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The National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics since 1957, is the principal source of information on the health of the U.S. civilian noninstitutionalized population. NHIS selects one adult (Sample Adult) and, when applicable, one child (Sample Child) randomly within a family (through 2018) or a household (2019 and forward). Sampling weights for the separate analysis of data from Sample Adults and Sample Children are provided annually by the National Center for Health Statistics. A growing interest in analysis of parent-child pair data using NHIS has been observed, which necessitated the development of appropriate analytic weights. Objective This report explains how dyad weights were created such that data users can analyze NHIS data from both Sample Children and their mothers or fathers, respectively. Methods Using data from the 2019 NHIS, adult-child pair-level sampling weights were developed by combining each pair's conditional selection probability with their household-level sampling weight. The calculated pair weights were then adjusted for pair-level nonresponse, and large sampling weights were trimmed at the 99th percentile of the derived sampling weights. Examples of analyzing parent-child pair data by means of domain estimation methods (that is, statistical analysis for subpopulations or subgroups) are included in this report. Conclusions The National Center for Health Statistics has created dyad or pair weights that can be used for studies using parent-child pairs in NHIS. This method could potentially be adapted to other surveys with similar sampling design and statistical needs., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Introduction: This study estimates the prevalence and number of people living with Alzheimer's disease (AD) dementia in 50 US states and 3142 counties., Methods: We used cognitive data from the Chicago Health and Aging Project, a population-based study, and combined it with the National Center for Health Statistics 2020 bridged-race population estimates to determine the prevalence of AD in adults ≥65 years., Results: A higher prevalence of AD was estimated in the east and southeastern regions of the United States, with the highest in Maryland (12.9%), New York (12.7%), and Mississippi (12.5%). US states with the highest number of people with AD were California, Florida, and Texas. Among larger counties, those with the highest prevalence of AD were Miami-Dade County in Florida, Baltimore city in Maryland, and Bronx County in New York., Discussion: The state- and county-specific estimates could help public health officials develop region-specific strategies for caring for people with AD., (© 2023 the Alzheimer's Association.)

Objective This report on the third round of the Research and Development Survey (RANDS 3) provides a general description of RANDS 3 and presents percentage estimates of selected demographic and health-related variables from the overall sample and by one set of experimental groups embedded in the survey. Statistical tests comparing estimates for the two randomized groups were conducted to evaluate the randomization. Methods NORC at the University of Chicago conducted RANDS 3 for the National Center of Health Statistics in 2019 using its AmeriSpeak Panel in web-only mode. To assess question-response patterns, probe questions and four sets of experiments were embedded in RANDS 3, with panelists randomized into two groups for each set of experiments. Participants in each group received questions with differences in wording, question-andresponse formats, or question order. Results Of the 4,255 people sampled, 2,646 completed RANDS 3 for a completion rate of 62.2% and a weighted cumulative response rate of 18.1%. Iterative raking was performed using demographic and selected health condition variables to calibrate the RANDS 3 sample to 2019 National Health Interview Survey (NHIS) estimates. As a result, the overall demographic distribution and percentages of asthma, diabetes, hypertension, and high cholesterol for the calibrated RANDS 3 sample aligned with the percentages estimated from the 2019 NHIS. The distributions of demographic and healthrelated variables were comparable between the two randomized groups examined except for ever-diagnosed hypertension. Conclusion As part of a research series using probability-based survey panels, RANDS 3 included health-related questions with a focus on disability and opioids. Because RANDS is an ongoing research platform, a variety of persistent and emergent research questions relating to survey methodology will continue to be examined in current and future rounds of RANDS., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Objective-Linking data is a powerful mechanism to provide policy-relevant information. The National Center for Health Statistics' Data Linkage Program produces linked mortality files (LMFs) for research by linking data from the National Center for Health Statistics' surveys, including the National Health Interview Survey (NHIS), to mortality data from the National Death Index. Assessing the accuracy of the linked data is an important step in ensuring its analytic use. This report compares the cumulative survival probabilities estimated with the 2006-2018 NHIS LMFs to those from the annual U.S. life tables., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Data System. Federal health surveys, like the National Health Interview Survey (NHIS), represent important surveillance mechanisms for collecting timely, representative data that can be used to monitor the health and health care of the US population. Data Collection/Processing. Conducted by the National Center for Health Statistics (NCHS), NHIS uses an address-based, complex clustered sample of housing units, yielding data representative of the civilian noninstitutionalized US population. Survey redesigns that reduce survey length and eliminate proxy reporting may reduce respondent burden and increase participation. Such were goals in 2019, when NCHS implemented a redesigned NHIS questionnaire that also focused on topics most relevant and appropriate for surveillance of child and adult health. Data Analysis/Dissemination. Public-use microdata files and selected health estimates and detailed documentation are released online annually. Public Health Implications. Declining response rates may lead to biased estimates and weaken users' ability to make valid conclusions from the data, hindering public health efforts. The 2019 NHIS questionnaire redesign was associated with improvements in the survey's response rate, declines in respondent burden, and increases in data quality and survey relevancy. ( Am J Public Health . 2023;113(4):408-415. https://doi.org/10.2105/AJPH.2022.307197).

