Aged 60 to 69 Aged 70 to 79 Aged 80 or older

164.7 155.9 164.7 171.3 172.1 170.5 155.6 142.2

145.4* 135.7 145.5 148.8 150.4 146.9** – –

19.3 20.2 19.2 22.5 21.7 – – –

* People aged 20 to 74. ** People aged 60 to 74. Note: Data are based on the measured weight of a sample of the civilian noninstitutionalized population. “–” means data are not available. Source: National Center for Health Statistics, Mean Body Weight, Height, and Body Mass Index, United States 1960–2002, Advance Data, No. 347, 2004, Internet site http://www.cdc.gov/nchs/pressroom/04news/americans.htm; and Anthropometric Reference Data for Children and Adults: United States, 2003–2006, National Health Statistics Reports, No. 10, 2008, Internet site http://www.cdc.gov/nchs/products/nhsr.htm; calculations by New Strategist

AMERICAN HEALTH

419

Table 14.3

Average Measured Weight by Race, Hispanic Origin, Age, and Sex, 2003–06

(average weight in pounds of people aged 20 or older, by race, Hispanic origin, age, and sex, 2003–06) men

women

194.7

164.7

199.8 202.4 201.0 189.0

184.8 181.6 190.1 180.8

Hispanic (Mexican) Total aged 20 or older Aged 20 to 39 Aged 40 to 59 Aged 60 or older

180.5 181.1 180.7 175.9

163.7 158.9 171.0 158.8

White, non-Hispanic Total aged 20 or older Aged 20 to 39 Aged 40 to 59 Aged 60 or older

197.4 193.5 203.8 192.3

162.2 160.5 168.4 153.0

TOTAL PEOPLE Black, non-Hispanic Total aged 20 or older Aged 20 to 39 Aged 40 to 59 Aged 60 or older

Note: Data are based on the measured weight of a sample of the civilian noninstitutionalized population. Source: National Center for Health Statistics, Anthropometric Reference Data for Children and Adults: United States, 2003–2006, National Health Statistics Reports, No. 10, 2008, Internet site http://www.cdc.gov/nchs/products/nhsr.htm; calculations by New Strategist

Table 14.4

Caloric Intake by Sex and Age, 1976–80 and 2003–06

(average number of kilocalories consumed by people aged 20 to 74 in the past 24 hours from all foods and beverages including alcoholic beverages, by sex and age, 1976–80 and 2003–06; change in number of calories, 1976–80 and 2003–06) 2003–06

1976–80

change

Men, total Aged 20 to 39 Aged 40 to 59 Aged 60 to 74

2,725 2,978 2,693 2,137

2,459 2,753 2,315 1,906

266 225 378 231

Women, total Aged 20 to 39 Aged 40 to 59 Aged 60 to 74

1,861 2,001 1,823 1,633

1,525 1,643 1,473 1,322

336 358 350 311

Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

420 AMERICAN HEALTH

WEIGHT AND EXERCISE

Most Americans Are Overweight The ranks of the obese are growing rapidly. The percentage of Americans whose weight is deﬁned as healthy has dropped sharply over the past three decades. In 2003–06, only 26 percent of men and 37 percent of women had a healthy weight, meaning a body mass index between 18.5 and 24.9. Among both men and women, the share with a healthy weight dropped by 17 to 19 percentage points between 1976–80 and 2003–06. As the ranks of those with a healthy weight have fallen, the number of Americans who are overweight (deﬁned as having a body mass index of 25 or higher) has ballooned. Between 1976–80 and 2003–06, the percentage of men who are overweight climbed from 53 to 73 percent. Among women the ﬁgure rose from 42 to 61 percent. Even more alarming is the increase in obesity (deﬁned as having a body mass index of 30 or higher). Among men, the obesity rate rose from 13 to 33 percent and among women it increased from 17 to 35 percent during those years. ■ The growing number of overweight Americans means more people with serious health problems such as diabetes and heart disease.

Fewer women are at a healthy weight 75

(percent distribution of women aged 20 to 74 by weight status, 1976–80 and 2003–06)

seventy

61%

oh-six

54% 50

50%

42%

37% 25

25% 100000

0

0%

all 1976–80

2003–06 dual

75000

healthy healthy weight

over overweight

50000

25000

0

with

w/out

AMERICAN HEALTH

421

Table 14.5

Adults Measured as Having a Healthy Weight by Sex and Age, 1976–80 and 2003–06

(percent of people aged 20 to 74 who have a healthy weight, by sex and age, 1976–80 and 2003–06; percentage point change, 1976–80 to 2003–06) healthy weight 2003–06

1976–80

percentage point change

Men aged 20 to 74 Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74

26.1% 35.9 24.1 20.8 19.3 21.2

45.4% 57.1 41.3 38.7 38.7 42.3

–19.3 –21.2 –17.2 –17.9 –19.4 –21.1

Women aged 20 to 74 Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74

36.6 45.1 37.6 31.1 29.5 28.5

53.7 65.0 55.6 48.7 43.5 37.8

–17.1 –19.9 –18.0 –17.6 –14.0 –9.3

Note: “Healthy weight” is deﬁned as a body mass index between 18.5 and 24.9. Body mass index is calculated by dividing weight in kilograms by height in meters squared. Data are based on measured height and weight of a representative sample of the civilian noninstitutionalized population. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

Table 14.6

Adults Measured as Overweight by Sex and Age, 1976–80 and 2003–06

(percent of people aged 20 to 74 who are overweight, by sex and age, 1976–80 and 2003–06; percentage point change, 1976–80 to 2003–06) overweight 2003–06

1976–80

percentage point change

Men aged 20 to 74 Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74

72.6% 61.6 75.2 78.5 79.7 78.0

52.9% 41.2 57.2 60.2 60.2 54.2

19.7 20.4 18.0 18.3 19.5 23.8

Women aged 20 to 74 Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74

61.2 50.9 60.7 67.3 69.6 70.5

42.0 27.9 40.7 48.7 53.7 59.5

19.2 23.0 20.0 18.6 15.9 11.0

Note: “Overweight” is deﬁned as a body mass index of 25 or higher. Body mass index is calculated by dividing weight in kilograms by height in meters squared. Data are based on measured height and weight of a representative sample of the civilian noninstitutionalized population. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

422 AMERICAN HEALTH

WEIGHT AND EXERCISE

Table 14.7

Adults Measured as Obese by Sex and Age, 1976–80 and 2003–06

(percent of people aged 20 to 74 who are obese, by sex and age, 1976–80 and 2003–06; percentage point change, 1976–80 to 2003–06) obese 2003–06

1976–80

percentage point change

Men aged 20 to 74 Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74

33.1% 26.2 37.0 34.6 39.3 33.0

12.8% 8.9 13.5 16.7 14.1 13.2

20.3 17.3 23.5 17.9 25.2 19.8

Women aged 20 to 74 Aged 20 to 34 Aged 35 to 44 Aged 45 to 54 Aged 55 to 64 Aged 65 to 74

35.2 28.4 36.1 40.0 41.0 36.4

17.1 11.0 17.8 19.6 22.9 21.5

18.1 17.4 18.3 20.4 18.1 14.9

Note: “Obesity” is deﬁned as a body mass index of 30 or higher. Body mass index is calculated by dividing weight in kilograms by height in meters squared. Data are based on measured height and weight of a representative sample of the civilian noninstitutionalized population. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

423

Americans Are In Denial about Their Weight What they say is different from how they measure. Determining how many people are overweight depends on how weight is measured. Some government surveys determine the percentage of overweight Americans by asking people how much they weigh and how tall they are. Researchers then calculate body mass indexes and determine how many are overweight. Based on self-reported heights and weights, 68 percent of men and 55 percent of women are overweight. Other government surveys do not depend on self-reports because of the tendency for men to overstate their height and for women to understate their weight. Instead, these surveys actually measure the height and weight of each survey respondent and calculate body mass indexes from those numbers. Based on measured heights and weights, a larger 73 percent of men and 61 percent of women are overweight. ■ Self-reported heights and weights are not a reliable way to determine Americans’ weight status.

Fantasy versus reality (percent of people aged 18 or older who are overweight based on self-reported and measured heights and weights, 2003–06 and 2008)

90

self-re

77%

measu

68% 60

60%

30

30%

61%

55%

100000

0

0%

men men

all self-reported

measured dual

75000

women women

50000

25000

0

424 AMERICAN HEALTH

with

w/out

WEIGHT AND EXERCISE

Table 14.8

Self-Reported Weight Status of People Aged 18 or Older by Selected Characteristics, 2008

(number of people aged 18 or older and percent distribution by weight status and selected characteristics, 2008; numbers in thousands) overweight number

underweight

healthy weight

total

obese

TOTAL PEOPLE Sex Men Women

225,227

1.8%

36.2%

62.0%

27.4%

108,755 116,472

1.1 2.5

30.8 42.3

68.2 55.2

26.6 27.6

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

110,615 77,335 19,869 17,409

2.2 0.9 1.1 3.5

40.0 31.1 30.2 42.0

57.8 68.0 68.7 54.4

25.1 32.4 30.4 16.9

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

10,501 26,765 30,583 154,483

4.8 1.4 0.8 1.9

54.5 29.3 28.8 38.5

40.7 69.3 70.3 59.7

9.4 36.1 31.3 25.6

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

1.4 1.5 1.2 1.5

27.9 30.1 32.5 41.2

70.7 68.4 66.3 57.3

34.5 33.6 30.0 21.1

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

2.2 1.4 1.6 1.6 1.9

35.6 34.3 33.8 35.0 41.0

62.2 64.3 64.6 63.5 57.2

30.0 29.7 30.6 25.5 21.6

Note: “Underweight” is a body mass index (BMI) below 18.5; “healthy weight” is a BMI of 18.5 to 24.9; “overweight” is a BMI of 25.0 or higher; “obese” is a BMI of 30.0 or more. BMI is calculated by dividing weight in kilograms by height in meters squared. Data are based on self-reported heights and weights of a representative sample of the civilian noninstitutionalized population. Numbers may not add to total because “weight unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

425

Many Children Are Overweight Nearly one in ﬁve children aged 6 to 17 is overweight. Given that most adults are overweight, it is not surprising that some children and teenagers also need to lose weight. Among children aged 6 to 19, from 17 to 18 percent are overweight. The likelihood of being overweight varies by race and Hispanic origin. Among boys, Hispanics are most likely to be overweight, with 22.1 to 27.5 percent classiﬁed as weighing too much. Among girls, non-Hispanic blacks are most likely to be overweight, with 24.0 to 27.7 percent weighing more than they should. A survey of high school students ﬁnds 15 percent of girls and 16 percent of boys to be overweight. High school girls are more likely than boys to think they are overweight (34.5 versus 24.2 percent). A substantial 60 percent of girls are trying to lose weight. ■ Overweight children risk becoming overweight adults, with resulting health problems.

Among teen boys, Hispanics are most likely to be overweight (percent of children aged 12 to 17 who are overweight, by sex, race, and Hispanic origin, 2003–06) 30

27.7% 22.1%

20

20%

18.5%

black hisp

19.9%

white

17.3% 14.5%

10

10%

30

black black, non-Hispanic hisp (Mexican) Hispanic

0

20

0%

white, non-Hispanic white

boys boys

girls girls

10

0

426 AMERICAN HEALTH

boys

girls

WEIGHT AND EXERCISE

Table 14.9

Children Measured as Overweight by Sex, Race, Hispanic Origin, and Age, 2003–06

(percent of people aged 6 to 19 who are overweight, by sex, race, Hispanic origin, and age, 2003–06) 6 to 11

12 to 19

TOTAL OVERWEIGHT Boys Black, non-Hispanic Hispanic (Mexican) White, non-Hispanic

17.0% 18.0 18.6 27.5 15.5

17.6% 18.2 18.5 22.1 17.3

Girls Black, non-Hispanic Hispanic (Mexican) White, non-Hispanic

15.8 24.0 19.7 14.4

16.8 27.7 19.9 14.5

Note: “Overweight” is deﬁned as a body mass index of 25 or higher. Body mass index is calculated by dividing weight in kilograms by height in meters squared. Data are based on measured height and weight of a representative sample of the civilian noninstitutionalized population. Source: National Center for Health Statistics, Health, United States, 2009, Internet site http://www.cdc.gov/nchs/hus.htm; calculations by New Strategist

AMERICAN HEALTH

427

Table 14.10

Weight Problems and Dieting Behavior of 9th to 12th Graders by Sex, 2007

(percent of 9th to 12th graders by weight status and dieting behavior, by sex and grade, 2007) total

BOYS Overweight* Described themselves as overweight Were trying to lose weight Ate less food, fewer calories, or foods low in fat to lose weight or to avoid gaining weight in past 30 days Exercised to lose weight or to avoid gaining weight in past 30 days Went without eating for at least 24 hours to lose weight or to avoid gaining weight in past 30 days Took diet pills, powders, or liquids without a doctor’s advice to lose weight or avoid gaining weight in past 30 days Vomited or took a laxative to lose weight or to avoid gaining weight in past 30 days GIRLS Overweight* Described themselves as overweight Were trying to lose weight Ate less food, fewer calories, or foods low in fat to lose weight or to avoid gaining weight in past 30 days Exercised to lose weight or to avoid gaining weight in past 30 days Went without eating for at least 24 hours to lose weight or to avoid gaining weight in past 30 days Took diet pills, powders, or liquids without a doctor’s advice to lose weight or avoid gaining weight in past 30 days Vomited or took a laxative to lose weight or to avoid gaining weight in past 30 days

9th grade

10th grade

11th grade

12th grade

16.4% 24.2 30.4

17.0% 24.3 31.0

17.7% 24.8 31.6

15.9% 25.8 30.1

14.9% 21.6 28.7

28.3

27.3

29.1

29.8

27.4

55.0

58.7

54.2

54.9

51.1

7.3

6.5

6.5

8.1

8.0

4.2

2.9

3.8

5.0

5.7

2.2

2.1

1.8

2.1

2.6

15.1 34.5 60.3

18.3 33.6 58.6

14.2 33.8 50.2

14.2 36.2 61.3

13.1 34.9 61.6

53.2

50.5

53.0

54.0

56.4

67.0

70.6

67.7

65.0

63.7

16.3

16.8

19.1

14.8

13.6

7.5

6.1

6.9

7.4

10.2

6.4

5.5

7.6

5.7

6.6

* Students who were overweight were at or above the 95th percentile for body mass index, by age and sex. Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance–United States, 2007, Mortality and Morbidity Weekly Report, Vol. 57/SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

428 AMERICAN HEALTH

WEIGHT AND EXERCISE

Most Want to Lose Weight But few are succeeding. Given that most adults need to lose weight, it is not surprising that the majority of respondents to a 2009 Gallup survey say they want to lose weight. The percentage of men and women who want to lose weight had been rising for decades but now appears to have leveled off. Fifty-four percent of men and 56 percent of women said they wanted to lose weight in 2009, but the ﬁgures peaked at 56 percent for men and 68 percent for women earlier in the decade. Gallup’s survey of the weight of Americans not only asks respondents how much they weigh, it also asks how much they think they should weigh—or their ideal weight. In 2009, men reported weighing an average of 194 pounds, and they believed their ideal weight was 182 pounds. Women reported weighing 154 pounds, on average. Their ideal weight was 138 pounds. The gap between actual and ideal weight has grown for both men and women over the years. ■ Not only have Americans been gaining weight, but their ideal weight has been growing too.

