Health, United States 2018 Chartbook
ea t nite tatesHealth, United StatesI- -20182018 -U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics
Copyright informationPermission has been obtained from the copyright holdersto reproduce certain quoted material in this report. Furtherreproduction of this material is prohibited without specificpermission of the copyright holder. All other material containedin this report is in the public domain, and may be used andreprinted without special permission; source citation, however,is appreciated.Suggested citationNational Center for Health Statistics.Health, United States, 2018. Hyattsville, MD. 2019.U.S. Department of Health and Human ServicesAlex M. Azar, IISecretaryCenters for Disease Control and PreventionRobert R. Redfield, M.D.DirectorNational Center for Health StatisticsJennifer H. Madans, Ph.D.Acting Director
PrefaceHealth, United States, 2018 is the 42nd report onthe health status of the nation and is submitted by theSecretary of the Department of Health and Human Servicesto the President and the Congress of the United States incompliance with Section 308 of the Public Health Service Act.This report was compiled by the National Center for HealthStatistics (NCHS) of the Centers for Disease Control andPrevention (CDC).The Health, United States series presents an annualoverview of national trends in key health indicators. The2018 report presents trends and current information onselected measures of morbidity, mortality, health careutilization and access, health risk factors, prevention, healthinsurance, and personal health care expenditures in a20-figure chartbook.The Health, United States, 2018 Chartbook issupplemented by several other products including TrendTables, an At-a-Glance table, Appendixes, and SpotlightInfographics available for download on the Health,United States website at: https://www.cdc.gov/nchs/hus/index.htm.The 2018 EditionThe Health, United States, 2018 Chartbook contains20 figures and 20 tables on health and health care in theUnited States. Examining trends in health informs thedevelopment, implementation, and evaluation of healthpolicies and programs. The first section (Figures 1–12)focuses on health status and determinants: life expectancy,infant mortality, leading causes of death, overdose deaths,teen births, preterm births, use of tobacco products, obesity,asthma, diabetes prevalence, hypertension, and functionallimitations. The second section (Figures 13–15) presentstrends in health care utilization: childhood vaccinationcoverage, use of prescription drugs, and unmet medicalneeds. The third section (Figures 16–17) focuses on healthcare resources: availability of dentists and use of long-termcare facilities. The fourth section (Figures 18–20) describestrends in personal health care expenditures and healthinsurance coverage. The Highlights section summarizes majorfindings from the Chartbook.Supplementary Materials Availableon the WebTrend TablesWith the release of Health, United States, 2018, 47detailed Trend Tables that highlight major trends in keyhealth indicators in the four areas: health status anddeterminants, health care utilization, health care resources,Health, United States, 2018and health care expenditures will be available for downloadat: https://www.cdc.gov/nchs/hus/contents2018.htm. Animportant criterion used in selecting Trend Tables for theHealth, United States series is the availability of comparablenational data over a period of several years. Trend Tables areincluded in the online supplement for indicators featuredin the Chartbook or on the NCHS FastStats site. FastStatsprovides quick access to statistics on topics of public healthimportance and is available at: https://www.cdc.gov/nchs/fastats/default.htm.The At-a-Glance table summarizes major findings fromthe Trend Tables, and is available for download from the webat: xesAppendix I. Data Sources describes each data sourceused in Health, United States, 2018 and provides referencesfor further information about the sources. Data sourcesare listed alphabetically within two broad categories:Government Sources and Private and Global Sources.Appendix II. Definitions and Methods includes selectedterms used in Health, United States, 2018. It also containsinformation on the statistical methodologies used in thereport.The Appendixes for Health, United States, 2018 areavailable for download at: t InfographicsThe Health, United States Spotlight is an infographicseries that explores topics of public health importanceusing trend data from Health, United States. Spotlights arepublished throughout the year and feature the most currentdata available at the time of publication.The Spotlight infographics are available for download at:https://www.cdc.gov/nchs/hus/hus infographic.htm.Data FinderThe Data Finder is a useful tool on the Health,United States website for locating data by topic. Using theData Finder, users may narrow down the list of tables andcharts by health topic and populations of interest. Topicsinclude areas such as drug overdose, prescription druguse, and functional limitation. Populations include groupsclassified by age, race and Hispanic origin, and geographicregion. See the Health, United States website ii
