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Preventative Clinical Services

Dental Visit

Oral health problems are largely preventable through routine visits to the dentist and good oral hygiene.
Findings
Nationally, the percentage of adults who reported visiting a dentist or dental clinic within the past year decreased 1% from 67.6% to 66.7% between 2018 and 2020. Roughly 2.8 million fewer adults visited a dentist in 2020 compared with 2018.
Annual dental visits significantly decreased in 10 states and the District of Columbia, led by 10% in Alaska (69.3% to 62.5%), 8% in both the District of Columbia (73.8% to 67.9%) and Kentucky (61.9% to 57.2%) and 7% in Florida (65.7% to 61.2%) between 2018 and 2020. Over the same period, annual dental visits significantly increased 10% in South Carolina (61.8% to 67.7%) and 7% in Mississippi (54.1% and 57.7%).
Between 2018 and 2020, annual dental visits significantly decreased among Asian and white adults, all income levels except the lowest, both genders, adults ages 18-44 and 45-64, and adults ages 25 and older with some college education and college graduates. By group, the largest decreases were:
  • 7% among Asian adults (70.1% to 65.4%).
  • 5% among adults ages 25 and older with an annual household income of $50,000-$74,999 (71.2% to 67.9%).
Disparities
In 2020, annual dental visits were highest in Hawaii (74.7%), Rhode Island (74.2%) and Massachusetts (73.3%); they were lowest in Arkansas (57.0%), Kentucky (57.2%) and Texas (57.5%).
In 2020, annual dental visits varied most by education and income, but also significantly varied by race and ethnicity, gender and age. The percentage was higher among:

Flu Vaccination

Each year in the United States, millions of people get the flu, and thousands of people die from it. A flu vaccine is the best protection against seasonal influenza viruses. The vaccine can prevent people from coming down with the virus and mitigate symptoms of those who get the flu.
Findings
Nationally, the percentage of adults who reported receiving a seasonal flu vaccine in the past 12 months increased 8% from 43.7% to 47.0% between 2019 and 2020, the highest rate since 2012, when America’s Health Rankings started tracking the measure.
Flu vaccination significantly increased in 25 states and the District of Columbia, led by 27% in Illinois (38.8% to 49.4%), 17% in Nevada (32.5% to 38.1%) and 16% in both Maine (46.4% to 53.6%) and Michigan (40.4% to 46.7%) between 2019 and 2020.
Between 2019 and 2020, flu vaccination significantly increased among Asian and white adults, all education and income levels except the lowest, all age groups and both genders. By group, the largest increases were:
  • 18% among Asian adults (43.5% to 51.3%).
  • 10% among adults ages 25 and older with some college education (42.9% to 47.1%).
  • 10% among adults ages 25 and older with an annual household income of $75,000 or more (48.5% to 53.4%).
  • 10% among adults ages 18-44 (32.8% to 36.2%).
  • 9% among males (39.0% to 42.4%).
Disparities
In 2020, flu vaccination was highest in Massachusetts (56.5%), the District of Columbia (55.7%), Rhode Island (55.1%) and South Dakota (54.6%); it was lowest in Florida and Nevada (both 38.1%) and Alaska (39.6%).
In 2020, flu vaccination varied the most by age and education, but also significantly varied by race and ethnicity, income and gender. The percentage was higher among:
Related Findings
Nationally, the percentage of adolescents ages 13-17 who received all recommended doses of the human papillomavirus (HPV) vaccine significantly increased 8% from 54.2% to 58.6% between 2019 and 2020, and 35% from 43.4% in 2016, the data year the measure was first included in America’s Health Rankings. Only one state had a significant increase between 2019 and 2020: 19% in New York (57.0% to 68.1%). In 2020, HPV vaccination was highest in Rhode Island (83.0%), Hawaii (73.9%) and Massachusetts (73.4%); it was lowest in Mississippi (31.9%), West Virginia (43.4%) and Wyoming (44.8%).