Women would have to lose 16 pounds to be at their ideal weight (self-reported and ideal weight in pounds for men and women, 2009)

240

self

194 lbs.

ideal

182 lbs. 154 lbs.

160 160 lbs.

80

138 lbs.

80 lbs. 100000

0

0 lbs.

men men

all self-reported weight

ideal dualweight

75000

women women

50000

Source: The Gallup Organization, Personal Weight Situation, 2009, Internet site http://www.gallup.com/poll/7264/ Personal-Weight-Situation.aspx 25000

0

with

w/out

AMERICAN HEALTH

429

Table 14.11

People Who Want to Lose Weight, 1951 to 2009

(percent of people aged 18 or older who want to lose weight, by sex, selected years, 1951 to 2009) men

2009 2008 2007 2006 2005 2004 2003 2002 2001 1999 1996 1990 1957 1955 1954 1951

women

54% 51 51 53 56 56 51 49 49 44 45 42 25 24 26 21

56% 67 68 64 64 67 68 66 68 58 63 61 45 49 45 44

Source: The Gallup Organization, Personal Weight Situation, 1951 to 2009, Internet site http://www.gallup.com/poll/7264/ Personal-Weight-Situation.aspx

Table 14.12

Self-Reported and Ideal Weight by Sex, 1990 to 2009

(people aged 18 or older by self-reported and ideal weight in pounds, by sex, 1990 to 2009)

self-reported weight

ideal weight

difference between reported and ideal weight

Men 2009 1999 1990

194 190 180

182 180 171

12 10 9

Women 2009 1999 1990

154 150 142

138 136 129

16 14 13

Source: The Gallup Organization, Personal Weight Situation, 1990 to 2009, Internet site http://www.gallup.com/poll/7264/ Personal-Weight-Situation.aspx

430 AMERICAN HEALTH

WEIGHT AND EXERCISE

Americans Do Not Exercise Enough More than one in three are physically inactive. The growing number of overweight adults is the result of a simple formula: calories in minus calories out. Americans are consuming more calories, but most are not getting enough exercise to burn off their increased caloric intake. Thirty-six percent of adults are physically inactive—meaning they do not engage in even light to moderate physical activity. An even larger 58 percent say they never engage in vigorous physical activity. Most likely to be physically inactive are older Americans (54 percent of people aged 75 or older), the less educated (60 percent of people without a high school diploma), and the less afﬂuent (48 percent of people with household incomes below $35,000). Those most likely to engage in vigorous physical activity at least once a week are 18-to-44-year-olds (46 percent), college graduates (53 percent), and people in households with incomes of $100,000 or more (56 percent). ■ Physical activity increases with education and income, in part because the well-educated and afﬂuent have jobs with ﬂexible schedules, giving them time to exercise.

The majority of college graduates participate in vigorous physical activity at least once a week 60

40

(percent of people aged 18 or older who participate in vigorous physical activity at least once a week, by educational attainment, 2008)

53%

37%

40%

26% 20

20%

0

0%

16%

a school not a high graduate

high b school graduate

someccollege

colleged graduate

AMERICAN HEALTH

431

Table 14.13

Physical Activity Status of People Aged 18 or Older, 2008

(number of people aged 18 or older and percent distribution by leisure-time physical activity status, by selected characteristics, 2008; numbers in thousands) total number

percent

physically inactive

some leisure-time physical activity

regular leisure-time physical activity

TOTAL PEOPLE Sex Men Women

225,227

100.0%

35.6%

30.3%

31.6%

108,755 116,472

100.0 100.0

33.1 37.9

30.3 30.3

33.8 29.6

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

110,615 77,335 19,869 17,409

100.0 100.0 100.0 100.0

30.4 36.4 44.8 54.5

31.9 30.0 27.1 24.8

35.5 30.8 25.4 18.0

Race and Hispanic origin Asian Black Hispanic Non-Hispanic white

10,501 26,765 30,583 154,483

100.0 100.0 100.0 100.0

32.8 45.5 45.1 32.3

35.9 27.0 27.8 30.9

29.8 25.3 25.5 34.1

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

100.0 100.0 100.0 100.0

60.1 46.4 31.9 19.7

22.2 27.2 34.0 33.2

15.7 23.8 31.2 44.9

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

100.0 100.0 100.0 100.0 100.0

47.7 40.9 32.2 26.3 19.5

26.2 29.4 32.6 35.1 34.5

23.1 27.3 33.1 36.6 44.5

Note: Adults classiﬁed as “inactive” reported no sessions of light to moderate or vigorous leisure-time activity of at least 10 minutes’ duration. Adults classiﬁed as having “some leisure-time activity” reported at least one session of light to moderate or vigorous physical activity of at least 10 minutes but did not meet the deﬁnition of regular leisure-time activity. Adults classiﬁed as having “regular leisure-time activity” reported three or more sessions per week of vigorous activity lasting at least 20 minutes or ﬁve or more sessions per week of light to moderate activity lasting at least 30 minutes. Numbers may not add to total because “unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

432 AMERICAN HEALTH

WEIGHT AND EXERCISE

Table 14.14

Frequency of Vigorous Physical Activity among People Aged 18 or Older, 2008

(number of people aged 18 or older and percent distribution by number of leisure-time periods per week of vigorous physical activity lasting 10 minutes or more, by selected characteristics, 2008; numbers in thousands) total

TOTAL PEOPLE Sex Men Women

number

frequency of vigorous physical activity per week percent

never

less than one

one to two

three to four

ﬁve or more

225,227

100.0%

58.0%

108,755 116,472

100.0 100.0

51.8 63.8

3.6 2.3

14.4 10.4

15.2 12.5

13.2 9.6

110,615 77,335 19,869 17,409

100.0 100.0 100.0 100.0

48.7 60.9 75.2 84.6

3.7 2.9 0.8 0.9

16.1 10.8 5.4 3.5

17.1 12.6 8.1 4.6

13.1 11.0 8.7 4.8

Race and Hispanic origin Asian 10,501 Black 26,765 Hispanic 30,583 Non-Hispanic white 154,483

100.0 100.0 100.0 100.0

58.4 63.8 65.5 55.5

3.7 2.7 2.2 3.1

13.5 10.9 10.9 12.7

13.3 11.5 11.4 14.7

10.1 9.5 9.0 12.2

Education Less than high school High school graduate Some college College graduate

29,013 53,874 55,174 56,681

100.0 100.0 100.0 100.0

81.5 70.3 57.6 41.7

0.9 2.1 3.5 3.3

5.6 9.1 12.6 15.7

3.8 8.6 13.8 22.3

6.7 8.3 11.0 15.4

Household income Less than $35,000 $35,000 to $54,999 $55,000 to $74,999 $75,000 to $99,999 $100,000 or more

68,352 31,715 38,300 25,842 43,165

100.0 100.0 100.0 100.0 100.0

70.1 63.1 56.0 50.5 39.5

2.2 3.1 3.4 3.3 3.9

8.7 11.7 13.7 14.6 17.1

7.9 11.8 14.9 16.2 22.8

9.3 8.8 10.9 14.0 15.6

Age Aged 18 to 44 Aged 45 to 64 Aged 65 to 74 Aged 75 or older

2.9%

12.4%

13.8%

11.3%

Note: “Vigorous physical activity” is deﬁned as activity that causes heavy sweating and large increases in breathing or heart rate. Numbers may not add to total because “unknown” is not shown. Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_series.htm; calculations by New Strategist

AMERICAN HEALTH

433

Most High School Students Play Sports Only about one-third meet recommended levels of physical activity, however. The percentage of high school students who take physical education classes falls as students rise through the grades. Among ninth graders, 65 to 68 percent are in PE classes. By senior year, only 45 percent of boys and an even smaller 38.5 percent of girls are in PE. There is more enthusiasm among high school students for sports. From 51 to 55 percent of girls in 9th through 11th grade are on a school or community sports team. The ﬁgure falls to 42 percent among girls in 12th grade. Most boys play sports throughout high school, the ﬁgure ranging from a high of 65 percent among 10th graders to a low of 56 percent among 12th graders. Only 35 percent of high school students meet the federal government’s recommended level of physical activity, which is any kind of physical activity that increases their heart rate and makes them breathe hard for at least 60 minutes per day on ﬁve or more days during the past week. Among senior girls, only 21 percent meet the recommended level. ■ The decline in physical activity with advancing age—evident among adults— begins in the teenage years.

Boys are more likely than girls to play sports (percent of students in 9th through 12th grade who participated in one or more school or community sports teams in the past year, by sex, 2007) 75

62% 50

50%

25

25%

0

0%

434 AMERICAN HEALTH

50%

a boys

b girls

WEIGHT AND EXERCISE

Table 14.15

Participation of High School Students in Physical Education Classes, Team Sports, and Physical Activity, 2007

(percent of 9th through 12th graders who attended a physical education class at least one day a week, participated in at least one sports team, and who met the recommended level of physical activity, by sex and grade, 2007)

attended PE class

played on sports team in past year

met recommended levels of physical activity

TOTAL HIGH SCHOOL STUDENTS Boys 9th grade 10th grade 11th grade 12th grade

53.6% 57.7 68.3 62.3 51.4 44.6

56.3% 62.1 63.4 64.7 63.0 56.2

34.7% 43.7 44.4 45.1 45.2 38.7

Girls 9th grade 10th grade 11th grade 12th grade

49.4 65.1 51.2 38.8 38.5

50.4 54.7 50.8 52.5 41.9

25.6 31.5 24.4 24.6 20.6

Note: “Recommended level of physical activity” is any kind of physical activity that increased their heart rate and made them breathe hard for at least 60 minutes per day on ﬁve or more days during the past week. Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance–United States, 2007, Mortality and Morbidity Weekly Report, Vol. 57/SS-4, June 6, 2008, Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm

AMERICAN HEALTH

435

Participation in Some Sports Is Declining Exercise walking is increasingly popular, however. Many Americans lead sedentary lives. A survey of sports participation by the National Sporting Goods Association shows participation in some sports is declining. The number of people aged 7 or older who went ﬁshing more than once in the past year fell 3 percent between 1998 and 2008. Other sports with declines in participation include golﬁng, hunting, and skiing. The trend is up for exercise walking. The number of people participating in exercise walking six or more times in the past 12 months climbed 24 percent between 1998 and 2008. More than onethird of the population walked for exercise in 2008. Children aged 7 to 11 are less likely to participate in a number of sports, including bicycling, basketball, and baseball. But their participation in skateboarding climbed sharply between 1998 and 2007. Among teenagers, participation in many popular sports fell. The number playing basketball was down 16 percent between 1998 and 2007. The number who went bicycling fell 17 percent. But skateboarding grew in popularity during those years. More than one in ﬁve children aged 12 to 17 went skateboarding more than once in 2007. ■ Children’s declining participation in many sports may mean they will be less physically active as adults.

Fewer children are playing basketball (percent change in number of people aged 7 to 17 who participated in selected sports more than once during the past year, by age, 1998 and 2007)

0

a

0%

b

c

7 to

12 t -15

–15%

–16%

–16%

–17%

100000

–22%

-30

–32% baseball

–30% 50000

basketball

bicycle riding

25000

0

436 AMERICAN HEALTH

aged dual12 to 17

75000

–30%

-45

all 7 to 11 aged

with

w/out

WEIGHT AND EXERCISE

Table 14.16

Sports Participation of People Aged 7 or Older, 1998 and 2008

(total number of people aged 7 or older, and number and percent participating in selected sports more than once during the past year, 1998 and 2008; percent change in number and percentage point change in share, 1998–2008; numbers in millions) number participating

Total people Aerobic exercising Backpacking/wilderness camping Baseball Basketball Bicycle riding Billiards/pool Boating (motor) Bowling Camping (vacation/overnight) Canoeing Cheerleading Exercise walking Exercising with equipment Fishing Football (tackle) Golf Hiking Hockey (ice) Hunting with ﬁrearms Hunting with bow and arrow In–line roller skating Mountain biking (off road) Muzzleloading Paintball games Running/jogging Scooter riding Skateboarding Skiing (alpine) Skiing (cross country) Snowboarding Soccer Softball Swimming Target shooting Target shooting (air gun) Tennis Volleyball Water skiing Weightlifting Workout at club Yoga

2008

1998

270.3 36.2 13.0 15.2 29.7 44.7 31.7 27.8 49.5 49.4 10.3 2.9 96.6 63.0 42.2 10.5 25.6 38.0 1.9 18.8 6.2 9.3 10.2 3.4 6.7 35.9 10.1 9.8 6.5 1.6 5.9 15.5 12.8 63.5 20.3 5.0 12.6 12.2 5.6 37.5 39.3 16.0

