health, united states, 2014 (5/2015)

Copyright information

Permission has been obtained from the copyright holders to reproduce certain quoted material in this report. Further reproduction of this material is prohibited without specific permission of the copyright holder. All other material contained in this report is in the public domain and may be used and reprinted without special permission; citation as to source, however, is appreciated.

Suggested citation

National Center for Health Statistics. Health, United States, 2014: With Special Feature on Adults Aged 5564. Hyattsville, MD. 2015.

Library of Congress Catalog Number 76641496 For sale by Superintendent of Documents U.S. Government Printing Office Washington, DC 20402

U.S. Department of Health and Human Services

Sylvia M. Burwell Secretary

Centers for Disease Control and Prevention

Thomas R. Frieden, M.D., M.P.H. Director

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A. Director

Preface

Health, United States, 2014 is the 38th report on 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 Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS).

The Health, United States series presents an annual overview of national trends in health statistics. The report contains a Chartbook that assesses the nation's health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization and access, health risk factors, prevention, health insurance, and personal health care expenditures. This year's Chartbook includes a Special Feature on the health of adults aged 5564. The report also contains 123 Trend Tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. A companion reportHealth, United States: In Brieffeatures information extracted from the full report. The complete report, In Brief, and related data products are available on the Health, United States website at: http://www.cdc.gov/nchs/hus.htm.

The 2014 Edition

Health, United States, 2014 contains a summary At a Glance table that displays selected indicators of health and their determinants, cross-referenced to charts and tables in the report. This is followed by a Highlights section, a Chartbook, detailed Trend Tables, two Appendixes, and an Index. The major sections of the 2014 report are described below.

Chartbook

The 2014 Chartbook contains 29 figures, including 10 figures on this year's Special Feature on the health of adults aged 5564 (Figures 2029). The Special Feature figures provide an overview of the health and well-being of the current 5564 group as they approach retirement age and enrollment in the Medicare program, noting similarities and differences with 55- to 64-year-olds a decade ago, who are now enrolled in Medicare. Data are presented on leading causes of death, prevalence of chronic physical and mental health conditions, health behavior patterns, health insurance coverage, and health care utilization and access in this years Special Feature.

Health, United States, 2014

Trend Tables

The Chartbook is followed by 123 detailed Trend Tables that highlight major trends in health statistics. Comparability across editions of Health, United States is fostered by including similar Trend Tables in each volume, and timeliness is maintained by improving the content of tables to reflect key topics in public health. An important criterion used in selecting these tables is the availability of comparable national data over a period of several years.

Appendixes

Appendix I. Data Sources describes each data source used in Health, United States and provides references for further information about the sources. Data sources are listed alphabetically within two broad categories: Government Sources, and Private and Global Sources.

Appendix II. Definitions and Methods is an alphabetical listing of selected terms used in Health, United States. It also contains information on the statistical methodologies used in the report.

Index

The Index to the Trend Tables and Chartbook figures is a useful tool for locating data by topic. Tables and figures are cross-referenced by such topics as child and adolescent health; older population aged 65 and over; women's health; men's health; state data; American Indian and Alaska Native, Asian, black or African American, and Hispanic-origin populations; education; injury; disability; and metropolitan and nonmetropolitan data. Many of the Index topics are also available as conveniently grouped chart packages on the Health, United States website at: http://www.cdc.gov/nchs/ hus.htm.

Data Considerations

Racial and Ethnic Data

Many tables in Health, United States present data according to race and Hispanic origin, consistent with a department-wide emphasis on expanding racial and ethnic detail when presenting health data. Trend data on race and ethnicity are presented in the greatest detail possible after taking into account the quality of the data, the amount of missing data, and the number of observations. These issues significantly affect the availability of reportable data for certain populations, such as the Native Hawaiian and Other Pacific

Preface iii
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Islander population and the American Indian and Alaska Native population. Standards for the classification of federal data on race and ethnicity are described in an appendix. (See Appendix II, Race.)

Education and Income Data

Many Trend Tables in Health, United States present data according to socioeconomic status, using education and family income as proxy measures. Education and income data are generally obtained directly from survey respondents and are not usually available from records-based data collection systems. (See Appendix II, Education; Family income; Poverty.)

Disability Data

Disability can include the presence of physical or mental impairments that limit a person's ability to perform an important activity and affect the use of or need for support, accommodation, or intervention to improve functioning. Information on disability in the U.S. population is critical to health planning and policy. Several initiatives are currently under way to coordinate and standardize the measurement of disability across federal data systems. Health, United States includes data from the National Health Interview Survey to create disability measures consistent with two of the conceptual components that have been identified in disability models and legislation: basic actions difficulty and complex activity limitation.

Basic actions difficulty captures limitations or difficulties in movement and sensory, emotional, or mental functioning that are associated with a health problem. Complex activity limitation describes limitations or restrictions in a person's ability to participate fully in social role activities such as working or maintaining a household. Health, United States, 2014 includes the following disability-related information for the civilian noninstitutionalized population: basic actions difficulty and complex activity limitation (Table 47), vision and hearing limitations for adults (Tables 48 and 49), and disability-related information for Medicare enrollees (Table 117), Medicaid recipients (Table 118), and veterans with service-connected disabilities (Table 120). For more information on disability statistics, see Altman and Bernstein (1).

Statistical Significance

All statements in the text describing differences, or lack thereof, in estimates indicate that statistical testing was performed. Differences between two point estimates were determined to be statistically significant at the 0.05 level using two-sided significance tests (z-tests) without correction for multiple comparisons. Data tables include point estimates and standard errors for users who would like to perform additional statistical tests. In the text, the

Preface iv

standard terminology used when a difference between two point estimates was tested is, Between (estimate 1) and (estimate 2). For example, the statement Between 2012 and 2013 indicates that the difference between the point estimate for 2012 and that for 2013 was tested for statistical significance.

The statistical significance of a time trend was assessed using weighted least squares regression applied to data for all years in the time period. (For a description of the trend testing technique, see the Technical Notes that follow the Chartbook.) The terminology used in the text to indicate testing of a trend is During (time period 1)(time period 2). For example, the statement During 20032013 indicates that a statistical test of trend was conducted that included estimates for all 11 years in the time period. Because statistically significant differences or trends are partly a function of sample size (i.e., the larger the sample, the smaller the change that can be detected), statistically significant differences or trends do not necessarily have public health significance (2).

Terms such as similar,stable, and no difference indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between statistics does not necessarily suggest that the difference was tested and found to not be significant.

Overall estimates generally have relatively small standard errors, but estimates for certain population subgroups may be based on small numbers and have relatively large standard errors. Although numbers of births and deaths from the Vital Statistics System represent complete counts (except for births in those states where data are based on a 50% sample for selected years) and are not subject to sampling error, the counts are subject to random variation, which means that the number of events that actually occur in a given year may be considered as one of a large series of possible results that could have arisen under the same circumstances. When the number of events is small and the probability of such an event is small, considerable caution must be observed in interpreting the conditions described by the estimates. Estimates that are unreliable because of large standard errors or small numbers of events are noted with an asterisk. The criteria used to designate or suppress unreliable estimates are indicated in the table footnotes.

For NCHS surveys, point estimates and their corresponding variances were calculated using the SUDAAN software package (3), which takes into consideration the complex survey design. Standard errors for other surveys or data sets were computed using the methodology recommended by the programs providing the data or were provided directly by those programs. Standard errors are available for selected tables in the spreadsheet version on the Health, United States website at: http://www.cdc.gov/nchs/hus.htm.

www.cdc.gov/nchs/hus.htm

Accessing Health, United States

Health, United States can be accessed in its entirety at: http://www.cdc.gov/nchs/hus.htm. The website is a user-friendly resource for Health, United States and related products. In addition to the full report, the website contains the In Brief companion report in PDF format. Also found on the website are data conveniently organized and grouped by topic. The Chartbook figures are provided as PowerPoint slides, and the Trend Tables and Chartbook data tables are provided as spreadsheet and PDF files. Many spreadsheet files include additional years of data not shown in the printed report, along with standard errors where available. Visitors to the website can join the Health, United States e-mail list (http://www.cdc.gov/nchs/hus/hus_ electronic_mailing.htm) to receive announcements about release dates and notices of updates. Previous editions of Health, United States, and their Chartbooks, can also be accessed from the website.

Printed copies of Health, United States can be purchased from the U.S. Government Printing Office at: http://bookstore.gpo.gov.

Questions?

If you have questions about Health, United States or related data products, please contact:

Office of Information Services Information Dissemination Staff National Center for Health Statistics Centers for Disease Control and Prevention 3311 Toledo Road, Room 5419 Hyattsville, MD 207822064 Phone: 1800CDCINFO (18002324636) TTY: 18882326348 Internet: http://www.cdc.gov/nchs Online request form: http://www.cdc.gov/cdc-info/ requestform.html For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/ govdelivery.htm.

