Public dental expenditures and dental visits among children in the U.S., 1996-2004

OBJECTIVES: Congress created the State Children's Health Insurance Program (SCHIP) in 1997 as an expansion of the Medicaid program to provide health insurance to children whose family income is above the Medicaid eligibility standards-generally up to 200% of the federal poverty level (FPL). This article examines changes in the utilization of dental services during a period of increasing public funding of dental services. METHODS: Public dental expenditure estimates came from the Centers for Medicare & Medicaid Services (CMS), and a breakdown of these expenditures by patient age and income level was based on the Medical Expenditure Panel Survey (MEPS). RESULTS: According to CMS, funding for dental SCHIP and dental SCHIP expansion grew from $0 prior to 1998 to $517 million in 2004. According to the MEPS, between 1996 and 2004 there was an increase in the number and percent of children 2 to 20 years of age who reported a dental visit during the past year. These increases were most notable among children in the 100% to 200% FPL category. Approximately 900,000 more children in this income group visited a dentist in 2003-2004 than in 1996-1997. Children in this income group reported an increase in the amount of mean dental charges paid for by Medicaid and a real increase in mean dental charges per patient from $217 to $310. CONCLUSIONS: Recent increases in the public funding of dental services targeted to children in the 100% to 200% FPL category were related to increased utilization of dental services among these children from 1996 to 2004.     

Health risks among submarine personnel in the U.S. Navy, 1974-1979

This study evaluated health risks associated with U.S. Navy submarine duty by comparing hospitalization rates of submariners with surface ship personnel. The groups were compared using age-adjusted hospitalization rates for 16 major diagnostic categories and several specific diagnoses postulated to be submarine associated. Submarine personnel did not have significantly higher hospitalization rates for any diagnostic categories nor for any of the submarine-associated illnesses. Submariner relative risk of hospital admissions was greater for a few selected diagnoses but statistical significance was not attained. Submarine personnel had lower hospitalization rates for nearly all of the diagnostic categories examined. Reasons for these lower rates may be stringent screening of submariners, higher levels of education among submariners, difficulty of evacuation from a submarine, and the healthy-worker effect. The health status of U.S. Navy personnel does not seem to be adversely affected by submarine duty.     

The impact of U.S. family planning programs on births, abortions and miscarriages, 1970-1979

This paper estimates births (as well as total pregnancies, abortions and miscarriages) averted by program enrollment during the 1970s based not on the common assumption of constant program impact on birth rates, but on assumptions that take into account the changing use of abortion. Estimates of births averted from two national studies are translated into estimates of unintended pregnancies averted and projections of program impact throughout the decade are made assuming constant program impact on pregnancy rates. The number of pregnancies averted is broken into births, abortions and miscarriages averted based on actual distribution of those unintended pregnancies that did occur each year. This methodology is more appropriate to the United States or any other country during a time period when use of abortion has been changing. It also focuses attention on the fact that births averted reflect only part of the program's impact and that much of the program's effect is on averting abortions. During the decade, an estimated 5,434,000 unintended pregnancies were averted by enrollment in the family planning program. In 1979, 4,486,000 women were enrolled in family planning clinics. An estimated 792,000 unintended pregnancies were averted as a direct result, 1 for every 5.7 patients. The 274,000 averted births would have increased the number of births in 1980 in the U.S. from 3,598,000 to 3,872,000, an increase of 8%. The estimated 420,000 abortions averted would have increased abortions in the U.S. about 25% higher, to about 2,000,000.     

Estimated economic costs of obesity to U.S. business.