Access to Care

Avoided Care Due to Cost

The high cost of health care in the U.S. is one of the leading factors in avoiding needed care. Lack of access to health care has long been associated with increased preventable hospitalizations and missed opportunities to prevent disease and manage chronic conditions, all of which can lead to worse and more expensive health outcomes.
Findings
Nationally, the percentage of adults who reported a time in the past 12 months when they needed to see a doctor but could not because of cost decreased 22% from 12.6% to 9.8% between 2019 and 2020, equaling nearly 27.4 million adults in 2020.
Avoiding care due to cost significantly decreased in 28 states and the District of Columbia, led by 33% in the District of Columbia (10.4% to 7.0%), 32% in Michigan (11.7% to 7.9%) and 31% in New Mexico (13.9% to 9.6%) between 2019 and 2020.
Between 2019 and 2020, avoiding care due to cost significantly decreased among Asian, multiracial, white, Hispanic and Black adults; all age, education and income levels; and both genders. By group, the largest decreases were:
Disparities
In 2020, avoiding care due to cost was highest in Texas (15.2%), Georgia (15.1%) and Oklahoma (14.6%); it was lowest in Hawaii (6.0%), the District of Columbia (7.0%), Iowa (7.3%) and North Dakota (7.4%).
In 2020, avoiding care due to cost varied most by income and age, but also significantly varied by education, race and ethnicity and gender. The percentage was higher among:
  • Adults ages 25 and older with an annual household income less than $25,000 (18.9%), 4.2 times higher than among those with an income of $75,000 or more (4.5%). Avoiding care due to cost was significantly lower with each increase in income level.
  • Adults ages 18-44 (13.8%), 3.3 times higher than among adults ages 65 and older (4.2%). Avoiding care due to cost was significantly lower with each increase in age group.
  • Adults ages 25 and older with less than a high school education (17.4%), 2.8 times higher than among college graduates (6.3%).
  • Hispanic adults (16.7%), 2.2 times higher than among Asian adults (7.7%). White adults also had a low prevalence (8.4%).
  • Females (11.6%) than males (9.7%).

Mental Health Providers

Mental health providers offer essential care to adults and children who have a mental or behavioral disorder by offering services such as assessment, diagnosis, treatment, medication and therapeutic interventions. Demand for mental health professionals is projected to increase as a result of the COVID-19 pandemic.

Findings
Nationally, the number of mental health providers per 100,000 population increased 6% from 268.6 to 284.3 between 2020 and 2021, and 30% from 218.0 in 2017, when the measure was first included in America’s Health Rankings. Providers included psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, as well as advanced practice nurses specializing in mental health care, including those treating alcohol and other drug abuse. In 2021, there were approximately 937,000 mental health providers in the U.S., nearly 55,000 more than in 2020.
The supply of mental health providers increased 6% or more in 28 states between 2020 and 2021, led by 19% in Alaska (523.8 to 625.9) and 8% in Illinois, Minnesota, Mississippi, New Jersey, Texas and Virginia.

Disparities
In 2021, the supply of mental health providers per 100,000 population was highest in Massachusetts (693.6), Alaska (625.9) and Oregon (602.7); it was lowest in Alabama (120.8), Texas (133.0) and West Virginia (149.7).

Primary Care Providers

Having a sufficient supply of primary care providers in a community wields numerous benefits, including lower rates of low-birthweight births, lower all-cause mortality, longer life spans and reductions in health system costs and health disparities across populations.
Findings
Nationally, the number of active primary care providers (including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics, internal medicine, physician assistants and nurse practitioners) per 100,000 population increased 4% from 241.9 to 252.3 between 2020 and 2021, and 18% from 213.8 in 2018, the year the measure was first included in America’s Health Rankings. In 2021, there were approximately 831,000 primary care providers in the U.S., 37,000 more than in 2020.
The supply of primary care providers increased 5% or more in 14 states, led by 8% in Hawaii (223.5 to 242.0) and 6% in Florida (252.0 to 266.9) between 2020 and 2021.
Disparities
In 2021, the supply of primary care providers per 100,000 population was highest in the District of Columbia (494.0), Massachusetts (373.3), Rhode Island (352.2) and Maine (344.1); it was lowest in Nevada (191.1), Utah (194.3) and California (197.8).

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