Mmwr Surveillance Summaries最新文献

{"title":"Surveillance for Lyme Disease — United States, 2008–2015","authors":"Amy M Schwartz, A. Hinckley, P. Mead, S. Hook, K. Kugeler","doi":"10.15585/mmw.ss6622a1","DOIUrl":"https://doi.org/10.15585/mmw.ss6622a1","url":null,"abstract":"Problem/Condition Lyme disease is the most commonly reported vectorborne disease in the United States but is geographically focal. The majority of Lyme disease cases occur in the Northeast, mid-Atlantic, and upper Midwest regions. Lyme disease can cause varied clinical manifestations, including erythema migrans, arthritis, facial palsy, and carditis. Lyme disease occurs most commonly among children and older adults, with a slight predominance among males. Reporting Period 2008–2015. Description of System Lyme disease has been a nationally notifiable condition in the United States since 1991. Possible Lyme disease cases are reported to local and state health departments by clinicians and laboratories. Health department staff conduct case investigations to classify cases according to the national surveillance case definition. Those that qualify as confirmed or probable cases of Lyme disease are reported to CDC through the National Notifiable Diseases Surveillance System. States with an average annual incidence during this reporting period of ≥10 confirmed Lyme disease cases per 100,000 population were classified as high incidence. States that share a border with those states or that are located between areas of high incidence were classified as neighboring states. All other states were classified as low incidence. Results During 2008–2015, a total of 275,589 cases of Lyme disease were reported to CDC (208,834 confirmed and 66,755 probable). Although most cases continue to be reported from states with high incidence in the Northeast, mid-Atlantic, and upper Midwest regions, case counts in most of these states have remained stable or decreased during the reporting period. In contrast, case counts have increased in states that neighbor those with high incidence. Overall, demographic characteristics associated with confirmed cases were similar to those described previously, with a slight predominance among males and a bimodal age distribution with peaks among young children and older adults. Yet, among the subset of cases reported from states with low incidence, infection occurred more commonly among females and older adults. In addition, probable cases occurred more commonly among females and with a higher modal age than confirmed cases. Interpretation Lyme disease continues to be the most commonly reported vectorborne disease in the United States. Although concentrated in historically high-incidence areas, the geographic distribution is expanding into neighboring states. The trend of stable to decreasing case counts in many states with high incidence could be a result of multiple factors, including actual stabilization of disease incidence or artifact due to modifications in reporting practices employed by some states to curtail the resource burden associated with Lyme disease surveillance. Public Health Action This report highlights the continuing public health challenge of Lyme disease in states with high incidence and demonstrates its emergence in","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"111 1","pages":"1 - 12"},"PeriodicalIF":24.9,"publicationDate":"2017-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89768445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance for Lyme Disease - United States, 2008-2015.","authors":"Amy M Schwartz, Alison F Hinckley, Paul S Mead, Sarah A Hook, Kiersten J Kugeler","doi":"10.15585/mmwr.ss6622a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6622a1","url":null,"abstract":"<p><strong>Problem/condition: </strong>Lyme disease is the most commonly reported vectorborne disease in the United States but is geographically focal. The majority of Lyme disease cases occur in the Northeast, mid-Atlantic, and upper Midwest regions. Lyme disease can cause varied clinical manifestations, including erythema migrans, arthritis, facial palsy, and carditis. Lyme disease occurs most commonly among children and older adults, with a slight predominance among males.</p><p><strong>Reporting period: </strong>2008-2015.</p><p><strong>Description of system: </strong>Lyme disease has been a nationally notifiable condition in the United States since 1991. Possible Lyme disease cases are reported to local and state health departments by clinicians and laboratories. Health department staff conduct case investigations to classify cases according to the national surveillance case definition. Those that qualify as confirmed or probable cases of Lyme disease are reported to CDC through the National Notifiable Diseases Surveillance System. States with an average annual incidence during this reporting period of ≥10 confirmed Lyme disease cases per 100,000 population were classified as high incidence. States that share a border with those states or that are located between areas of high incidence were classified as neighboring states. All other states were classified as low incidence.