OBJECTIVE: To estimate the economic costs of obesity to U.S. business. METHODS: Standard epidemiologic methods for risk attribution and techniques for ascertaining cost of illness were used to estimate obesity-attributable expenditures on selected employee benefits, including health, life, and disability insurance and paid sick leave by private-sector firms in the U.S. in 1994. Data were obtained from a variety of secondary sources, including the National Health Interview Survey, reports from the Bureau of Labor Statistics and other federal agencies, and the published literature. Attention was focused on employees between the ages of 25 and 64 years who were classified according to body mass index (BMI) as "nonobese" (BMI < 25 kg/m2), "mildly obese" (BMI = 25-28.9 kg/m2), or "moderately to severely obese" (BMI > or = 29 kg/m2). RESULTS: The cost of obesity to U.S. business in 1994 was estimated to total $12.7 billion, including $2.6 billion as a result of mild obesity and $10.1 billion due to moderate to severe obesity. Health insurance expenditures constituted $7.7 billion of the total amount, representing 43% of all spending by U.S. business on coronary heart disease, hypertension, type 2 diabetes, hypercholesterolemia, stroke, gallbladder disease, osteoarthritis of the knee, and endometrial cancer. Obesity-attributable business expenditures on paid sick leave, life insurance, and disability insurance amounted to $2.4 billion, $1.8 billion, and $800 million, respectively. CONCLUSIONS: The health-related economic cost of obesity to U.S. business is substantial, representing approximately 5% of total medical care costs. Further research is needed to determine the cost-effectiveness of worksite weight management programs and of other efforts to reduce the prevalence of obesity in the U.S. workforce.     

An approach to forecasting health expenditures,with application to the U.S. Medicare system

OBJECTIVE: To quantify uncertainty in forecasts of health expenditures. STUDY DESIGN: Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. DATA SOURCES/STUDY SETTING: A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. PRINCIPAL FINDINGS: Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. CONCLUSIONS: History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high-low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP.     

Exposures to wood dust in U.S. industries and occupations, 1979 to 1997.

BACKGROUND: We analyzed 1,632 measurements of airborne wood dust reported to OSHA's Integrated Management Information System in the period 1979 to 1997. METHODS: The relationships between wood dust concentrations and various factors documented in the OSHA database were examined in a multiple regression model. RESULTS: Exposures ranged from less than 0.03 to 604 mg/m3, with an arithmetic mean of 7.93 and a geometric mean of 1.86. Reported exposure levels decreased substantially over time (e.g., unadjusted geometric mean in 1979 = 4.59 mg/m3; in 1997 = 0.14 mg/m3). High exposure jobs included sanders in the transportation equipment industry (unadjusted geometric mean = 17.5 mg/m3), press operators in the wood products industry (12.3 mg/m3), lathe operators in the furniture industry (7.46 mg/m3), and sanders in the wood cabinet industry (5.83 mg/m3). CONCLUSIONS: In the multiple regression model, year, state, job, and industry were found to be predictors of exposure. Year and state were likely surrogates for other factors which directly influence exposure, but which were not included in the IMIS database, such as the use of engineering control measures.     

Trends in mortality from coronary heart disease and stroke among U.S. veterans; 1954-1979

A cohort of nearly 300,000 insured veterans (Dorn Cohort), experienced a much greater percent decline in CHD death rate over the period, 1954-1979, than the population of the U.S., while for stroke, the percent decline in death rate was virtually the same as the U.S. For CHD, greater percent declines were noted over the study period for non-smokers compared to cigarette smokers, for professionals compared to non-professionals and for persons with high socioeconomic scores (SES) compared to those with low scores. In each group, younger persons experienced greater percent declines than older persons. For stroke, non-smokers experienced a somewhat greater percent decline in rate than smokers but this did not hold true for all age groups. Unlike CHD, professionals experienced a smaller percent decline in their stroke death rate than non-professionals, as did persons with high SES compared to those with low SES. The contradictory patterns observed for the two diseases with respect to occupation and SES suggest that the risk factors for stroke and coronary heart disease are not exactly the same. Throughout, the findings were much more convincing for CHD than for stroke.     

Assessing interdisciplinary education in U.S. dental hygiene programs

This study was done to examine the role of interdisciplinary education in dental hygiene curricula, identify factors associated with its implementation, explore the perceptions of dental hygiene educators related to interdisciplinary education, and explore these educators' perception of its validity and barriers to implementation. A 36-item questionnaire mailed to directors of all 216 dental hygiene programs in the United States elicited program demographics and information about participation in clinical and didactic interdisciplinary educational experience as well as attitudes regarding such experiences. The response rate was 63% (n = 136). Of the 136 respondents, 31% (n = 69) indicated that the dental hygiene curricula at their institutions included interdisciplinary activities; 15% (n = 33) indicated participation in both clinical and didactic interdisciplinary course work. Student participation was minimal, with most interdisciplinary activities taking place in didactic course work, but 74% (n = 160) of the respondents felt their students should be participating in interdisciplinary educational experiences. Chi-square analysis identified no consistent association among interdisciplinary activity variables. Many respondents felt that interdisciplinary educational experiences would benefit their students, but very few had incorporated them into their curricula, citing lack of resources and time as reasons. In addition, the term interdisciplinary was interpreted variably.     