References

1. Altman B, Bernstein A. Disability and health in the United States, 20012005. Hyattsville, MD: NCHS; 2008. Available from: http://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf.

2. CDC. Youth Risk Behavior Surveillance System (YRBSS). Interpretation of YRBS trend data. Atlanta, GA; 2014. Available from: http://www.cdc.gov/HealthyYouth/yrbs/pdf/ YRBS_trend_interpretation.pdf.

3. SUDAAN, release 11.0.0 [computer software]. Research Triangle Park, NC: RTI International; 2012.

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Acknowledgments

Overall responsibility for planning and coordinating the content of this volume rested with the National Center for Health Statistics(NCHS) Office of Analysis and Epidemiology, under the direction of Julia S. Holmes and Irma E. Arispe.

Production of Health, United States, 2014 was managed by Sheila J. Franco, Virginia M. Freid, and Julia S. Holmes. Preparation of the volume, including highlights, trend tables, appendixes, and index was completed by Mary Ann Bush, La-Tonya D. Curl, Anne K. Driscoll, Catherine R. Duran, Sheila J. Franco, Virginia M. Freid , Nancy Han, Hashini S. Khajuria, Ji-Eun Kim, Xianfen Li, Anita L. Powell, Ilene B. Rosen, and Naga Shanmugam. Administrative and word processing assistance was provided by Lillie C. Featherstone.

Production of the Chartbook was managed by Sheila J. Franco and Virginia M. Freid. The Special Feature on Adults Aged 5564 was prepared and written by Virginia M. Freid with Ji-Eun Kim. Data and analysis for specific charts were provided by Sheila J. Franco, Virginia M. Freid, Hashini S. Khajuria, and Ji-Eun Kim. Technical assistance and programming were provided by Mary Ann Bush, La-Tonya D. Curl, Catherine R. Duran, Nancy Han, and Xianfen Li.

Publication production was performed by CDC/OSELS/ NCHS/OD/Office of Information Services, Information Design and Publishing Staff (IDPS). Project management was provided by Elom L. Lawson and Barbara J. Wassell. Editorial review was provided by Jane Sudol, Barbara J. Wassell, and Danielle Woods. Graphic design was provided by Odell D. Eldridge (contractor) and Kyung M. Park. Layout and production were done by Jacqueline M. Davis and Zung T. Le. Overview for IDPS publications and electronic products was provided by Kimberly N. Ross and Tommy C. Seibert, Jr. Printing was managed by Nathanael Brown, CDC/OD/OADC.

Electronic access through the NCHS website was provided by Christine J. Brown, Jacqueline M. Davis, Virginia M. Freid, Hashini S. Khajuria, Ji-Eun Kim, Elom L. Lawson, Zung T. Le, Anthony Lipphardt, Jennifer A. Moore, Kyung M. Park, Anita L. Powell, Anthony R. Quintana, Ilene B. Rosen, and Barbara J. Wassell.

Data and technical assistance were provided by staff of the following NCHS organizations: Division of Health Care Statistics: Susan M. Schappert; Division of Health and Nutrition Examination Surveys: Naman Ahluwalia, Margaret D. Carroll, Mark S. Eberhardt, Qiuping Gu, Brian K. Kit, Cynthia L. Ogden, Ryne Paulose-Ram, and Sung Sug (Sarah) Yoon; Division of Health Interview Statistics: Patricia F. Adams, Veronica E. Benson, Lindsey Black, Debra Blackwell, Barbara Bloom, Tainya Clarke, Robin A. Cohen, Gulnur Freeman, Jacqueline Lucas, Michael Martinez, Colleen Nugent, Jeannine Schiller, Charlotte Schoenborn, Maria Villarroel, and Brian Ward; Division of Vital Statistics: Robert N. Anderson,

Acknowledgments vi

Joyce A. Arbertha, Elizabeth Arias, Amy M. Branum, Melonie Heron, Jo Jones, Sharon E. Kirmeyer, Kenneth D. Kochanek, Annie Liu, Marian F. MacDorman, Joyce A. Martin, T. J. Mathews, Arialdi M. Minino, Jaleh Mousavi, Sherry L. Murphy, Steven J. Steimel, Betzaida Tejada-Vera, and Elizabeth C. Wilson; Office of Analysis and Epidemiology: Li-Hui Chen, Catherine R. Duran, Deborah D. Ingram, Laura A. Pratt, Cheryl V. Rose, and Ritu Tuteja; Office of the Center Director: Juan Albertorio and Francis C. Notzon; and Office of Research and Methodology: Meena Khare.

Additional data and technical assistance were provided by the following organizations of the Centers for Disease Control and Prevention (CDC): National Center for Chronic Disease Prevention and Health Promotion: Karen Pazol; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Lori Elmore, Anna Satcher Johnson, Laura Kann, Steve Kinchen, Jennifer A. Ludovic, and the Surveillance and Data Management Branch; Office of Public Health Scientific Services, Center for Surveillance, Epidemiology, and Laboratory Services: Ruth Ann Jajosky; National Institute for Occupational Safety and Health: Roger Rosa; by the following organizations within the Department of Health and Human Services: Agency for Healthcare Research and Quality: Roxanne Andrews, Anne Elixhauser, and Steven R. Machlin; Centers for Medicare & Medicaid Services: Catherine A. Curtis, Tony Dean, Maria Diacogiannis, Nathan Espinosa, Micah Hartman, Deborah W. Kidd, Barbara S. Klees, David Lassman, Anne Martin, Maggie S. Murgolo, Arun Natarajan, Joseph F. Regan, Jeffrey S. Silverman, Christopher J. Truffer, and Lekha Whittle; National Institutes of Health: Kathy Cronin, Bruce Dye, Paul Eggers, Lloyd Johnston, Marsha Lopez, the Monitoring the Future Team, and Anne-Michelle Noone; Substance Abuse and Mental Health Services Administration: Beth Han, Kevin Hennessey, Sharon Larson, Neil Russell, and Judith Teich; and by the following governmental and nongovernmental organizations: U.S. Census Bureau: Bernadette D. Proctor and Danielle Taylor; Bureau of Labor Statistics: Elizabeth Ashack, Christen Byler, and Audrey Watson; Department of Veterans Affairs: Tom Garin, Pheakdey Lim, and Dat Tran; American Association of Colleges of Pharmacy: Danielle A. Taylor and Jamie N. Taylor; American Association of Colleges of Osteopathic Medicine: Lisa M. Cole; American Association of Colleges of Podiatric Medicine: Moraith G. North; American Dental Education Association: Sylvia M. Zeno; American Medical Association Physician Masterfile: Cheryl Ashe; Association of American Medical Colleges: Brianna Gunter and Will Weiler; Association of Schools and Colleges of Optometry: Joanne Zuckerman; Association of Schools & Programs of Public Health: Christine M. Plepys; Cowles Research Group: C. McKeen Cowles; and NOVA Research Company: Shilpa Bengeri.


Contents

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

List of Chartbook Figures . . . . . . . . . . . . . . . . . . . . . . . . . xi

List of Trend Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

At a Glance Table and Highlights At a Glance Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Special Feature on Adults Aged 5564 . . . . . . . . . . . . 4 Health Status and Determinants . . . . . . . . . . . . . . . . . 4

Life Expectancy and Mortality . . . . . . . . . . . . . . . . . 4 Fertility and Natality. . . . . . . . . . . . . . . . . . . . . . . . . 4 Health Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Measures of Health and Disease Prevalence. . . . . . 5

Utilization of Health Resources . . . . . . . . . . . . . . . . . . 5 Use of Health Care Services . . . . . . . . . . . . . . . . . . . 5 Use of Preventive Medical Care Services. . . . . . . . . 6 Nonreceipt of Needed Medical Care, Prescription

Drugs, and Dental Care Due to Cost . . . . . . . . . . . 6 Health Care Resources . . . . . . . . . . . . . . . . . . . . . . . . . 6 Health Care Expenditures and Payers . . . . . . . . . . . . . 6

Health Care Expenditures . . . . . . . . . . . . . . . . . . . . 6 Health Care Payers . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Health Insurance Coverage . . . . . . . . . . . . . . . . . . . 7

Chartbook With Special Feature on Adults Aged 5564 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Life Expectancy at Birth . . . . . . . . . . . . . . . . . . . . . . . . 10 Infant Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Selected Causes of Death . . . . . . . . . . . . . . . . . . . . . . 11 Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Natality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Teenage Childbearing . . . . . . . . . . . . . . . . . . . . . . . . . 12

Morbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Diabetes Prevalence. . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Disability Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Basic Actions Difficulty and Complex Activity

Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13


Health Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Current Cigarette Smoking . . . . . . . . . . . . . . . . . . . . . 13 Uncontrolled High Blood Pressure . . . . . . . . . . . . . . . 14 Obesity Among Children and Adolescents. . . . . . . . . 14 Overweight and Obesity Among Adults. . . . . . . . . . . 15

Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Influenza and Pneumococcal Vaccination . . . . . . . . . 15 Vaccination Coverage Among Children

Aged 1935 Months. . . . . . . . . . . . . . . . . . . . . . . . . . 16 Colorectal Tests and Procedures . . . . . . . . . . . . . . . . . 16

Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Coverage Among Adults Aged 1864. . . . . . . . . . . . . 17 Coverage Among Adults Aged 1925. . . . . . . . . . . . . 17

Utilization and Access . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Emergency Department Use . . . . . . . . . . . . . . . . . . . . 18 Delay or Nonreceipt of Needed Medical Care or

Nonreceipt of Needed Dental Care Due to Cost . . . 18

Personal Health Care Expenditures . . . . . . . . . . . . . . . . . 19 Major Source of Funds . . . . . . . . . . . . . . . . . . . . . . . . . 19

Special Feature on Adults Aged 5564 . . . . . . . . . . . . . 22 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Profile of the 5564 Age Group . . . . . . . . . . . . . . . . . . 24 Leading Causes of Death . . . . . . . . . . . . . . . . . . . . . . 25 Selected Chronic Conditions . . . . . . . . . . . . . . . . . . . 26 Psychological Distress: Serious or Mild-moderate . . . 27 Current Cigarette Smoking . . . . . . . . . . . . . . . . . . . . . 28 Leisure-time Physical Activity . . . . . . . . . . . . . . . . . . . 29 Health Insurance Coverage . . . . . . . . . . . . . . . . . . . . . 30 Health Care Utilization . . . . . . . . . . . . . . . . . . . . . . . . . 31 Use of Preventive and Screening Services . . . . . . . . . 32 Prescription Drug Use . . . . . . . . . . . . . . . . . . . . . . . . . 33 Delay or Nonreceipt of Medical Care or Nonreceipt of

Prescription Drugs Due to Cost . . . . . . . . . . . . . . . . 34 Data Tables for Special Feature: Figures 2029. . . . . . 35 Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Contents ix

Trend Tables Health Status and Determinants . . . . . . . . . . . . . . . . . . . 53

Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Fertility and Natality. . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Determinants and Measures of Health . . . . . . . . . . . . 147

Utilization of Health Resources . . . . . . . . . . . . . . . . . . . . 225 Ambulatory Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Inpatient Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Health Care Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Health Care Expenditures and Payers . . . . . . . . . . . . . . . 302 National Health Expenditures . . . . . . . . . . . . . . . . . . . 302 Health Care Coverage and Major Federal Programs . . . 322 State Health Expenditures and Health Insurance. . . . 344

Appendixes Appendix Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

Appendix I. Data Sources . . . . . . . . . . . . . . . . . . . . . . . . 357

Appendix II. Definitions and Methods . . . . . . . . . . . . . . 394

Index Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449

Contents Health, United States, 2014 x

List of Chartbook Figures

Mortality Figure 1. Life expectancy at birth, by selected characteristics: United States, 19802013 . . . . . . . . . . . . 10

Figure 2. Infant, neonatal, and postneonatal mortality rates: United States, 20032013 . . . . . . . . . . . . . . . . . . . . 10

Figure 3. Age-adjusted death rates for selected causes of death for all ages, by sex: United States, 20032013 . . . . 11

Figure 4. Suicide death rates, by sex and age: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Natality Figure 5. Teenage childbearing, by maternal age and race and Hispanic origin: United States, 20032013 . . . . . . . . 12

Morbidity Figure 6. Diagnosed and undiagnosed diabetes prevalence among adults aged 20 and over, by age: United States 19881994 and 20092012 . . . . . . . . . . . . . . . . . . . . . . . . 12

Disability Measures Figure 7. Basic actions difficulty and complex activity limitation among adults aged 18 and over, by sex and age: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . 13

Health Risk Factors Figure 8. Current cigarette smoking among high school seniors and adults aged 18 and over, by sex and age: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . . . . . 13

Figure 9. Uncontrolled high blood pressure among adults aged 20 and over with hypertension, by sex and age: United States, 19881994 through 20092012 . . . . . . . . 14

Figure 10. Obesity among children and adolescents, by sex and age: United States, 20092012. . . . . . . . . . . . . . . 14

Figure 11. Overweight and obesity among adults aged 20 and over, by sex: United States, 19881994 through 20092012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Prevention Figure 12. Influenza and pneumococcal vaccination among noninstitutionalized adults aged 18 and over, by type of vaccination and age: United States, 20032013. . . . . . . . 15

Figure 13. Vaccination coverage for combined series (4:3:1:3*:3:1:4) among children aged 1935 months by race and ethnicity and poverty level: United States, 2013. . . . 16

Figure 14. Colorectal tests and procedures among adults aged 5075, by race and ethnicity: United States, 2003 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16


Health Insurance Figure 15. Health insurance coverage among adults aged 1864, by type of coverage: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 16. Health insurance coverage among adults aged 1925, by type of coverage: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Utilization and Access Figure 17. One or more emergency department visits in the past 12 months, by age and type of coverage: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . . . . . 18

Figure 18. Delay or nonreceipt of needed medical care or nonreceipt of needed dental care in the past 12 months due to cost among adults aged 1864, by percent of poverty level: United States, 20032013. . . . . . . . . . . . . . 18

Personal Health Care Expenditures Figure 19. Personal health care expenditures, by source of funds: United States, 20032013. . . . . . . . . . . . . . . . . . 19

Special Feature on Adults Aged 5564 Figure 20. Death rates for leading causes of death among adults aged 5564, by sex: United States, 20032013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Figure 21. Selected chronic conditions among adults aged 5564: United States, 19992002 and 20092012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Figure 22. Serious or mild-moderate psychological distress in the past 30 days among adults aged 5564, by selected characteristics: United States, average annual 20022003 and 20122013 . . . . . . . . . . . . . . . . . . . . . . . . 27

Figure 23. Current cigarette smoking among adults aged 5564, by selected characteristics: United States, average annual 20022003 and 20122013. . . . . . . . . . . 28

Figure 24. Participation in recommended levels of leisure-time aerobic and muscle-strengthening activities among adults aged 5564, by selected characteristics: United States, average annual 20022003 and 20122013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Figure 25. Health insurance coverage among adults aged 5564, by percent of poverty level and type of coverage: United States, average annual 20022003 and 20122013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Figure 26. Health care utilization in the past 12 months among adults aged 5564, by type of visit: United States, average annual 20022003 and 20122013. . . . . . . . . . . 31

Figure 27. Use of preventive services and screening among noninstitutionalized adults aged 5564: United States, 2003 and 2013 . . . . . . . . . . . . . . . . . . . . . . 32

Contents xi

Figure 28. Prescription drug use in the past 30 days among adults aged 5564, by number of drugs and selected drug class: United States, 19992002 and 20092012 . . . . . . . 33

Figure 29. Adults aged 5564 who delayed or did not receive needed medical care or needed prescription drugs due to cost in the past 12 months, by insurance status: United States, average annual 20022003 and 20122013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Contents Health, United States, 2014 xii

Summary List of Trend Tables by Topic Tables 1123

Population (Tables 1 and 2)

Resident population Persons in poverty

Fertility and Natality (Tables 310)

Births Low birthweight Breastfeeding and more . . .

Mortality (Tables 1136)

Infant mortality Life expectancy Death rates, by cause and more . . .

Determinants and Measures of Health (Tables 3766)

Health status Cigarette smoking Alcohol consumption High blood pressure Overweight and obesity and more . . .

Ambulatory Care (Tables 6786)

Visits: health care, dentists, emergency departments and more . . . Prevention: mammograms, pap smears, vaccinations

Inpatient Care (Tables 8791)

Hospital stays and procedures Nursing homes and more . . .

Personnel (Tables 9297)

Physicians Dentists Nurses Health professions school enrollment and more . . .

Facilities (Tables 98101)

Hospitals Nursing homes and more . . .

National Health Expenditures (Tables 102110)

Personal health expenditures Out-of-pocket costs Prescription drug expenditures Nursing home costs and more . . .

Health Care Coverage and Major Federal Programs (Tables 111120)

Insurance coverage Medicare Medicaid Private coverage Uninsured

and more . . .