</p><p><strong>Results: </strong>During 2008-2015, a total of 275,589 cases of Lyme disease were reported to CDC (208,834 confirmed and 66,755 probable). Although most cases continue to be reported from states with high incidence in the Northeast, mid-Atlantic, and upper Midwest regions, case counts in most of these states have remained stable or decreased during the reporting period. In contrast, case counts have increased in states that neighbor those with high incidence. Overall, demographic characteristics associated with confirmed cases were similar to those described previously, with a slight predominance among males and a bimodal age distribution with peaks among young children and older adults. Yet, among the subset of cases reported from states with low incidence, infection occurred more commonly among females and older adults. In addition, probable cases occurred more commonly among females and with a higher modal age than confirmed cases.</p><p><strong>Interpretation: </strong>Lyme disease continues to be the most commonly reported vectorborne disease in the United States. Although concentrated in historically high-incidence areas, the geographic distribution is expanding into neighboring states. The trend of stable to decreasing case counts in many states with high incidence could be a result of multiple factors, including actual stabilization of disease incidence or artifact due to modifications in reporting practices employed by some states to curtail the resource burden associated with Lyme disease surveillance.</p><p><strong>Public health action: </strong>","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 22","pages":"1-12"},"PeriodicalIF":24.9,"publicationDate":"2017-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10266148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational Exposure to Vapor-Gas, Dust, and Fumes in a Cohort of Rural Adults in Iowa Compared with a Cohort of Urban Adults.","authors":"Brent C Doney,&nbsp;Paul K Henneberger,&nbsp;Michael J Humann,&nbsp;Xiaoming Liang,&nbsp;Kevin M Kelly,&nbsp;Jean M Cox-Ganser","doi":"10.15585/mmwr.ss6621a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6621a1","url":null,"abstract":"<p><strong>Problem/condition: </strong>Many rural residents work in the field of agriculture; however, employment in nonagricultural jobs also is common. Because previous studies in rural communities often have focused on agricultural workers, much less is known about the occupational exposures in other types of jobs in rural settings. Characterizing airborne occupational exposures that can contribute to respiratory diseases is important so that differences between rural and urban working populations can be assessed.</p><p><strong>Reporting period: </strong>1994-2011.</p><p><strong>Description of system: </strong>This investigation used data from the baseline questionnaire completed by adult rural residents participating in the Keokuk County Rural Health Study (KCRHS). The distribution of jobs and occupational exposures to vapor-gas, dust, and fumes (VGDF) among all participants was analyzed and stratified by farming status (current, former, and never) then compared with a cohort of urban workers from the Multi-Ethnic Study of Atherosclerosis (MESA). Occupational exposure in the last job was assessed with a job-exposure matrix (JEM) developed for chronic obstructive pulmonary disease (COPD). The COPD JEM assesses VGDF exposure at levels of none or low, medium, and high.</p><p><strong>Results: </strong>The 1,699 KCRHS (rural) participants were more likely to have medium or high occupational VGDF exposure (43.2%) at their last job than their urban MESA counterparts (15.0% of 3,667 participants). One fifth (20.8%) of the rural participants currently farmed, 43.1% were former farmers, and approximately one third (36.1%) had never farmed. These three farming groups differed in VGDF exposure at the last job, with the prevalence of medium or high exposure at 80.2% for current farmers, 38.7% for former farmers, and 27.4% for never farmers, and all three percentages were higher than the 15.0% medium or high level of VGDF exposure for urban workers.</p><p><strong>Interpretation: </strong>Rural workers, including those who had never farmed, were more likely to experience occupational VGDF exposure than urban workers.</p><p><strong>Public health action: </strong>The occupational exposures of rural adults assessed using the COPD JEM will be used to investigate their potential association with obstructive respiratory health problems (e.g., airflow limitation and chronic bronchitis). This assessment might highlight occupations in need of preventive interventions.</p>","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 21","pages":"1-5"},"PeriodicalIF":24.9,"publicationDate":"2017-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35565904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.","authors":"Karen Pazol, Cheryl L Robbins, Lindsey I Black, Katherine A Ahrens, Kimberly Daniels, Anjani Chandra, Anjel Vahratian, Lorrie E Gavin","doi":"10.15585/mmwr.ss6620a1","DOIUrl":"10.15585/mmwr.ss6620a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Receipt of key preventive health services among women and men of reproductive age (i.e., 15-44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2011-2013.