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Behaviors
















Fruits, 2016 Annual Report

Why does this matter?

According to the Dietary Guidelines for Americans, roughly half of adults in the United States suffer from one or more preventable chronic diseases related to poor diet and physical inactivity. Diets high in fruits and vegetables reduce the risk of many chronic diseases such as cardiovascular disease, type 2 diabetes and obesity. Fruits contain essential vitamins and minerals and are an excellent source of fiber.

A landmark study showed that consuming three or more fruits and vegetables per day, compared to one or less, was associated with lower chances of stroke and heart disease incidence and death. Focusing on quantity rather than variety of fruit and vegetable intake is further associated with greater decreases in cardiovascular disease risk.







Insufficient Sleep*, 2016 Annual Report

Why does this matter?

Insufficient sleep is a threat to public health. Sleep is critical for brain and body functions including cognition and emotion, as well as for the immune, hormonal and metabolic systems. Insufficient sleep is associated with chronic diseases, including cancer, depression, diabetes, hypertension and obesity.

Insufficient sleep is also associated with reduced productivity and quality of life and increased risk of motor vehicle and other transportation accidents, industrial accidents and medical errors. The National Highway Traffic Safety Administration estimated 91,000  police-reported crashes are due to drowsy driving each year, resulting in approximately 50,000 injuries and nearly 700 deaths. 

A 2016 report by the Rand Corporation estimated insufficient sleep cost $411 billion in missed work days and reduced productivity. If those who sleep less than six hours nightly increased their sleep to between six and seven hours, an additional $226.4 billion could be added to the economy according to their analysis.








*The data appearing in this edition are the same that appeared in the 2015 edition. An update was not available at the time of this publication.


Seat Belt Use, 2016 Annual Report

Why does this matter?

Motor vehicle crashes are the second-leading cause of unintentional injury death in the United States. A total of 23,714 drivers and passengers died in 2016 and more than 2.6 million people were injured and treated in emergency departments as a result of motor vehicle crashes.

Wearing a seat belt is the most effective way to prevent deaths and injuries in car accidents:

  • Wearing a seat belt reduces the risk of critical injury and death by 50% and 45%, respectively.
  • More than half of teens and adults who died in crashes in 2016 were not wearing seat belts at the time of the crash.
  • In 2016, 2,456 deaths could have been prevented if all passenger-vehicle occupants had been restrained.

 

Non-fatal injuries to drivers and passengers resulted in more than $48 billion in lifetime medical costs and lost work productivity in 2016.









Vegetables, 2016 Annual Report

Why does this matter?

According to the Dietary Guidelines for Americans, roughly half of adults in the United States suffer from one or more preventable chronic diseases related to poor diet and physical inactivity. Diets high in fruits and vegetables reduce the risk of many chronic diseases such as cardiovascular disease, type 2 diabetes and obesity. Vegetables contain essential vitamins and minerals and are an excellent source of fiber.

A landmark study showed that consuming three or more fruits and vegetables per day, compared to one or less, was associated with lower stroke and heart disease incidence and death. Focusing on quantity rather than variety of fruit and vegetable intake is further associated with greater decreases in cardiovascular disease risk.








Community & Environment










Median Household Income, 2016 Annual Report

Why does this matter?    

The median household income indicates the relative wealth of a geographic area; the higher the median household income, the wealthier the area. Median household income tends to more accurately reflect the typical household of a geographic area than average household income, which can be distorted by a few extremely wealthy households. Median household income reflects a household’s ability to support a healthy lifestyle with quality food, housing, education, preventive medicine and curative care. Individuals with a low household income tend to have a higher prevalences of diseases and die earlier compared with people with higher household incomes, even after taking into account the effect of overall health on their income. There is an increase in stress associated with being in the lower end of the income spectrum, which is associated with unhealthy behaviors and outcomes. Individuals who have a higher burden of stress in adulthood tend to have higher body mass indexes, higher smoking rates, higher alcohol consumption and lower physical activity after adjusting for age.

 

The median household income in the United States in 2018 was $63,179, which is not significantly different than 2017. This ends three years of increases in median household income.

















Underemployment Rate, 2016 Annual Report

Why does this matter?