Objectives The Research and Development Survey (RANDS) is a series of web-based, commercial panel surveys that have been conducted by the National Center for Health Statistics (NCHS) since 2015. RANDS was designed for methodological research purposes,including supplementing NCHS' evaluation of surveys and questionnaires to detect measurement error, and exploring methods to integrate data from commercial survey panels with high-quality data collections to improve survey estimation. The latter goal of improving survey estimation is in response to limitations of web surveys, including coverage and nonresponse bias. To address the potential bias in estimates from RANDS,NCHS has investigated various calibration weighting methods to adjust the RANDS panel weights using one of NCHS' national household surveys, the National Health Interview Survey. This report describes calibration weighting methods and the approaches used to calibrate weights in web-based panel surveys at NCHS., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

For the CIs used in the Standards for rates from vital statistics and complex health surveys, this report evaluates coverage probability, relative width, and the resulting percentage of rates flagged as statistically unreliable when compared with previously used standards. Additionally, the report assesses the impact of design effects and the denominator's sampling variability, when applicable., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

To evaluate the quality of web surveys, the National Center for Health Statistics' Division of Research and Methodology has been conducting a series of studies with survey data from commercially recruited panels,referred to as the Research and Development Survey (RANDS). This report describes the propensity-score adjusted estimates from the second round of RANDS (RANDS 2) using the 2016 National Health Interview Survey (NHIS)., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

The purpose of this report is to provide guidance to users of NCHS data in the selection of modeling options when using the NCI Joinpoint regression software to analyze trends. This report complements another report, "National Center for Health Statistics Guidelines for Analysis of Trends." Considerations are presented for selecting the modeling options, with examples illustrating the choices. The tradeoffs and consequences of choosing the various modeling options using data from NCHS data systems are discussed.encounters., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Objective-This report demonstrates use of three National Center for Health Statistics (NCHS) data systems to study differences in health by sexual orientation. Sexual orientation differences in a broad selection of health indicators were examined using the National Health and Nutrition Examination Survey (NHANES), National Survey of Family Growth (NSFG), and National Health Interview Survey (NHIS)., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Objective: To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years., Methods: Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age., Results: There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups., Conclusion: Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age., Competing Interests: Financial Disclosure Veronica Gillispie-Bell reports receiving funding from AbbVie, Inc., the Institute of Healthcare Improvement, and Lecturio GmBH. The other authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Background/purpose: Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population., Methods: This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates., Results: In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer., Conclusion: Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Based on nationally representative anthropometric data, the National Center for Health Statistics (NCHS) has published reference tables on the distribution of various body measurements for the U.S. population (1-5). National Health and Nutrition Examination Survey (NHANES) data are the primary source of body measurement information for the U.S. population. These measurements reflect the mean weight, height, length, and various circumferences of U.S. children and adults. Anthropometry is a measure of nutritional or general health status, dietary adequacy, and growth. This report presents anthropometric reference data from the years 2015-2018 for U.S. children and adults., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Background-Injury diagnosis frameworks, or matrices, based on the International Classification of Diseases (ICD) provide standardized categories for reporting injuries by body region and nature of injury. In 2016, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed injury diagnosis matrix for use with data coded using the ICD, 10th Revision, Clinical Modification (ICD-10-CM). At the time the proposed matrix was developed, ICD-10-CM coded data were not available to evaluate the performance of the proposed matrix. As data became available, NCHS and NCIPC received recommendations from clinicians and researchers to improve the consistency and clinical applicability of categorization of codes within the matrix. This report describes the modifications made to the 2016 proposed ICD-10-CM injury diagnosis matrix and presents the final 2020 ICD-10-CM injury diagnosis matrix. Methods-Comments on the 2016 proposed matrix were received from several federal agencies, military health centers, state health departments, researchers, and others. Additionally, subject matter experts from NCHS, NCIPC, the Council of State and Territorial Epidemiologists, and others reviewed code descriptions, coding guidelines, updates to the ICD-10-CM code set, and other materials to identify possible needed changes to the 2016 proposed ICD-10-CM injury diagnosis matrix. Results-Consideration of issues raised by clinicians and researchers and from the internal review resulted in relocation of approximately 3% of the 9,000 codes in the 2016 proposed ICD-10-CM injury diagnosis matrix. These relocations generally involved changes to the assigned nature-of-injury category. Additionally, approximately 200 new injury diagnosis codes not available at the time the 2016 proposed matrix was developed were added to create the final 2020 matrix. Conclusions-The 2020 final ICD-10-CM injury diagnosis matrix provides standard categories for reporting injuries by body region and nature of injury. Use of this tool promotes consistency for comparisons across populations and over time., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Objective: This report provides a general description of the background and operation of the first two rounds of the Research and Development Survey (RANDS), a series of cross-sectional surveys from probability-sampled commercial survey panels. The Division of Research and Methodology of the National Center for Health Statistics (NCHS) conducted the first two rounds of RANDS in 2015 and 2016. RANDS 1 and 2 are being used primarily for question design evaluation and for investigating statistical methodologies for estimation. Methods: NCHS contracted with Gallup, Inc. to conduct RANDS 1 in Fall 2015 and RANDS 2 in Spring 2016. RANDS 1 and 2 were conducted using a web survey mode and included survey questions from the National Health Interview Survey (NHIS) that were specifically chosen to provide comparison and evaluation of the survey methodology properties of web surveys and traditional household surveys. In this report, some demographic and health estimates are provided from both sources to describe the RANDS data. Results: In RANDS 1, 2,304 out of the original 9,809 invited panel members completed the survey, for a completion rate of 23.5%. In RANDS 2, 2,480 of the initial 8,231 invited respondents completed the survey, for a completion rate of 30.1%. RANDS 1 and 2 participants were similar to the quarterly NHIS participants with respect to sex, census region, and whether they had worked for pay in the previous week. Other characteristics varied, including age, race and ethnicity, and income. Most health estimates differed between RANDS and NHIS. Public-use versions of the RANDS data can be found at: https://www.cdc.gov/nchs/rands. Conclusion: RANDS is an ongoing platform for research to understand the properties of probability-sampled recruited panels of primarily web users, investigating and developing statistical methods for using such data in conjunction with large nationally representative health surveys, and for extending question-design evaluations., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Maternal mortality is a sentinel health indicator. To improve the identification of maternal deaths, a pregnancy question was added during the 2003 revision of the US standard death certificate. Its adoption across all states in the United States took 16 years (2003-2018), and therefore the National Center for Health Statistics did not provide the national maternal mortality rate between 2007 and 2018. During this time, researchers raised questions about the accuracy of the checkbox information, particularly regarding its contribution to overreporting of maternal deaths in the United States. Checkbox errors were especially evident for women aged >40 years and for nonspecific causes of death. In January 2020, the NCHS resumed the reporting of maternal mortality data and provided the 2018 figures using a new coding method (ie, the 2018 method). Despite internal analyses suggesting the presence of both high false positive and high false negative pregnancy checkbox errors, the National Center for Health Statistics reported identification of 658 maternal deaths nationwide and a maternal mortality rate of 17.4 deaths per 100,000 live births for 2018. The 2018 coding method restricts the entry of checkbox information to decedents aged 10-44 years; the information cannot, therefore, be entered for women aged >45 years when no pregnancy-related cause of death information is indicated on the death certificate. Reported deaths with a pregnancy or obstetrical condition entered in the cause of death section of the death certificate continue to be coded as maternal deaths regardless of age. The 2018 method likely corrects errors introduced by the use of the checkbox for women aged >45 years, but whether it provides accurate maternal mortality figures remains unknown. We call for efforts to urgently and systematically validate the pregnancy checkbox information. Post hoc coding adjustments cannot substitute for providing accurate and actionable maternal mortality data., (Copyright © 2020 Elsevier Inc. All rights reserved.)