242.9 25.8 14.6 15.9 29.4 43.5 32.3 25.7 40.1 46.5 7.1 3.1 77.6 46.1 43.6 8.1 27.5 27.2 2.1 19.2 5.6 27.0 8.6 3.1 – 22.5 – 5.8 7.7 2.6 3.6 13.2 15.6 58.2 18.9 3.3 11.2 14.8 7.2 – 26.5 –

percent change

11.3% 40.3 –11.0 –4.4 1.0 2.8 –1.9 8.2 23.4 6.2 45.1 –6.5 24.5 36.7 –3.2 29.6 –6.9 39.7 –9.5 –2.1 10.7 –65.6 18.6 9.7 – 59.6 – 69.0 –15.6 –38.5 63.9 17.4 –17.9 9.1 7.4 51.5 12.5 –17.6 –22.2 – 48.3 –

percent participating 2008

1998

100.0% 13.4 4.8 5.6 11.0 16.5 11.7 10.3 18.3 18.3 3.8 1.1 35.7 23.3 15.6 3.9 9.5 14.1 0.7 7.0 2.3 3.4 3.8 1.3 2.5 13.3 3.7 3.6 2.4 0.6 2.2 5.7 4.7 23.5 7.5 1.8 4.7 4.5 2.1 13.9 14.5 5.9

100.0% 10.6 6.0 6.5 12.1 17.9 13.3 10.6 16.5 19.1 2.9 1.3 31.9 19.0 17.9 3.3 11.3 11.2 0.9 7.9 2.3 11.1 3.5 1.3 – 9.3 – 2.4 3.2 1.1 1.5 5.4 6.4 24.0 7.8 1.4 4.6 6.1 3.0 – 10.9 –

percentage point change

– 2.8 –1.2 –0.9 –1.1 –1.4 –1.6 –0.3 1.8 –0.9 0.9 –0.2 3.8 4.3 –2.3 0.5 –1.9 2.9 –0.2 –0.9 0.0 –7.7 0.2 0.0 – 4.0 – 1.2 –0.8 –0.5 0.7 0.3 –1.7 –0.5 –0.3 0.5 0.1 –1.6 –0.9 – 3.6 –

Note: Numbers shown are people aged 7 or older who participated more than once during the past year except for the following activities, in which participation had to have been six or more times in the past year: aerobic exercise, bicycle riding, exercise walking, exercising with equipment, running/jogging, step aerobics, swimming, and weightlifting. “–” means not applicable or data not available. Source: National Sporting Goods Association, Internet site http://www.nsga.org

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Table 14.17

Sports Participation of Children Aged 7 to 17, 1998 and 2007

(number and percent of people aged 7 to 17 participating in selected sports more than once during the past year, by age, 1998 and 2007; percent change in number and percentage point change in participation rate; numbers in thousands) number participating 2007

1998

AGED 7 TO 11 Total children Baseball Basketball Bicycle riding Bowling Fishing Football (tackle) Golf Ice hockey In-line skating Mountain biking (off road) Skateboarding Skiing (alpine) Snowboarding Soccer Softball Tennis Volleyball

19,410 3,975 4,923 7,046 5,091 2,894 1,442 654 252 3,013 640 3,156 533 782 5,041 1,155 1,446 1,189

19,873 4,714 6,273 10,055 4,865 4,627 1,211 1,264 365 9,052 1,040 2,309 548 487 5,489 3,040 1,204 1,551

AGED 12 TO 17 Total children Baseball Basketball Bicycle riding Bowling Fishing Football (tackle) Golf Ice hockey In-line skating Mountain biking (off road) Skateboarding Skiing (alpine) Snowboarding Soccer Softball Tennis Volleyball

25,341 2,909 6,952 6,518 6,813 3,107 3,906 1,441 419 3,384 942 4,171 821 1,352 3,332 1,795 1,883 3,041

23,241 4,307 8,246 7,844 6,055 4,086 3,014 2,432 593 6,892 1,224 2,253 1,262 1,477 3,936 3,263 2,011 3,807

percent change

percentage point change

2007

1998

–2.3% –15.7 –21.5 –29.9 4.6 –37.5 19.1 –48.3 –31.0 –66.7 –38.5 36.7 –2.7 60.6 –8.2 –62.0 20.1 –23.3

100.0% 20.5 25.4 36.3 26.2 14.9 7.4 3.4 1.3 15.5 3.3 16.3 2.7 4.0 26.0 6.0 7.4 6.1

100.0% 23.7 31.6 50.6 24.5 23.3 6.1 6.4 1.8 45.5 5.2 11.6 2.8 2.5 27.6 15.3 6.1 7.8

– –3.2 –6.2 –14.3 1.7 –8.4 1.3 –3.0 –0.5 –30.0 –1.9 4.6 0.0 1.6 –1.6 –9.3 1.4 –1.7

9.0 –32.5 –15.7 –16.9 12.5 –24.0 29.6 –40.7 –29.3 –50.9 –23.0 85.1 –34.9 –8.5 –15.3 –45.0 –6.4 –20.1

130.6 15.0 35.8 33.6 35.1 16.0 20.1 7.4 2.2 17.4 4.9 21.5 4.2 7.0 17.2 9.2 9.7 15.7

116.9 21.7 41.5 39.5 30.5 20.6 15.2 12.2 3.0 34.7 6.2 11.3 6.4 7.4 19.8 16.4 10.1 19.2

13.6 –6.7 –5.7 –5.9 4.6 –4.6 5.0 –4.8 –0.8 –17.2 –1.3 10.2 –2.1 –0.5 –2.6 –7.2 –0.4 –3.5

Note: “–” means not applicable. Source: National Sporting Goods Association, Internet site http://www.nsga.org

438 AMERICAN HEALTH

percent participating

Glossary Abortion Includes legal abortions only; deﬁned as a procedure performed by a licensed physician or someone acting under the supervision of a licensed physician to induce the termination of a pregnancy. Acquired immunodeﬁciency syndrome (AIDS) All 50 states and the District of Columbia report AIDS cases to the Centers for Disease Control and Prevention using a uniform case deﬁnition and case report form. Acute condition. See Condition. Adjusted for inﬂation Income or a change in income that has been adjusted for the rise in the cost of living, or the consumer price index (CPI-U-RS). Age of householder. See Householder, age of. AIDS. See Acquired immunodeﬁciency syndrome. Alternative medicine. See Complementary and alternative medicine. Ambulatory care Medical care provided at a health care facility or provider’s ofﬁce to persons who are not currently admitted to the health care institution on the premises. Ambulatory patient Person seeking care from a health care facility or provider’s ofﬁce who is not currently admitted to the health care institution on the premises. See Ambulatory care. Asians In this book, Asians include Native Hawaiians and other Paciﬁc Islanders unless those groups are shown separately. Average length of stay In the National Hospital Discharge Survey, average length of stay is computed by dividing the total number of days of care, counting the date of admission but not the date of discharge, by the number of patients discharged. Baby-boom generation Americans born between 1946 and 1964. Behavioral Risk Factor Surveillance System (BRFSS) The BRFSS is a collaborative project of the Centers for Disease Control and Prevention and U.S. states and territories. It is an ongoing data collection program designed to measure behavioral risk factors in the adult population aged 18 or older. All 50 states, three territories, and the District of Columbia take part in the survey, making the BRFSS the primary source of information on the health-related behaviors of Americans. Birth rate. See Rate: Birth and related rates. Birth weight The ﬁrst weight of the newborn obtained after birth. Low birth weight is deﬁned as less than 2,500 grams, or 5 pounds 8 ounces. Blacks Blacks are those who identiﬁed themselves as being “black” or “African American.”

440 AMERICAN HEALTH

Body Mass Index BMI is calculated by dividing weight in kilograms by height in meters squared. It is used to determine who is overweight and obese. Overweight is deﬁned as a BMI of 25.0 or higher. Obese is deﬁned as a BMI of 30.0 or higher. Cause of death For the purpose of national mortality statistics, every death is attributed to one underlying condition based on information reported on the death certiﬁcate and using the international rules for selecting the underlying cause of death from the reported conditions. Chronic condition. See Condition. Complementary and alternative medicine CAM is deﬁned as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Condition A health condition is a departure from a state of physical or mental wellbeing. Based on duration, there are two categories of conditions, acute and chronic. An acute condition is a condition that has lasted less than three months and has involved either a physician visit (medical attention) or restricted activity. A chronic condition is a condition lasting three months or more or one that is classiﬁed as chronic regardless of its time of onset (for example, diabetes, heart conditions, emphysema, and arthritis). Consumer Expenditure Survey The CEX is an ongoing study of the day-to-day spending of American households administered by the Bureau of Labor Statistics. The CEX includes an interview survey and a diary survey. The average spending ﬁgures shown in this book are integrated data from both the diary and interview components of the survey. Two separate, nationally representative samples are used for the interview and diary surveys. For the interview survey, about 7,500 consumer units are interviewed on a rotating panel basis each quarter for ﬁve consecutive quarters. For the diary survey, 7,500 consumer units keep weekly diaries of spending for two consecutive weeks. Consumer price index The CPI is prepared by the Bureau of Labor Statistics. It is a monthly measure of the average change in prices paid by urban consumers for a ﬁxed basket of goods and services. The medical care component of the CPI shows trends in medical care prices based on speciﬁc indicators of hospital, medical, dental, and drug prices. Consumer unit (on selected spending tables only) The term consumer unit is used by the Bureau of Labor Statistics in the annual Consumer Expenditure Survey. For convenience, the terms consumer unit and household are used interchangeably in the spending tables of this book, although consumer units are somewhat different from households. A consumer unit comprises all related members of a household or a ﬁnancially independent member of a household. Thus, a household may include more than one consumer unit. See also Household.

WEIGHT AND EXERCISE Current Population Survey The CPS is a nationally representative survey of the civilian noninstitutionalized population aged 15 or older. It is taken monthly by the Census Bureau for the Bureau of Labor Statistics, collecting information from more than 50,000 households on employment and unemployment. In March of each year, the survey includes the Annual Social and Economic Supplement, which is the source of most national data on the characteristics of Americans, such as their incomes, living arrangements, and health insurance status. Current smoker In the National Health Interview Survey, current smokers are deﬁned as those who answer “everyday” or “some days” to the question: “Do you smoke everyday, some days, or not at all?” Death rate. See Rate: Death and related rates. Diagnosis. See First-listed diagnosis. Disability (Current Population Survey) People 15 and older were identiﬁed as having a disability in a communication, mental, or physical domain. They were classiﬁed as having a communication disability if they had difﬁculty seeing, hearing, or speaking; if they were blind or deaf; or if they identiﬁed one or more related conditions as the cause of a reported activity limitation (blindness or vision problem, deafness or hearing problems, or speech disorders). People were identiﬁed as having a disability in a physical domain if they used a wheelchair, cane, crutches, or walker; had difﬁculty with one or more functional activities (walking a quarter of a mile, climbing a ﬂight of stairs, lifting something as heavy as a ten pound bag of groceries, grasping objects, getting in or out of bed); identiﬁed one or more related conditions as the cause of a reported activity limitation (arthritis or rheumatism, back or spine problems, broken bone or fracture, cancer, cerebral palsy, diabetes, epilepsy, head or spinal cord injury, heart trouble or hardening of arteries, hernia or rupture, high blood pressure, kidney problems, lung or respiratory problems, missing legs/arms/feet/ hands/ﬁngers, paralysis, stiffness or deformity of legs/ arms/feet/hands, stomach/digestive problems, stroke, thyroid problems, or tumor, cyst, or growth). People were identiﬁed as having a disability in a mental domain if they had one or more speciﬁed conditions (a learning disability, mental retardation or another developmental disability, Alzheimer’s disease, or some other type of mental or emotional condition); had any other mental or emotional condition that seriously interfered with everyday activities (frequently depressed or anxious, trouble getting along with others, trouble concentrating, or trouble coping with day-to-day stress); had difﬁculty managing money/bills; or identiﬁed one or more related conditions as the cause of a reported activity limitation (attention deﬁcit hyperactivity disorder, autism, learning disability, mental or emotional problems, mental retardation, senility, dementia, or Alzheimer’s). Disability (American Community Survey) Those who are blind, deaf, or had severe vision or hearing impairments, and/or had a condition that substantially limited one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying. It also included people who, because of a physical, mental,

or emotional condition lasting six months or more, have difﬁculty learning, remembering, concentrating, dressing, bathing, getting around inside the home, going outside the home alone to shop or visit a doctor’s ofﬁce, or working at a job or business. The American Community Survey is limited to the household population and excludes those living in institutions, college dormitories, and other group quarters. Disability (National Health Interview Survey) The NHIS estimates the number of people aged 18 or older who have difﬁculty in physical functioning, probing whether respondents could perform nine activities by themselves without using special equipment. The categories are walking a quarter mile; standing for two hours; sitting for two hours; walking up ten steps without resting; stooping, bending, kneeling; reaching over one’s head; grasping or handling small objects; carrying a ten-pound object; and pushing/pulling a large object. Adults who reported that any of these activities was very difﬁcult or they could not do it at all were deﬁned as having physical difﬁculties. Discharge The National Health Interview Survey deﬁnes a hospital discharge as the completion of any continuous period of stay of one or more nights in a hospital by an inpatient, not including well newborn infants. According to the National Hospital Discharge Survey, discharge is the formal release of an inpatient (excluding newborn infants) by a hospital, that is, the termination of a period of hospitalization (including stays of zero nights) by death or by disposition to a place of residence, nursing home, or another hospital. Earnings A type of income, earnings is the amount of money a person receives from his or her job. See also Income. Emergency department An E.R. is a hospital facility staffed 24-hours a day for the provision of unscheduled outpatient services to patients whose conditions require immediate care. Off-site emergency departments open less than 24 hours are included if staffed by the hospital’s emergency department. An emergency department visit is a direct personal exchange between a patient and a physician or other health care provider working under the physician’s supervision for the purpose of seeking care and receiving personal health services. Employed All civilians who did any work as a paid employee or farmer/self-employed worker, or who worked 15 hours or more as an unpaid farm worker or in a familyowned business, during the reference period. All those who have jobs but who are temporarily absent from their jobs due to illness, bad weather, vacation, labor management dispute, or personal reasons are considered employed. Expenditures. See Health expenditures, consumer; Health expenditures, national. Family A group of two or more people (one of whom is the householder) related by birth, marriage, or adoption and living in the same household. Family household A household maintained by a householder who lives with one or more people related to him or her by blood, marriage, or adoption.

