Childbearing characteristics of U.S.- and foreign-born Hispanic mothers

This study compares maternal and infant health and sociodemographic characteristics of U.S.-born and foreign- or Puerto Rican-born Hispanic mothers and their babies, using data from the national vital statistics system and the 1980 National Natality Survey. While nearly half of all Hispanic mothers and Mexican and Puerto Rican mothers were born in the United States, less than 10 percent of Cuban and other Hispanic mothers were U.S. born. Compared with foreign- or Puerto Rican-born Hispanic mothers, U.S.-born mothers tended to be younger, to have had fewer high-order births, to be less likely to receive delayed or no prenatal care, to have higher educational attainment, and to be more likely to be unmarried. The incidence of low birth weight among infants born to Hispanic mothers, particularly Mexican and Cuban women, was relatively low. When the proportions of low birth weight were examined by nativity status, infants born to foreign- or Puerto Rican-born women were consistently less likely to be of low birth weight. In an effort to account for these findings, the mother's smoking status before and during pregnancy is examined. Compared with non-Hispanic mothers, Hispanic mothers were much less likely to have smoked before or during pregnancy. These data are examined to see if they account for the better outcome as measured by birth weight for Hispanic births, especially those to foreign- or Puerto Rican-born women.     

Health characteristics of adults 55 years of age and over: United States, 2000-2003

OBJECTIVE: This report highlights the health characteristics of four age groups of older adults-55-64 years, 65-74 years, 75-84 years, and 85 years and over-providing estimates by sex, race and Hispanic origin, poverty status, health insurance status, and marital status. METHODS: The estimates in this report were derived from the 2000-2003--National Health Interview Surveys' Family and Sample Adult questionnaires. Estimates are based on interviews with 39,990 sample adults aged 55 years and over. RESULTS: Overall, prevalence rates for fair or poor health, chronic health conditions (with the exception of diabetes), sensory impairments, and difficulties with physical and social activities increased with advancing age, doubling or even tripling between the age groups 55-64 and 85 years and over. About one in five adults aged 55-64 years were in fair or poor health, rising to about one-third of adults aged 85 years and over. Men and women were about equally likely to be in fair or poor health across the age groups studied, but women were more likely to have difficulty in physical or social activities. Sociodemographic variations in health were noted across the age groups studied, with the most consistent and striking results found for poverty status and health insurance coverage. Poor and near poor adults and those with public health insurance were, by far, the most disadvantaged groups of older adults in terms of health status, health care utilization, and health behaviors. CONCLUSIONS: Health status, health care utilization, and health-promoting behaviors among adults aged 55 and over vary considerably by age and other sociodemographic characteristics. Identifying these variations can help government and private agencies pinpoint areas of greatest need and greatest opportunity for extending years of healthy life among the Nation's seniors.     

Health of the foreign-born population: United States, 1989-90

The health status of immigrants is of vital interest to health policy planners as the number of immigrants in the United States increases. This report has shown that, overall, foreign-born persons had better health than the U.S.-born population, although this health advantage varied by length of residence in the United States. In virtually every measure of health status, and with regard to almost every sociodemographic characteristic, the most recent immigrants were healthier than foreign-born persons who have lived in the United States 10 years or more as well as healthier than the U.S.-born population. Immigrants who had lived in the United States 10 years or longer were generally healthier than U.S.-born adults, although the differences were not as striking as between recent immigrants and the native-born population. These findings may be explained in several ways. First, recent cohorts of immigrants may have been healthier than earlier cohorts of immigrants at the time of immigration. If so, as their duration of residence in the United States increases, they will continue to be significantly healthier than native-born persons. Second, earlier cohorts of immigrants may have been as healthy as recent cohorts at the time of immigration, but their health has deteriorated with increased duration of residence in the United States. This suggests that immigrants had or acquired physical conditions or behaviors that put them at risk in their new environment or that access to health care has been limited. It also suggests that more recent cohorts of immigrants could experience a similar deterioration of health as their duration of residence in the United States increases. Finally, these findings may reflect a combination of these influences or other factors not considered. To understand these patterns will require additional research, including comparative studies of the health of immigrants in the United States with the health of nonmigrants (stayers) in the countries of immigrant origin.     