In 2018, an estimated 7.2% of American adults had a major depressive episode in the past year (1). Depression is associated with diminished quality of life and increased disability (2). Antidepressants are one of the primary treatments for depression (3) and are among the most frequently used therapeutic medications in the United States (4). This data brief provides recent prevalent estimates for antidepressant use among U.S. adults aged 18 and over, by age, sex, race and Hispanic origin, and education. Trends in antidepressant use over the decade from 2009-2010 through 2017-2018 are described., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Heavy drinking is defined as the average consumption of more than 7 drinks per week for women and more than 14 drinks per week for men in the past year (1). Heavy drinking is associated with an increased risk of alcohol use disorders, suicide, interpersonal violence, traffic injuries, liver disease, certain cancers and infectious diseases, and adverse birth outcomes in pregnant women (1,2). This report describes adult alcohol use in the United States and presents the prevalence of heavy drinking by demographic characteristics, select mental health indicators, and select measures of health care access and utilization., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Linking national survey data with administrative data sources enables researchers to conduct analyses that would not be possible with each data source alone. Recently, the Data Linkage Program at the National Center for Health Statistics (NCHS) released updated linked mortality files, including the National Health Interview Survey data linked to the National Death Index mortality files. Two versions of the files were released: restricted-use files available through NCHS and Federal Statistical Research Data Centers and public-use files. To reduce the reidentification risk, statistical disclosure limitation methods were applied to the public-use files before they were released. This included limiting the amount of mortality information available and perturbing cause of death and follow-up time for select records. To assess the comparability of the restricted-use and public-use files, relative hazard ratios for all-cause and cause-specific mortality using Cox proportional hazards models were estimated and compared. The comparative analysis found that the two data files yielded very similar descriptive and model results., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Background: Pregnancy-related deaths in the United States are increasing. Medical, social, economic, and cultural issues have all been implicated in this trend, but few data exist to differentiate the relative contributions of these various factors., Objective: The objective of the study was to examine trends in US pregnancy-related mortality by place of death and maternal race and age. We hypothesized that such an analysis may allow some distinction between deaths related to medical performance and those more closely related to social, cultural, or environmental issues., Study Design: We conducted a retrospective, cross-sectional study for the years 2003-2016 using multiple cause-of-death mortality data provided by the Centers for Disease Control and Natality Data provided by National Vital Statistics System of the National Center for Health Statistics. Temporal trends analyses for the place of death, race/ethnicity, and age at the time of death were performed using joinpoint regression over the study period., Results: Approximately one third of pregnancy-related deaths occurred outside a medical facility. The fraction of maternal deaths occurring in inpatient facilities fell by 20% over the study period, from 53% to 44% of all maternal deaths (P < .0001). Maternal deaths in an outpatient facility or emergency room demonstrated a similar decline (24%) in relative frequency (P < .0001). In contrast, there was a significant increase in the relative frequency of maternal mortality in other settings, particularly within the descendant's home, with a doubling over this time period. However, overall pregnancy-related deaths continued to increase in all settings. These increases were particularly striking in non-Hispanic black and white women and among women in the youngest and oldest age groups., Conclusion: Against a background of rising US pregnancy-related mortality, stratification of such deaths by place of death and maternal age and race highlights both the need for ongoing improvements in the quality of medical care and the potential contribution of events occurring outside a medical facility to the overall morality ratio. Current trends in pregnancy-related mortality in the United States are, in part, driven by social, cultural, and financial issues beyond the direct control of the medical community., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: To assess trends and factors associated with place of death among individuals with Alzheimer's disease-related dementias (ADRD)., Design: Cross-sectional analysis., Setting: Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research, 2003-2017., Participants: Natural deaths occurring between 2003 and 2017 for which ADRD was determined to be the underlying cause., Measurements: Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. Aggregate data included age, race, Hispanic ethnicity, sex, urbanization, and census division. Individual-level predictors included age, race, Hispanic ethnicity, sex, marital status, and education., Results: From 2003 to 2017, nursing facility and hospital deaths declined from 65.7% and 12.7% to 55.0% and 8.0% while home and hospice facility deaths increased from 13.6% and .2% to 21.9% and 6.2%, respectively. Odds of hospital and hospice facility deaths declined with age while odds of nursing facility deaths increased with age. Male sex was associated with higher odds of hospital or hospice facility death and lower odds of home or nursing facility death. Nonwhite race, Hispanic ethnicity, and being married were associated with increased odds of hospital or home death and reduced odds of nursing facility death. More education was associated with higher odds of home or in a hospice facility death and reduced odds of death in a nursing facility or hospital. Significant disparities in place of death by urban-rural status were also noted., Conclusion: As ADRD deaths at home increase, the need for caregiver support and home-based palliative care may become more critical. Further research should examine the care preferences and experiences of ADRD patients and caregivers, the financial impact of home death on families and insurers, and explore factors that may contribute to differences in actual and preferred place of death. J Am Geriatr Soc 68:250-255, 2020., (© 2019 The American Geriatrics Society.)