Fatal work-related injuries in the U.S. chemical industry 1984–89

Several mortality studies of the chemical industry have examined fatal injuries, but most of these studies have been of employees of large chemical firms and have not separated work-related from non-work-related injuries. We examined all U.S. Occupational Safety and Health Administration (OSHA) investigation files in 1984-89 in 47 U.S. states of fatal injuries in the chemical industry, Standard Industrial Classification (SIC) 2800–2899. OSHA investigates all reported deaths over which it has jurisdiction; this includes most causes of work-related death except for homicide and motor vehicle crashes. For the 6 year period, there were 234 fatalities in the chemical industry, for a work-related fatality rate of 0.55 per 10,000 workers/year. The largest category of deaths was from explosions, with 99 (42%), followed by fire & burns, with 32 (14%), poisoning, with 31 (13%), and falls, with 18 (8%). Of the 99 deaths from explosions, 45 (45%) involved manufacture or handling of fireworks or other explosives. The fatality rate at firms with fewer than 50 employees was more than twice that of larger firms (P < 0.05) and employees at small firms were less likely to have been covered by a union contract (P < 0.05). OSHA issued citations for safety violations in 73% of the deaths. While regulatory authorities and the media often focus attention on large, multinational chemical corporations, the highest worker fatality rates are found at the smallest chemical firms.     

Estimated dietary flavonoid intake and major food sources of U.S. adults

Estimating flavonoid intake is a first step toward documenting the protective effects of flavonoids against risk of chronic diseases. Although flavonoids are important dietary sources of antioxidants, insufficient data on the comprehensive food composition of flavonoids have delayed the assessment of dietary intake in a population. We aimed to estimate the dietary flavonoid intake in U.S. adults and its sociodemographic subgroups and to document major dietary sources of flavonoids. We expanded the recently released USDA Flavonoid Database to increase its correspondence with the 24-h dietary recall (DR) of the NHANES 1999-2002. We systematically assigned a particular food code to all foods that were prepared or processed similarly. This expanded database included 87% of fruits and fruit juices, 86% of vegetables, 75% of legumes, and, overall, 45% of all foods reported by the 24-h DR of the NHANES 1999-2002. Estimated mean daily total flavonoid intake, 189.7 mg/d, was mainly from flavan-3-ols (83.5%), followed by flavanones (7.6%), flavonols (6.8%), anthocyanidins (1.6%), flavones (0.8%), and isoflavones (0.6%). The flavonoid density of diets increased with age (P < 0.001) and income (P < 0.05). It was higher in women (P < 0.001), Caucasians (P < 0.001), and vitamin supplement users (P < 0.001) and lower in adults with high levels of nonleisure time physical activity (P < 0.01) compared with their counterparts. The greatest daily mean intake of flavonoids was from the following foods: tea (157 mg), citrus fruit juices (8 mg), wine (4 mg), and citrus fruits (3 mg). The proposed relation between flavonoid intake and the prevention of chronic diseases needs further investigation using the estimates introduced in this study.     

Gang homicides - five U.S. cities, 2003-2008

Gang homicides account for a substantial proportion of homicides among youths in some U.S. cities; however, few surveillance systems collect data with the level of detail necessary to gang homicide prevention strategies. To compare characteristics of gang homicides with nongang homicides, CDC analyzed 2003-2008 data from the National Violent Death Reporting System (NVDRS) for five cities with high levels of gang homicide. This report describes the results of that analysis, which indicated that, consistent with similar previous research, a higher proportion of gang homicides than other homicides involved young adults and adolescents, racial and ethnic minorities, and males. Additionally, the proportion of gang homicides resulting from drug trade/use or with other crimes in progress was consistently low in the five cities, ranging from zero to 25%. Furthermore, this report found that gang homicides were more likely to occur with firearms and in public places, which suggests that gang homicides are quick, retaliatory reactions to ongoing gang-related conflict. These findings provide evidence for the need to prevent gang involvement early in adolescence and to increase youths' capacity to resolve conflict nonviolently.     