AMERICAN HEALTH

441

Federal hospital. See Hospital. Female/male householder A woman or man who maintains a household without a spouse present. May head family or nonfamily households. Fertility rate. See Rate: Birth and related rates. First-listed diagnosis In the National Hospital Discharge Survey, this is the ﬁrst recorded ﬁnal diagnosis on the medical record face sheet. Foreign-born population People who are not U.S. citizens at birth. Full-time employment Full-time is 35 or more hours of work per week during a majority of the weeks worked. Full-time, year-round employment Indicates 50 or more weeks of full-time employment during the previous calendar year. General Social Survey The GSS is a biennial survey of the attitudes of Americans taken by the University of Chicago’s National Opinion Research Center. NORC conducts the GSS through face-to-face interviews with an independently drawn, representative sample of 1,500 to 3,000 noninstitutionalized people aged 18 or older who live in the United States. Generation X Americans born between 1965 and 1976. Gestation The period of gestation is deﬁned as beginning with the ﬁrst day of the last normal menstrual period and ending with the day of birth or day of termination of pregnancy. Gross domestic product GDP is the market value of the goods and services produced by labor and property located in the United States. The suppliers (that is, the workers and, for property, the owners) may be either U.S. residents or residents of the rest of the world. Group quarters population The group quarters population includes all people not living in households. Two general categories of people in group quarters are recognized: 1) the institutionalized population, which includes people under formally authorized, supervised care or custody in institutions at the time of enumeration such as correctional institutions, nursing homes, and juvenile institutions; and 2) the noninstitutionalized population, which includes all people who live in group quarters other than institutions such as college dormitories, military quarters, and group homes. Health expenditures, consumer Consumer spending statistics show the amounts spent out-of-pocket on health care products and services by individual consumer units during a 12-month period, including the amount spent on sales tax. The full cost of each purchase is recorded even though full payment may not have been made at the date of purchase. Average expenditure ﬁgures may be artiﬁcially low for infrequently purchased items such as eyeglasses because ﬁgures are calculated using all consumer units within a demographic segment rather than just purchasers.

442 AMERICAN HEALTH

Health expenditures, Medical Expenditure Panel Survey The sum of direct payments for health care provided during the year, including out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources. Payments for over-the-counter drugs, alternative care services, and phone contacts with medical providers are not included in MEPS total expenditure estimates. Indirect payments not related to speciﬁc medical events, such as Medicaid Disproportionate Share and Medicare Direct Medical Education subsidies, also are not included. MEPS expenditures are classiﬁed into the following categories: —Hospital inpatient services This category includes room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge and payments for separately billed physician inpatient services. —Emergency room services This category includes hospital diagnostic and laboratory expenses associated with ER facility charge and payments for separately billed inpatient services. —Outpatient services This category includes outpatient diagnostic and laboratory expenses associated with the basic facility charge and payments for separately billed inpatient services. —Medical provider visits This category covers expenses for visits to a medical provider seen in an ofﬁce-based setting. —Prescribed medicines This category includes expenses for all prescribed medications that were initially purchased or otherwise obtained during the calendar year, as well as any reﬁlls. —Dental services This category covers expenses for any type of dental care provider, including general dentists, dental hygienists, dental technicians, dental surgeons, orthodontists, endodontists, and periodontists. —Home health services This category includes expenses for care provided by home health agencies and independent home health providers. Agency providers accounted for most of the expenses in this category. Health expenditures, national These statistics show the total amount spent for all health services and supplies and health-related research and construction activities in the United States during a calendar year. Detailed estimates are available by source of expenditure (for example, out-of-pocket payments, private health insurance, and government programs) and by type of expenditure (for example, hospital care, physician services, and drugs). They are in current dollars for the year of report. —Personal health care expenditures National outlays for goods and services relating directly to patient care. Expenditures in this category are total national health expenditures minus expenditures for research and construction, expenses for administering health insurance programs, and government public health activities. —Private expenditures Outlays for services provided or paid for by nongovernmental sources—consumers, insurance companies, private industry, and philanthropic and other nonpatient care sources.

WEIGHT AND EXERCISE —Public expenditures Outlays for services provided or paid for by federal, state, and local government agencies or expenditures required by governmental mandate (such as workmen’s compensation insurance payments). Health maintenance organization (HMO) A prepaid health plan delivering comprehensive care to members through designated providers, having a ﬁxed monthly payment for health care services, and requiring beneﬁciaries to be plan members for a speciﬁed period of time (usually one year). Hispanic origin Of Mexican, Puerto Rican, Cuban, Central and South American, and other or unknown Spanish origins. Because Hispanic is an ethnic origin rather than a race, Hispanics may be of any race. While most Hispanics are white, there are black, Asian, American Indian, and even Native Hawaiian Hispanics. HIV. See Human immunodeﬁciency virus infection. Home health care Care provided to individuals and families in their place of residence for promoting, maintaining, or restoring health or for minimizing the effects of disability and illness including terminal illness. Hospice care A program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones. Hospice care is available in home and inpatient settings. Hospital In the National Hospital Ambulatory Medical Care Survey, hospitals include all those with an average length of stay for all patients of less than 30 days (shortstay) and hospitals whose specialty is general (medical or surgical) or children’s general. Federal hospitals, hospital units of institutions, and hospitals with fewer than six beds staffed for patient use are excluded. Household All the persons who occupy a housing unit. A household includes the related family members and all the unrelated persons, if any, such as lodgers, foster children, wards, and employees who share the housing unit. A person living alone is counted as a household. A group of unrelated people who share a housing unit as roommates or unmarried partners is also counted as a household, but group quarters such as college dormitories, prisons, and nursing homes are not. Household, race/ethnicity of Households are categorized according to the race or ethnicity of the householder only. Householder The householder is the person (or one of the persons) in whose name the housing unit is owned or rented or, if there is no such person, any adult member. With married couples, the householder may be either the husband or wife. The householder is the reference person for the household. Householder, age of The age of the householder is used to categorize households into age groups. Married couples, for example, are classiﬁed according to the age of either husband or wife depending on which one identiﬁed himor herself as the householder.

Human immunodeﬁciency virus (HIV) infection In 1987, the National Center for Health Statistics introduced a speciﬁc category for classifying HIV infection as a cause of death. Prior to that time, HIV deaths were classiﬁed under a variety of codes depending on the speciﬁc course taken by the disease. Therefore, beginning with 1987, death statistics for HIV infection are not strictly comparable with data for earlier years. Incidence The number of cases of disease having their onset during a prescribed period of time. It is often expressed as a rate, for example, the incidence of measles per 1,000 children aged 5 to 15 during a speciﬁed year. Incidence is a measure of morbidity or other events that occur within a speciﬁed period of time. See Prevalence. Income Money received in the preceding calendar year by each person aged 15 or older from each of the following sources: 1) earnings from longest job or self-employment); 2) earnings from jobs other than longest job; 3) unemployment compensation; 4) workers’ compensation; 5) Social Security; 6) Supplemental Security income; 7) public assistance; 8) veterans’ payments; 9) survivor beneﬁts; 10) disability beneﬁts; 11) retirement pensions; 12) interest; 13) dividends; 14) rents and royalties or estates and trusts; 15) educational assistance; 16) alimony; 17) child support; 18) ﬁnancial assistance from outside the household, and other periodic income. Income is reported in several ways in this book. Household income is the combined income of all household members. Income of persons is all income accruing to a person from all sources. Earnings are the money a person receives from his or her job. Institutionalized population.

population.

See

Group

quarters

Labor force The labor force includes both the employed and the unemployed (people who are looking for work). People are counted as in the labor force if they were working or looking for work during the reference week in which the Census Bureau ﬁelds the Current Population Survey. Labor force participation rate The percent of the civilian noninstitutionalized population that is in the civilian labor force, which includes both the employed and the unemployed. Length of stay. See Average length of stay. Life expectancy The average number of years of life remaining to a person at a particular age and is based on a given set of age-speciﬁc death rates, generally the mortality conditions existing in the period mentioned. Life expectancy may be determined by race, sex, or other characteristics using age-speciﬁc death rates for the population with that characteristic. Limitation of activity A long-term reduction in a person’s capacity to perform the usual kind or amount of activities associated with his or her age group. Each person is classiﬁed according to the extent to which his or her activities are limited, as follows: unable to carry on major activity, limited in the amount or kind of major activity performed, not limited in major activity but otherwise limited, and not limited in activity. AMERICAN HEALTH

443

Live birth The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or deﬁnite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born. Live-birth order The total number of live births the mother has had, including the present birth, as recorded on the birth certiﬁcate. Fetal deaths are excluded. Low birth weight. See Birth weight. Major (or usual) activity The principal activity of a person or of his or her age-sex group. For children aged 1 to 5, major activity refers to ordinary play with other children; for children aged 5 to 17, major activity refers to school attendance; for adults aged 18 to 69, major activity usually refers to a job, housework, or school attendance; for persons aged 70 or older, major activity refers to the capacity for independent living (bathing, shopping, dressing, and eating without needing the help of another person). Marital status The term married encompasses all married people including those separated from their spouses. Unmarried includes those who are single (never married), divorced, or widowed. Married couples with or without children under age 18 Refers to married couples with or without own children under age 18 living in the same household. Couples without children under age 18 may be parents of grown children who live elsewhere, or they could be childless couples. Median The median is the amount that divides the population or households into two equal portions: one below and one above the median. Medians can be calculated for income, age, and many other characteristics. Median income The amount that divides the income distribution into two equal groups, half having incomes above the median, half having incomes below the median. The medians for households or families are based on all households or families. The median for persons are based on all persons aged 15 or older with income. Medicaid This program provides health care services for certain low-income persons. It is state operated and administered but has federal ﬁnancial participation. Within certain broad federally determined guidelines, states decide on eligibility; the amount, duration, and scope of services covered; rates of payment for providers; and methods of administering the program. Medicaid does not provide health services to all poor people in every state. The program was authorized in 1965 by Title XIX of the Social Security Act. Medical Expenditure Panel Survey MEPS is a nationally representative survey that collects detailed information on the health status, access to care, health care use and expenses and health insurance coverage of the civilian noninstitutionalized population of the U.S. and nursing home residents. MEPS comprises four component 444 AMERICAN HEALTH

surveys: the Household Component, the Medical Provider Component, the Insurance Component, and the Nursing Home Component. The Household Component is the core survey and is conducted each year, and includes 15,000 households and 37,000 people. Medicare This nationwide health insurance program provides health insurance protection to people aged 65 or older, people entitled to Social Security disability payments for two or more years, and people with end-stage renal disease, regardless of income. The program was enacted July 30, 1965, as Title XVIII, Health Insurance for the Aged of the Social Security Act, and became effective on July 1, 1966. Mental illness The National Survey on Drug Use and Health deﬁnes serious mental illness as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the fouth edition of the Statistical Manual of Mental Disorders and that resulted in functional impairment that substantially limited one or more major life activities. Metropolitan area A county or group of counties that includes at least one city having a population of 50,000 or more plus adjacent counties that are metropolitan in character and are economically and socially integrated with the central city. In New England, towns and cities rather than counties are the units used in deﬁning metropolitan areas. There is no limit to the number of adjacent counties included in the metropolitan area as long as they are integrated with the central city. A metropolitan area’s boundaries may cross state lines. Millennial generation Americans born between 1977 and 1994. Monitoring the Future Project The MTF survey is conducted by the University of Michigan Survey Research Center. The survey is administered to approximately 50,000 students in 420 public and private secondary schools every year. High school seniors have been surveyed annually since 1975. Students in 8th and 10th grade have been surveyed annually since 1991. National Ambulatory Medical Care Survey The NAMCS is an annual survey of visits to nonfederally employed ofﬁce-based physicians who are primarily engaged in direct patient care. Data are collected from physicians rather than patients, with each physician assigned a one-week reporting period. During that week, the physician (or his staff) records the visit characteristics of a systematic random sample of patients. National Compensation Survey The Bureau of Labor Statistics’ National Compensation Survey examines the incidence and detailed provisions of selected employee beneﬁt plans in private establishments and state and local governments. Each year BLS economists visit a representative sample of establishments across the country, asking questions about the establishment, its employees, and their beneﬁts. National Health and Nutrition Examination Survey The NHANES is a continuous survey of a representative sample of the U.S. civilian noninstitutionalized population. Respondents are interviewed at home about their health

WEIGHT AND EXERCISE and nutrition, and this interview is followed up by a physical examination that measures height and weight, among other things, in mobile examination centers. National Health Interview Survey The NHIS is a continuing nationwide sample survey of the civilian noninstitutional population of the U.S. conducted by the Census Bureau for the National Center for Health Statistics. Each year, data are collected from more than 100,000 people about their illnesses, injuries, impairments, chronic and acute conditions, activity limitations, and the use of health services. National Home and Hospice Care Survey These are a series of surveys of a nationally representative sample of home and hospice care agencies in the U.S., sponsored by the National Center for Health Statistics. Data on the characteristics of patients and services provided are collected through personal interviews with administrators and staff. National Hospital Ambulatory Medical Care Survey The NHAMCS is an annual national probability sample survey of visits to emergency departments and outpatient departments at non-Federal, short stay and general hospitals. Hospital staff collects data from patient record forms. National Hospital Discharge Survey This survey has been conducted annually since 1965, sponsored by the National Center for Health Statistics, to collect nationally representative information on the characteristics of inpatients discharged from nonfederal, short-stay hospitals in the U.S. The survey collects data from a sample of approximately 270,000 inpatient records acquired from a national sample of about 500 hospitals. National Nursing Home Survey This is a series of national sample surveys of nursing homes, their residents, and staff conducted at various intervals since 1973-74 and sponsored by the National Center for Health Statistics. The latest survey was taken in 2004. Data for the survey are obtained from a sample of about 1,500 facilities through personal interviews with administrators and staff. National Survey of Family Growth The 2002 NSFG, sponsored by the National Center for Health Statistics, is a nationally representative survey of the civilian noninstitutional population aged 15 to 44. In-person interviews were completed with 12,571 men and women, collecting data on marriage, divorce, contraception, and infertility. The 2002 survey updates previous NSFG surveys taken in 1973, 1976, 1988, and 1995. National Survey on Drug Use and Health (formerly called the National Household Survey on Drug Abuse) This survey, sponsored by the Substance Abuse and Mental Health Services Administration, has been conducted since 1971. It is the primary source of information on the use of illegal drugs by the U.S. population. Each year, a nationally representative sample of about 70,000 individuals aged 12 or older is surveyed in the 50 states and the District of Columbia. Nonfamily household A household maintained by a householder who lives alone or who lives with people to whom he or she is not related.