This study examines patterns of and explanations for racial/ethnic-education disparities in infant mortality in the United States. Using linked birth and death data (2007-2010), we find that while education-specific infant mortality rates are similar for Mexican Americans and Whites, infants of college-educated African American women experience 3.1 more deaths per 1,000 live births (Rate Ratio = 1.46) than infants of White women with a high school degree or less. The high mortality rates among infants born to African American women of all educational attainment levels are fully accounted for by shorter gestational lengths. Supplementary analyses of data from the National Longitudinal Study of Adolescent to Adult Health show that college-educated African American women exhibit similar socioeconomic, contextual, psychosocial, and health disadvantages as White women with a high school degree or less. Together, these results demonstrate African American-White infant mortality and socioeconomic, health, and contextual disparities within education levels, suggesting the role of life course socioeconomic disadvantage and stress processes in the poorer infant health outcomes of African Americans relative to Whites.

This report describes changes in how the National Center for Health Statistics (NCHS) will code, publish, and release maternal mortality data and presents official 2018 maternal mortality estimates using a new coding method. Due to the incremental implementation of the pregnancy status checkbox item on the 2003 revised U.S. Standard Certificate of Death, NCHS last published an official estimate of the U.S. maternal mortality rate in 2007. As of 2018, implementation of the revised certificate, including its pregnancy checkbox, is complete for all 50 states (noting that California implemented a different checkbox than that on the U.S. Standard Certificate of Death), allowing NCHS to resume the routine publication of maternal mortality statistics. However, an evaluation of data quality indicated some errors with the reporting of maternal deaths (deaths within 42 days of pregnancy) following adoption of the checkbox, including overreporting of maternal deaths among older women. Therefore, NCHS has adopted a new method (to be called the 2018 method) for coding maternal deaths to mitigate these probable errors. The 2018 method involves further restricting application of the pregnancy checkbox to decedents aged 10-44 years from the previous age group of 10-54. In addition, the 2018 method restricts assignment of maternal codes to the underlying cause alone when the checkbox is the only indication of pregnancy on the death certificate, and such coding would be applied only to decedents aged 10-44 based solely on the checkbox when no other pregnancy information is provided in the cause-of-death statement. Based on the new method, a total of 658 deaths were identified in 2018 as maternal deaths. The maternal mortality rate for 2018 was 17.4 deaths per 100,000 live births, and the rate for non-Hispanic black women (37.1) was 2.5 to 3.1 times the rates for non-Hispanic white (14.7) and Hispanic (11.8) women. Rates also increased with age. Maternal mortality rates calculated without using information obtained from the checkbox are also presented for 2002, 2015, 2016, 2017, and 2018 to provide comparisons over time using a comparable coding approach across all states., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Purpose: Sex, race/ethnicity, and geographic disparities in sarcoidosis-associated mortality were assessed for the most recent period., Methods: US data for multiple causes of death for 1999-2016 were used to determine numbers of deaths and age-adjusted rates for sarcoidosis as an underlying or a contributing cause of death using International Classification of Diseases, 10th Revision code D86 for Hispanics, non-Hispanic blacks, and non-Hispanic whites., Results: For persons of all ages in the United States in 1999-2016, there were a total of 28,923 sarcoidosis-associated deaths. In 2008-2016, 9112 deaths had sarcoidosis as the underlying cause (56%) compared with 16,129 with sarcoidosis listed as any cause. Age-adjusted annual death rates per 100,000 were 5.7 (95% confidence interval [CI], 5.6-5.8) for females and 4.1 (95% CI, 4.0-4.2) for males. Age-adjusted annual death rates were 1.5 (95% CI, 1.4-1.6) for Hispanics and 5.4 (95% CI, 5.3-5.4) for non-Hispanics. Rates in non-Hispanic blacks were 8 times those in non-Hispanic whites. Among females, the highest rate was in non-Hispanic blacks in the East-Central division. Between 1999-2007 and 2008-2016, rates increased most in non-Hispanic white males (52.5%) and least in non-Hispanic black females (5.8%)., Conclusions: Sarcoidosis-related multiple cause of death mortality rates were highest in females and in non-Hispanic blacks, and they varied geographically., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: This study examines the effect of economic recession on the suicide differential between rural and urban counties., Methods: A negative binomial regression model and county mortality data are used to estimate the effect of recession and rurality on county-level suicides from 2002-2016., Results: After accounting for differences in population, urban counties have more female suicides than rural counties, but urban counties experience smaller increases in female suicide numbers during periods of recession than rural counties. Long-term factors such as high chronic poverty or unemployment have a greater impact on male suicide rates, while short-term economic crises have a larger impact on female suicides. Higher percentages of children in the county have an increasing effect on male suicides, but a decreasing effect on female suicides. Finally, farm-dependent counties have fewer suicides than non-farm-dependent counties. This holds true for both males and females., Conclusions: Periods of recession impact suicide numbers; however, this effect is most noticeable for females, with rural counties having larger increases in female suicide numbers than their urban counterparts during recession years., (© 2018 National Rural Health Association.)