State Health Expenditures and Health Insurance (Tables 121123)

Medicare, Medicaid, managed care expenditures and enrollees

Uninsured persons

List of Trend Tables

Health Status and Determinants

Population Table 1. Resident population, by age, sex, race, and Hispanic origin: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Table 2. Persons below poverty level, by selected characteristics, race, and Hispanic origin: United States, selected years 19732013 . . . . . . . . . . . . . . . . . . . . . . . . 56

Fertility and Natality Table 3. Crude birth rates, fertility rates, and birth rates, by age, race, and Hispanic origin of mother: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . 58

Table 4. Teenage childbearing, by age and detailed race and Hispanic origin of mother: United States, selected years 19702013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Table 5. Nonmarital childbearing, by detailed race and Hispanic origin of mother, and maternal age: United States, selected years 19702013 . . . . . . . . . . . . 63

Table 6. Low birthweight live births, by detailed race and Hispanic origin of mother: United States, selected years 19702013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Table 7. Low birthweight live births, by race and Hispanic origin of mother, state, and territory: United States and U.S. dependent areas, 20002002, 20032005, and 20112013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Table 8. Legal abortions, legal abortion rates, and legal abortion ratios: United States and 46 continuous reporting areas, 20022011. . . . . . . . . . . . . . . . . . . . . . . 68

Table 9. Contraceptive use in the past month among women aged 1544, by age, race and Hispanic origin, and method of contraception: United States, selected years 19822013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Table 10. Breastfeeding among mothers aged 1544, by year of baby's birth and selected characteristics of mother: United States, average annual 19861988 through 20052007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Mortality Table 11. Infant, neonatal, postneonatal, fetal, and perinatal mortality rates, by detailed race and Hispanic origin of mother: United States, selected years 19832012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Table 12. Infant mortality rates, by race: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . 78

Table 13. Infant mortality rates, by race and Hispanic origin of mother, state, and territory: United States and U.S. dependent areas, average annual 19891991, 20032005, and 20102012 . . . . . . . . . . . . . . . . . . . . . . 79

Table 14. Infant mortality rates and international rankings: Organisation for Economic Co-operation and Development (OECD) countries, selected years 19602011 . . . . . . . . . 82


Table 15. Life expectancy at birth and at age 65, by sex: Organisation for Economic Co-operation and Development (OECD) countries, selected years 19802012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Table 16. Life expectancy at birth, at age 65, and at age 75, by sex, race, and Hispanic origin: United States, selected years 19002013 . . . . . . . . . . . . . . . . . . . . . . . . 85

Table 17. Age-adjusted death rates, by race, Hispanic origin, state, and territory: United States and U.S. dependent areas, average annual 19791981, 19891991, and 20112013 . . . . . . . . . . . . . . . . . . . . . . 87

Table 18. Age-adjusted death rates for selected causes of death, by sex, race, and Hispanic origin: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . 89

Table 19. Years of potential life lost before age 75 for selected causes of death, by sex, race, and Hispanic origin: United States, selected years 19802013 . . . . . . 93

Table 20. Leading causes of death and numbers of deaths, by sex, race, and Hispanic origin: United States, 1980 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Table 21. Leading causes of death and numbers of deaths, by age: United States, 1980 and 2013 . . . . . . . . 101

Table 22. Age-adjusted death rates, by race, sex, region, and urbanization level: United States, average annual, selected years 19961998 through 20112013 . . . . . . . 103

Table 23. Death rates for all causes, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Table 24. Death rates for diseases of heart, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Table 25. Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . 113

Table 26. Death rates for malignant neoplasms, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Table 27. Death rates for malignant neoplasms of trachea, bronchus, and lung, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . 120

Table 28. Death rates for malignant neoplasm of breast among females, by race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . 123

Table 29. Death rates for human immunodeficiency virus (HIV) disease, by sex, race, Hispanic origin, and age: United States, selected years 19872013 . . . . . . . . . . . . 125

Table 30. Death rates for drug poisoning and drug poisoning involving opioid analgesics, by sex, age, race, and Hispanic origin: United States, selected years 19992013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Table 31. Death rates for motor vehicle-related injuries, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . 130

Table 32. Death rates for homicide, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Contents xiii

Table 33. Death rates for suicide, by sex, race, Hispanic origin, and age: United States, selected years 19502013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Table 34. Death rates for firearm-related injuries, by sex, race, Hispanic origin, and age: United States, selected years 19702013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Table 35. Deaths from selected occupational diseases among persons aged 15 and over: United States, selected years 19802013 . . . . . . . . . . . . . . . . . . . . . . . . 144

Table 36. Occupational fatal injuries, by industry, sex, age, race, and Hispanic origin: United States, selected years 20032012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Determinants and Measures of Health Table 37. Selected notifiable disease rates and number of new cases: United States, selected years 19502012. . . 147

Table 38. Human immunodeficiency virus (HIV) diagnoses, by year of diagnosis and selected characteristics: United States, 20082012 . . . . . . . . . . . . . . . . . . . . . . . . 149

Table 39. Health conditions among children under age 18, by selected characteristics: United States, average annual, selected years 19971999 through 20112013 . . . . . . . 151

Table 40. Age-adjusted cancer incidence rates for selected cancer sites, by sex, race, and Hispanic origin: United States, selected geographic areas, selected years 19902011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Table 41. Five-year relative cancer survival rates for selected cancer sites, by race and sex: United States, selected geographic areas, selected years 19751977 through 20042010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Table 42. Respondent-reported prevalence of heart disease, cancer, and stroke among adults aged 18 and over, by selected characteristics: United States, average annual, selected years 19971998 through 20122013 . . . . . . . 161

Table 43. Number of respondent-reported chronic conditions from 10 selected conditions among adults aged 18 and over, by selected characteristics: United States, selected years 20022013 . . . . . . . . . . . . . . . . . . . . . . . . 163

Table 44. Diabetes prevalence and glycemic control among adults aged 20 and over, by sex, age, and race and Hispanic origin: United States, selected years 19881994 through 20092012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Table 45. End-stage renal disease patients, by selected characteristics: United States, selected years 20002012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Table 46. Severe headache or migraine, low back pain, and neck pain among adults aged 18 and over, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Table 47. Disability measures among adults aged 18 and over, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Table 48. Vision limitations among adults aged 18 and over, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

xiv Contents

Table 49. Hearing limitations among adults aged 18 and over, by selected characteristics: United States, selected years 20072013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Table 50. Respondent-assessed fair-poor health status, by selected characteristics: United States, selected years 19912013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Table 51. Serious psychological distress in the past 30 days among adults aged 18 and over, by selected characteristics: United States, average annual, selected years 19971998 through 20122013 . . . . . . . . . . . . . . 180

Table 52. Current cigarette smoking among adults aged 18 and over, by sex, race, and age: United States, selected years 19652013 . . . . . . . . . . . . . . . . . . . . . . . . 182

Table 53. Age-adjusted prevalence of current cigarette smoking among adults aged 25 and over, by sex, race, and education level: United States, selected years 19742013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Table 54. Current cigarette smoking among adults aged 18 and over, by sex, race, Hispanic origin, age, and education level: United States, average annual, selected years 19901992 through 20112013 . . . . . . . . . . . . . . 185

Table 55. Use of selected substances in the past month among persons aged 12 and over, by age, sex, race, and Hispanic origin: United States, selected years 20022013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Table 56. Use of selected substances in the past 30 days among 12th graders, 10th graders, and 8th graders, by sex and race: United States, selected years 19802013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

Table 57. Health risk behaviors among students in grades 912, by sex, grade level, race, and Hispanic origin: United States, selected years 19912013 . . . . . . 193

Table 58. Heavier drinking and drinking five or more drinks in a day among adults aged 18 and over, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

Table 59. Selected health conditions and risk factors, by age: United States, selected years 19881994 through 20112012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Table 60. Hypertension among adults aged 20 and over, by selected characteristics: United States, selected years 19881994 through 20092012 . . . . . . . . . . . . . . 201

Table 61. Cholesterol among adults aged 20 and over, by selected characteristics: United States, selected years 19881994 through 20092012 . . . . . . . . . . . . . . . . . . . 203

Table 62. Mean macronutrient intake among adults aged 20 and over, by sex and age: United States, selected years 19881994 through 20092012 . . . . . . . 207

Table 63. Participation in leisure-time aerobic and muscle-strengthening activities that meet the federal 2008 Physical Activity Guidelines for Americans among adults aged 18 and over, by selected characteristics: United States, selected years 19982013 . . . . . . . . . . . . 209


Table 64. Healthy weight, overweight, and obesity among adults aged 20 and over, by selected characteristics: United States, selected years 19881994 through 20092012 . . . . . . . . . . . . . . . . . . . 214

Table 65. Obesity among children and adolescents aged 219 years, by selected characteristics: United States, selected years 19881994 through 20092012 . . . . . . . 221

Table 66. Untreated dental caries, by selected characteristics: United States, selected years 19881994 through 20112012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Utilization of Health Resources

