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Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965
Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965
Source: Morbidity and Mortality Weekly Report (CDC)
Hepatitis C virus (HCV) is an increasing cause of morbidity and mortality in the United States. Many of the 2.7–3.9 million persons living with HCV infection are unaware they are infected and do not receive care (e.g., education, counseling, and medical monitoring) and treatment. CDC estimates that although persons born during 1945–1965 comprise an estimated 27% of the population, they account for approximately three fourths of all HCV infections in the United States, 73% of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCV-related liver disease. With the advent of new therapies that can halt disease progression and provide a virologic cure (i.e., sustained viral clearance following completion of treatment) in most persons, targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce HCV-related morbidity and mortality. CDC is augmenting previous recommendations for HCV testing (CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47[No. RR–19]) to recommend one-time testing without prior ascertainment of HCV risk for persons born during 1945–1965, a population with a disproportionately high prevalence of HCV infection and related disease. Persons identified as having HCV infection should receive a brief screening for alcohol use and intervention as clinically indicated, followed by referral to appropriate care for HCV infection and related conditions. These recommendations do not replace previous guidelines for HCV testing that are based on known risk factors and clinical indications. Rather, they define an additional target population for testing: persons born during 1945–1965. CDC developed these recommendations with the assistance of a work group representing diverse expertise and perspectives. The recommendations are informed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, an approach that provides guidance and tools to define the research questions, conduct the systematic review, assess the overall quality of the evidence, and determine strength of the recommendations. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, implementation, and evaluation of prevention and clinical services. These recommendations will be reviewed every 5 years and updated to include advances in the published evidence.
Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Pra ctices (ACIP) — United States, 2012–13 Influenza Season
Source: Morbidity and Mortality Weekly Report (CDC)
In 2010, the Advisory Committee on Immunization Practices (ACIP) first recommended annual influenza vaccination for all persons aged ≥6 months in the United States (1). Annual influenza vaccination of all persons aged ≥6 months continues to be recommended. This document 1) describes influenza vaccine virus strains included in the U.S. seasonal influenza vaccine for 2012–13; 2) provides guidance for the use of influenza vaccines during the 2012–13 season, including an updated vaccination schedule for children aged 6 months through 8 years and a description of available vaccine products and indications; 3) discusses febrile seizures associated with administration of influenza and 13-valent pneumococcal conjugate (PCV-13) vaccines; 4) provides vaccination recommendations for persons with a history of egg allergy; and 5) discusses the development of quadrivalent influenza vaccines for use in future influenza seasons. Information regarding issues related to influenza vaccination that are not addressed in this update is available in CDC’s Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010 and associated updates (1,2).
Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010
Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010
Source: National Center for Health Statistics
Key findings
Data from the National Health and Nutrition Examination Survey
- In 2009–2010, about 47% of adults had at least one of three risk factors for cardiovascular disease—uncontrolled high blood pressure, uncontrolled high levels of low-density lipoproteins (LDL) cholesterol, or current smoking.
- Men were more likely than women to have at least one of the three cardiovascular disease risk factors.
- From 1999–2000 through 2009–2010, a decrease was observed in the percentage of non-Hispanic white and Mexican-American adults who had at least one of the three risk factors for cardiovascular disease. However, this decrease was not found among non-Hispanic black adults.
- The prevalence of uncontrolled high blood pressure and of uncontrolled high LDL cholesterol declined between 1999–2000 and 2009–2010, but no significant change occurred in the percentage of adults who smoke cigarettes.
CDC — 2011 State Obesity Map Now Available
2011 State Obesity Map Now Available
Source: Centers for Disease Control and Prevention
In 2011, rates of adult obesity remain high, with state estimates ranging from 20.7 percent in Colorado to 34.9 percent in Mississippi. No state had a prevalence of adult obesity less than 20 percent, and 12 states (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia) had a prevalence of 30 percent or more. The South had the highest prevalence of adult obesity (29.5 percent), followed by the Midwest (29 percent), the Northeast (25.3 percent) and the West (24.3 percent).