Background: Since the mid-1980s, the burden of liver cancer in the United States has doubled, with 31,411 new cases and 24,698 deaths occurring in 2014. Foreign-born individuals may be more likely to die of liver cancer than individuals in the general US-born population because of higher rates of hepatitis B infection, a low socioeconomic position, and language barriers that limit the receipt of early cancer detection and effective treatment., Methods: To determine whether liver cancer mortality rates were higher among foreign-born individuals versus US-born individuals in the United States, population-based cancer mortality data were obtained from the National Center for Health Statistics of the Centers for Disease Control and Prevention. Annual population estimates were obtained from the US Census Bureau's American Community Survey. Age-adjusted mortality rates and rate ratios (RRs) for liver cancer stratified by birth place were calculated, and the average annual percent change (AAPC) was used to evaluate trends., Results: A total of 198,557 deaths from liver and intrahepatic bile duct cancer were recorded during 2005-2014, and 16% occurred among foreign-born individuals. Overall, foreign-born individuals had a 24% higher risk of liver cancer mortality than US-born individuals (RR, 1.24; 95% confidence interval [CI], 1.22-1.25). Foreign-born individuals did not have any significant changes in liver cancer mortality rates overall, but among US-born individuals, liver cancer mortality rates significantly increased (AAPC, 2.7; 95% CI, 2.1-3.3)., Conclusions: Efforts that address the major risk factors for liver cancer are needed to help to alleviate the health disparities observed among foreign-born individuals and reverse the increasing trend observed in the US-born population., (© 2018 American Cancer Society.)

Objectives: The objective of this study was to examine whether the association between maternal smoking and gestational hypertension varies by the timing of exposure., Study Design: Retrospective cohort study of women identified in 2015 US natality records for singleton births., Main Outcome Measures: Our outcome was whether a woman was diagnosed with gestational hypertension (GH) on the birth record, a category which includes preeclampsia., Results: Women who smoked before and during pregnancy had a reduced risk for GH relative to non-smokers (adjusted RR 0.92, 95% CI 0.90-0.94). In contrast, women who apparently quit just before the start of pregnancy had higher risk than non-smokers (adjusted RR 1.02, 95% CI 1.00-1.05). When the trimester-specific effects were examined, only women who smoked before pregnancy and in all three trimesters had reduced risk for GH. Smoking mothers who quit just before the start of the 3rd trimester had an increased risk for GH compared to non-smokers (adjusted RR 1.08, 95% CI 1.02-1.16)., Conclusion: In our analysis, women who smoked before pregnancy and in all three trimesters have reduced risk of GH compared to non-smokers, while smokers who reported quitting before pregnancy were at an increased risk. Our results offer new insights into the importance of timing of smoking in pregnancy on risk of GH, and challenge the notion that any smoking during pregnancy has a protective effect., (Copyright © 2019 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Since the most recent peak in the total fertility rate (the estimated number of lifetime births expected per 1,000 women) in 2007, the United States has experienced a decreasing total fertility rate and an increasing mean, or average, age of mothers at first birth (1-4). Previous research shows rural areas have persistently higher fertility and worse birth outcomes compared with metropolitan (metro) areas (2,5-8). This report describes trends and differences in total fertility rates and mean maternal age at first birth overall, and by race and Hispanic origin, between rural and small or medium metro, and rural and large metro counties, from 2007 through 2017., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Background: Little is known about the changes in the ranking of leading cause of death (COD) among people died with schizophrenia across years in the United States (U.S.). This study aims to determine the ranking of leading COD among U.S. decedents with mention of schizophrenia by age from 2000 to 2015., Methods: The mortality multiple COD files maintained by the National Center for Health Statistics were used to identify decedents aged 15 years old and above with mention of schizophrenia anywhere on the death certificates to determine the number and proportion of deaths attributed to various underlying CODs., Results: Of 13,289, 13,655, 14,135, and 15,033 people who died in 2000-2003, 2004-2007, 2008-2011and 2012-2015 with mention of schizophrenia, similar to all decedents, heart disease and cancer was the first and the second leading COD throughout the study years. Schizophrenia ranked the third in most years except in 2004-2007. The first leading COD for decedents with mention of schizophrenia aged 15-24, 25-44, 45-64, 65-74, and 75+ years old in 2012-2015 was suicide, accidents, heart disease, heart disease, and Alzheimer's disease and related dementia, respectively. Nevertheless, it was accidents, accidents, cancer, cancer, and heart disease, respectively for all decedents., Conclusion: The ranking of leading CODs among U.S. decedents with mention of schizophrenia changed across years and differed from all decedents by age, which suggest that different interventions should be designed accordingly., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Many reports present analyses of trends over time based on multiple years of data from National Center for Health Statistics (NCHS) surveys and the National Vital Statistics System (NVSS). Trend analyses of NCHS data involve analytic choices that can lead to different conclusions about the trends. This report discusses issues that should be considered when conducting a time trend analysis using NCHS data and presents guidelines for making trend analysis choices. Trend analysis issues discussed include: choosing the observed time points to include in the analysis, considerations for survey data and vital records data (record level and aggregated), a general approach for conducting trend analyses, assorted other analytic issues, and joinpoint regression. This report provides 12 guidelines for trend analyses, examples of analyses using NCHS survey and vital records data, statistical details for some analysis issues, and SAS and SUDAAN code for specification of joinpoint regression models. Several an lytic choices must be made during the course of a trend analysis, and the choices made can affect the results. This report highlights the strengths and limitations of different choices and presents guidelines for making some of these choices. While this report focuses on time trend analyses, the issues discussed and guidelines presented are applicable to trend analyses involving other ordinal and interval variables., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