Ambulatory Care Table 67. No usual source of health care among children under age 18, by selected characteristics: United States, average annual, selected years 19931994 through 20122013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Table 68. No usual source of health care among adults aged 1864, by selected characteristics: United States, average annual, selected years 19931994 through 20122013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Table 69. Delay or nonreceipt of needed medical care, nonreceipt of needed prescription drugs, or nonreceipt of needed dental care during the past 12 months due to cost, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . 229

Table 70. No health care visits to an office or clinic within the past 12 months among children under age 18, by selected characteristics: United States, average annual, selected years 19971998 through 20122013 . . . . . . . 232

Table 71. Health care visits to doctor offices, emergency departments, and home visits within the past 12 months, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Table 72. Vaccination coverage for selected diseases among children aged 1935 months, by race, Hispanic origin, poverty level, and location of residence in metropolitan statistical area: United States, selected years 19952013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Table 73. Vaccination coverage for selected diseases among adolescents aged 1317, by selected characteristics: United States, 20082013 . . . . . . . . . . . 240

Table 74. Influenza vaccination among adults aged 18 and over, by selected characteristics: United States, selected years 19892013 . . . . . . . . . . . . . . . . . . . . . . . . 241

Table 75. Pneumococcal vaccination among adults aged 18 and over, by selected characteristics: United States, selected years 19892013 . . . . . . . . . . . . 243

Table 76. Use of mammography among women aged 40 and over, by selected characteristics: United States, selected years 19872013 . . . . . . . . . . . . 245

Table 77. Use of Pap smears among women aged 18 and over, by selected characteristics: United States, selected years 19872013 . . . . . . . . . . . . . . . . . . . . . . . . 248


Table 78. Use of colorectal tests or procedures among adults aged 5075, by selected characteristics: United States, selected years 20002013 . . . . . . . . . . . . 253

Table 79. Emergency department visits within the past 12 months among children under age 18, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Table 80. Emergency department visits within the past 12 months among adults aged 18 and over, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

Table 81. Initial injury-related visits to hospital emergency departments, by sex, age, and intent and mechanism of injury: United States, average annual, selected years 20052006 through 20102011 . . . . . . . . . . . . . . . . . . . 262

Table 82. Visits to physician offices, hospital outpatient departments, and hospital emergency departments, by age, sex, and race: United States, selected years 19952011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264

Table 83. Visits to primary care generalist and specialty care physicians, by selected characteristics and type of physician: United States, selected years 19802010 . . . 267

Table 84. Dental visits in the past year, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Table 85. Prescription drug use in the past 30 days, by sex, age, race and Hispanic origin: United States, selected years 19881994 through 20092012 . . . . . . . 271

Table 86. Selected prescription drug classes used in the past 30 days, by sex and age: United States, selected years 19881994 through 20092012 . . . . . . . . . . . . . . 273

Inpatient Care Table 87. Persons with hospital stays in the past year, by selected characteristics: United States, selected years 19972013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Table 88. Discharges, days of care, and average length of stay in nonfederal short-stay hospitals, by selected characteristics: United States, selected years 1980 through 20092010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280

Table 89. Discharge rate in nonfederal short-stay hospitals, by sex, age, and selected first-listed diagnosis: United States, selected years 1990 through 20092010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

Table 90. Discharges with at least one procedure in nonfederal short-stay hospitals, by sex, age, and selected procedures: United States, selected years 1990 through 20092010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

Table 91. Hospital admissions, average length of stay, outpatient visits, and outpatient surgery, by type of ownership and size of hospital: United States, selected years 19752012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290

Contents xv

Health Care Resources

Personnel Table 92. Active physicians and physicians in patient care, by state: United States, selected years 19752012. . . . . 291

Table 93. Doctors of medicine, by place of medical education and activity: United States and outlying U.S. areas, selected years 19752012 . . . . . . . . . . . . . . . . . . . 292

Table 94. Doctors of medicine in primary care, by specialty: United States and outlying U.S. areas, selected years 19492012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

Table 95. Active dentists, by state: United States, selected years 19932011 . . . . . . . . . . . . . . . . . . . . . . . . 294

Table 96. Healthcare employment and wages, by selected occupations: United States, selected years 20012013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

Table 97. First-year enrollment and graduates of health professions schools, and number of schools, by selected profession: United States, selected academic years 19801981 through 20122013 . . . . . . . . . . . . . . 296

Facilities Table 98. Hospitals, beds, and occupancy rates, by type of ownership and size of hospital: United States, selected years 19752012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Table 99. Community hospital beds and average annual percent change, by state: United States, selected years 19802012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298

Table 100. Occupancy rates in community hospitals and average annual percent change, by state: United States, selected years 19802012 . . . . . . . . . . . . . . . . . . . . . . . . 299

Table 101. Nursing homes, beds, residents, and occupancy rates, by state: United States, selected years 19952013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300

Health Care Expenditures and Payers

National Health Expenditures Table 102. Gross domestic product, national health expenditures, per capita amounts, percent distribution, and average annual percent change: United States, selected years 19602013 . . . . . . . . . . . . . . . . . . . . . . . . 302

Table 103. National health expenditures, average annual percent change, and percent distribution, by type of expenditure: United States, selected years 19602013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304

Table 104. Personal health care expenditures, by source of funds and type of expenditure: United States, selected years 19602013 . . . . . . . . . . . . . . . . . . . . . . . . 306

Table 105. Cost of hospital discharges with common hospital operating room procedures in nonfederal community hospitals, by age and selected principal procedure: United States, selected years 20002012. . . 309

xvi Contents

Table 106. Expenses for health care and prescribed medicine, by selected population characteristics: United States, selected years 19872011 . . . . . . . . . . . . 312

Table 107. Sources of payment for health care, by selected population characteristics: United States, selected years 19872011 . . . . . . . . . . . . . . . . . . . . . . . . 315

Table 108. Out-of-pocket health care expenses among persons with medical expenses, by age: United States, selected years 19872011 . . . . . . . . . . . . . . . . . . . . . . . . 318

Table 109. National health expenditures and percent distribution, by sponsor: United States, selected years 19872013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

Table 110. Employers' costs per employee-hour worked for total compensation, wages and salaries, and health insurance, by selected characteristics: United States, selected years 19992014 . . . . . . . . . . . . . . . . . . . . . . . . 321

Health Care Coverage and Major Federal Programs Table 111. Private health insurance coverage among persons under age 65, by selected characteristics: United States, selected years 19842013 . . . . . . . . . . . . 322

Table 112. Private health insurance coverage obtained through the workplace among persons under age 65, by selected characteristics: United States, selected years 19842013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325

Table 113. Medicaid coverage among persons under age 65, by selected characteristics: United States, selected years 19842013 . . . . . . . . . . . . . . . . . . . . . . . . 328

Table 114. No health insurance coverage among persons under age 65, by selected characteristics: United States, selected years 19842013 . . . . . . . . . . . . . . . . . . . . . . . . 331

Table 115. Health insurance coverage of noninstitutionalized Medicare beneficiaries aged 65 and over, by type of coverage and selected characteristics: United States, selected years 19922012 . . . . . . . . . . . . 334

Table 116. Medicare enrollees and expenditures and percent distribution, by Medicare program and type of service: United States and other areas, selected years 19702013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336

Table 117. Medicare beneficiaries, by race, Hispanic origin, and selected characteristics: United States, selected years 19922011 . . . . . . . . . . . . . . . . . . . . . . . . 338

Table 118. Medicaid beneficiaries and payments, by basis of eligibility, and race and Hispanic origin: United States, selected fiscal years 19992011 . . . . . . . 340

Table 119. Medicaid beneficiaries and payments, by type of service: United States, selected fiscal years 19992011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342

Table 120. Department of Veterans Affairs health care expenditures and use, and persons treated, by selected characteristics: United States, selected fiscal years 20002013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343


State Health Expenditures and Health Insurance Table 121. Medicare enrollees, enrollees in managed care, payment per fee-for-service enrollee, and short-stay hospital utilization, by state: United States, 1994 and 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344

Table 122. Medicaid beneficiaries, beneficiaries in managed care, and payments per beneficiary, by state: United States, selected fiscal years 20002011 . . . . . . . 346

Table 123. Persons under age 65 without health insurance coverage, by age, state, and territory: United States and Puerto Rico, 20092013. . . . . . . . . . . 347

Health, United States, 2014 Contents xvii

At a Glance Table and Highlights

Health, United States, 2014: At a Glance

Value (year)


Figure/Table No.

