Concept: United States Census
Suicide is a major and continuing public health concern in the United States. During 1999-2015, approximately 600,000 U.S. residents died by suicide, with the highest annual rate occurring in 2015 (1). Annual county-level mortality data from the National Vital Statistics System (NVSS) and annual county-level population data from the U.S. Census Bureau were used to analyze suicide rate trends during 1999-2015, with special emphasis on comparing more urban and less urban areas. U.S. counties were grouped by level of urbanization using a six-level classification scheme. To evaluate rate trends, joinpoint regression methodology was applied to the time-series data for each level of urbanization. Suicide rates significantly increased over the study period for all county groupings and accelerated significantly in 2007-2008 for the medium metro, small metro, and non-metro groupings. Understanding suicide trends by urbanization level can help identify geographic areas of highest risk and focus prevention efforts. Communities can benefit from implementing policies, programs, and practices based on the best available evidence regarding suicide prevention and key risk factors. Many approaches are applicable regardless of urbanization level, whereas certain strategies might be particularly relevant in less urban areas affected by difficult economic conditions, limited access to helping services, and social isolation.
We report the largest experience, to our knowledge, of home cardiorespiratory monitoring in 47,495 newborns using the novel Owlet Smart Sock (OSS) technology (October 2015 to May 2017). On average, 47,495 newborns were monitored for 6 months, 4.5 d/wk, 9.9 h/d. Continuous readings of oxygen saturation and heart rate were obtained from 39,626 full-term newborns. OSS users were likely first-time parents in their 30s with at least a college degree; 37% had a healthcare professional in the family; and 28% were at or below median income level per the US Census Bureau. “Peace of mind” was the reason to own an OSS in 75%, and 82% of parents followed Safe Sleep Guidelines. A total of 94% of parents reported a better quality of sleep. The fast and continuous pace of device adoption and reported experience suggest excellent parental acceptance of the OSS. Prospective studies are warranted to further evaluate its applications in the high-risk newborn population.
- Proceedings of the National Academy of Sciences of the United States of America
- Published 6 months ago
Close kin provide many important functions as adults age, affecting health, financial well-being, and happiness. Those without kin report higher rates of loneliness and experience elevated risks of chronic illness and nursing facility placement. Historical racial differences and recent shifts in core demographic rates suggest that white and black older adults in the United States may have unequal availability of close kin and that this gap in availability will widen in the coming decades. Whereas prior work explores the changing composition and size of the childless population or those without spouses, here we consider the kinless population of older adults with no living close family members and how this burden is changing for different race and sex groups. Using demographic microsimulation and the United States Census Bureau’s recent national projections of core demographic rates by race, we examine two definitions of kinlessness: those without a partner or living children, and those without a partner, children, siblings, or parents. Our results suggest dramatic growth in the size of the kinless population as well as increasing racial disparities in percentages kinless. These conclusions are driven by declines in marriage and are robust to different assumptions about the future trajectory of divorce rates or growth in nonmarital partnerships. Our findings draw attention to the potential expansion of older adult loneliness, which is increasingly considered a threat to population health, and the unequal burden kinlessness may place on black Americans.
The launch of the Affordable Care Act was accompanied by major insurance information campaigns by government, nonprofit, political, news media, and private-sector organizations, but it is not clear to what extent these efforts were associated with insurance gains. Using county-level data from the Census Bureau’s American Community Survey and broadcast television airings data from the Wesleyan Media Project, we examined the relationship between insurance advertisements and county-level health insurance changes between 2013 and 2014, adjusting for other media and county- and state-level characteristics. We found that counties exposed to higher volumes of local insurance advertisements during the first open enrollment period experienced larger reductions in their uninsurance rates than other counties. State-sponsored advertisements had the strongest relationship with declines in uninsurance, and this relationship was driven by increases in Medicaid enrollment. These results support the importance of strategic investment in advertising to increase uptake of health insurance but suggest that not all types of advertisements will have the same effect on the public.
OBJECTIVES: To provide updated estimates of Alzheimer disease (AD) dementia prevalence in the United States from 2010 through 2050. METHODS: Probabilities of AD dementia incidence were calculated from a longitudinal, population-based study including substantial numbers of both black and white participants. Incidence probabilities for single year of age, race, and level of education were calculated using weighted logistic regression and AD dementia diagnosis from 2,577 detailed clinical evaluations of 1,913 people obtained from stratified random samples of previously disease-free individuals in a population of 10,800. These were combined with US mortality, education, and new US Census Bureau estimates of current and future population to estimate current and future numbers of people with AD dementia in the United States. RESULTS: We estimated that in 2010, there were 4.7 million individuals aged 65 years or older with AD dementia (95% confidence interval [CI] = 4.0-5.5). Of these, 0.7 million (95% CI = 0.4-0.9) were between 65 and 74 years, 2.3 million were between 75 and 84 years (95% CI = 1.7-2.9), and 1.8 million were 85 years or older (95% CI = 1.4-2.2). The total number of people with AD dementia in 2050 is projected to be 13.8 million, with 7.0 million aged 85 years or older. CONCLUSION: The number of people in the United States with AD dementia will increase dramatically in the next 40 years unless preventive measures are developed.