The National Immunization Survey (NIS) family of surveys includes NIS-Child, which monitors vaccination coverage for the U.S. population of children aged 19-35 months; NIS- Teen, which monitors vaccination coverage for the U.S. population of adolescents aged 13-17; and NIS-Flu, which monitors influenza vaccination coverage for the U.S. population of children aged 6 months through 17 years. This report describes the methods used in this family of surveys during the 2005-2014 period., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Because of classification errors reported by the National Center for Health Statistics, an estimated 42 % of the same-sex married partners in the sample for this study are misclassified different-sex married partners, thus calling into question findings regarding same-sex married parents. Including biological parentage as a control variable suppresses same-sex/different-sex differences, thus obscuring the data error. Parentage is not appropriate as a control because it correlates nearly perfectly (+.97, gamma) with the same-sex/different-sex distinction and is invariant for the category of joint biological parents.

Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate. Using standard protocols, three field representatives conducted NAMCS physician induction interviews (PIIs) while trained ethnographers observed and audio recorded the interviews. Transcripts and field notes were analyzed to identify recurrent issues in the data collection process. Results The majority of the NAMCS items appeared to have been easily answered by the physician respondents. Among the items that appeared to be difficult to answer, three themes emerged: (a) physician respondents demonstrated an inconsistent understanding of "location" in responding to questions; (b) lack of familiarity with administrative matters made certain questions difficult for physicians to answer; and (c) certain primary care‑oriented questions were not relevant to specialty care providers. Conclusions Some PII survey questions were challenging for physicians in a multispecialty practice setting. Improving the design and administration of NAMCS data collection is part of NCHS' continuous quality improvement process., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Objectives-This report presents final 2015 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2015," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2015. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Results-In 2015, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2015 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Purpose: To examine the prevalence of 13 chronic conditions and fair/poor health among people aged ≥65 years in the United States with and without vision impairment., Design: Cross-sectional study from the 2010-2014 National Health Interview Survey., Methods: We examined hypertension, heart disease, high cholesterol, stroke, arthritis, asthma, chronic obstructive pulmonary disease, cancer, weak/failing kidneys, diabetes, hepatitis, depression, and hearing impairment. We used logistic regression to show the association between vision impairment and chronic conditions and the association between vision impairment and poor health for those with chronic conditions., Results: People aged ≥65 years with vision impairment reported greater prevalence of chronic conditions compared to people without vision impairment. After controlling for covariates (age, sex, education, race, smoking, physical activity, and obesity), people with vision impairment were more likely than those without to report chronic conditions (hypertension: OR [odds ratio] 1.43; heart disease: OR 1.68; high cholesterol: OR 1.26; stroke: OR 1.99; arthritis; OR 1.71; asthma: OR 1.56; chronic obstructive pulmonary disease: OR 1.65; cancer: OR 1.23; weak/failing kidneys: OR 2.29; diabetes: OR 1.56; hepatitis: OR 1.30; depression: OR 1.47; hearing impairment: OR 1.91) (all P < .05). Among older people with chronic conditions, those with vision impairment and chronic conditions compared to people without vision impairment and chronic conditions were 1.66-2.98 times more likely to have fair/poor health than those without vision impairment (all P < .05)., Conclusion: Higher prevalence of chronic conditions is strongly associated with vision impairment among the older people and poor health is strongly associated with vision impairment and chronic conditions., (Published by Elsevier Inc.)

Objectives This report presents the development, plan, and operation of the 2011-2012 National Survey of Children's Health, a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics. Funding was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. The survey was designed to produce national and state prevalence estimates of the physical and emotional health of children aged 0-17 years, as well as factors that may relate to child well-being including medical homes, family interactions, parental health, school and after-school experiences, and neighborhood characteristics., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

This study explored potential risk factors for injuries from patient violence among direct care workers in U.S. homes (DCWHs). A national probability sample of 3,377 DCWHs including home health and personal care aides was analyzed using complex sample analysis and generalized estimating equation. Injury from violence was defined as a workrelated injury sustained by aggression, violence, or abuse that was reported to the agency, required medical attention or resulted in absenteeism from work. An association between suffering an injury from patient violence and having a language barrier with patients was noted (OR = 4.44; 95% CI = 1.57, 12.56; p = .005). Findings illuminate the importance of homecare providers to match language between DCWHs and patients to reduce patient violence and improve quality of care in the home setting.