Vital Signs: Walking Among Adults — United States, 2005 and 2010
Vital Signs: Walking Among Adults — United States, 2005 and 2010
Source: Morbidity and Mortality Weekly Report (CDC)
Background: Physical activity has numerous health benefits, including improving weight management. The 2008 Physical Activity Guidelines for Americans recommend ≥150 minutes/week of moderate-intensity aerobic physical activity (e.g., brisk walking) for substantial health benefits. Walking is the most commonly reported physical activity by U.S. adults.
Methods: CDC used data from the 2005 and 2010 National Health Interview Surveys to assess changes in prevalence of walking (defined as walking for transportation or leisure in at least one bout of 10 minutes or more in the preceding 7 days) by sex, age group, race/ethnicity, education, body mass index category, walking assistance status, region, and physician-diagnosed chronic disease. CDC also assessed the association between walking and meeting the aerobic physical activity guideline.
Results: Overall, walking prevalence increased significantly from 55.7% in 2005 to 62.0% in 2010. Significantly higher walking prevalence was observed in most demographic and health characteristic categories examined. In 2010, the adjusted odds ratio of meeting the aerobic physical activity guideline among walkers, compared with non-walkers, was 2.95 (95% confidence interval = 2.73–3.19).
Conclusions and Implications for Public Health Practice: To sustain increases in the prevalence of walking, communities can implement evidence-based strategies such as creating or enhancing access to places for physical activity, or using design and land use policies and practices that emphasize mixed-use communities and pedestrian-friendly streets. The impact of these strategies on both walking and physical activity should be monitored systematically at the national, state, and local levels. Public health efforts to promote walking as a way to meet physical activity guidelines can help improve the health of U.S. residents.
Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults
Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults
Source: Morbidity and Mortality Weekly Report (CDC)
In the United States, an estimated 48,100 new human immunodeficiency virus (HIV) infections occurred in 2009 (1). Of these, 27% were in heterosexual men and women who did not inject drugs, and 64% were in men who have sex with men (MSM), including 3% in MSM who inject drugs. In January 2011, following publication of evidence of safety and efficacy of daily oral tenofovir disoproxil fumarate 300 mg (TDF)/emtricitabine 200 mg (FTC) (Truvada, Gilead Sciences) as antiretroviral preexposure prophylaxis (PrEP) to reduce the risk for HIV acquisition among MSM in the iPrEx trial, CDC issued interim guidance to make available information and important initial cautions on the use of PrEP in this population. Those recommendations remain valid for MSM, including MSM who also have sex with women (2). Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug Administration (FDA) approved a label indication for reduction of risk for sexual acquisition of HIV infection among adults, including both heterosexuals and MSM.* This interim guidance includes consideration of the new information and addresses pregnancy and safety issues for heterosexually active adults at very high risk for sexual HIV acquisition that were not discussed in the previous interim guidance for the use of PrEP in MSM.
Current Tobacco Use Among Middle and High School Students — United States, 2011
Current Tobacco Use Among Middle and High School Students — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Tobacco use continues to be the leading preventable cause of death and disease in the United States, with nearly 443,000 deaths occurring annually because of cigarette smoking and exposure to secondhand smoke (1). Moreover, nearly 90% of adult smokers begin smoking by age 18 years (2). To assess current tobacco use among youths, CDC analyzed data from the 2011 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which indicated that, in 2011, the prevalence of current tobacco use among middle school and high school students was 7.1% and 23.2%, respectively, and the prevalence of current cigarette use was 4.3%, and 15.8%, respectively. During 2000–2011, among middle school students, a linear downward trend was observed in the prevalence of current tobacco use (14.9% to 7.1%), current combustible tobacco use (14.0% to 6.3%), and current cigarette use (10.7% to 4.3%). For high school students, a linear downward trend also was observed in these measures (current tobacco use [34.4% to 23.2%], current combustible tobacco use [33.1% to 21.0%], and current cigarette use [27.9% to 15.8%]). Interventions that are proven to prevent and reduce tobacco use among youths include media campaigns, limiting advertisements and other promotions, increasing the price of tobacco products, and reducing the availability of tobacco products for purchase by youths. These interventions should continue to be implemented as part of national comprehensive tobacco control programs and should be coordinated with Food and Drug Administration (FDA) regulations restricting the sale, distribution, and marketing of cigarettes and smokeless tobacco products to youths (2–4).
Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections
Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections
Source: Morbidity and Mortality Weekly Report (CDC)
Gonorrhea is a major cause of serious reproductive complications in women and can facilitate human immunodeficiency virus (HIV) transmission (1). Effective treatment is a cornerstone of U.S. gonorrhea control efforts, but treatment of gonorrhea has been complicated by the ability of Neisseria gonorrhoeae to develop antimicrobial resistance. This report, using data from CDC’s Gonococcal Isolate Surveillance Project (GISP), describes laboratory evidence of declining cefixime susceptibility among urethral N. gonorrhoeae isolates collected in the United States during 2006–2011 and updates CDC’s current recommendations for treatment of gonorrhea (2). Based on GISP data, CDC recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea. CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections. If cefixime is used as an alternative agent, then the patient should return in 1 week for a test-of-cure at the site of infection.
The Health of Male Veterans and Nonveterans Aged 25–64: United States, 2007–2010
The Health of Male Veterans and Nonveterans Aged 25–64: United States, 2007–2010
Source: National Center for Health Statistics
A snapshot view of the health of nonelderly veterans reveals a mixed picture of their health and functioning. Overall, veterans aged 25–64 appear to be in poorer health than nonveterans, although not all differences in health are significant for all age groups. When age differences are examined, only veterans aged 45–54 are significantly more likely than nonveterans to report fair or poor health and serious psychological distress. Other health disadvantages for veterans (e.g., the prevalence of two or more chronic conditions) appear at age 45 and over. Differences in work limitations between veterans and nonveterans are seen beginning at age 35. However, the measures presented here do not reveal major health differences between male veterans and nonveterans aged 25–34.
The health differences that appear at older ages suggest that the effects of military service on health may appear later in life. Veterans also differ from nonveterans in some sociodemographic characteristics, and these characteristics may be related to observed differences in their health and functioning. Veterans are more likely to have health insurance, which may influence their access to health care and the likelihood of being diagnosed with various conditions.
The health measures presented here are not inclusive of all possible differences in health and functioning. Specifically, the measure of mental health in this report, although associated with anxiety disorders and depression, identifies only people with the most severe psychological distress (4–6). Other measures of mental health that capture a wider range of mental disorders might show more differences between veterans and nonveterans.
The sampling universe of NHIS does not include homeless people or the institutionalized population (e.g., people in long-term care facilities or in prison), which excludes some severely ill people (veterans and nonveterans) from our analysis. Addressing the problem of homelessness among veterans is a priority of the Veterans Administration (7).
This analysis is also limited in that it excludes certain other groups. The suffering of younger veterans returning from overseas with significant injuries and stress-related disorders is the focus of increased public attention. However, the number of veterans aged 18–24 included in NHIS was not large enough to support estimates for this age group. Although the percentage of women serving in the military has been steadily increasing, the relatively small numbers of female veterans also precluded their inclusion in this report.
Food safety guides for groups most vulnerable to foodborne illness now available
Food safety guides for groups most vulnerable to foodborne illness now available
Source: U.S. Food and Drug Administration
The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) and the Department of Health and Human Services’ Food and Drug Administration (FDA) have partnered to create six booklets with food safety advice for populations that are most susceptible to foodborne illness. The booklets in this “at-risk series” are tailored to help older adults, transplant recipients, pregnant women, and people with cancer, diabetes or HIV/AIDS reduce their risk for foodborne illness.
“These booklets are a much needed resource for consumers who are at increased risk of getting sick from food,” said USDA Under Secretary for Food Safety Dr. Elisabeth Hagen. “The clear, understandable information in these booklets will help at-risk individuals feel confident about the safety of foods they prepare and eat. The booklets are also helpful to physicians and other health care providers for educating their at-risk patients about foodborne illnesses.”
Each of the booklets contains 24 pages of practical guidance on how to prevent foodborne illness. The information is presented in easy-to-read charts, illustrated how-tos, and straightforward descriptions of why each group is at higher risk for foodborne illness and symptoms that may mean trouble. The booklets contain three tear-out cards with quick-reference tips for grocery shopping, cooking to the right temperature, and eating at restaurants for times when taking along the entire booklet would be impractical.