Disease and illness in U.S. mining, 1983-2001

OBJECTIVES: We describe inconsistencies in disease and illness reporting in U.S. mining, identify under-reporting of disease and illness in U.S. mining, and summarize selected disease and illness in U.S. mining from 1983 through 2001. METHODS: We summarized information on mining-related disease and illness data for the years 1983-2001 from the Mining Safety and Health Administration database (MSHA). RESULTS: Discrepancies exist in types of information collected by the Centers for Disease and Control, the National Institute for Occupational Safety and Health, and the Mining Safety and Health Administration database. Several factors, including a worker's fear of losing his or her job, health insurance, or other job-related benefits contribute to under-reporting of disease and illness information in the US mining industry. CONCLUSIONS: Since 1997, both number of workers employed in mining and disease and illness rates have decreased; however, the highest disease and illness rates in mining continue to be coal worker's pneumoconiosis and hearing loss.     

Vaccination practices in U.S. emergency departments, 1992-2000

To determine how frequently emergency department (ED) patients are vaccinated against influenza and pneumococcus, we analyzed all adult ED vaccinations in the combined databases of the annual National Hospital Ambulatory Medical Care Surveys, 1992-2000. During this period, EDs gave 27,738,000 vaccinations (95%CI: 25,878,000-29,598,000). Of these, 93% (87-100%) were against tetanus. The count of pneumococcal or influenza vaccinations was too small to permit estimation of a national total. Large-scale vaccination of ED patients appears feasible, given the tetanus experience, but ED patients are rarely vaccinated against influenza or pneumococcus. Reasons for this disconnect between burden of disease and preventive practices are discussed.     

Blood lead levels in U.S. workers, 1988-1994

Limited research has been conducted to measure the association between elevated blood lead levels and sociodemographic factors among U.S. workers in various industries and occupations using population-based survey data. Data from the Third National Health and Nutrition Examination Survey ( n = 10,127) were used to determine the blood lead levels in the U.S. workers. The prevalence of elevated blood lead levels > or = 50 microg/dL was 0.001% (1560) among U.S. workers compared with 0.2% (19,953) workers with elevated lead levels > or = 40 microg/dL. Regression analyses indicated that workers in the repair service industry were correlated with higher blood lead levels than those workers in the construction industry. Although low blood lead levels were found for the entire working population, the results showed that there were still high blood lead levels in certain occupations and industries during 1988 to 1994.     

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.     

Generational differences in U.S. public spending, 1980-2000

The balance between spending on children and spending on the elderly is important in evaluating the allocation of public welfare spending. We examine trends in public spending on social welfare programs for children and the elderly during 1980-2000. For both groups, social welfare spending as a percentage of gross domestic product changed little, even during the economic expansions of the 1990s. In constant dollars, the gap in per capita social welfare spending between children and the elderly grew 20 percent. Unlike spending for programs for the elderly, spending for children's programs suffered during recessions. Public discussion about the current imbalance in public spending is needed.     

Simulation of average energy expenditures and related inhalation rates for the U.S. population

Inhalation rates (rVe) for determining intakes of air pollutants generally must be estimated because it is difficult to make direct inhalation measurements in free-standing populations. The key to quantifying rVe is to estimate the oxygen consumption rate (rO2) required to sustain an individual’s total daily energy expenditure (TDEE) and then to convert rO2 to rVe using the ventilatory equivalent for oxygen (VQ). To estimate TDEEs for U.S. population cohorts, nonlinear equations that predict TDEE were developed using data derived from doubly labeled water metabolic studies involving 222 groups with a total of 6,027 subjects. Monte Carlo sampling of lognormally distributed body weights, VQ values, and error terms of the TDEE predictions were then used to simulate average TDEE and rVe for U.S. population cohorts. The maximum TDEE value for males was 13.5 MJ/day, which occurred within the 19–29 year age cohort, and for females it was 10.4 MJ/day at ages 18–19 years. Analyses of the relationship between the body mass index (BMI) and physical activity level (PAL?=?TDEE?÷?resting metabolic rate) showed that PAL is not very sensitive to changes in BMI. The highest daily inhalation rates for males and females were 17 and 13 m³/day, respectively, and estimated breathing rates for active (nonresting) hours were about a factor of two greater than for inactive (sleep/resting) periods. Finally, it was shown that efforts to control obesity in the USA have the potential for reducing inhalation rates due to the decreased oxygen/energy requirements of lower body weights.