The purpose of this project was to evaluate a standardized measure of health care personnel (HCP) influenza vaccination during the first year of implementation. The measure requires acute care hospitals to gather vaccination status data from employees, licensed independent practitioners (LIPs), and adult students/trainees and volunteers. The evaluation included a hospital sampling frame stratified by 4 United States Census Bureau Regions and hospital bed count. The hospitals were selected within strata using simple random sampling and the probability proportional to size method, without replacement.
Urban transportation systems are vulnerable to congestion, accidents, weather, special events, and other costly delays. Whereas typical policy responses prioritize reduction of delays under normal conditions to improve the efficiency of urban road systems, analytic support for investments that improve resilience (defined as system recovery from additional disruptions) is still scarce. In this effort, we represent paved roads as a transportation network by mapping intersections to nodes and road segments between the intersections to links. We built road networks for 40 of the urban areas defined by the U.S. Census Bureau. We developed and calibrated a model to evaluate traffic delays using link loads. The loads may be regarded as traffic-based centrality measures, estimating the number of individuals using corresponding road segments. Efficiency was estimated as the average annual delay per peak-period auto commuter, and modeled results were found to be close to observed data, with the notable exception of New York City. Resilience was estimated as the change in efficiency resulting from roadway disruptions and was found to vary between cities, with increased delays due to a 5% random loss of road linkages ranging from 9.5% in Los Angeles to 56.0% in San Francisco. The results demonstrate that many urban road systems that operate inefficiently under normal conditions are nevertheless resilient to disruption, whereas some more efficient cities are more fragile. The implication is that resilience, not just efficiency, should be considered explicitly in roadway project selection and justify investment opportunities related to disaster and other disruptions.
In evaluating research investments, it is important to establish whether the expertise gained by researchers in conducting their projects propagates into the broader economy. For eight universities, it was possible to combine data from the UMETRICS project, which provided administrative records on graduate students supported by funded research, with data from the U.S. Census Bureau. The analysis covers 2010-2012 earnings and placement outcomes of people receiving doctorates in 2009-2011. Almost 40% of supported doctorate recipients, both federally and nonfederally funded, entered industry and, when they did, they disproportionately got jobs at large and high-wage establishments in high-tech and professional service industries. Although Ph.D. recipients spread nationally, there was also geographic clustering in employment near the universities that trained and employed the researchers. We also show large differences across fields in placement outcomes.
Use of the prescription opioid methadone for treatment of pain, as opposed to treatment of opioid use disorder (e.g., addiction), has been identified as a contributor to the U.S. opioid overdose epidemic. Although methadone accounted for only 2% of opioid prescriptions in 2009 (1), it was involved in approximately 30% of overdose deaths. Beginning with 2006 warnings from the Food and Drug Administration (FDA), efforts to reduce methadone use for pain have accelerated (2,3). The Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services and CDC analyzed methadone distribution, reports of diversion (the transfer of legally manufactured methadone into illegal markets), and overdose deaths during 2002-2014. On average, the rate of grams of methadone distributed increased 25.1% per year during 2002-2006 and declined 3.2% per year during 2006-2013. Methadone-involved overdose deaths increased 22.1% per year during 2002-2006 and then declined 6.5% per year during 2006-2014. During 2002-2006, rates of methadone diversion increased 24.3% per year; during 2006-2009, the rate increased at a slower rate, and after 2009, the rate declined 12.8% per year through 2014. Across sex, most age groups, racial/ethnic populations, and U.S. Census regions, the methadone overdose death rate peaked during 2005-2007 and declined in subsequent years. There was no change among persons aged ≥65 years, and among persons aged 55-64 years the methadone overdose death rate continued to increase through 2014. Additional clinical and public health policy changes are needed to reduce harm associated with methadone use for pain, especially among persons aged ≥55 years.
Recent cancellations of nongroup health insurance plans generated much policy debate and raised concerns that the Affordable Care Act (ACA) may increase the number of uninsured Americans in the short term. This article provides evidence on the stability of nongroup coverage using US census data for the period 2008-11, before ACA provisions took effect. The principal findings are threefold. First, this market was characterized by high turnover: Only 42 percent of people with nongroup coverage at the outset of the study period retained that coverage after twelve months. Second, 80 percent of people experiencing coverage changes acquired other insurance within a year, most commonly from an employer. Third, turnover varied across groups, with stable coverage more common for whites and self-employed people than for other groups. Turnover was particularly high among adults ages 19-35, with only 21 percent of young adults retaining continuous nongroup coverage for two years. Given estimates from 2012 that 10.8 million people were covered in this market, these results suggest that 6.2 million people leave nongroup coverage annually. This suggests that the nongroup market was characterized by frequent disruptions in coverage before the ACA and that the effects of the recent cancellations are not necessarily out of the norm. These results can serve as a useful pre-ACA baseline with which to evaluate the law’s long-term impact on the stability of nongroup coverage.