Life Expectancy and Mortality

Life Expectancy, in years Table 16

At birth 76.8 (2000) 78.8 (2012) 78.8 (2013)

Infant deaths per 1,000 live births Figure 2/Table 12

All infants 6.91 (2000) 5.98 (2012) 5.96 (2013)

Deaths per 100,000 population, age-adjusted Table 18

All causes 869.0 (2000) 732.8 (2012) 731.9 (2013) Heart disease 257.6 (2000) 170.5 (2012) 169.8 (2013) Cancer 199.6 (2000) 166.5 (2012) 163.2 (2013) Chronic lower respiratory diseases 44.2 (2000) 41.5 (2012) 42.1 (2013) Unintentional injuries 34.9 (2000) 39.1 (2012) 39.4 (2013) Stroke 60.9 (2000) 36.9 (2012) 36.2 (2013) Alzheimers disease 18.1 (2000) 23.8 (2012) 23.5 (2013) Diabetes 25.0 (2000) 21.2 (2012) 21.2 (2013) Influenza and pneumonia 23.7 (2000) 14.4 (2012) 15.9 (2013) Nephritis, nephrotic syndrome and nephrosis 13.5 (2000) 13.1 (2012) 13.2 (2013) Suicide 10.4 (2000) 12.6 (2012) 12.6 (2013)

Morbidity and Risk Factors

Fair or poor health, percent Table 50

All ages 8.9 (2000) 10.3 (2012) 10.2 (2013) 65 years and over 26.9 (2000) 22.7 (2012) 23.1 (2013)

Heart disease (ever told), percent Table 42

18 years and over 11.3 (20002001) 11.6 (20102011) 11.4 (20122013) 65 years and over 30.9 (20002001) 30.5 (20102011) 29.8 (20122013)

Cancer (ever told), percent Table 42

18 years and over 5.0 (20002001) 6.3 (20102011) 6.4 (20122013) 65 years and over 15.2 (20002001) 18.5 (20102011) 18.4 (20122013)

Hypertension,1 percent Table 60

20 years and over 30.2 (19992002) 32.1 (20032006) 32.2 (20092012)

Diabetes,2 percent Table 44

20 years and over 9.8 (19992002) 10.9 (20032006) 12.3 (20092012)

Hypercholesterolemia,3 percent Table 61

20 years and over 25.0 (19992002) 28.0 (20032006) 29.5 (20092012)

Obese, percent Figure 10/ Tables 64 and 65

Obese,4 20 years and over 30.5 (19992002) 33.5 (20032006) 35.5 (20092012) Obese (BMI at or above sex- and age-specific 95th percentile): 25 years 10.3 (19992002) 12.5 (20032006) 10.2 (20092012) 611 years 15.9 (19992002) 17.0 (20032006) 17.9 (20092012) 1219 years 16.0 (19992002) 17.6 (20032006) 19.4 (20092012)

Cigarette smoking, percent Table 52

18 years and over 23.2 (2000) 18.1 (2012) 17.8 (2013)

Aerobic activity and muscle strengthening,5 percent meeting both guidelines

18 years and over 15.1 (2000) 20.3 (2012) 20.4 (2013) Table 63

1Having measured high blood pressure (systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg) and/or respondent report of taking antihypertensive medication. 2Includes physician-diagnosed and undiagnosed diabetes (fasting plasma glucose of at least 126 mg/dL or a hemoglobin A1c of at least 6.5%). 3Having high serum total cholesterol of 240 mg/dL or greater and/or respondent report of taking cholesterol-lowering medication. 4Obesity is a body mass index (BMI) greater than or equal to 30 for adults. Height and weight are measured rather than self-reported. 5Federal guidelines recommend at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity a week and muscle-strengthening activities at least twice a week.

2 At a Glance Health, United States, 2014

Health, United States, 2014: At a Glance

Value (year)


Figure/Table No.

Health Care Utilization

No health care visit in past 12 months, percent Table 71

Under 18 years 12.3 (2000) 8.1 (2012) 8.2 (2013) 1844 years 23.4 (2000) 24.7 (2012) 24.8 (2013) 4564 years 14.9 (2000) 15.1 (2012) 15.2 (2013) 65 years and over 7.4 (2000) 6.1 (2012) 6.4 (2013)

Emergency room visit in past 12 months, percent Tables 79 and 80


Dental visit in past year, percent Table 84

217 years 74.1 (2000) 82.3 (2012) 83.0 (2013) 1864 years 65.1 (2000) 61.6 (2012) 61.7 (2013) 65 years and over 56.6 (2000) 61.8 (2012) 60.6 (2013)

Prescription drug in past 30 days, percent Table 85


Hospitalization in past year, percent Table 87

1844 years 7.0 (2000) 6.1 (2012) 6.1 (2013) 4564 years 8.4 (2000) 8.0 (2012) 7.8 (2013) 65 years and over 18.2 (2000) 15.9 (2012) 15.3 (2013)

Health Insurance and Access to Care

Uninsured, percent Table 114

Under 65 years Under 18 years 1844 years

1925 years 4564 years

17.0 (2000) 12.6 (2000) 22.4 (2000) 32.3 (2000) 12.6 (2000)

16.9 (2012) 6.6 (2012)

24.8 (2012) 26.3 (2012) 15.6 (2012)

16.7 (2013) 6.6 (2013)

24.2 (2013) 26.7 (2013) 15.4 (2013)

Delay or nonreceipt of needed medical care in past 12 months due to cost, percent Table 69

Under 18 years 1844 years 4564 years 65 years and over

4.6 (2000) 9.5 (2000) 8.8 (2000) 4.5 (2000)

3.2 (2012) 12.7 (2012) 14.0 (2012) 4.1 (2012)

3.1 (2013) 11.9 (2013) 13.2 (2013) 4.2 (2013)


Patient care physicians per 10,000 population6 Table 92

United States 22.7 (2000) 26.1 (2011) 26.9 (2012) Highest state 54.5 (DC) (2000) 68.3 (DC) (2011) 65.9 (DC) (2012) Lowest state 14.4 (ID) (2000) 17.7 (ID) (2011) 18.0 (ID,MS) (2012)

Community hospital beds per 1,000 population7 Table 99

United States 2.9 (2000) 2.6 (2011) 2.6 (2012) Highest state 6.0 (ND) (2000) 5.9 (DC) (2011) 5.7 (DC) (2012) Lowest state 1.9 (NM,NV,OR,UT,WA) (2000) 1.7 (WA) (2011) 1.7 (OR) (2012)

Health Care Expenditures

Personal health care expenditures, in dollars Table 104

Total, in trillions $1.2 (2000) $2.4 (2012) $2.5 (2013) Per capita $4,129 (2000) $7,597 (2012) $7,826 (2013)

6Copyright 2014. Used with permission of the American Medical Association. 7Copyright 2014. Used with permission of Health Forum LLC, an affiliate of the American Hospital Association.

NOTES: Estimates in this table are taken from the PDF, printed, or spreadsheet versions of the cited tables. For more information and the spreadsheet versions of the tables, see the complete report, Health, United States, 2014, available from: http://www.cdc.gov/nchs/hus.htm.

3 Health, United States, 2014 At a Glance
http://www.cdc.gov/nchs/hus.htm

Highlights

This section presents selected data from this year's Special Feature on the health of the population aged 5564 and from the four major areas included in the report: health status and determinants, utilization of health resources, health care resources, and health care expenditures and payers. The section focuses on topics of public health importance and illustrates the breadth of material included in Health, United States. Each highlight includes a reference to the detailed trend table, spreadsheet file, or figure where more information can be obtained.

Special Feature on Adults Aged 5564

All-cause death rates in 2013 for those aged 5564 were 6% lower for men and 11% lower for women than in 2003, driven by decreases in death rates for cancer and heart disease (Figure 20).

In 20122013, 18.1% of noninstitutionalized adults aged 5564 were current cigarette smokers, 8% lower than the percentage in 20022003 (19.7%) (Figure 23).

For adults aged 5564, the percentage with private health insurance was lower for all family income groups in 2012 2013 compared with 20022003, with the largest loss of private coverage occurring for those with family income below 200% of the poverty level (Figure 25).

In 20092012, the percentage of adults aged 5564 who took no, 14, or 5 or more prescription drugs in the past 30 days was similar to levels in 19992002; use of prescription cholesterol-lowering drugs was 54% higher among 55- to 64-year-olds in 20092012 (31.8%) compared with 19992002 (20.6%) (Figure 28).

Health Status and Determinants

Life Expectancy and Mortality

In 2013, life expectancy at birth in the United States for the total population was 78.8 years76.4 years for males and 81.2 years for females (Table 16).

Between 2003 and 2013, life expectancy at birth increased 1.9 years for males and 1.5 years for females. The gap in life expectancy between males and females narrowed from 5.2 years in 2003 to 4.8 years in 2013 (Table 16).

Between 2003 and 2013, life expectancy at birth increased more for the black than for the white population, thereby narrowing the gap in life expectancy between these two racial groups. In 2003, life expectancy at birth for the white population was 5.3 years longer than for the black

Highlights 4

population; by 2013, the difference had narrowed to 3.6 years (Table 16).