Background: Maternal mortality ratios (MMR) appear to have increased in the United States over the last decade. Three potential contributing factors are (1) a shifting maternal age distribution, (2) changes in age-specific MMR, and (3) the addition of a checkbox indicating recent pregnancy on the death certificate., Objective: To determine the contribution of increasing maternal age on changes in MMR from 1978 to 2012 and estimate the contribution of the pregnancy checkbox on increases in MMR over the last decade., Study Design: Kitagawa decomposition analyses were conducted to partition the maternal age contribution to the MMR increase into 2 components: changes due to a shifting maternal age distribution and changes due to greater age-specific mortality ratios. We used National Vital Statistics System natality and mortality data. The following 5-year groupings were used: 1978-1982, 1988-1992, 1998-2002, and 2008-2012. Changes in age-specific MMRs among states that adopted the standard pregnancy checkbox onto their death certificate before 2008 (n = 23) were compared with states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (n = 11) to estimate the percentage increase in the MMR due to the pregnancy checkbox., Results: Overall US MMRs for 1978-1982, 1988-1992, and 1998-2002 were 9.0, 8.1, and 9.1 deaths per 100,000 live births, respectively. There was a modest increase in the MMR between 1998-2002 and 2008-2012 in the 11 states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (8.6 and 9.9 deaths per 100,000, respectively). However, the MMR more than doubled between 1998-2002 and 2008-2012 in the 23 states that adopted the standard pregnancy checkbox (9.0-22.4); this dramatic increase was almost entirely attributable to increases in age-specific MMRs (94.9%) as opposed to increases in maternal age (5.1%), with an estimated 90% of the observed change reflecting the change in maternal death identification rather than a real change in age-specific rates alone. Of all age categories, women ages 40 and older in states that adopted the standard pregnancy checkbox had the largest increase in MMR-from 31.9 to 200.5-a relative increase of 528%, which accounted for nearly one third of the overall increase. An estimated 28.8% of the observed change was potentially due to maternal death misclassification among women ≥40 years., Conclusion: Increasing age-specific maternal mortality seems to be contributing more heavily than a changing maternal age distribution to recent increases in MMR. In states with the standard pregnancy checkbox, the vast majority of the observed change in MMR over the last decade was estimated to be due to the pregnancy checkbox, with the greatest change in MMR occurring in women ages ≥40 years. The addition of a pregnancy checkbox on state death certificates appears to be increasing case identification but also may be leading to maternal death misclassification, particularly for women ages ≥40 years., (Published by Elsevier Inc.)

The 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) is the first federal survey designed exclusively to measure the health of the noninstitutionalized civilian NHPI population of the United States., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

The National Center for Health Statistics (NCHS) disseminates information on a broad range of health topics through diverse publications. These publications must rely on clear and transparent presentation standards that can be broadly and efficiently applied. Standards are particularly important for large, cross-cutting reports where estimates cannot be individually evaluated and indicators of precision cannot be included alongside the estimates. This report describes the NCHS Data Presentation Standards for Proportions. The multistep NCHS Data Presentation Standards for Proportions are based on a minimum denominator sample size and on the absolute and relative widths of a confidence interval calculated using the Clopper-Pearson method. Proportions (usually multiplied by 100 and expressed as percentages) are the most commonly reported estimates in NCHS reports., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Objectives This report presents the development, plan, and operation of the 2011-2012 National Survey of Children's Health, a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics. Funding was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. The survey was designed to produce national and state prevalence estimates of the physical and emotional health of children aged 0-17 years, as well as factors that may relate to child well-being including medical homes, family interactions, parental health, school and after-school experiences, and neighborhood characteristics., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Background California is the most populated state and Los Angeles County is the most populated county in the United States. National Health and Nutrition Examination Survey (NHANES) sample weights and variance units were developed for these places to obtain subnational estimates. Objective This report describes the California and Los Angeles County NHANES 1999-2006 and 2007-2014 samples, including the creation of the sample weights and variance units and descriptions of the resulting data files. Some analytic guidelines are provided. Results Eight years of NHANES data were combined for each data file to provide an adequate sample size and reduce disclosure risks. Because Los Angeles County has been a self-representing primary sampling unit, sample weights for Los Angeles County were relatively straightforward. However, a modelbased approach was used to create sample weights for California. The relatively large proportion of Mexican- American and other Hispanic persons in California, coupled with the different NHANES 1999-2014 sample design requirements for oversampling these groups within the small number of NHANES locations selected each cycle, led to a relatively large size of these groups in the California and Los Angeles County NHANES files. For example, 1,137 and 374 of the 3,353 Mexican-Americans persons in NHANES 2007-2014 were in the California and Los Angeles County samples, respectively. Conclusion The California and Los Angeles County NHANES 1999-2006 and 2007-2014 samples are available in the National Center for Health Statistics Research Data Center., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.