Nonfamily householder A householder who lives alone or with nonrelatives. Non-Hispanic People who do not identify themselves as Hispanic are classiﬁed as non-Hispanic. Non-Hispanics may be of any race. Non-Hispanic white People who identify their race as white and who do not indicate a Hispanic origin. Noninstitutionalized population. See Group quarters population. Nonmetropolitan area Counties that are not classiﬁed as metropolitan. See also Metropolitan area. Nursing home An establishment with three or more beds that provides nursing or personal care services to the aged, inﬁrm, or chronically ill. Obese Having a body mass index (BMI) of 30.0 or higher. BMI is calculated by dividing weight in kilograms by height in meters squared. Ofﬁce In the National Health Interview Survey, the term ofﬁce refers to the ofﬁce of any physician in private practice not located in a hospital. In the National Ambulatory Medical Care Survey, an ofﬁce is any location for a physician’s ambulatory practice other than a hospital, nursing home, other extended care facility, patient home, industrial clinic, college clinic, and family planning clinic. Private ofﬁces in hospitals, however, are included. Ofﬁce visit In the National Ambulatory Medical Care Survey, an ofﬁce visit is any direct personal exchange between an ambulatory patient and a physician or member of his or her staff for the purposes of seeking care and rendering health services. Operation. See Procedure. Outpatient department According to the National Hospital Ambulatory Medical Care Survey, an outpatient department is a hospital facility where nonurgent ambulatory medical care is provided, excluding ambulatory surgical centers, employee health services, and facilities providing chemotherapy, renal dialysis, methadone maintenance, and radiology. An outpatient department visit is a direct personal exchange between a patient and a physician or other health care provider working under the physician’s supervision for the purpose of seeking care and receiving personal health services. Outpatient visit The American Hospital Association deﬁnes outpatient visits as visits for receipt of medical, dental, or other services by patients who are not lodged in the hospital. Each appearance by an outpatient to each unit of the hospital is counted individually as an outpatient visit. Outside principal city The portion of a metropolitan county or counties that falls outside of the principal city or cities; generally regarded as the suburbs. Overweight Having a body mass index (BMI) of 25.0 or higher. BMI is calculated by dividing weight in kilograms by height in meters squared.

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Part-time employment Part-time is less than 35 hours of work per week in a majority of the weeks worked during the year.

and immunology, anesthesiology, child and adolescent psychiatry, dermatology, general surgery, obstetrics and gynecology, and psychiatry.

Patient A person who is formally admitted to the inpatient service of a hospital for observation, care, diagnosis, or treatment.

Poverty level The ofﬁcial income threshold below which families and people are classiﬁed as living in poverty. The threshold rises each year with inﬂation and varies depending on family size and age of householder.

Percent change The change (either positive or negative) in a measure expressed as a proportion of the starting measure. Percentage point change The change (either positive or negative) in a value that is already expressed as a percentage. Personal health care expenditures, national.

expenditures.

See

Health

Physical activity, recommended amount Physical activity at least ﬁve times a week for 30 minutes each time or vigorous physical activity at least three times a week for 20 minutes each time. Physician Physicians are classiﬁed by the American Medical Association and others as licensed doctors of medicine or osteopathy, as follows: —Active (or professionally active) physician Physician currently practicing medicine for a minimum of 20 hours per week. Excluded are physicians who are inactive, practicing medicine less than 20 hours per week, have unknown addresses, or practice specialties not classiﬁed (when specialty information is presented). —Federal physician Physician employed by the federal government. —Hospital-based physician Physician who spends plurality of time as salaried physician in a hospital. —Ofﬁce-based physician Physician who spends plurality of time working in a practice based in a private ofﬁce. See Ofﬁce; Physician contact; Physician specialty. Physician specialty Any speciﬁc branch of medicine in which a physician may concentrate. Data are based on physician self-reports of their primary area of specialty. Physician data are broadly categorized into two general areas of practice: generalists and specialists. —Generalist physician Synonymous with primary care generalist. Includes physicians practicing in the general ﬁelds of family and general practice, general internal medicine, and general pediatrics. Speciﬁcally excludes primary care specialists. —Primary care specialist Physician practicing in the subspecialties of general and family practice, internal medicine, and pediatrics. The primary care subspecialties for family practice include such specialties as geriatric medicine and sports medicine. For internal medicine they include such specialties as infectious diseases, medical oncology, and rheumatology. For pediatrics they include such specialties as critical care pediatrics, and pediatric cardiology. —Specialist physician Those practicing in primary care subspecialties and all other specialist ﬁelds not included in the generalist deﬁnition. Specialist ﬁelds include allergy

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Prevalence The number of cases of a disease, infected persons, or persons with some other problem during a particular interval of time. It is often expressed as a rate, for example, the prevalence of diabetes per 1,000 persons during one year. See Incidence. Primary admission diagnosis In the National Home and Hospice Care Survey, the primary admission diagnosis is the ﬁrst-listed diagnosis at admission on the patient’s medical record as provided by the agency staff member most familiar with the care provided to the patient. Primary care specialties. See Physician specialty. Principal cities The largest city (or cities) in a metropolitan area is called the principal city. The balance of the metropolitan area outside the principal city is regarded as the “suburbs.” Private expenditures. See Health expenditures, national. Procedure The National Hospital Discharge Survey deﬁnes procedure as a surgical or nonsurgical operation, diagnostic procedure, or special treatment assigned by the physician and recorded on the medical record of patients discharged from the inpatient service of short-stay hospitals. A maximum of four operations or diagnostic procedures are permitted per discharge. Procedures are subdivided into diagnostic and other nonsurgical procedures and surgical operations. —Diagnostic and other nonsurgical procedures Procedures generally not considered to be surgery, including diagnostic endoscopy, radiography, and other tests as well as physical medicine and rehabilitation. —Surgical operations Surgery is deﬁned as a major or minor surgical episode performed in the operating room. During a single episode, multiple surgical procedures may be performed, and the National Hospital Discharge Survey codes up to four surgical procedures per surgical episode. Proportion or share The value of a part expressed as a percentage of the whole. If there are 4 million people aged 25 and 3 million of them are white, then the white proportion is 75 percent. Public expenditures. See Health expenditures, national. Race Race is self-reported and can be deﬁned in three ways. The “race alone” population is people who identify themselves as only one race. The “race in combination” population is people who identify themselves as more than one race, such as white and black. The “race, alone or in combination” population includes both those who identify themselves as one race and those who identify themselves as more than one race.

WEIGHT AND EXERCISE Rate The measure of some event, disease, or condition in relation to a unit of population, along with some speciﬁcation of time. Birth and related rates: —Birth rate: Calculated by dividing the number of live births in a population in one year by the midyear resident population. Birth rate is expressed as the number of live births per 1,000 population. The rate may be restricted to births to women of speciﬁc age, race, marital status, or geographic location. —Fertility rate: The number of live births per 1,000 women of reproductive age, 15 to 44. Death and related rates: —Death rate: Calculated by dividing the number of deaths in a population in one year by the midyear resident population. Death rate is expressed as the number of deaths per 100,000 population. The rate may be restricted to deaths in speciﬁc age, race, sex, or geographic groups or from speciﬁc causes of death. —Infant mortality rate: Calculated by dividing the number of infant deaths during one year by the number of live births reported in the same year. Regions The four regions and nine census divisions of the United States are composed as follows: Northeast: —New England: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont —Middle Atlantic: New Jersey, New York, and Pennsylvania Midwest: —East North Central: Illinois, Indiana, Michigan, Ohio, and Wisconsin —West North Central: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota South: —South Atlantic: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia —East South Central: Alabama, Kentucky, Mississippi, and Tennessee —West South Central: Arkansas, Louisiana, Oklahoma, and Texas

18 years of age and older, the answers are self-reported, and no proxies are allowed. The K6 is designed to identify persons with serious psychological distress using as few questions as possible. The questions are: During the past 30 days, how often did you feel 1) so sad that nothing could cheer you up; 2) nervous; 3) restless or ﬁdgety; 4) hopeless; 5) that everything was an effort; 6) worthless. Possible answers are all of the time (4 points), most of the time (3 points), some of the time (2 points), a little of the time (1 point), and none of the time (0 points). To score the K6, the points are added together yielding a possible total of 0 to 24 points. A threshold of 13 or more is used to deﬁne serious mental illness. Persons answering ‘‘some of the time’’ to all six questions would not reach the threshold for serious mental illness, since to achieve a score of 13 they would need to answer ‘‘most of the time’’ to at least one item. Short-stay hospital. See Hospital. Smoker. See Current smoker. Suburbs. See Outside principal city. Surgical operations. See Procedure. Unemployed Unemployed people are those who, during the survey period, had no employment but were available and looking for work. Those who were laid off from their jobs and were waiting to be recalled are also classiﬁed as unemployed. Unrelated individuals Persons who live alone or with others to whom they are not related by blood, marriage, or adoption. White The “white” racial category includes many Hispanics (who may be of any race) unless the term “nonHispanic white” is used. See also Non-Hispanic white. Youth Risk Behavior Surveillance System The YRBSS was created by the Centers for Disease Control to monitor health risks being taken by young people at the national, state, and local level. The national survey is taken every two years based on a nationally representative sample of 16,000 students in 9th through 12th grade in public and private schools.

West: —Mountain: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming —Paciﬁc: Alaska, California, Hawaii, Oregon, and Washington Rounding Percentages are rounded to the nearest tenth of a percent; therefore, the percentages in a distribution do not always add exactly to 100.0 percent. The totals, however, are always shown as 100.0. Moreover, individual ﬁgures are rounded to the nearest thousand without being adjusted to group totals, which are independently rounded; percentages are based on the unrounded numbers. Serious psychological distress The serious psychological distress scale (K6) is a six-item scale developed to measure serious mental illness. The K6 is asked of adults

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Bibliography Agency for Healthcare Research and Quality Internet site http://www.ahrq.gov/ —2007 Medical Expenditure Panel Survey, Internet site http://www.meps.ahrq .gov/mepsweb/survey_comp/household.jsp Bureau of Labor Statistics Internet site http://www.bls.gov —2008 Consumer Expenditure Survey, Internet site http://www.bls.gov/cex/home .htm —Employee Beneﬁts in the United States: March 2009, National Compensation Survey, Internet site http://www.bls.gov/ncs/ebs/home.htm Bureau of the Census Internet site http://www.census.gov/ —2009 Current Population Survey Annual Social and Economic Supplement, Internet site http://www.census.gov/hhes/www/income/dinctabs.html —Americans with Disabilities: 2005, detailed tables, Internet site http://www .census.gov/hhes/www/disability/sipp/disable05.html —Fertility of American Women, Historical Time Series Tables, Internet site http:// www.census.gov/population/www/socdemo/fertility.html#hist —Fertility of American Women: June 2006, detailed tables, Internet site http:// www.census.gov/population/www/socdemo/fertility/cps2006.html —Historical Health Insurance Tables, Current Population Survey, Internet site http://www.census.gov/hhes/www/hlthins/historic/index.html —Statistical Abstract of the United States: 2010, Internet site http://www.census .gov/compendia/statab/cats/health_nutrition.html —“Table H108: Health Insurance Coverage Status and Type of coverage by Selected Characteristics for Children Under 18: 2008,” 2009 Current Population Survey, Internet site http://www.census.gov/hhes/www/cpstables/032009/health/toc.htm Centers for Disease Control and Prevention Internet site http://www.cdc.gov —“Abortion Surveillance—United States, 2005,” Mortality and Morbidity Weekly Report, Vol. 57/SS13, November 28, 2008, Internet site http://www.cdc.gov/ MMWR/preview/mmwrhtml/ss5713a1.htm —Behavioral Risk Factor Surveillance System, Prevalence Data, Internet site http://apps.nccd.cdc.gov/brfss/index.asp —Breastfeeding among U.S. Children Born 1999-2006, CDC National Immunization Survey, Internet site http://www.cdc.gov/breastfeeding/data/NIS_data/index .htm

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—Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2007, HIV/AIDS Surveillance Report, Vol. 19, 2009, Internet site http://www.cdc .gov/hiv/topics/surveillance/resources/reports/2007report/default.htm —Health-Related Quality of Life, Prevalence Data, Internet site http://apps.nccd .cdc.gov/HRQOL/ —“Youth Risk Behavior Surveillance—United States, 2007,” Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 57/SS-4, June 6, 2008 Internet site http://www.cdc.gov/HealthyYouth/yrbs/index.htm Centers for Medicare and Medicaid Services Internet site http://www.cms.hhs.gov/ —Data Compendium 2009, Internet site http://www.cms.hhs.gov/ DataCompendium/ The Gallup Poll Internet site http://www.galluppoll.com/ —“About One in Six Americans Report History of Depression,” Brett W. Pelham, October 22, 2009, Internet site http://www.gallup.com/poll/123821/ One-Six-Americans-Report-History-Depression.aspx —“Personal Weight Situation,” Internet site http://www.gallup.com/poll/7264/ Personal-Weight-Situation.aspx Guttmacher Institute Internet site http://www.guttmacher.org —Abortion in the United States: Incidence and Access to Services, 2005, Perspectives on Sexual and Reproductive Health, 2008 40(1), Internet site http://www .guttmacher.org/media/presskits/2005/06/28/abortionoverview.html Institute for Social Research, University of Michigan Internet site http://www.isr.umich.edu/home/ —2009 Monitoring the Future Survey, Internet site http://monitoringthefuture .org/data/09data.html National Center for Health Statistics Internet site http://www.cdc.gov/nchs —2006 National Hospital Discharge Survey, National Health Statistics Reports, No. 5, 2008, Internet site http://www.cdc.gov/nchs/nhds.htm —Ambulatory Medical Care Utilization Estimates for 2006, National Health Statistics Reports, No. 8, 2008, Internet site http://www.cdc.gov/nchs/ahcd/ahcd_reports .htm —Anthropometric Reference Data for Children and Adults: United States, 2003– 2006, National Health Statistics Reports, No. 10, 2008, Internet site http://www .cdc.gov/nchs/products/nhsr.htm —Births: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 7, 2009, Internet site http://www.cdc.gov/nchs/nvss/new_births.htm