“Everyone from farmers to food manufacturers to food preparers in the home has a role in food safety,” said FDA Deputy Commissioner for Foods Michael Taylor. “It is important that consumers, particularly those who are at higher risk of foodborne illness, have information they can use to do their part in preventing illness by properly selecting and preparing foods.”
While booklets on five of these topics were previously produced in 2006, the two agencies this year created a sixth booklet for pregnant women, who are at particular risk for the illness listeriosis. The six new booklets list food safety resources, such as www.foodsafety.gov, that have been made available since the earlier copies were printed. They also include revised safe cooking temperatures for meat and poultry: 145 °F for whole cuts of meat, followed by a three-minute rest time; 160 °F for ground meats; and 165 °F for all poultry and leftovers.
Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011
Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011
Source: Morbidity and Mortality Weekly Report (CDC)
Smoking cigarettes and other combustible tobacco products causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases (1). A priority of the U.S. Department of Health and Human Services is to develop innovative, rapid-response surveillance systems for assessing changes in tobacco use and related health outcomes (2). The two standard approaches for measuring smoking rates and behaviors are 1) surveying a representative sample of the public and asking questions about personal smoking behaviors and 2) estimating consumption based on tobacco excise tax data (3). Whereas CDC regularly publishes findings on national and state-specific smoking rates from public surveys (4), CDC has not reported consumption estimates. The U.S. Department of Agriculture (USDA), which previously provided such estimates, stopped reporting on consumption in 2007 (5). To estimate consumption for the period 2000–2011, CDC examined excise tax data from the U.S. Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB); consumption estimates were calculated for cigarettes, roll-your-own tobacco, pipe tobacco, and small and large cigars. From 2000 to 2011, total consumption of all combustible tobacco decreased from 450.7 billion cigarette equivalents to 326.6, a 27.5% decrease; per capita consumption of all combustible tobacco products declined from 2,148 to 1,374, a 36.0% decrease. However, while consumption of cigarettes decreased 32.8% from 2000 to 2011, consumption of loose tobacco and cigars increased 123.1% over the same period. As a result, the percentage of total combustible tobacco consumption composed of loose tobacco and cigars increased from 3.4% in 2000 to 10.4% in 2011. The data suggest that certain smokers have switched from cigarettes to other combustible tobacco products, most notably since a 2009 increase in the federal tobacco excise tax that created tax disparities between product types.
Inappropriate and Questionable Billing by Medicare Home Health Agencies
Inappropriate and Questionable Billing by Medicare Home Health Agencies (PDF)
Source: U.S. Office of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
In 2010, Medicare paid $19.5 billion to 11,203 home health agencies (HHA) for services provided to 3.4 million beneficiaries. Recent investigations and prior Office of Inspector General studies have found that home health services are vulnerable to fraud, waste, and abuse.HOW WE DID THIS STUDY
We analyzed data from home health, inpatient hospital, and skilled nursing facility claims from 2010 to identify inappropriate home health payments. In addition, we identified HHAs that billed unusually high amounts according to at least one of our six measures of questionable billing. Although these six measures indicate potential fraud, there may be legitimate reasons for an HHA to exceed the threshold for unusually high billing on any of the six measures. We also determined the geographic locations of HHAs that had questionable billing.
WHAT WE FOUND
In 2010, Medicare inappropriately paid $5 million for home health claims with three specific errors: overlapping with claims for inpatient hospital stays, overlapping with claims for skilled nursing facility stays, or billing for services on dates after beneficiaries’ deaths. Further, we found that approximately one in every four HHAs exceeded the threshold that indicated unusually high billing for at least one of our six measures of questionable billing. Overall, HHAs with questionable billing were located mostly in Texas, Florida, California, and Michigan.
WHAT WE RECOMMEND
We recommend that CMS:
(1) Implement claims processing edits or improve existing edits to prevent inappropriate payments for the three specific errors we reviewed,
(2) Increase monitoring of billing for home health services,
(3) Enforce and consider lowering the 10‑percent cap on the total outlier payments an HHA may receive annually,
(4) Consider imposing a temporary moratorium on new HHA enrollments in Florida and Texas, and
(5) Take appropriate action regarding the inappropriate payments we identified and HHAs with questionable billing.