Public health surveillance for smallpox - United States, 2003-2005

In June 1987, nearly 10 years after the World Health Organization (WHO) declared smallpox eradicated, the Council of State and Territorial Epidemiologists (CSTE) recommended removal of smallpox, a highly contagious viral disease, from the National Notifiable Diseases Surveillance System (NNDSS). However, the attacks of September 11, 2001, raised concern that smallpox (variola) virus, might exist in laboratories other than two WHO-designated repositories and could be used as an agent of biologic terrorism. In response to this concern, CSTE and CDC recommended in June 2003 that smallpox again be made reportable through NNDSS and that all states, territories, and cities add smallpox to their lists of reportable diseases. In 2005, CSTE conducted a cross-sectional survey in the United States and its territories to assess key components for surveillance of suspected smallpox disease, including legal reporting requirements, laboratory testing, and training and education (e.g., oral presentations and guides). This report summarizes the results of that survey, which indicated that 100% had the capacity to receive and investigate reports, 94% of states had legal requirements to report suspected smallpox disease, 70% had mandatory laboratory reporting of results indicative of smallpox disease, and 68% were providing ongoing training and education of health-care providers and public health staff.     

Trends in U.S. health insurance coverage, 2001-2003

Against the backdrop of a sluggish economy and rapidly rising health insurance premiums, the proportion of Americans under age 65 covered by employer-sponsored insurance fell dramatically from 67 percent to 63 percent between 2001 and 2003. Although the decline in employer coverage could have spurred a large increase in the uninsured, the proportion of Americans without health insurance did not increase significantly, according to findings from the Center for Studying Health System Change's (HSC) Community Tracking Study Household Survey. Expansion of public health insurance--including Medicaid and the State Children's Health Insurance Program (SCHIP)--forestalled a significant increase in the uninsured, as the proportion of the under-65 population enrolled in public coverage increased from 9 percent to 12 percent.     

Fall injury episodes among noninstitutionalized older adults: United States, 2001-2003

OBJECTIVE: This report presents national estimates of fall injury episodes for noninstitutionalized U.S. adults aged 65 years and over, by selected characteristics. Circumstances surrounding the fall injury and activity limitations and utilization of health care resulting from the fall injury are also presented. METHODS: Combined data from the 2001-2003 National Health Interview Surveys (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), were analyzed to produce estimates for the U.S. civilian noninstitutionalized population. Data on nonfatal medically attended fall injuries occurring within the 3 months preceding the interview were obtained from an adult family member. RESULTS: The annualized rate of fall injury episodes for noninstitutionalized adults aged 65 years and over in 2001-2003 was 51 episodes per 1,000 population. Rates of fall injuries increased with age, and were higher for women compared with men. Non-Hispanic white older adults had higher rates of fall injuries compared with non-Hispanic black older adults. Older adults with certain chronic conditions and activity limitations had higher rates of fall injuries compared with older adults without these conditions. The most common cause of fall injuries among older adults was slipping, tripping, or stumbling, and most fall injuries occurred inside or around the outside of the home. Nearly 60 percent of older adults who experienced a fall injury visited an emergency room for treatment or advice. Nearly one-third of older adults experiencing a fall injury needed help with activities of daily living as a result, and over one-half of these persons expected to need this help for at least 6 months. A similar percentage experienced limitation in instrumental activities of daily living as a result of fall injuries. CONCLUSION: Fall injuries remain very prevalent among older adults and result in high health care utilization and activity limitations. Rates of fall injuries vary by demographic and health characteristics of older noninstitutionalized adults.     

Changes in incidence of diabetes in U.S. adults, 1997-2003

BACKGROUND: The incidence of self-reported diagnosed diabetes may be increasing because of recent changes in the diagnostic criteria for diabetes, enhanced case detection, and a true increase in disease incidence. These factors may also be changing the characteristics of newly diagnosed cases. Therefore, we examined recent trends in the incidence of diagnosed diabetes, changes to the characteristics of incident cases, and factors associated with incidence. METHODS: First, National Health Interview Survey data for 1997 to 2003 were used to examine 7-year trends in the incidence of diagnosed diabetes among U.S. adults aged 18 to 79 years. Second, among 1997-1998 and 2002-2003 incident cases, differences in sociodemographic characteristics, risk factors, and indicators of health status were examined. Lastly, multivariate-adjusted incidence from multiple logistic regression of 2001-2003 survey data were derived. RESULTS: From 1997 to 2003, the incidence of diagnosed diabetes increased 41% from 4.9 to 6.9 per 1,000 population (p <0.01). Incidence increased among men and women, non-Hispanic whites, persons with at least a high school education, nonsmokers, active and inactive persons, and among obese persons (p <0.05). Obesity was more prevalent (p <0.01) and physical limitation was less prevalent (p =0.03) in 2002-2003 versus 1997-1998 incident cases. Multivariate-adjusted incidence increased with age and BMI category, and decreased with education level (p <0.05). CONCLUSIONS: Obesity was a major factor in the recent increase of newly diagnosed diabetes. Lifestyle interventions that reduce or prevent the prevalence of obesity among persons at risk for diabetes are needed to halt the increasing incidence of diabetes.     