Between 2003 and 2013, the infant mortality rate decreased 13%, from 6.85 to 5.96 deaths per 1,000 live births. In 2003, the infant mortality rate for white mothers was 5.72, compared with 14.01 for black mothers; by 2013, the infant mortality rate declined to 5.07 among white mothers and 11.22 among black mothers (Table 12).

In 2013, the 10 leading causes of death were heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimers disease, diabetes, influenza and pneumonia, nephritis, and suicide. These 10 causes of death accounted for 74% of the 2.6 million deaths in 2013 (Table 20).

Between 2003 and 2013, the age-adjusted heart disease death rate decreased 28%, from 236.3 to 169.8 deaths per 100,000 population. In 2013, 24% of all deaths in the United States were from heart disease (Tables 20 and 24).

Between 2003 and 2013, the age-adjusted cancer death rate decreased 15%, from 190.9 to 163.2 deaths per 100,000 population. In 2013, 23% of all deaths in the United States were from cancer (Tables 20 and 26).

Between 2003 and 2013, the age-adjusted suicide death rate increased 17%, from 10.8 to 12.6 deaths per 100,000 population. In 2013, 17% of deaths among those aged 1524 and 11% of deaths among those aged 2544 were from suicide (Tables 21 and 33).

Between 2003 and 2013, the age-adjusted drug poisoning death rate involving opioid analgesics increased from 2.9 to 5.1 deaths per 100,000 population. In 2013, the drug poisoning death rate involving opioid analgesics was highest among those aged 4554 (10.6), followed by those aged 3544 (8.6), 2534 (7.5), and 5564 (7.5) (Table 30).

Fertility and Natality

Between 2003 and 2013, the birth rate among teenagers aged 1519 fell 36%, from 41.1 to 26.5 live births per 1,000 femalesa record low for the United States (Table 3).

The percentage of low-birthweight births (infants weighing less than 2,500 grams [5.5 pounds] at birth) was 8.02% in 2013, down 3% from the recent high of 8.26% in 2006 (Table 6).


Health Risk Factors

Children

In 20092012, the prevalence of obesity among children aged 25 years was 10.2%, 17.9% among children aged 611, and 19.4% among adolescents aged 1219 (Table 65 and Figure 10).

In 2013, 16.3% of 12th graders, 9.1% of 10th graders, and 4.5% of 8th graders had smoked cigarettes in the past 30 days. Smoking prevalence declined for all grades from 2003 levels, when 24.4% of 12th graders, 16.7% of 10th graders, and 10.2% of 8th graders reported smoking cigarettes in the past 30 days (Table 56).

In 2013, 24.7% of students in grades 912 reported they were in a physical fight during the past year, and the percentage was higher among male students (30.2%) than female students (19.2%) (Table 57).

In 2013, 21.9% of students in grades 912 rode in a car in the past 30 days with a driver who had been drinking alcohol, down from 30.2% in 2003 (Table 57).

Adults

In 2013, 20.4% of adults aged 18 and over met the 2008 federal physical activity guidelines for both aerobic activity and muscle strengthening (Table 63).

Between 19881994 and 20092012, the percentage of adults aged 20 and over with grade 1 obesity (a body mass index [BMI] of 30.034.9) increased from 14.8% to 20.4%. Those with grade 2 obesity (BMI of 35.039.9) rose from 5.2% to 8.6%, and those with grade 3 or higher obesity (BMI of 40 or higher) doubled, from 3.0% to 6.3% (percentages are age-adjusted) (Table 64).

In 2013, 17.8% of noninstitutionalized adults aged 18 and over were current cigarette smokers, a decline from 2000 (23.2%). Men (20.5%) were more likely than women (15.3%) to be current cigarette smokers (Table 52).

Measures of Health and Disease Prevalence

In 20112013, 5.3% of children under age 18 had an asthma attack in the past year, and 5.6% had a food allergy (Table 39).

Among children aged 517, 10.1% were diagnosed with attention deficit/hyperactivity disorder and 5.5% had serious emotional or behavioral difficulties in 20112013 (Table 39).

In 2013, the percentage of noninstitutionalized adults who reported their health as fair or poor ranged from 6.2% of those aged 1844 to 27.6% of those aged 75 and over (Table 50).


In 2013, 58.9% of noninstitutionalized adults aged 65 and over reported having at least one basic actions difficulty (e.g., movement, emotional, sensory [seeing or hearing], or cognitive difficulty) and 32.0% of noninstitutionalized adults aged 65 and over reported having at least one complex activity limitation (e.g., self-care, social, or work limitation) (Table 47).

In 20122013, 12.1% of noninstitutionalized adults aged 4564 and 29.8% of noninstitutionalized adults aged 65 and over had ever been told by a physician or other health professional that they had heart disease (Table 42).

In 20122013, 6.7% of noninstitutionalized adults aged 4564 and 18.4% of noninstitutionalized adults aged 65 and over had ever been told by a physician or other health professional that they had cancer (excluding squamous and basal cell skin cancers) (Table 42).

The prevalence of diabetes increases with age. In 2009 2012, 3.7% of adults aged 2044, 16.2% of adults aged 4564, and 26.8% of adults aged 65 and over had diabetes (physician-diagnosed and undiagnosed) (Table 44 and Figure 6).

In 20092012, nearly one-third (32.2%) of adults aged 20 and over had hypertension (diagnosed and undiagnosed). Of adults aged 20 and over with hypertension (diagnosed and undiagnosed), nearly one-half (47.4%) continued to have uncontrolled high blood pressure (Table 60 and Figure 9).

Utilization of Health Resources

Use of Health Care Services

In 2013, 15.8% of persons had no health care visits in the past year, 47.0% had 13 health care visits, 24.5% had 49 visits, and 12.7% had 10 or more visits. Health care visits for illness, preventive care, or an injury include visits to see a health care provider at physician offices, emergency departments, clinics, or some other place, and home visits by health care professionals (Table 71).

In 2011, there were 126 million visits to hospital outpatient departments and 136 million visits to hospital emergency departments (Table 82).

In 2013, 83.0% of children aged 217 years, 61.7% of adults aged 1864, and 60.6% of adults aged 65 and over had visited a dentist in the past year (Table 84).

The percentage of the population taking at least one prescription drug during the past 30 days increased from 39.1% in 19881994 to 47.3% in 20092012. During the same period, the percentage taking three or more prescription drugs rose from 11.8% to 20.6%, and the percentage taking five or more drugs more than doubled, from 4.0% to 10.1% (percentages are age-adjusted) (Table 85).

Highlights 5

Use of Preventive Medical Care Services

In 2013, 70% of children aged 1935 months had completed the combined series of childhood vaccinations (at least 4 doses of diphtheria/tetanus/pertussis vaccine, 3 doses of polio vaccine, 1 dose of measles-containing vaccine, 3 or 4 doses of Haemophilus influenzae type b vaccine depending on product type, 3 doses of hepatitis B vaccine, 1 dose of varicella vaccine, and 4 doses of pneumococcal conjugate vaccine) (Table 72 and Figure 13).

In 2013, 41.0% of noninstitutionalized adults aged 18 and over had received an influenza vaccination in the past year. Influenza vaccination increased with age, with 29.6% of those aged 1849, 46.6% of those aged 5064, and 67.9% of those aged 65 and over reporting an influenza vaccination in the past year (Table 74 and Figure 12).

In 2013, 59.7% of noninstitutionalized adults aged 65 and over ever had a pneumococcal vaccination (Table 75 and Figure 12).

In 2013, two-thirds of women aged 40 and over had a mammogram in the past 2 years. Between 2003 and 2013, mammography use decreased 7% among women aged 4049 (to 59.6% in 2013), 6% among those 5064 (to 71.4%), and 7% among those 75 and over (to 56.5%), while remaining steady among those aged 6574 (75.3% in 2013). Recommendations regarding which age groups should have screening mammograms have changed over time (Table 76).

In 2013, almost 7 of 10 women aged 18 and over had a Pap smear in the past 3 years (69.4%). Those aged 65 and over were less likely to have had a recent Pap smear (42.7%) than those aged 1844 (77.2%) and 4564 (73.9%). Currently, the U.S. Preventive Services Task Force does not recommend Pap smear screening for women aged 65 and over at low risk for cervical cancer (Table 77).

In 2013, almost 6 of 10 adults aged 5075 had the recommended colorectal cancer screening tests (57.8%). Those aged 5075 with at least some college education were more likely to have been screened (63.1%) than those with only a high school diploma or GED (53.4%) or those without a high school diploma (43.5%). Currently, the U.S. Preventive Services Task Force recommends colorectal cancer screening for those aged 5075 (Table 78).