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—Births: Preliminary Data for 2008, National Vital Statistics Report, Vol. 58, No. 16, 2010, Internet sites http://www.cdc.gov/nchs/products/nvsr.htm —Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, No. 12, 2008, Internet site http://nccam.nih.gov/news/camstats/2007/index.htm —Deaths: Final Data for 2006, National Vital Statistics Reports, Vol. 57, No. 14, 2009; Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol57 —Deaths: Preliminary Data for 2007, National Vital Statistics Report, Vol. 58, No. 1, 2009, Internet site http://www.cdc.gov/nchs/products/nvsr.htm#vol58 —Delayed Childbearing: More Women Are Having Their First Child Later in Life, NCHS Data Brief, No. 21, August 2009, Internet site http://www.cdc.gov/nchs/data/ databriefs/db21.htm —Estimated Pregnancy Rates for the United States, 1990–2005: An Update, National Vital Statistics Reports, Volume 58, No. 4, 2009, Internet site http://www.cdc .gov/nchs/nvss/birth_products.htm —Fertility, Contraception, and Fatherhood: Data on Men and Women from Cycle 6 of the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 26, 2006, Internet site http://www.cdc.gov/nchs/nsfg.htm —Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 25, 2005, Internet site http://www.cdc.gov/nchs/nsfg.htm —Health Characteristics of Adults Aged 55 Years and Over: United States, 2004– 2007, National Health Statistics Reports, No. 16, 2009, Internet site http://www.cdc .gov/nchs/products/nhsr.htm —Health Data Interactive, Internet site http://www.cdc.gov/nchs/hdi.htm —Health United States 2009, Internet site http://www.cdc.gov/nchs/hus.htm —Mean Body Weight, Height, and Body Mass Index, United States 1960–2002, Advance Data, No. 347, 2004, Internet site http://www.cdc.gov/nchs/pressroom/ 04news/americans.htm —National Ambulatory Medical Care Survey: 2006 Summary, National Health Statistics Reports, No. 3, 2008; Internet site http://www.cdc.gov/nchs/ahcd/ahcd_ reports.htm —National Ambulatory Medical Care Surveys, 1996 to 2006, Internet site http:// www.cdc.gov/nchs/ahcd/ahcd_reports.htm —National Home and Hospice Care Survey, Internet site http://www.cdc.gov/nchs/ nhhcs/nhhcs_patient_trends.htm —National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, National Health Statistics Reports, No. 7, 2008, Internet site http:// www.cdc.gov/nchs/ahcd/ahcd_reports.htm —National Ambulatory Medical Care Survey: 2006 Outpatient Department Summary, National Health Statistics Reports, No. 4, 2008, Internet site http://www.cdc .gov/nchs/ahcd/ahcd_reports.htm

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—Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008, Series 10, No. 243, 2009, Internet site http://www.cdc.gov/nchs/nhis/ nhis_ series.htm —Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008, Series 10, No. 242, 2009, Internet site http://www.cdc.gov/nchs/nhis/nhis_ series.htm —Summary Health Statistics for U.S. Children: National Health Interview Survey, 2008, Vital and Health Statistics, Series 10, No. 244, 2009, Internet site http:// www.cdc.gov/nchs/nhis/nhis_series.htm —Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002, Vital and Health Statistics, Series 23, No. 24, 2004, Internet site http://www.cdc.gov/nchs/nsfg.htm —Use of Contraception and Use of Family Planning Services in the United States: 1982—2002, Advance Data, No. 350, 2004, Internet site http://www.cdc.gov/nchs/ nsfg.htm National Institute of Mental Health Internet site http://www.nimh.nih.gov —The Numbers Count: Mental Disorders in America, 2008, Internet site http:// www.nimh.nih.gov/publicat/numbers.cfm National Sporting Goods Association Internet site http://www.nsga.org —Sports Participation, Internet site http://www.nsga.org Pew Internet & American Life Project Internet site http://www.pewinternet.org —The Social Life of Health Information, June 11, 2009, Internet site http://www .pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information.aspx Substance Abuse and Mental Health Services Administration Internet site http://www.samhsa.gov —National Survey on Drug Use and Health, 2008, Internet site http://www.oas .samhsa.gov/NSDUH/2K8NSDUH/tabs/toc.htm Survey Documentation and Analysis, Computer-assisted Survey Methods Program, University of California, Berkeley Internet site http://sda.berkeley.edu/ —General Social Surveys, 1972-2008 Cumulative Data Files, Internet site http:// sda.berkeley.edu/cgi-bin/hsda?harcsda+gss08

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Index Abortion, 95, 98–100 Accidents as cause of death, 185, 188, 190–201 as reason for hospital emergency room visit, 348 Activity limitations. See also Disabilities. among Medicare beneﬁciaries, 42–44 due to chronic conditions, 225–227 in past 30 days, 73–75 African Americans. See Blacks. Age. See also Children and Teenagers. abortions by, 99 AIDS by, 265–267 alternative medicine use by, 49, 51–52, 57 at ﬁrst birth, 114–116 attitudes toward health care providers by, 65–67, 80, 83–94 average length of hospital stay by, 354, 359 births by, 95, 104, 107–109, 112–119 breastfeeding by, 122–123 caloric intake by, 420 childless by, 101–103 children without health insurance by, 300–301 cigarette smoking by, 4–8, 11–13 contraceptive use by, 399–401, 408–412 deaths by, 193–204 delayed medical care by, 290 dental visits by, 327–331 diabetes by, 229, 231–233, 235–237, 239–241, 243–245, 247–249, 256–258, 282–286 disabled by, 37–39, 42–43, 209–215, 220, 222–227 drinking by, 14–22 drug and alcohol abuse treatment by, 34–35 drug use by, 23–32 exercise, frequency of by, 431–438 family planning services, use by, 399–401, 408–412 ﬂu shots by, 38 health care access by, 40 health care, problems receiving by, 77–79, 300–301 health care spending by, 153–181 health care visits by, 287, 292, 295–309, 314, 334–338, 344–348, 352–371 health conditions by, 229–233, 251–262, 264–280, 354–364 health insurance coverage by, 125, 131, 133–136, 140–146, 182–184 health status by, 70–73 high cholesterol by, 229, 253–255 hospital care by, 333–338, 353–360, 366–370 hypertension by, 229–233, 238, 250–252 incontinence by, 37, 41, 44 life expectancy by, 205–208 medicaid enrollees by, 182–183 medicare enrollees by, 182, 184 mental health by, 373–374, 380, 386–387

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of nursing home residents, 37, 45–47 out of pocket spending on health care by, 154–161, 172–175 pregnancy, attitude toward by, 395–396 pregnancy outcomes by, 96–99 prescription drug use by, 274–276 reason for no health insurance by, 140–142 spending on dental care by, 175–177 spending on emergency room visits by, 169 spending on home health care by, 178, 180 spending on hospital inpatient services by, 166 spending on hospital outpatient services by, 168 spending on physician visits by, 164–165 spending on prescription drugs by, 170–171 spending on visits to nurses or nurse practitioners by, 179 sports, participation in by, 432–438 sexual attitudes and behavior by, 389, 394–412 weight status by, 419–420, 422–423, 425–428 without health insurance by, 125 AIDS as cause of death, 188, 191, 198, 201 by age at diagnosis, 270–271 by race and Hispanic origin, 269–270 by sex, 270–271 by transmission category, 269, 271 children with, 270–271 Alcohol use and alternative medicine, 55 attitude toward, 22 binge drinking, 14, 19 by age, 14–22 by education, 14–17, 20–21 by income, 14–17, 21 by race and Hispanic origin, 14–17, 21 by sex, 14–17, 19–20 teenage, 14, 18–22 treatment for, 34–35 Allergies as diagnosis during physician ofﬁce visit, 311 in children, 274–277 Alternative medicine spending on, 49, 61–64 total visits, 62 types used, 51, 58, 60–63 use by age, 49, 51–52, 57, 59 use by children, 57 use by education, 50, 54 use by health conditions, 56–59 use by health insurance status, 49, 54 use by number of doctor visits, 56–57 use by race, 53, 57 use by sex 49, 52, 57 use of, 49–64 use, to avoid cost of conventional care, 57

WEIGHT AND EXERCISE Alzheimer’s disease as cause of death, 189–195, 202–204 as type of disability, 212 American Indians alternative medicine as treatment by, 53 births to, 109, 116, 121 with AIDS, 270 Anxiety alternative medicine as treatment for, 58–59 disorder, 374–375. See also Mental health. Arthritis alternative medicine as treatment for, 58–59 as diagnosis during hospital inpatient care, 357, 359, 362, 364 as diagnosis during physician ofﬁce visit, 311 as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 261, 282–286 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Asians alternative medicine use by, 53, 57 attitudes toward health care providers, 81–94 average age at giving birth, 105 births to, 95, 107–109, 111–113, 115, 121 breastfeeding by, 123 children without health insurance, 143–145, 300–301 cigarette smoking, 5–8 deaths of, 188, 191 dental visits, 327–331 disabled, 217, 222–224, 226 drinking, 14–17 drug and alcohol abuse treatment, 35 health care, problems receiving by, 77, 300–301 health care spending by, 163–181 health care visits, 292–295, 309, 314, 323, 335, 338, 353 health conditions, 238–241, 251–252, 254–258, 260–262, 265–268, 270, 274–277, 280 health insurance coverage, 135, 138 health status, 71–72 hospital care, 354 mental health, 377–379 prescription drug use by, 278–280 reason for no health insurance by, 140–142 spending on dental care by, 176–177 spending on emergency room visits by, 169 spending on health care by, 163–181 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 weight status, 425 with AIDS, 265–266 Asthma alternative medicine as treatment for, 59 as diagnosis during hospital inpatient care, 356, 358, 361, 363 as diagnosis during physician ofﬁce visit, 311, 315

as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 282–286 average length of hospital stay for, 363 children with, 270–273 cost of, 284–286 number of events, 282 number of people experiencing event, 283 therapy ordered or provided during hospital outpatient visits, 342 therapy ordered or provided during physician ofﬁce visits, 324 Attention deﬁcit hyperactivity disorder, 222–223 Attitudes toward abortion, 95, 98, 100 toward alternative medicine, 50 toward cigarette smoking, 11, 13 toward drinking, 20, 22 toward drug use, 28, 30, 33 toward government’s role in health care, 65–66, 69 toward health care providers, 65–67, 80–94, 294, 299, 304, 319 toward health care quality and cost, 65, 67–68, 71–73 toward leaders of health care industry, 65–67 toward nursing homes, 42, 44 toward physician and physician visits, 65, 83–84, 92–94, 288, 294, 299, 304, 316, 319 toward problems receiving health care, 76–79 toward public spending on health care, 65, 68 toward sexual behavior, 389–396, 400, 402–403, 408toward weight, 413–414, 424–425, 429–430 Back problems alternative medicine as treatment for, 49, 58–59 as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 282–286 as reason for hospital emergency room visit, 348 as reason for hospital outpatient visit, 339 as reason for physician ofﬁce visit, 310–311 cost of, 284–286 number of events, 283 number of people experiencing event, 282 Binge drinking. See Alcohol use. Birth control. See Contraceptive use. Birth control pill. See Contraceptive use. Births. See also Pregnancy. as reason for hospital inpatient care, 357, 359–360, 362 average age at ﬁrst, 105 average length of hospital stay for, 364 by age, 95, 104, 107–109, 112–119 by birth order, 114–116 by education, 107, 111, 113 by marital status, 95, 107, 111–113 by method of delivery, 95, 117–118 by race and Hispanic origin, 95, 107–109, 111–113, 115, 121 cost of, 284–286 in past year, 106–107, 116, 118–119 multiple, 119 rate, 104–106

AMERICAN HEALTH

453

Blacks abortions, 99 alternative medicine use by, 53, 57 attitudes toward health care providers, 80–94 average age at giving birth, 105 births to, 95, 107–109, 111–113, 115, 121 breastfeeding, 122–123 children without health insurance, 300–301 cigarette smoking, 5–8, 12 contraceptive use, 399–401, 408–412 deaths of, 188, 191 dental visits, 327–331 disabled, 217, 223–224, 226–227 drinking, 14–17, 21 drug and alcohol abuse treatment, 34–35 exercise, frequency of, 432–433 family planning services, use by, 412 health care, problems receiving, 77–79, 300–301 health care spending by, 163–181 health care visits, 292, 295, 299–304, 306, 309, 314, 323, 334–335, 338, 353 health conditions, 238–241, 251–252, 254–258, 260–262, 265– 270, 274–277, 280 health insurance coverage, 135, 138 health status, 71–72 hospital care, 353 in nursing homes, 47 life expectancy, 208 mental health, 376–379, 382, 386–387 pregnancy, attitude toward, 394–396 pregnancy outcomes, 98–100 prescription drug use, 278–280 reason for no health insurance, 140–142 sexual attitudes and behavior, 396–398, 400–402, 406–408, 412 spending on dental care by, 176–177 spending on emergency room care by, 169 spending on health care by, 163–181 spending on home health care by, 179–180 spending on inpatient hospital care by, 166–167 spending on outpatient hospital care by, 168 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 suicide, considered by high school students, 386–388 weight status, 420, 425–427 with AIDS, 265–266 with diabetes, 238–241, 256–258 with high cholesterol, 254–255 with hypertension, 238–241, 251–252 Blood pressure reading during physician ofﬁce visit, 312–314 during hospital outpatient visit, 341 Blood test ordered or provided, 312–313,341, 351 Blue Cross, Blue Shield. spending on, 154, 156, 158, 160 Breastfeeding, 95, 126–127 Caesarean delivery, 95, 117–118 Calories consumed, 420 454 AMERICAN HEALTH