Data ConsiderationsAccessing Health, United StatesRacial and Ethnic DataThe Health, United States, 2018 Chartbook can beaccessed at: https://www.cdc.gov/nchs/hus/index.htm.The Chartbook figures are also available for download asPowerPoint slides. Trend Tables and Chartbook data tablesare available for download as Excel and PDF files. Excel TrendTable files include additional years of data not shown in thePDF files, along with standard errors, where available. Filesmay be downloaded from the Health, United States websiteat: tors to the website can join the Health, United Statese-mail distribution list (https://www.cdc.gov/nchs/hus/hus electronic mailing.htm) to receive announcementsabout release dates and notices of updates. Previous editionsof Health, United States and its Chartbooks can also beaccessed from the website.Printed copies of Health, United States can be purchasedfrom the U.S. Government Publishing Office at:https://bookstore.gpo.gov.Some tables in Health, United States present dataaccording to race and Hispanic origin, consistent with adepartment-wide emphasis on ensuring that health dataon racial and ethnic minority populations are presentedwhenever possible. Trend data on race and ethnicity arepresented in the greatest detail possible after taking intoaccount the quality of the data, the amount of missing data,and the number of observations. These issues significantlyaffect the availability of reportable data for certainpopulations, such as the Native Hawaiian or Other PacificIslander populations and the American Indian or AlaskaNative populations. Standards for the classification of federaldata on race and ethnicity are described in Appendix II. (SeeAppendix II, Race.)Education and Income DataSome tables in Health, United States present dataaccording to socioeconomic status, using educationand family income as proxy measures. Education andincome data are generally obtained directly from surveyrespondents, and are not usually available from recordsbased data collection systems. (See Appendix II, Education;Family income; Poverty.)Statistical SignificanceAll statements in the text describing differences, orlack thereof, between estimates or across time indicatethat statistical testing was performed. Differences betweentwo point estimates were determined to be statisticallysignificant at the 0.05 level using two-sided significancetests (z-tests) without correction for multiple comparisons.Terms such as “similar,” “no difference,” “stable,” and “noclear trend” indicate that the statistics being compared werenot significantly different or that the slope of the trend linewas not significantly different from zero. For data sourceswith no standard errors, relative differences greater than10% are generally discussed in the text. Trends are testedusing regression analysis. The specific approaches usedto analyze trends over time depend on the data source,type of dependent variable, and number of data points(1). Chartbook data tables and Trend Tables include pointestimates and standard errors, when available, for users whowould like to perform additional statistical tests. Additionalinformation on statistical reliability and testing can be foundin the Technical Notes, which follow the Chartbook.ivQuestions?If you have questions about Health, United States or relateddata products, please contact:Office of Information ServicesInformation Dissemination StaffNational Center for Health StatisticsCenters for Disease Control and Prevention3311 Toledo RoadHyattsville, MD 20782–2064Phone: 1–800–CDC–INFO (1–800–232–4636)TTY: 1–888–232–6348E-mail: healthus@cdc.govOnline request form: https://www.cdc.gov/cdc-info/requestform.htmlFor e-mail updates on NCHS publication releases, subscribeonline at: https://www.cdc.gov/nchs/email-updates.htm.Health, United States, 2018
AcknowledgmentsThe National Center for Health Statistics’ (NCHS) Divisionof Analysis and Epidemiology planned and coordinated thecontent of this volume under the direction of Irma E. Arispeand Renee M. Gindi.Production of Health, United States, 2018 was managedby Sheila J. Franco and Renee M. Gindi. Preparation of thevolume, including data, analysis, text for specific charts,highlights, trend tables, and appendixes was completed byShilpa Bengeri, Mary Ann Bush, La-Tonya D. Curl, Barnali Das,Sheila J. Franco, Nancy Han, Ji-Eun Kim, Florence C. Lee,Xianfen Li, Diane M. Makuc, Zakia C. Nelson, Anita L. Powell,and Ashley M. Woodall.Publication assistance was provided by CDC/OSELS/NCHS/OD/Office of Information Services, InformationDesign and Publishing Staff (IDPS). Project management wasprovided by Yolanda L. Jones and Danielle Taylor. Editorialreview was provided by Yolanda L. Jones and Laura Drescher.Graphic design was provided by Simon McCann, OdellEldridge, and Kyung M. Park. Cover design was provided byLiviu Tanase. Overview for IDPS publications and electronicproducts was provided by Kyung M. Park and Tommy C.Seibert, Jr. Electronic access through the NCHS website wasprovided by Shilpa Bengeri, La-Tonya D. Curl, Florence C. Lee,Diane M. Makuc, Jennifer A. Moore, and Ashley M. Woodall.Printing was managed by Nathanael Brown (CDC/OD/OADC).Data and technical assistance were provided by staffof the following NCHS organizations: Division of Health CareStatistics: Lauren Harris-Kojetin and Manisha Sengupta;Division of Health and Nutrition Examination Surveys:Namanjeet Ahluwalia, Lara Akinbami, Mark S. Eberhardt,Eleanor B. Fleming, Crescent Martin, Cynthia L. Ogden,Yechiam Ostchega, and Ryne Paulose-Ram; Division of HealthInterview Statistics: Veronica Benson, Lindsey I. Black, DebraL. Blackwell, Peter Boersma, Amy E. Cha, Tainya C. Clarke,Robin A. Cohen, Jacqueline B. Lucas, Tina Norris, Jeannine S.Schiller, Emily P. Terlizzi, Maria A. Villarroel; Division of VitalStatistics: Elizabeth Arias, Sally C. Curtin, Patrick Drake, AnneK. Driscoll, Danielle Ely, Elizabeth C. Gregory, Joyce A. Martin,Steven J. Steimel, Betzaida Tejada-Vera; Division of Analysisand Epidemiology: Cheryl V. Rose and Julie Weeks.Additional data and technical assistance were providedby the following organizations of the Centers for DiseaseControl and Prevention (CDC): National Center for ChronicDisease Prevention and Health Promotion: Brian S. Armour,Elizabeth A. Courtney-Long, Andrea Gentzke, and AhmedJamal; National Center for HIV/AIDS, Viral Hepatitis, STD,and TB Prevention: Lori Elmore, Jennifer Ludovic, and theSurveillance and Data Management Branch; National Centerfor Immunization and Respiratory Diseases: Laurie D. ElamEvans, Benjamin Fredua, Holly A. Hill, Samuel F. Posner, JamesA. Singleton, Tanja Y. Walker, and David Yankey; OPHSS/CSELS, Division of Health Informatics and Surveillance: RuthAnn Jajosky and Tara Strine; by the following organizationsHealth, United States, 2018within the Department of Health and Human Services:Centers for Medicare & Medicaid Services: Mary CarolBarron, Aaron C. Catlin, and Lekha S. Whittle; and SubstanceAbuse and Mental Health Services Administration: BethHan; and by the following nongovernmental organization:American Dental Association: Bradley Munson.We acknowledge the contributions from local, state,and territorial health departments and other sources in thecollection and reporting of health indicators.v
ContentsPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiThe 2018 Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiSupplementary Materials Available on the Web . . . . . . . . iiiData Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vList of Chartbook Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viiList of Trend Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiiHighlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Health Status and Determinants . . . . . . . . . . . . . . . . . . . . . 1Health Care Access and Utilization . . . . . . . . . . . . . . . . . . . 2Health Care Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Health Care Expenditures and Payers . . . . . . . . . . . . . . . . 3Chartbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Health Status and Determinants . . . . . . . . . . . . . . . . . . . . . . . 6Life Expectancy at Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Infant Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selected Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . 8Drug Overdose Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Teen Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Preterm Singleton Births . . . . . . . . . . . . . . . . . . . . . . . . . . 11Use of Tobacco Products . . . . . . . . . . . . . . . . . . . . . . . . . . 12Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Current Asthma Among Children . . . . . . . . . . . . . . . . . . . 14Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Functional Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Health Care Access and Utilization . . . . . . . . . . . . . . . . . . . . 18Vaccination Coverage Among ChildrenAged 19–35 Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Unmet Need Due to Cost . . . . . . . . . . . . . . . . . . . . . . . . . . 20Health Care Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Dentists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Long-Term Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . 22Health Care Expenditures and Payers . . . . . . . . . . . . . . . . . . 23Personal Health Care Expenditures . . . . . . . . . . . . . . . . . 23Health Insurance Coverage Among Children . . . . . . . . . 24Health Insurance Coverage Among AdultsAged 18–64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Data Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Statistical Reliability of Estimates . . . . . . . . . . . . . . . . . . . 53Statistical Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55viHealth, United States, 2018
List of Chartbook FiguresHypertensionLife Expectancy at BirthFigure 11. Hypertension and uncontrolled high bloodpressure among adults aged 20 and over, by sex and age:United States, 1999–2000 through 2015–2016Figure 1. Life expectancy at birth, by sex and race andHispanic origin: United States, 2007–2017Functional LimitationInfant MortalityFigure 12. Functional limitation among adults aged 18 andover, by age and level of difficulty: United States, 2010–2017Figure 2. Infant mortality rates, by race and Hispanic origin ofmother and leading causes of death: United States, 2007–2017Selected Causes of DeathFigure 3. Age-adjusted death rates for selected causes ofdeath for all ages, by sex: United States, 2007–2017Drug Overdose DeathsVaccination Coverage Among ChildrenAged 19–35 MonthsFigure 13. Vaccination coverage for combined series amongchildren aged 19–35 months, by selected characteristics:United States, 2017Prescription DrugsFigure 4. Drug overdose death rates among persons aged 15years and over, by sex and age: United States, 2007–2017Figure 14. Prescription drug use in the past 30 days, bynumber of drugs taken and age: United States, 1999–2000through 2015–2016Teen BirthsUnmet Need Due to CostFigure 5. Teen births among females aged 15–19 years, byrace and Hispanic origin: United States, 2007–2017Preterm Singleton BirthsFigure 15. Delay or nonreceipt of needed medical care andnonreceipt of needed prescription drugs in the past 12months due to cost among adults aged 18–64, by percent ofpoverty level: United States, 2007–2017Figure 6. Preterm singleton births, by gestational age andrace and Hispanic origin of mother: United States, 2007–2017DentistsUse of Tobacco ProductsFigure 16. Number of dentists per 100,000 residentpopulation, by state: United States, 2017Figure 7. Cigarette smoking among adults aged 18 and over,by age and tobacco use among adolescents in grades 9–12,by type of product: United States, 2007–2018ObesityFigure 8. Obesity among children and adolescents aged 2–19years and adults aged 20 and over, by sex: United States,1999–2000 through 2015–2016Long-Term Care ServicesFigure 17. Use of long-term care services, by type of serviceand age: United States, 2011–2012 and 2015–2016Personal Health Care ExpendituresFigure 18. Personal health care expenditures, by sourc
the health status of the nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the National Center for Health
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