Underemployment is associated with poorer physical and mental health, similar to the effects of unemployment though its effects have been studied far less. The underemployed are more likely to report lower general well-being as well as lower self esteem, depression, psychological stress, feeling a loss of control, and strained relationships with their spouse, family and friends than adequately employed adults.

 

The effects of underemployment on the family are profound. Underemployment may lead to breakups or divorce among couples, likely from the strain of depression and financial stress. The stress of underemployment may strain the relationship between parents and children resulting in a less positive household atmosphere. Children may be impacted as they may no longer be able to afford new clothes or participate in activities with their friends.









Unemployment Rate, 2016 Annual Report

Why does this matter?

There is a strong relationship between employment status and mental and physical health. A stable, safe and well-paying job makes it easier for people to live in healthier neighborhoods, provide quality child care and education for their families, afford nutritious food and access medical care — all critical factors to maintaining good health that are jeopardized by unemployment. Unemployment is associated with a higher risk of all-cause mortality, especially among adults ages 18-24. Unemployment may also lead to lower self-esteem, higher levels of depression, straining of family ties and the loss of work friends. The effects of job loss are not limited to the individual: studies have shown that there is a profound effect on impacted spouses and children.

High unemployment rates increase the economic burden on states due to decreased revenue from income taxes and increased demand for unemployment insurance and social welfare programs. Adults who are unemployed have a 2.6 times higher prevalence of being uninsured compared to those that are employed.








Policy

Water Fluoridation, 2016 Annual Report

Why does this matter?

Community water fluoridation, the addition of an optimal amount of fluoride to a public water supply, is an effective way of preventing tooth decay in children and adults. Tooth decay, called dental caries by medical professionals, is the result of bacteria dissolving the enamel of a tooth. Dental caries are the most common chronic disease in children and can lead to:

  • Bacterial infections of the tooth root
  • Tooth extraction
  • Bacterial infections in the rest of the body
  • Pain, which can lead to decreased productivity and quality of life

Children with dental caries have nearly three times the odds of missing school due to dental pain compared with children with good oral health and, on average, have poorer school performance. Children and populations with low socioeconomic status have a higher prevalence of dental caries yet have barriers to accessing dental care, and less frequently have private dental insurance. Community water fluoridation is one of the primary methods of addressing this disparity. Fluoride inhibits mineral loss and enhances remineralization in tooth enamel, and also inhibits bacterial activity in dental plaque.








Clinical Care


Cholesterol Check, 2016 Annual Report

Why does this matter?

High cholesterol is a major and modifiable risk factor for heart disease and stroke, the leading and fifth-leading causes of death in the United States, respectively. High cholesterol has no symptoms, but a simple blood test can measure total cholesterol, low-density lipoprotein cholesterol (the “bad” kind), high-density lipoprotein cholesterol (the "good" kind) and triglyceride levels.

The American Heart Association recommends adults ages 20 and older have their cholesterol checked every four to six years.









Colorectal Cancer Screening, 2016 Annual Report

Why does this matter?

There is strong evidence that screening for colorectal cancer reduces mortality by detecting cancer early when treatments are more effective and removing abnormal growths. Colorectal cancer is the second-leading cause of cancer deaths and the third most common cancer in both men and women in the United States. According to the American Cancer Society’s Cancer Facts & Figures 2020 report, there will be an estimated 147,950 new cases of colorectal cancer and over 53,200 colorectal cancer deaths in 2020.

According to the U.S. Preventive Services Task Force, screening for colorectal cancer, which may include fecal sample testing, colonoscopy and/or sigmoidoscopy, is recommended for all adults ages 50-75. Screening at earlier ages is recommended for those with particular risk factors or a family history of colorectal cancer. 

Multiple studies have shown that screening for colorectal cancer is cost-effective compared to not screening. An estimated 20 to 24 colorectal cancer deaths can be averted for every 1,000 adults screened.









Dental Visits Annual*, 2016 Annual Report

Why does this matter?

Oral health is a vital component of overall health. Oral diseases such as tooth decay, dental caries (cavities) and periodontal (gum) disease are common and can cause pain, tooth loss and oral infection if left undiagnosed and untreated. Oral health is also associated with chronic conditions such as heart disease and diabetes.