Background: Various dietary components have been studied in relation to overall mortality; however, little is known about the relationship between the inflammatory potential of overall diet and mortality., Materials and Methods: We examined the association between the dietary inflammatory index (DII) and mortality in the National Health and Nutrition Examination Survey III follow-up study. The DII was computed from baseline dietary intake assessed using 24-h dietary recalls (1988-1994). Mortality was determined from the National Death Index records through 2006. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence interval (95 % CI). During the follow-up, 2795 deaths were identified, including 1233 due to cardiovascular disease (CVD), and 615 due to cancer, 158 of which were due to digestive-tract cancers., Results: Multivariate Cox proportional hazards regression analyses, adjusting for age, race, diabetes status, hypertension, physical activity, body mass index, poverty index, and smoking, revealed positive associations between higher DII scores and mortality. Comparing subjects in DII tertile 3 versus tertile 1, significant associations were noted for all-cause mortality (HR Tertile3vs1 1.34; 95 % CI 1.19-1.51, P trend  < 0.0001), CVD mortality (HR Tertile3vs1 1.46; 95 % CI 1.18-1.81, P trend  = 0.0006), cancer mortality (HR Tertile3vs1 1.46; 95 % CI 1.10-1.96, P trend  = 0.01), and digestive-tract cancer mortality (HR Tertile3vs1 2.10; 95 % CI 1.15-3.84, P trend  = 0.03)., Conclusion: These results indicate that a pro-inflammatory diet, as indicated by higher DII scores, was associated with higher risk of all-cause, CVD, and cancer mortality.

Background and Objectives: The surveillance of children's growth reflects a population's nutritional status and risk for adverse outcomes. This study aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months., Methods: We analyzed NHANES data from 1976-1980, 1988-1994, 1999-2002, 2003-2006, 2007-2010, and 2011-2014. We estimated z scores < -2 (low) and ≥+2 (high) in comparison with World Health Organization growth standards for each indicator. Weight gain (relative to sex-age-specific medians) from birth until survey participation was estimated. Trends were assessed by low birth weight status and race/Hispanic origin. Race/Hispanic origin trends were assessed from 1988-1994 to 2011-2014., Results: In 2011-2014, the prevalence of low and high length-for-age was 3.3% (SE, 0.8) and 3.7% (SE, 0.8); weight-for-age was 0.6% (SE, 0.3) and 7.0% (SE, 1.1); and weight-for-length was 1.0% (SE, 0.4) and 7.7% (SE, 1.2). The only significant trend was a decrease in high length-for-age (5.5% in 1976-1980 vs 3.7% in 2011-2014; P = .04). Relative weight gain between birth and survey participation did not differ over time, although trends differed by race/Hispanic origin. Non-Hispanic black children gained more weight between birth and survey participation in 2011-2014 versus 1988-1994, versus no change among other groups., Conclusions: Between 1976-1980 and 2011-2014, there were no significant trends in low or high weight-for-age and weight-for-length among 6- to 23-month-old children whereas the percent with high length-for-age decreased. A significant trend in relative weight gain between birth and survey participation was observed among non-Hispanic black children., (published in the public domain by the American Academy of Pediatrics.)

Background: A common issue in descriptive injury epidemiology is that in order to calculate injury rates that account for the time spent in an activity, both injury cases and exposure time of specific activities need to be collected. In reality, few national surveys have this capacity. To address this issue, we combined statistics from two different national complex surveys as inputs for the numerator and denominator to estimate injury rate, accounting for the time spent in specific activities and included a procedure to estimate variance using the combined surveys., Methods: The 2010 National Health Interview Survey (NHIS) was used to quantify injuries, and the 2010 American Time Use Survey (ATUS) was used to quantify time of exposure to specific activities. The injury rate was estimated by dividing the average number of injuries (from NHIS) by average exposure hours (from ATUS), both measured for specific activities. The variance was calculated using the 'delta method', a general method for variance estimation with complex surveys., Results: Among the five types of injuries examined, 'sport and exercise' had the highest rate (12.64 injuries per 100 000 h), followed by 'working around house/yard' (6.14), driving/riding a motor vehicle (2.98), working (1.45) and sleeping/resting/eating/drinking (0.23). The results show a ranking of injury rate by activity quite different from estimates using population as the denominator., Conclusions: Our approach produces an estimate of injury risk which includes activity exposure time and may more reliably reflect the underlying injury risks, offering an alternative method for injury surveillance and research., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective To evaluate the correlation of size, according to age, of the anthropometric growth references of Colombian indigenous children studied in Encuesta Nacional de la Situación Nutricional de Colombia 2010 -ENSIN 2010 (National Survey of Nutrition in Colombia - 2010). Method A secondary analysis of 2598 data of indigenous Colombian children under five years of age, evaluated by ENSIN in 2010, was performed. The considered variables were size according to age, gender, height, place of residence, department and socioeconomic position. The classification of the deficit in size, based on the references of the National Center for Health Statistics (NCHS) and the World Health Organization (WHO), was made by using the Z <-2 score and the Anthro software. The Kappa coefficient was estimated to assess the correlation between anthropometric categories and was classified taking into account the proposal of Altman DG. Results One in four children had a deficit in size in the light of both anthropometric references. The prevalence of the deficit was higher when using the WHO standard, increased with age and was higher in children who resided in low altitude (m). The correlation between the two references was good (kappa ≥0,688, p=0,000) for children of both genders and all ages; the exception corresponded to children of age two, since it was moderate (kappa=0,601, p=0,000). The greatest disagreement in the classification was observed in the category "tall". Conclusion According to the statistical correlation found between the two anthropometric references (WHO vs. NCHS), any reference could be used for assessment of size according to for age.