Trends in tuberculosis--United States, 1998-2003

During 2003, a total of 14,871 tuberculosis (TB) cases (5.1 cases per 100,000 population) were reported in the United States, representing a 1.4% decrease in cases and a 1.9% decline in the rate from 2002. This decline is the smallest since 1992, when TB incidence peaked after a 7-year resurgence. In addition, the rate remains higher than the national interim goal of 3.5 cases per 100,000 population that was set for 2000. This report summarizes data from the national TB surveillance system for 2003 and describes trends during a 5-year period, with comparison to 1998 and 2002. Despite a decline in TB nationwide, rates have increased in certain states, and elevated TB rates continue to be reported in certain populations (e.g., foreign-born persons and racial/ethnic minorities). Targeted interventions for these at-risk populations, continued collaborative efforts toward the global fight against TB, and adequate local resources are essential to eliminating TB in the United States.     

Cancer information disparities between U.S.- and foreign-born populations

Immigrant health is an important component of American public health. But relatively little is known about immigrants' cancer information use. Using the 2005 Health Information National Trends Survey (HINTS) data, this study examined potential disparities between foreign-born (n?=?563) and U.S.-born (n?=?4,830) populations in their access to and experience with cancer information. Logistic regressions showed that foreign-born Hispanics were less likely than the U.S.-born to have ever sought cancer information (adjusted odds ratio [OR]?=?.51). Foreign-born individuals overall were also less likely to have had somebody else look for cancer information for them (OR?=?.66). Compared with the U.S.-born, foreign-born individuals in general faced greater obstacles during the process of cancer information seeking (ORs?=?1.98-2.27). They were also less trusting of some important sources of health information (ORs?=?.50-.64), a pattern that was particularly pronounced among Hispanics (ORs?=?.20-.43). Implications of these disparities were explored through multiple linear regressions that revealed negative associations between cancer information use and undesirable cancer beliefs.     

Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003

Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons > or =65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons > or =65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed.     

Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003

BACKGROUND: Immigrants are a growing segment of the US population. In 2003, there were 33.5 million immigrants, accounting for 12% of the total US population. Despite a rapid increase in their numbers, little information exists as to how immigrants' health and mortality profile has changed over time. In this study, we analysed trends in social and behavioural characteristics, life expectancy, and mortality patterns of immigrants and the US-born from 1979 to 2003. METHODS: We used national mortality and census data (1979-2003) and 1993 and 2003 National Health Interview Surveys to examine nativity differentials over time in health and social characteristics. Life tables, age-adjusted death rates, and logistic regression were used to examine nativity differentials. RESULTS: During 1979-81, immigrants had 2.3 years longer life expectancy than the US-born (76.2 vs 73.9 years). The difference increased to 3.4 years in 1999-2001 (80.0 vs 76.6 years). Nativity differentials in mortality increased over time for major cancers, cardiovascular diseases, diabetes, respiratory diseases, unintentional injuries, and suicide, with immigrants experiencing generally lower mortality than the US-born in each period. Specifically, in 1999-2001, immigrants had at least 30% lower mortality from lung and oesophageal cancer, COPD, suicide, and HIV/AIDS, but at least 50% higher mortality from stomach and liver cancer than the US-born. Nativity differentials in mortality, health, and behavioural characteristics varied substantially by ethnicity. CONCLUSIONS: Growing ethnic heterogeneity of the immigrant population, and its migration selectivity and continuing advantages in behavioural characteristics may partly explain the overall widening health gaps between immigrants and the US-born.     

Physical activity trends--United States, 1990-1998

Physical activity is associated with numerous health benefits, and increased participation in various types of leisure-time physical activity had been encouraged during the 1990s. To determine national estimates of leisure-time physical activity during 1990-1998, data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that leisure-time physical activity trends have remained unchanged.     

United States life tables, 1998.

The life tables in this report are current life tables for the United States based on age-specific death rates in 1998. Data used to prepare these life tables are 1998 final mortality statistics; July 1, 1998, population estimates; and data from the Medicare program. Presented are complete life tables by age, race, and sex. In 1998 the overall expectation of life at birth was 76.7 years, an increase of 0.2 years compared with life expectancy in 1997. Life expectancy increased from 1997 to 1998 for each of the four race-sex groups for which life expectancy is reported. Life expectancy increased for black males by 0.4 year (from 67.2 to 67.6), for black females by 0.1 year (from 74.7 to 74.8), for white males by 0.2 year (from 74.3 to 74.5), and for white females by 0.1 year (from 79.9 to 80.0).