Nonreceipt of Needed Medical Care, Prescription Drugs, and Dental Care Due to Cost

In 2013, among noninstitutionalized persons, 9.1% reported not receiving or delaying needed medical care due to cost, 6.4% reported not receiving needed prescription drugs due to cost, and 11.1% reported not receiving needed dental care due to cost (Table 69).

Among adults aged 1864, the percentage who reported not receiving or delaying seeking needed medical care due

Highlights 6

to cost in the past 12 months increased during 20032010, then was stable during 20102013. Among adults aged 1864, the percentage who reported not receiving needed prescription drugs due to cost in the past 12 months increased during 20032010, then declined during 2010 2013. Among adults aged 1864, the percentage who reported not receiving needed dental care due to cost in the past 12 months increased during 20032010, then was stable through 2013 (Table 69).


In 2012, there were 26.9 physicians in patient care per 10,000 population in the United States. The number of patient care physicians per 10,000 population ranged from 18.0 in Idaho and Mississippi to 41.3 in Massachusetts and 65.9 in the District of Columbia (Table 92).

In 2012, the United States had 4,999 community hospitals and 800,566 community hospital beds. Community hospital occupancy averaged 63.4% in 2012, similar to the levels in 2010 and 2011 (Table 98).

In 2013, there were 15,663 certified nursing homes with 1,697,484 nursing home beds. U.S. nursing home occupancy averaged 80.8% in 2013. Nursing home occupancy rates were highest in North Dakota (92.9%) and the District of Columbia (92.9%) in 2013 (Table 101).

Health Care Expenditures and Payers

Health Care Expenditures

In 2013, personal health care expenditures in the United States totaled $2.5 trillion, a 3.8% increase from 2012. The per capita personal health care expenditure for the total U.S. population was $7,826 in 2013, up from $7,597 in 2012 (Table 102).

Expenditures for hospital care accounted for 38.0% of all personal health care expenditures in 2013. Physician and clinical services accounted for 23.8% of total personal health care expenditures, prescription drugs for 11.0%, and nursing care facilities and continuing care retirement communities for 6.3%; the remainder of spending was for other types of care (Table 103).

In 2013, prescription drug expenditures totaled $271.1 billion, up from $264.4 billion in 2012 (Table 103).

In 2012, the average inflation-adjusted cost for the entire hospitalization involving a heart valve procedure was $52,625, a coronary artery bypass graft procedure was $40,142, cardiac pacemaker or defibrillator insertion or replacement was $35,028, and spinal fusion was $28,190 (Table 105).


Health, United States, 2014 Highlights 7

Health Care Payers

In 2013, 34.3% of all personal health care expenditures were paid by private health insurance, 22.3% were paid by Medicare, and 16.6% by Medicaid; consumers paid 13.7% out of pocket; and the remainder was paid by other types of insurance, payers, and programs (Table 104).

In 2011, children under age 21 accounted for 47.2% of Medicaid recipients but only 19.6% of Medicaid expenditures. The aged and blind and persons with disabilities accounted for 20.3% of Medicaid recipients and 60.6% of Medicaid expenditures (Table 118).

In 2013, the Medicare program had 52.3 million enrollees and expenditures of $582.9 billion, up from 50.9 million enrollees and $574.2 billion expenditures the previous year. Expenditures for the Medicare drug program (Part D) were $69.7 billion in 2013 (Table 116).

Health Insurance Coverage

Between 2003 and 2013, the percentage of adults aged 1864 who were uninsured increased 6% from 19.3% to 20.5% (Table 114).

Based on preliminary data, from 2013 to the second quarter of 2014 (AprilJune), the percentage of adults aged 1864 who were uninsured declined 24%, to 15.6% (preliminary data; Martinez ME, Cohen RA. Health insurance coverage: Early release of estimates from the National Health Interview Survey, JanuaryJune 2014. NCHS; 2014. Available from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/ Quarterly_estimates_2010_2014_Q12.pdf).

Between 2003 and 2010, the percentage of adults aged 1925 who were uninsured was stable at 31%34%, and then decreased to 26.7% in 2013 (Table 114).

Based on preliminary data, from 2013 to the second quarter of 2014 (AprilJune), the percentage of adults aged 1925 who were uninsured declined 28%, to 19.2% (preliminary data; Martinez ME, Cohen RA. Health insurance coverage: Early release of estimates from the National Health Interview Survey, JanuaryJune 2014. NCHS; 2014. Available from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/ insur201412.pdf and unpublished data).

Between 2003 and 2013, the percentage of the population under age 65 with private health insurance obtained through the workplace declined from 64.4% to 56.6% (Table 112).

Between 2003 and 2013, among children in families with income of 100%199% of poverty, the percentage of uninsured children under age 18 dropped from 15.6% to 11.1%, while Medicaid or the Childrens Health Insurance Program (CHIP) coverage among children in families with income of 100%199% of poverty increased from 41.7% to 60.1% (Tables 113 and 114).

In 2013, Massachusetts (4.4%), the District of Columbia (7.1%), Puerto Rico (7.7%), Vermont (8.1%), and Hawaii (8.3%) had the lowest percentages of persons uninsured (i.e., without public or private coverage) among those under 65, while Nevada (23.4%), Florida (24.2%), and Texas (24.5%) had the highest percentages (Table 123, a new table in the 2014 edition).
http://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_estimates_2010_2014_Q12.pdfhttp://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201412.pdf

Chartbook: Figures 119

Mortality Life Expectancy at Birth

0

60

80

100

Figure 1. Life expectancy at birth, by selected characteristics: United States, 19802013

2013

Female

Male

Black, not Hispanic

White, not Hispanic

Hispanic

71.8

76.5

79.1

78.1

81.2

83.8

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exp

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s

White female

Black female

White male

Black male

1980 1990 2000 2013 0 20 40 60 80 100 Life expectancy at birth, in years

/nchs/hus/contents2014.htm#fig01

Figure 2. Infant, neonatal, and po20032013

10

8

Infant

Neonatal

Postneonatal Dea

ths

per

1,0

00 li

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s

6

4

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10 Chartbook

Between 2003 and 2013, life expectancy at birth increased for white females (1.2 years), white males (1.6 years), black females (2.7 years), and black males (3.4 years).

Life expectancy is a measure often used to gauge the overall health of a population (1). Between 1980 and 2013, life expectancy at birth in the United States increased from 70.0 to 76.4 years for males and from 77.4 to 81.2 years for females. Racial disparities in life expectancy at birth persisted for both males and females in 2013 but continue to narrow. Life expectancy at birth was 6.2 years longer for white males than for black males in 2003, and 4.4 years longer for white males than for black males in 2013. In 2003, life expectancy at birth was 4.5 years longer for white females than for black females; by 2013, life expectancy at birth was 3.0 years longer for white females than for black females. In 2013, Hispanic males and females had longer life expectancy at birth than non-Hispanic white or non-Hispanic black males and females.

NOTE: Life expectancy data by Hispanic origin were available starting in 2006.

SOURCE: CDC/NCHS, Health, United States, 2014, Table 16. Data from the National Vital Statistics System (NVSS).
Excel and PowerPoint: http://www.cdc.gov
Mortality Infant Mortality

stneonatal mortality rates: United States,
Infant, neonatal, and postneonatal mortality rates declined 13% between 2003 and 2013.
The infant mortality rate is the risk of death during the first year of life (1). The 2013 infant mortality rate of 5.96 per 1,000 live birthsa historical lowwas 13% lower than in 2003. During the same period, the neonatal mortality rate (death rate among infants under 28 days, a subset of infant mortality) decreased 13% to 4.04 per 1,000 live births, and the postneonatal mortality rate (death rate among infants 28 days through 11 months, a subset of infant mortality) declined 13% to 1.93 per 1,000 live births.

SOURCE: CDC/NCHS, Health, United States, 2014, Table 12 and Reference 1. Data from the National Vital Statistics System (NVSS).

2013

nchs/hus/contents2014.htm#fig02

http://www.cdc.gov/nchs/hus/contents2014.htm#fig02http://www.cdc.gov/nchs/hus/contents2014.htm#fig01

Mortality Selected Causes of Death

Figure 3. Age-adjusted death rates for selected causes of death for all ages, by sex: United States, 20032013

10,000 Male Female

All causes 1,000 All causes

Heart disease

100

injuries 10

2003 2013 2003 2013

Stroke

Diabetes

Alzheimers disease

Unintentional

Dea

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CLRD CLRD

Unintentional injuries

Stroke Diabetes

Alzheimers disease

Cancer

Heart disease Cancer

Excel and PowerPoint: http://www.cdc.gov/nchs/hus/contents2014.htm#fig03

Figure 4. Suicide death rates, by s

40

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65 years and over

4564 years

1524 years

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Between 2003 and 2013, the all-cause age-adjusted death rate decreased 15% among males and 13% among females.

During this 10-year period, age-adjusted death rates among male