Health, United States, 2017

Questions for Renee Gindi, Ph.D., Chief, Analytic Studies Branch, Office of Analysis and Epidemiology, who led production of “Health, United States, 2017”

Q: Why did you produce this report?

RG: We produced this report for a number of reasons. Health, United States, 2017 with Special Feature on Mortality is the 41st edition of the Congressionally-mandated annual report on the health of the nation from the Secretary of the Department of Health and Human Services to the President of the United States and to Congress.

This report benefits the public health community and the general public by bringing key national health data from different sources into one location. In this wide-ranging report, users can find graphs, tables, and descriptions of trends and current information on selected measures of health and disease. The Special Feature section of the report more closely examines a topic of public health interest and policy relevance.

Q: What made you decide to focus on deaths in the United States as the Special Feature for this study?

RG: It was the recent decrease in life expectancy at birth that caused us to want to look more deeply into what groups were most affected by this marked change. Life expectancy at birth decreased for the first time since 1993 by 0.2 years between 2014 and 2015 and then decreased another 0.1 years between 2015 and 2016. We found that between 2000 and 2016, death rates for 5 of the 12 leading causes of death increased: unintentional injuries, Alzheimer’s disease, suicide, chronic liver disease, and septicemia.

Q: Was there a finding in this edition of “Health, United States” that you hadn’t expected and that really surprised you?

RG: In addition to the decrease in life expectancy at birth, we found several trends that were particularly noteworthy. Here are a few of them:

• The increases (and acceleration of those increases) in death rates for specific causes of death in specific age groups:
  • In particular, drug overdose death rates among men aged 25–34 increased by an average of 26.7% per year during 2014-2016. For women aged 15-24, drug overdose death rates increased by an average of 19.4% per year during 2014-2016.
  • The suicide rate among children and young adults aged 15-24 has been increasing since 2006, with a recent increase of 7.0% per year during 2014-2016.
  • The rate of deaths from Alzheimer’s among adults aged 65 and older has also been increasing, by an average of 6.9% per year during 2013-2016.
• Current cigarette smoking has been decreasing among adults (18+), with declines observed in every age group in recent years.
• Among adolescents, cigarette smoking in the past 30 days has decreased between 2011 and 2016, but e-cigarette use in the past 30 days has increased more than seven-fold, from 1.5% in 2011 to 11.3% in 2016.
• The rate of births to teen mothers has been decreasing in recent years among all races and ethnic groups examined.

Q: What is new in the report this year?

RG: There are a couple of new items worth highlighting from this year’s edition of Health, United States. The Special Feature on mortality, with its look at when, why, and where individuals are dying in the United States, is a new focus this year.

Also new this year is the examination of trends in disability and functional limitation using a new data source, the Washington Group Short Set on Functioning (WG-SS). These questions are considered the international standard and replace the questions used to describe disability in previous editions of Health, United States.

Health, United States, 2017 includes information on the functional status of civilian noninstitutionalized adults. Level of difficulty in six basic, universal domains—seeing, hearing, mobility, communication, cognition (remembering or concentrating), and self-care—identify the population with disability, namely those at greater risk than the general population for participation restrictions due to these, if appropriate accommodations are not made. Functional status is summarized using three mutually exclusive categories: “a lot of difficulty” or “cannot do at all/unable to do” in at least one domain; “some difficulty” in at least one domain but no higher level of difficulty in any domain;  and those with “no difficulty” in all domains.

Q: What does this publication tell us about the health of our nation?

RG: This year’s Health, United States publication tells us a lot about the health of our nation. The overall age-adjusted death rate has decreased between 2006 and 2016 by 8%, from 791.8 to 728.8 deaths per 100,000 resident population. However, the majority of deaths (73%) are among persons aged 65 and older. The death rates for nearly all of the leading causes of death in this age group have been decreasing since 2006, including heart disease and cancer, the two leading causes of death in this age group.

However, the death rates in other age groups paint a different picture. Among persons aged 15-24, 25-44 and 45-64, death rates for several causes have been increasing in recent years—including unintentional injuries, suicide, homicide, and chronic liver disease.