Cancer, as cause of death, 185, 189–192, 194–195, 199–204 as diagnosis during hospital emergency room visit, 349 as diagnosis during hospital inpatient care, 363 as diagnosis during physician ofﬁce visit, 313 as health condition, 229, 231–233, 235–237, 239–241, 243–245, 247–249, 259, 261, 263–268, 282–286 average length of hospital stay for, 363 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Cerebrovascular disease as cause of death, 188–192, 194, 200–204 as diagnosis during hospital inpatient care, 363 average length of hospital stay for, 363 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Childless, 101, 103 Children. See also Teenagers. alternative health use by, 57, 59 attitude toward health care received by, 82, 84–85, 87, 89, 91–92, 94 average length of hospital stay, 353–354 deaths of, 196–198 dental visits, 327–331 disabled, 210–211, 213, 215, 222–224, 226–227 ever born, 103 health care, problems receiving, 300–301 health care spending on, 163–181 health care visits, 290–292, 302–303, 306–311, 333, 335–338, 344–348 health conditions of, 270–274 health insurance coverage, 143–146, 299–301 health status, 71–73 hospital care, 333, 335–338, 353–359, 366–370 in special education, 230, 232 life expectancy, 211–214 mental health problems, 386–388 participation in sports, 434–438 prescription drug use, 279–280 reason for no health insurance, 140–142 spending on dental care by, 176–178 spending on emergency room visits by, 169 spending on health care received by, 165–183 spending on inpatient hospital care by, 166–167 spending on outpatient hospital care by, 168 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 weight status, 426–428 with AIDS, 270–271 with learning disabilities, 222–224 with problems accessing health care, 300–301 without health insurance, 144–146 Chiropractic care as alternative medicine, 51–58, 61–63 spending on, 178, 180

WEIGHT AND EXERCISE Cholesterol alternative medicine as treatment, 59 high, 229, 253–255 test, ordered or provided, 314–315, 341, 351 Cigarette smoking advised to quit, 9–10 and alternative medicine, 50 attitude toward, 11, 13 by age, 4–13 by education, 5–8, 11–13 by income, 5–10 by race and Hispanic origin, 5–8, 12 by sex, 4–8, 10 during pregnancy, 124–125 teenage, 4, 8, 11–13 therapy ordered or provided by outpatient hospital visit, 342 therapy ordered or provided by physician’s visit, 315 Cocaine use, 23, 25–27, 32–33 Condoms. See Contraceptive use. Congenital malformations as reason for hospital inpatient care, 357, 359, 362, 364 average length of hospital stay for, 364 cost of, 284–286 deaths from, 197–200 number of events, 282 number of people experiencing event, 283 Contact lenses. See Vision. Contraceptive use, 389, 399–401, 408–412 Coronary as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 282–286 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Deaths. See also Life expectancy. by age, 185, 198–210 by cause, 193–210 by race and Hispanic origin, 193, 196–197 by sex, 188, 190 Delayed medical care. See Medical Care Dental care health insurance coverage of, 175–177 spending on, 127–128, 153, 155, 157, 159, 161, 175–177 visits, 287, 327–331 Depression, 373–375, 377. See also Mental health. Diabetes as cause of death, 189–192, 194–195, 200–201, 203–204 as diagnosis during hospital inpatient care, 356, 358, 361, 363 as diagnosis during physician ofﬁce visit, 311 as health condition, 229–233, 235–237, 239–241, 243–245, 247–249, 256–258, 282–286 as reason for hospital outpatient visit, 339 average length of hospital stay for, 363 cost of, 284–286

number of events, 282 number of people experiencing event, 283 Diet. See also Food. as alternative medicine, 52 caloric intake, 420 changes in, 414–417 for weight loss, 428–430 therapy ordered or provided during hospital outpatient visit, 342 therapy ordered or provided during physician ofﬁce visit, 315 Disabilities aids used for, 209, 213 by age, 37–39, 42–43, 209–215, 220, 222–227 by education, 214, 219, 222–224 by health insurance status, 223–224, 226–227 by income, 218, 223–224. 226, 227 by race and Hispanic origin, 217 by sex, 45–47, 216, 223–224, 226–227 by type, 210–213, 215–220, 222–225 learning, 212–213, 222–224 personal assistance needed because of, 209, 212, 220–221 work, 209, 215–219 Diseases. See Health conditions and speciﬁc diseases. Doctors. See Physicians. Drinking. See Alcohol use. Drug use, illegal. See also individual drugs. attitude toward, 23, 28, 30 by age, 23–32 by type, 23, 25–30, 32 teenage, 23–32 treatment for, 34–35 Drugs, nonprescription, spending on, 157–164 Drugs, prescription as reason for physician ofﬁce visit, 312 brands, top ten prescribed, 326 children using, 279–280 health insurance coverage of, 150, 152, 170–171 illegal use of, 23–32 prescribed during physician ofﬁce visits, 321–326 problems receiving, 70, 72, 288, 291 spending on, 130, 132–134, 156–164, 170–171 use of, 278–280 Eating disorders, 375. See also Mental health. Ecstasy. See Hallucinogens. Education alternative medicine use by, 50, 54 attitudes toward health care providers by, 67, 77–79 births by, 107, 111, 113 breastfeeding by, 95, 122–123 children without health insurance by parent’s, 300–301 cigarette smoking by, 5–8, 12 dental visits by, 328–332 diabetes by, 247–249 disabled by, 218, 223, 225, 233–234 drinking by, 14–17, 19–22 exercise, frequency by, 431–433

AMERICAN HEALTH

455

health care, problems receiving by, 77–79, 300–301 health care visits by, 295–303, 353 health conditions by, 246–249, 252, 255, 258, 260–268, 275–277 health status by, 71–72 high cholesterol by, 261 hospital care by, 353 hypertension by, 252–256, 258 mental health, 378, 386–388 reason for no health insurance by, 145 special, children in, 222–224 weight status by, 425 Emergency rooms. See Hospital emergency departments, Exercise. See also Sports. by age, 431–438 by education, 431–438 by income,431–433 by race and Hispanic origin, 432–433 by sex, 432–435 for weight loss, 428, 431 frequency of, 431–433 therapy ordered or provided during hospital outpatient visit, 343 therapy ordered or provided during physician ofﬁce visit, 315 Eyeglasses. See Vision. Family children without health insurance by type, 140–142, 300–301 dental visits by, 327–332 health care, problems receiving by type, 300–301 health care visits by type, 311–312 health insurance coverage of children by type, 147–149 health insurance premiums, 150, 155 out-of-wedlock childbearing by type, 114, 116 planning, 412 Fitness. See Exercise and Sports. Food consumption, 414–417. See also Diet. Foreign-born births to, 107 health insurance coverage of children, 144–146 The Gallup Organization, 377, 430 Government role in health care, 65–66, 69 spending on health care, 131, 162–184 Hallucinogens, 23, 25–27, 32–33 Hay fever, 231–233, 235–237, 239–241, 243–245, 247–249 Health care access. by age, 40 problems with, 76–79 Health care beneﬁts. See Health insurance. Health care industry, conﬁdence in leaders, 65–67 Health care, problems receiving, 76–79, 300–301 Health care spending. See also Health insurance, Medicaid, and Medicare.

456 AMERICAN HEALTH

attitude toward, 65–69 by age, 153–184 by health condition, 284–286 by insurance status, 162–181 by private insurance, 128, 162–174, 178–179 by race, 163–181 by sex, 163–181 by type of service, 127–128,153, 155, 157, 159, 161, 170–181 consumer price index for, 129 for alternative medicine, 49, 61–64 international, 126, 130 national, 125–127 paid out-of-pocket, 125–126, 128, 154–181 Health conditions. See also speciﬁc diseases and conditions. alternative medicine as treatment for, 56–59 by age, 229–233, 251–262, 264–280 by education, 246–249, 252, 255, 258, 260–268, 275–277 by income, 242–245, 252, 255, 258, 260–262, 265–268, 275–277 by race and Hispanic origin, 238–241, 251–258, 260–262, 265– 270, 274–277, 280 by sex, 234–237, 251–255, 257–258, 260–262, 264–265, 270–271, 274–279 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Health insurance. See also Medicare and Medicaid. as reason for problems receiving health care, 76–79 coverage by age, 125, 131, 133–136, 140–146, 182–184 coverage by family status, 143–146 coverage by income, 144–152 coverage by labor force status, 144–152 coverage by nativity, 144–146 coverage by occupation, 148–152 coverage by race and Hispanic origin, 143–146 coverage by region, 139–142 coverage by sex, 135, 137, 182–184 coverage by union membership status, 148–152 employer-provided, 125, 131–133, 135–138, 143–145, 147–152 people without, 131–132, 134–146, 290,297–303, 323 reason for no coverage, 126, 139–142 spending on, 154–163 type of, 125–126, 128, 131–133, 135–138, 143–145, 154–184 Health insurance coverage status alternative medicine use by, 49, 54 attitudes toward health care providers by, 76–94 dental visits by, 327–332 disabled by, 42–44, 224–225, 230, 232–234 health care, problems receiving by, 76–79, 299–301 health care visits by, 290, 293–298, 302–303 health status by, 71–73 hospital care, 353 spending on health care by, 162–181 use of alternative medicine by, 46, 50

WEIGHT AND EXERCISE Health maintenance organizations (HMOs), spending on, 154, 156, 158, 160 Health status historical, 70, 73–75 mental, 373–376 physical, 65, 70–75 Hearing aids spending on, 155, 157, 159, 161 Hearing problems, as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 282–286 Heart disease as cause of death, 188–195, 198–204 as diagnosis during hospital inpatient care, 356, 358, 360–361 as diagnosis during physician ofﬁce visit, 311 as health condition, 229–233, 235–237, 239–241, 243–245, 247–249, 259, 262, 282–286 average length of hospital stay for, 363 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Heroin use, 23, 25–27, 32–33 High blood pressure alternative medicine as treatment for, 54 as cause of death, 189, 194–195, 204 as diagnosis during hospital inpatient care, 356, 358, 361, 363 as diagnosis during physician ofﬁce visit, 311–312 as health condition, 229–233, 235–241, 243–245, 247–252, 282–286 as reason for hospital outpatient visit, 339 as reason for physician ofﬁce visit, 310 average length of hospital stay for, 363 cost of, 284–286 number of events, 282 number of people experiencing event, 283 Hip replacement, 367, 369, 371 Hispanics alternative medicine use, 57 attitudes toward health care providers, 65, 83–84, 92–94 average age at giving birth, 105 births to, 95, 107–109, 110–113, 115, 121 breastfeeding, 122–123 children without health insurance, 299–301 cigarette smoking, 5–8, 12 contraceptive use, 399–401, 408–412 deaths of, 188, 192 dental visits, 327–331 disabled, 218, 221, 224–225, 230, 232, 234 drinking, 14–17, 21 drug and alcohol abuse treatment, 34–35 exercise, frequency of, 432–433 family planning services, use by, 411 health care, problems receiving, 77–79, 300–301 health care spending by, 163–181 health care visits, 292, 295, 299–304, 306, 309, 314, 323 health conditions, 238–241, 251–252, 254–258, 260–262, 265– 270, 274–277, 280

health insurance coverage, 135, 138 health status, 71–72 hospital care, 335, 338 mental health, 377–379, 386, 388 nursing home residents, 47 pregnancy, attitude toward, 394–396 pregnancy outcomes, 98–100 prescription drug use, 278–280 reason for no health insurance, 139–142 sexual attitudes and behavior, 396–398, 400–402, 406–408, 412 spending on dental care by, 176–177 spending on emergency room visits by, 168 spending on health care, 163–181 spending on home health care by,179–180 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 suicide, considered by high school students, 386–388 weight status by, 420, 425–427 with AIDS, 269–270 with diabetes, 238–241, 256–258 with high cholesterol, 253–255 with hypertension, 238–240, 250–252 Home health care patients, 186–187 spending on, 178, 181 Homicide, as cause of death, 185, 191–196, 198, 200 Homosexuality, attitude toward, 393 Hospital emergency department care by age, 288, 290–292, 300–301, 343–347 by diagnosis, 349 by education, 300–301 by family structure, 300–301 by health condition, 348–349 by health insurance coverage status, 300–301 by income, 300–301 by race and Hispanic origin, 288, 290, 292, 300–301, 343, 345, 347 by reason for visit, 348 by services provided, 351 by sex, 344, 347 by source of payment, 166, 169 by type of provider seen, 350 by urgency status, 343, 346–347 spending on, 169, 284–286 visits, 288–289, 343–351 Hospital inpatient care and alternative medicine use, 46, 51 average length of stay, 333, 353, 355, 361, 364–365 by age, 352–360, 366–370 by diagnosis, 355–364 by education, 353 by health condition, 355–371 by health insurance coverage status, 353 by income, 353 by procedure, 365–371 by race and Hispanic origin, 353 by sex, 352–354 by source of payment, 166–167 AMERICAN HEALTH

457

overnight stays, 353 spending on, 166–167 visits, 289, 352–371 Hospital outpatient department care by age, 333–338 by diagnosis, 340 by education, 353 by race and Hispanic origin, 335, 336, 338 by reason for visit, 333, 337–339 by services ordered or provided, 337, 341–342 by sex, 334–336, 338 by source of payment, 166–168 by type of provider seen, 340 spending on, 168 visits, 334–340 Hypertension. See High blood pressure. Illegal drugs. See Drug use, illegal. Income attitudes toward health care providers by, 81–94 births by, 107 breastfeeding by, 123 children without health insurance by, 143–146, 300–301 cigarette smoking, 5–8, 12 dental visits by, 327–331 diabetes by, 258 disabled by, 218, 222, 224–225, 232–234 drinking by, 14–17, 21 exercise, frequency by, 432–433 health care, problems receiving by, 70–73, 300–301 health care spending by, 163–181 health care visits by, 295–303, 323 health conditions by, 242–245, 252, 255, 258, 260–262, 265–268, 275–277, health insurance coverage by, 147–149, 150–155 health status by, 71–72 high cholesterol, 255 hospital care, 353 hypertension by, 252 mental health, 383–384 reason for no health insurance by, 145 spending on dental care by, 176–177 spending on emergency room care by, 169 spending on health care by, 165–183 spending on inpatient hospital care by, 166–167 spending on outpatient hospital care by, 168 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 weight status by,425 Incontinence, 37, 41, 44 Industry, health insurance coverage by, 151–155 Inﬂuenza and pneumonia as cause of death, 189–192, 194–195, 197–198, 200, 203–204 as diagnosis during hospital inpatient care, 356, 358, 361 cost of, 284–286