In the United States:

  • 1in 4 adults has untreated cavities.
  • Nearly half of adults ages 30 and older have signs of gum disease.

Cost of care is the most common reason reported for not having visited the dentist within the past year. Inadequate access to oral health services results in the overuse of emergency departments as a primary and only source of care. Between 2000 and 2010, the number of individuals who sought care for dental conditions from an emergency department almost doubled.







*The data appearing in this edition are the same that appeared in the 2015 edition. An update was not available at the time of this publication.



Outcomes


Heart Attack, 2016 Annual Report

Why does this matter?

Having had a heart attack decreases the heart's ability to meet the demands of the body during some illnesses. People, particularly seniors, who have severe heart conditions are at higher risk of severe illness from coronavirus disease (COVID-19). For more information about COVID-19 see the Centers for Disease Control and Prevention website.

A heart attack occurs when a coronary artery is blocked limiting the flow of blood to the heart, resulting in permanent and sometimes fatal damage to the heart muscle. In 2015, an estimated 114,023 deaths were attributable to heart attack in the United States. Coronary artery disease is the most common cause of a heart attack. An estimated 720,000 heart attacks and 335,000 recurrent heart attacks occur yearly among U.S. adults. Due to modern treatments, only 10% of heart attacks are fatal, however, survivors are rarely unaffected by the experience. Survivors of a heart attack are at increased risk of experiencing more cardiac events such as heart failure, angina, arrhythmias or stroke.

People who have survived a heart attack are approximately 2.7 times more likely to report their health as fair or poor than similar people who had not had a heart attack. Survivors are also 49% more likely to report that their state of health prevented them from performing daily activities, 63% more likely to have had poor physical health and 25% more likely to have had poor mental health for at least 15 days in the past month. This can be from physical symptoms such as chest pain and shortness of breath, or from psychological consequences such as depression or anxiety.

The time between having a heart attack and receiving treatment for a heart attack can change the severity of the damage from the heart attack. It is important that patients know and recognize the symptoms of a heart attack and seek immediate medical attention. Racial and ethnic minorities are more likely to experience longer delays in receiving treatment.

The cost of heart attacks was $12.1 billion in 2013, which includes health care services, medication and lost productivity.









Heart Disease, 2016 Annual Report

Why does this matter?

Heart disease decreases the heart's ability to meet the demands of the body during some illnesses. People, particularly seniors, who have severe heart conditions are at higher risk of severe illness from coronavirus disease (COVID-19). For more information about COVID-19 see the Centers for Disease Control and Prevention website.

Coronary artery disease, the precursor to coronary heart disease (CHD) is the most common cause of a heart attack and directly resulted in 363,452 deaths in 2016 and was a factor in 533,126 deaths. CHD is characterized by a narrowing of blood vessels that supply the heart, usually from a buildup of plaque. The most common symptom of CHD is angina – chest pain that occurs when the heart does not receive enough blood. CHD may progress into heart failure, a condition where symptoms include fatigue, shortness of breath, persistent cough, increased urination and loss of appetite. Patients with heart failure describe these symptoms as a disruption of their everyday lives and their ability to perform routine activities leading to frustration, loss of confidence and a reduction in self-esteem.

Coronary heart disease has the highest associated indirect costs of all cardiovascular diseases. Between 2011 and 2014, 16.5 million U.S. adults had CHD. The direct and indirect costs of heart disease in 2013 to 2014 was $204.8 billion, including health care services, medication and lost productivity.









High Blood Pressure, 2016 Annual Report

Why does this matter?

High blood pressure, also known as hypertension, is a major risk factor for heart disease and stroke, the leading and fifth-leading causes of death, respectively. In 2018, nearly 96,000 deaths were primarily attributable to high blood pressure. 

High blood pressure often has no signs or symptoms. Once diagnosed, however, it can be controlled through a combination of diet, exercise and medication. High blood pressure is influenced by risk factors that can be changed such as smoking, obesity, physical inactivity, poor diet (eating foods high in sodium and low in potassium) and excessive alcohol use. Recently revised guidelines lowered the cutoff for what counts as high blood pressure, which means that even more people may unknowingly have it. 

In 2016-2017, the total direct cost of high blood pressure was $52.4 billion. By 2035, it is projected that the total direct costs of high blood pressure could reach $220.9 billion.









