After 22 years of viewing changes in population health over time, America’s Health Rankings® has established a new baseline from which all future changes will be compared. One of the underlying data sources for America’s Health Rankings® underwent significant changes in the last year and required this new baseline to be established. The new baseline is not comparable to prior trend information shown in prior years.
CDC’s Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of nearly half a million households and the source for 7 of the measures in the overall index, introduced 2 major changes in their most recent data release to improve the estimates of behaviors in a state’s population. These changes altered both the household selection process and the analysis methodology to better reflect the growth of cell phone only households and the increasing diversity of households within a state. This has caused the reported prevalence of many of the behavior measures, such as smoking, obesity, binge drinking, and diabetes, to be reported as higher this year than last year. This may or may not reflect an actual change in the behavior being measured, but it does represent a dramatic improvement in how well the estimates measure the behaviors. The new estimates are superior to estimates collected in prior years and set the standard going forward as the new baseline.
Some of the individual components of the index continue to be comparable over time and their changes are shown in below.
Potentially preventable hospitalizations (hospitalizations that may be preventable with high quality primary and preventive care) have declined over the last 11 years from 82.5 to 66.6 discharges per 1,000 Medicare enrollees. Preventable hospitalizations reflect how efficiently a population uses the various health care delivery options for necessary care. Hospital care is expensive and makes up the largest component of health care spending in the U.S., totaling over $750 billion.[1] Preventable hospitalizations often occur as a result of a failure to treat conditions early in an outpatient setting due to limited availability.[2] These rates are also highly correlated with general hospitalization rates and reflect the tendency for a population to overuse the hospital setting as a site for care. Preventable hospitalizations place a financial burden on heath care systems as they could have been avoided with earlier, less costly interventions. Preventable hospitalizations are more common in those who are uninsured, which often leads to large unpaid medical bills.[3]
Potentially preventable hospitalizations are a significant issue with regard to both quality and cost. The Agency for Healthcare Research and Quality (AHRQ) reports that in the year 2000, nearly 5 million admissions to U.S. hospitals involved treatment for one or more potentially preventable conditions, with a resulting cost of more than $26.5 billion. Furthermore, AHRQ states that “While some hospitalizations were likely inevitable, many might have been prevented if individuals had received high quality primary and preventive care. Identifying and reducing such avoidable hospitalizations could help alleviate the economic burden placed on the U.S. health care system. Assuming an average cost of $5,300 per admission, even a 5 percent decrease in the rate of potentially avoidable hospitalizations could result in a cost savings of more than $1.3 billion.”[4]
Preventable hospitalizations are also a window into the disparities that exist in the health care delivery system. In a study of 2003 data by Russo et al[5]., racial and ethnic disparities existed in the rates of preventable hospitalizations, with blacks generally having the highest rates and Hispanics the second highest rates. In particular, disparities were greatest for hospitalizations related to chronic health conditions such as diabetes, hypertension, and asthma. Compared with non-Hispanic whites, rates of admission for these conditions were about 3 to 5 times greater among blacks and approximately 2 to 3 times greater among Hispanics.
Deaths from cardiovascular disease have consistently declined by 2 percent to 3 percent per year for the last decade, a notable accomplishment of the health care system. This decline is in spite of increasing risk factors such as obesity, high cholesterol, and high blood pressure.
Cardiovascular disease accounts for 17 percent of medical spending, 30 percent of Medicare spending, and totals nearly $150 billion annually.[6]
The difficult economic climate increases the challenge of maintaining a healthy population. The following graph depicts the continuing high percentage of children in poverty, increasing from 16.1 percent of children in the 2001 Edition to 21.4 percent of children in the 2012 Edition. The historic low of 15.8 percent of persons under age 18 was recorded in the 2002 Edition.
Children in poverty is an indication of the lack of access to health care, including preventive care, for this vulnerable population.
Infant mortality improved significantly in the 1990s but has largely stagnated between 6.5 and 7.0 deaths per 1,000 live births for the last 10 years. The nation’s overall infant mortality rate is consistently higher than other developed countries, and significant racial and ethnic disparities exist.[7]
For the last 6 years, between 8.1 percent and 8.3 percent of all infants are born with a low birthweight (<2,500 grams or 5 pounds, 8 ounces). This is up from 7.0 percent in 1993.
Babies born with low birthweight are often born preterm or have inadequate growth for other reasons. Low birthweight may occur as a result of inadequate clinical care during the prenatal period. Through regular clinical visits, the health of the mother can be assessed, health risks can be identified, and steps can be taken to improve the mother’s health. Low birthweight is associated with many characteristics of the mother such as smoking status, nutritional status, and psychosocial problems.
[1] The Kaiser Family Foundation. Trends in Health Care Costs and Spending. 2009;7692-02.
[2] Billings J. Recent findings on preventable hospitalizations. Health Aff. 1996;15(3):239.
[3] Weissman JS. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992;268(17):2388.
[4] Agency for Healthcare Research and Quality, US Department of Health and Human Services, http://www.ahrq.gov/data/hcup/factbk5/factbk5a.htm . Accessed October 27, 2011.
[5] Russo CA, Andrews RM, Coffey RM. Healthcare Cost and Utilization Project (HCUP) Statistical Brief #10, Rockville, MD: http://www.ncbi.nlm.nih.gov/books/NBK63497/#sb10.s2. 2006. Accessed on Oct 27, 2011.
[6] Trogdon JG, Finkelstein EA, Nwaise IA, Tangka FK, Orenstein D. The economic burden of chronic cardiovascular disease for major insurers. Health Promotion Practice. 8.3 (2007):234-42. Print.
[7] MacDorman MF, Mathews TJ. Recent Trends in Infant Mortality in the United States. Hyattsville, MD: US Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2008.