CMS concurred with all five recommendations; however, it disagreed with our estimate of the inappropriate payments for home health claims overlapping with claims for inpatient hospital stays and skilled nursing facility stays.
Adoption Disruption and Dissolution
Adoption Disruption and Dissolution
Source: Child Welfare Information Gateway
A small percentage of adoptions disrupt (end before finalization) or are dissolved (ended after finalization). This factsheet looks at the statistics for adoption disruption and dissolution, examines the associated factors, and reviews trends. Factors associated with the child, family, and agency are explored.
Chronic Pain and Complementary Health Practices
Chronic Pain and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine
Millions of Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions, and headache costs U.S. businesses more than $61 billion a year in lost worker productivity.
Pain is the most common health problem for which adults use complementary health practices. Many people with conditions causing chronic pain turn to these practices to supplement other conventional medical treatment, or when their pain is resistant or in an effort to advert side effects of medications. Despite the widespread use of complementary health practices for chronic pain, scientific evidence on efficacy and mechanisms—whether the therapies help the conditions for which they are used and, if so, how—is, for the most part, limited. However, the evidence base is growing, especially for several complementary health practices most commonly used by people to lessen pain.
This issue highlights the research status for several therapies used for common kinds of pain, including arthritis, fibromyalgia, headache, low-back pain, and neck pain.
Medicines for Treating Depression: A Review of the Research for Adults
Medicines for Treating Depression: A Review of the Research for Adults
Source: Agency for Healthcare Research and Quality
Antidepressants are only one kind of medicine used to treat depression. They are the most common medicine used for this condition. Your doctor may prescribe other types of medicines to treat depression. This summary will review only the research on antidepressants. It does not review research on non-medicine therapies. The research studies also did not look at patients with bipolar disorder, substance abuse, bulimia nervosa, or schizophrenia.
Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
Source: Morbidity and Mortality Weekly Report (CDC)
One of the three primary goals of the National HIV/AIDS Strategy for the United States is to reduce the number of persons who become infected with human immunodeficiency virus (HIV) (1). In 2009, persons aged 15–29 years comprised 21% of the U.S. population but accounted for 39% of all new HIV infections (2). Sexual intercourse, sexual intercourse with multiple partners, sexual intercourse without using a condom, and injection drug use are behaviors that increase risk for HIV infection. To describe trends in the prevalence of HIV-related risk behaviors among high school students, CDC analyzed data from the biennial national Youth Risk Behavior Survey (YRBS) for the period 1991–2011. The results of that analysis indicated that, although the percentage of students overall who had ever had sexual intercourse decreased significantly from 54.1% in 1991 to 47.4% in 2011, the prevalence of ever having had sexual intercourse did not change significantly after reaching 45.6% in 2001. Similarly, although the percentage of students who had four or more sex partners decreased significantly from 18.7% in 1991 to 15.3% in 2011, the prevalence of having four or more sex partners did not change significantly after reaching 14.2% in 2001. Condom use at most recent sexual intercourse among students currently having sexual intercourse increased from 46.2% in 1991 to 60.2% in 2011. However, the prevalence of condom use did not change significantly beginning in 2003 (63.0%). The prevalence of injection drug use among students overall did not change significantly from 1995 (2.1%) to 2011 (2.3%). The results suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. To reduce the number of young persons who become infected with HIV, renewed educational efforts and other risk reduction interventions are warranted.
Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010
Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Alcohol use during pregnancy is a leading preventable cause of birth defects and developmental disabilities. Alcohol-exposed pregnancies (AEPs) can lead to fetal alcohol syndrome and other fetal alcohol spectrum disorders (FASDs), which result in neurodevelopmental deficits and lifelong disability (1). In 2005, the Surgeon General issued an advisory urging women who are pregnant or who might become pregnant to abstain from alcohol use (2). Healthy People 2020 set specific targets for abstinence from alcohol use (MICH-11.1) and binge drinking (MICH-11.2) for pregnant women (3). To estimate the prevalence of any alcohol use and binge drinking in the past 30 days among women aged 18–44 years, CDC analyzed 2006–2010 Behavioral Risk Factor Surveillance System (BRFSS) data. Based on their self-reports, an estimated 51.5% of nonpregnant women used alcohol, as did 7.6% of pregnant women. The prevalence of binge drinking was 15.0% among nonpregnant women and 1.4% among pregnant women. Among pregnant women, the highest prevalence estimates of reported alcohol use were among those who were aged 35–44 years (14.3%), white (8.3%), college graduates (10.0%), or employed (9.6%). Among binge drinkers, the average frequency and intensity of binge episodes were similar, approximately three times per month and six drinks on an occasion, among those who were pregnant and those who were not. Clinical practices that advise women about the dangers associated with drinking while pregnant, coupled with community-level interventions that reduce alcohol-related harms, are necessary to mitigate AEP risk among women of childbearing age and to achieve the Healthy People 2020 objectives.
Trends in Anticonvulsants Utilization and Expenditures for the U.S. Civilian Noninstitutionalized Population, 1999 and 2009
Rising health care costs in general and prescribed medicine costs in particular continue to be a concern for U.S. policymakers and consumers of care. Analyzing down total prescription drug costs into therapeutic classes and subclasses provides decision makers and the public with an understanding of the costs and extent to which specific therapeutic classes and subclasses of drugs are contributing to the upturn in total costs. This Statistical Brief provides trends for one therapeutic subclass of prescribed drugs—anticonvulsants.This Brief presents trends in utilization and expenditures for outpatient prescription anticonvulsants for the years 1999 and 2009. The estimates are for the U.S. civilian noninstitutionalized population and are derived from the 1999 and 2009 Household Component of the Medical Expenditure Panel Survey (MEPS-HC). For outpatient prescription anticonvulsants, the Brief compares, for 1999 and 2009, the number of persons obtaining at least one prescription, total expenditures, and total number of prescriptions, as well as average annual cost per person and average drug cost.Only prescriptions purchased or obtained in an outpatient setting are included in these estimates. Prescription medicines administered in an inpatient setting or in a clinic or physician’s office are excluded. Expenditure estimates are presented in real dollars; estimates for 1999 were inflated to 2009 dollars based on the GDP Price Index (http://www.meps.ahrq.gov/mepsweb/about_meps/ Price_Index.shtml). All differences discussed in the text are statistically significant at the 0.05 level.
SAMHSA Guide: Getting Through Tough Economic Times
SAMHSA Guide: Getting Through Tough Economic Times
- This guide covers:
- Possible health risks
- Warning signs
- Managing stress
- Getting help
- Suicide warning signs
- Other steps you can take
- Depression
- Anxiety
- Compulsive Behaviors (over-eating, excessive gambling, spending, etc.)
- Substance Abuse
Motor Vehicle Crash Deaths in Metropolitan Areas — United States, 2009
Motor Vehicle Crash Deaths in Metropolitan Areas — United States, 2009
Source: Morbidity and Mortality Weekly Report (CDC)
Although rates have declined in recent years, motor vehicle crashes (MVCs) remain a leading cause of injury death in the United States (1). In 2009, a total of 34,485 MVC deaths were reported among U.S. residents, and 22% of those who died were aged 15–24 years. MVCs were the leading cause of death for that age group, which represents approximately 14% of the total U.S. population (1). To assess patterns in MVC death rates for persons of all ages and for those aged 15–24 years, in recognition of the elevated risk for this age group, CDC used data from the National Vital Statistics System (NVSS) and the U.S. Census Bureau for 2009 representing the 50 most populous U.S. metropolitan statistical areas (MSAs). The overall MVC death rate (age-adjusted) for all 50 MSAs combined was 8.2 per 100,000 residents, compared with a national rate of 11.1; among MSAs, rates ranged from 4.4 to 17.8. For persons aged 15–24 years, the MVC death rate was 13.0 per 100,000 residents for all MSAs combined (range: 7.3–25.8), compared with a national rate of 17.3. Although rates for the MSAs generally were lower than the rate for the nation as a whole, higher rates for persons aged 15–24 years were observed both in the MSAs and nationally. The wide variation in rates among MSAs suggests a need to better understand how urban development patterns might relate to MVC deaths and to identify and implement effective strategies to reduce the number of such deaths.