458 AMERICAN HEALTH

number of events, 282 number of people experiencing event, 283 Inhalants, 23, 25–27, 32–33 Injury and poisoning as diagnosis during emergency department visit, 349 as diagnosis during hospital inpatient care, 357, 359, 362, 364 as diagnosis during hospital outpatient care, 340 as diagnosis during physician ofﬁce visit, 311 Knee replacement, 367, 369, 371 Lab test and X–rays services ordered or provided, 313, 341, 351 spending on, 157–164 Labor force status births by, 110 health insurance coverage by, 147–152 Learning disabilities. See Disabilities. Life expectancy by age, 185, 205–208 by race, 208 by sex, 205, 207–209 Long-term care insurance, spending on, 153, 155, 157, 159, 161 LSD. See Hallucinogens. Marijuana, 23–33 Marital status abortions by, 99 births by, 95, 107, 111–113 breastfeeding by, 122–123 contraceptive use, 410 family planning services, use by, 412 sexual behavior by, 389, 394–412 Medicaid as source of payment for hospital emergency visits, 169 as source of payment for hospital inpatient visits, 167 as source of payment for hospital outpatient visits, 168 as source of payment for physician ofﬁce visits, 165 coverage, 125–126, 128, 131–132, 135–138, 140–145, 182–183 expenses paid by, 126,130, 131–132, 162–184 hospital care by coverage, 353 problems receiving health care by coverage, 76–79 recipients who are disabled, 226–227 Medical care delayed, 288 by age, 290 due to cost, 290 Medical equipment spending on, 155–161 use of, 190, 226, 228 Medical services. See individual categories. Medicare as source of payment for hospital emergency visits, 169 as source of payment for hospital inpatient visits, 167

WEIGHT AND EXERCISE as source of payment for hospital outpatient visits, 168 as source of payment for physician ofﬁce visits, 165 attitude toward health care providers, 74–88 beneﬁciaries, disability status, 41–44 coverage, 125–126, 128, 131–132, 135–138, 140–142, 144–145,147–148, 182, 184 expenses paid by, 126, 128, 162–184 spending on, 156–164, 178–180 problems receiving health care by coverage, 77–79 Medications. See Drugs, prescription. Men. See also Children and Teenagers. alternative medicine use, 49, 52, 57 attitudes toward health care providers, 294, 299, 304, 319 average length of hospital stay, 352–355 caloric intake, 420 cigarette smoking 4–8, 12 contraceptive use, 399–401 deaths of, 188, 190 dental visits, 328–331 disabled, 216, 220, 225, 227, 230, 232, 234 drinking, 14–17, 21 drug and alcohol abuse treatment, 34–35 exercise, frequency of, 432–433health care, problems receiving, 70–73, 300–301 health care spending by, 163–181 health care visits, 292–295, 305, 309, 314, 323, 335, 338, 344, 347, health conditions, 234–237, 251–255, 257–258, 260–262, 264–266, 270–271, 274–279 health insurance coverage, 140, 142, 145, 184–186 health status, 71–73 hospital care, 334, 337, 341–343, 352–354 incontinent, 44 life expectancy, 205, 207–209 medicaid enrollees, 182–183 medicare enrollees, 182, 184 mental health, 376–379, 381, 386 prescription drug use, 274–275 reason for no health insurance, 145 sexual attitudes and behavior, 389, 394–404, 406 spending on dental care by, 176–177 spending on emergency room visits by, 169 spending on health care by, 165–183 spending on home health care by, 179–180 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 weight status by, 418–420, 422–430 with AIDS, 270–271 with diabetes, 235–237, 257–258 with high cholesterol, 253–255 with hypertension, 235–237, 251–252 Mental health as cause of disability, 212–213 as diagnosis during hospital emergency room visit, 349 as diagnosis during hospital inpatient care, 356, 358, 361, 363

as diagnosis during hospital outpatient visit, 340 average length of hospital stay for, 363 by age, 374, 376–380, 386–388 by education, 385 by income, 377–378, 383–384 by race and Hispanic origin, 377–379, 382, 386–388 by sex, 373, 376–379, 381, 386 by type of problem, 373–374, 377, 380–382, 384–388 cost of, 281, 284–286 exam during hospital emergency visit, 341, 349 internet, getting information on, 378 number of events, 282 number of people experiencing event, 283 status, 373–374, 376–377 therapy ordered or provided during hospital outpatient visit, 342 therapy ordered or provided during physician ofﬁce visit, 324 Methamphetamines, 23, 25–27, 32–33 Migraines, as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 282–286 Military health insurance, 137, 141–143, 147–148 Miscarriage, 98 Mobility problems as type of disability, 216–223, 226, 228 of Medicare beneﬁciaries, 42–43 National Sporting Goods Association, 437–438 Nativity status births by, 107 health insurance coverage of children by, 147–149 Natural products as alternative medicine, 54, 56 Nurses seen during hospital emergency room visit, 350 seen during hospital outpatient visit, 340 seen during physician ofﬁce visits, 319–320 spending on, 178–179 Nursing homes residents, 45–48 spending on, 155–161 Obesity. See Weight. Occupation, health insurance coverage by, 150–155 Operations. See Surgery. Optometrist visits spending on, 173 Orthodontic ofﬁce visits spending on, 177 Out-of-pocket spending. See Health care spending. Outpatient services. See Hospital outpatient departments. Overweight. See Weight. Parkinson’s disease, as cause of death, 194, 199–201 Pew Research Center, 366, 378 Physical education classes, participation in, 433–438 Physical health status. See Health status. Physician assistants seen during hospital emergency room visit, 350 seen during hospital outpatient visit, 340 seen during physician ofﬁce visits, 319–320

AMERICAN HEALTH

459

Physician ofﬁce visits. See also Physicians. attitude toward, 288, 294, 299, 304, 316, 319 by age, 290–291, 294–299, 302–303, 306–308, 310–311 by continuity of care, 318 by diagnosis, 311 by education, 295–303, 323 by family structure, 299–303, 330–331 by health condition, 307–315 by health insurance coverage status, 295–304, 323 by income, 295–303, 323 by medications prescribed, 322–326 by physician’s specialty, 322 by race and Hispanic origin, 292, 295, 299–304, 306, 309, 314, 323 by reason for visit, 310 by services ordered or provided, 312–315, 321 by sex, 292–295, 305, 309, 314, 323 by source of payment, 155–165, 284–286, by time spent with physician, 80, 83–84, 287, 316–317 by type of provider seen, 319–320 declining, 287–289 for preventive care, 287, 307–308 length of time since last, 294, 297–298, 302–303 number in past year, 294, 297–298, 307–322 spending on, 132–134, 164–165, 284–286 Physicians. See also Physician ofﬁce visits. seen during hospital emergency room visit, 346, 350 seen during hospital outpatient visit, 337, 340 seen during physician ofﬁce visits, 319–320 Prayer, as alternative medicine, 52–56 Pregnancy as reason for hospital outpatient visit, 339 as reason for physician ofﬁce visit, 310–311 outcome, 98–100 teenage attitude toward, 394–396 Prenatal care, 124–125 Prescription drugs. See Drugs, prescription. Preventive care, physician ofﬁce visits for, 307–308 Race. See American Indians, Asians, Blacks, Hispanics, Whites, and Whites, non-Hispanic. Region alternative medicine use by, 53 births by, 107 reason for no health insurance by, 144–145 Religion out-of-wedlock childbearing by, 113 relationship with sexual partner by, 406–407 Respiratory disease as cause of death, 189–195, 201, 203–204 as diagnosis during hospital emergency room visit, 349 as diagnosis during hospital inpatient care, 356, 358, 361, 363 as diagnosis during hospital outpatient visit, 340 as diagnosis during physician ofﬁce visit, 311 average length of hospital stay for, 363 cost of, 284–286

460 AMERICAN HEALTH

number of events, 282 number of people experiencing event, 283 Sex education, attitude toward, 390–391 Sexual attitudes and behavior abstinence, reason for, 402 attitude toward, 389–396, 400, 402–403, 408 by age, 389, 394–412 by marital status, 389, 394–412 by race and Hispanic origin, 396–398, 400–402, 406–408, 412 by religious background, 406–407 by sex, 389, 394–404, 406–412 contraceptive use, 389, 399–401, 408–412 family planning services, use of, 412 intercourse experience, 389, 397–401, 403–407 number of partners, 405 teenage, 389, 397–402 Smoking. See Cigarette smoking. Special education, children in, 222–224 Sports children’s participation, 434–438 high school student participation, 434–436 participation by type, 437–438 Steroids, illegal use of, 32 Stroke, as health condition, 231–233, 235–241, 243–245, 247–252, 282–286 Suicide as cause of death, 189–192, 194–196, 200–201 teenage, 196, 386–388 Surgery procedures, on hospital inpatients, 365–371 Teenagers. See also Children. contraceptive use, 399–401 drinking, 14, 18–22 drug use, 23–32 family planning use, 412 health status, 63–64 participation in physical activities, 434–438 sexual attitudes, 394–396, 400, 402–403, 408 sexual behavior, 389, 397–402 suicide, 196, 386–387 tobacco use 4, 8, 11–13 weight status, 426–428 Tobacco. See also Cigarette smoking. therapy ordered or provided during hospital outpatient visit, 343 therapy ordered or provided during physician ofﬁce visit, 315 Trauma-related disorders cost of, 281, 284–286 number of events, 282 number of people experiencing event, 283 Union membership, health insurance coverage status by, 150–155 Vision as reason for physician ofﬁce visit, 310–311 health insurance coverage for, 172–174

WEIGHT AND EXERCISE problems as health condition, 231–233, 235–237, 239–241, 243–245, 247–249, 282–286 spending on, 134, 155–161, 172–174, 284–286 Vitamins spending on, 157–164 Weight attitude toward, 413, 424, 428–430 by age, 418–420, 422–423, 425–427 by education, 425 by income, 425 by race and Hispanic origin, 418, 420, 425–427 by sex, 420, 425–427 healthy, 413, 421–422, 425 in pounds, 418–420, 429–430 ideal, 413, 429–430 obese, 421, 423 of children, 426–428 overweight, 413, 421–422, 425–428 status, 413, 421–427, 429–430 therapy ordered or provided during hospital outpatient visit, 337, 343 therapy ordered or provided during physician ofﬁce visit, 315 Whites. See also Whites, non-Hispanic. abortions, 99 alternative medicine use, 53, 57 cigarette smoking, 4–8, 12 drinking, 14–17, 21 health care visits, 290, 292, 310–311, 335, 338, 343, 345, 347, 353 life expectancy, 208 mental health, 377–379, 386–388 Whites, non-Hispanic. See also Whites. attitudes toward health care providers, 65, 83–84, 92–94 average age at giving birth, 105 births to, 95, 107–109, 111–113, 115, 121 breastfeeding, 122–123 children without health insurance, 300–301 cigarette smoking, 5–6, 10, 12 contraceptive use, 399–401, 408–412 deaths of, 188, 192 dental visits, 327–331 disabled, 214, 217, 223–224, 226–227 drinking, 14–16 drug and alcohol abuse treatment, 34–35 exercise, frequency of, 432–433 family planning services, use by, 412 health care, problems receiving, 300–301 health care spending by, 163–181 health care visits, 292, 295, 299–304, 306, 309, 314, 323 health conditions, 238–241, 251–252, 254–258, 260–262, 265– 270, 274–277, 280 health insurance coverage, 140, 143, 145–149, 184–185 hospital care, 334, 343, 353 health status, 71–72 mental health, 377–379, 386–388 pregnancy, attitude toward, 394–396

pregnancy outcomes, 98–100 prescription drug use, 278, 280 reason for no health insurance, 145 sexual attitudes and behavior, 396–398, 400–402, 406–408, 412 spending on dental care by, 176–177 spending on emergency room care by, 169 spending on health care by, 165–183 spending on home health care by, 179–180 spending on hospital inpatient services by, 166–167 spending on hospital outpatient services by, 168 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 suicide, considered by high school students, 386–388 weight status by, 420, 425–427 with AIDS, 269–270 with diabetes, 235–237, 257–258 with high cholesterol, 254–255 with hypertension, 238–240, 250–252 Women See also Children and Teenagers. abortions, 98–100 alternative medicine use, 49, 52, 57 attitudes toward health care providers, 80–94 average length of hospital stay, 352, 354 births to, 101–121 breastfeeding, 95, 122–123 caloric intake, 420 childless, 101, 103 cigarette smoking 4–8, 12 contraceptive use, 389, 399–401, 407–412 deaths of, 188, 190 dental visits, 328–331 disabled, 216, 220, 225, 227, 230, 232, 234 drinking, 14–17, 21 drug and alcohol abuse treatment, 34–35 exercise, frequency of, 432–433 family planning services, use of, 412 health care, problems receiving, 70–73, 300–301 health care spending by, 163–181 health care visits, 292–295, 305, 309, 314, 323, 335, 338, 344, 347, health conditions, 234–237, 251–255, 257–258, 260–262, 264–265, 267–268, 270–271, 274–279 health insurance coverage, 140, 142, 145, 184–186 health status, 71–73 hospital care, 335, 338, 352–354 incontinent, 44 life expectancy, 205, 207–209 medicaid enrollees, 182–183 medicare enrollees, 182, 184 mental health, 373, 376–379, 381, 386 nursing home residents, 45–47 pregnancy outcomes, 98–100 prescription drug use, 278–279 reason for no health insurance, 145 sexual attitudes and behavior, 389,394–404, 407–112 spending on dental care by, 176–177 spending on emergency room care by, 169 AMERICAN HEALTH

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spending on health care by, 165–183 spending on home health care by, 179–180 spending on inpatient hospital care by, 166–167 spending on outpatient hospital care by, 168 spending on physician visits by, 164–165 spending on prescription drugs by, 171 spending on visits to nurses or nurse practitioners by, 179 weight status by, 413, 421–430 with AIDS, 270–271 with diabetes, 235–237, 257–258 with high cholesterol, 253–255 with hypertension, 235–257, 251–252

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