High Cholesterol, 2016 Annual Report

Why does this matter?

High cholesterol is a major and modifiable risk factor for heart disease and stroke, the leading and fifth-leading causes of death in the United States, respectively. High total cholesterol (≥ 240 mg/dL) doubles the risk of heart disease, including heart attack. Excess low-density lipoprotein cholesterol (“bad” cholesterol) creates a plaque that narrows arteries and reduces oxygen-rich blood flow. When a coronary artery is blocked, the result is a heart attack. In addition, restricted blood flow to the brain can cause a stroke. An estimated 28.5 million U.S. adults have high total cholesterol.









High Health Status, 2016 Annual Report

Why does this matter?

Self-reported health status is a measure of how individuals perceive their health and is used as an indicator of a population’s health. It is a subjective measure of health-related quality of life and is not limited to certain health conditions or outcomes, but includes other factors such as life experiences, the health of others in a person’s life and support from family and friends.

Research shows that those with a high self-reported health status (i.e., excellent or very good) have lower rates of mortality from all causes than those with a low self-reported health status (i.e., fair or poor). The strong association between health status and mortality makes this measure a good predictor of future mortality rates and future use of health care.











Injury Deaths, 2016 Annual Report

Why does this matter?

Injuries are a leading cause of mortality in the United States. Unintentional injuries occur without any intention of harming oneself or others, while intentional injuries result from purposeful actions of harm.

Unintentional injuries

Among those ages 1 to 44, unintentional injuries are the leading cause of death. Unintentional injuries are the third-leading cause of death among the total population, with accidental poisonings and motor vehicle accidents as the top contributors. Accidental poisoning deaths are driven by the opioid epidemic and motor vehicle fatalities are largely associated with alcohol-impaired driving. In 2017, an average of 130 Americans died daily from opioid overdoses, and an alcohol-impaired driving fatality occurred every 48 minutes.

Intentional injuries

The most common intentional injury deaths are suicide by firearm, homicide by firearm, suicide by suffocation and suicide by poisoning. In 2017, suicide deaths were 2.5 times higher than homicide deaths. Both of these threats to health remain serious problems, accounting for more than 60,000 deaths annually.

The economic burden of fatal injury in terms of lifetime work loss and medical costs was estimated to be $214 billion in 2013. A recent analysis found that reducing the national injury death rate to that of the lowest state-specific rate would avert 48,400 injury deaths annually, save $61 billion in medical and work loss costs annually and increase average U.S. life expectancy at birth by 0.41 years.

























Stroke, 2016 Annual Report

Why does this matter?

People, particularly seniors, who have had a stroke may be at higher risk of severe illness from coronavirus disease (COVID-19). For more information about COVID-19 see the Centers for Disease Control and Prevention website.

Each year, approximately 795,000 people will experience a stroke in the United States. Of these, approximately 185,00 are people who have had at least one stroke before. Stroke causes approximately 146,383 deaths, or about 1 in 19, each year in the United States, making it the nation’s fifth-leading cause of death. For those who survive, a stroke often leads to serious long-term disability with complications that can leave a stroke survivor unable to work. 

The direct and indirect costs of strokes in 2014 to 2015 was $45.5 billion, including health care services, medication and lost productivity.









Suicide, 2016 Annual Report

Why does this matter?

Suicide is a troubling public health issue that leaves a lasting impact on families and communities. Between 1999 and 2019, the suicide death rate increased 33%. There were nearly 46,000 deaths by suicide in 2020, making it the 12th-leading cause of death in the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), that same year, 12.2 million adults seriously thought about suicide, 3.2 million made a plan and 1.2 million attempted suicide in the past year.

Recorded suicide attempts among older adults are usually more lethal than those among younger age groups. Older adults are nearly twice as likely to use firearms as a means of suicide, compared with adults younger than 60. Older adults may exhibit passive self-harm behaviors that can result in death, such as refusing food, medications or liquids; these are rarely recorded as suicide attempts or deaths by suicide. 

 

Suicide among adults ages 65 years and older cost more than $1.8 billion in combined medical and work-loss related expenses in 2013, averaging between $66,218 and $243,883 per decedent among older adults. 

 








Race and ethnicity populations are as defined by the original source.

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