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of the system: &lt;/strong&gt;Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15-44 years. This report uses data from the 2011-2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver live-born infants in the United States. Annual PRAMS data sets are created and used to produce statewide estimates of preconception and perinatal health behaviors and experiences. This report uses PRAMS data for 2011-2012 from 11 states (Hawaii, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, Utah, Vermont, and West Virginia). The National Health Interview Survey (NHIS) is a nationally representative survey of noninstitutionalized civilians in the United States. NHIS collects data on a broad range of health topics, including the prevalence, distribution, and effects of illness and disability and the services rendered for or because of such conditions. Households are identified through a multistage probability household sampling design, and estimates are produced ","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 20","pages":"1-31"},"PeriodicalIF":37.3,"publicationDate":"2017-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35643327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States.","authors":"Karin A Mack, Christopher M Jones, Michael F Ballesteros","doi":"10.15585/mmwr.ss6619a1","DOIUrl":"10.15585/mmwr.ss6619a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Drug overdoses are a leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Reporting period: &lt;/strong&gt;Illicit drug use and drug use disorders during 2003-2014, and drug overdose deaths during 1999-2015.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of data: &lt;/strong&gt;The National Survey of Drug Use and Health (NSDUH) collects information through face-to-face household interviews about the use of illicit drugs, alcohol, and tobacco among the U.S. noninstitutionalized civilian population aged ≥12 years. Respondents include residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories, migratory workers' camps, and halfway houses) and civilians living on military bases. NSDUH variables include sex, age, race/ethnicity, residence (metropolitan/nonmetropolitan), annual household income, self-reported drug use, and drug use disorders. National Vital Statistics System Mortality (NVSS-M) data for U.S. residents include information from death certificates filed in the 50 states and the District of Columbia. Cases were selected with an underlying cause of death based on the ICD-10 codes for drug overdoses (X40-X44, X60-X64, X85, and Y10-Y14). NVSS-M variables include decedent characteristics (sex, age, and race/ethnicity) and information on intent (unintentional, suicide, homicide, or undetermined), location of death (medical facility, in a home, or other [including nursing homes, hospices, unknown, and other locations]) and county of residence (metropolitan/nonmetropolitan). Metropolitan/nonmetropolitan status is assigned independently in each data system. NSDUH uses a three-category system: Core Based Statistical Area (CBSA) of ≥1 million persons; CBSA of &lt;1 million persons; and not a CBSA, which for simplicity were labeled large metropolitan, small metropolitan, and nonmetropolitan. Deaths from NVSS-M are categorized by the county of residence of the decedent using CDC's National Center for Health Statistics 2013 Urban-Rural Classification Scheme, collapsed into two categories (metropolitan and nonmetropolitan).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Although both metropolitan and nonmetropolitan areas experienced significant increases from 2003-2005 to 2012-2014 in self-reported past-month use of illicit drugs, the prevalence was highest for the large metropolitan areas compared with small metropolitan or nonmetropolitan areas throughout the study period. Notably, past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12-17 years). The prevalence of past-year illicit drug use disorders among persons using illicit drugs in the past year varied by metropolitan/nonmetropoli","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 19","pages":"1-12"},"PeriodicalIF":24.9,"publicationDate":"2017-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15585/mmwr.ss6619a1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35530002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015.","authors":"Asha Z Ivey-Stephenson, Alex E Crosby, Shane P D Jack, Tadesse Haileyesus, Marcie-Jo Kresnow-Sedacca","doi":"10.15585/mmwr.ss6618a1","DOIUrl":"10.15585/mmwr.ss6618a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Reporting period: &lt;/strong&gt;2001-2015.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Public health action: &lt;/strong&gt;Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioecon","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 18","pages":"1-16"},"PeriodicalIF":24.9,"publicationDate":"2017-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35574865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural and Urban Differences in Passenger-Vehicle-Occupant Deaths and Seat Belt Use Among Adults - United States, 2014.","authors":"Laurie F Beck,&nbsp;Jonathan Downs,&nbsp;Mark R Stevens,&nbsp;Erin K Sauber-Schatz","doi":"10.15585/mmwr.ss6617a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6617a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Motor-vehicle crashes are a leading cause of death in the United States. Compared with urban residents, rural residents are at an increased risk for death from crashes and are less likely to wear seat belts. These differences have not been well described by levels of rurality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Reporting period: &lt;/strong&gt;2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of systems: &lt;/strong&gt;Data from the Fatality Analysis Reporting System (FARS) and the Behavioral Risk Factor Surveillance System (BRFSS) were used to identify passenger-vehicle-occupant deaths from motor-vehicle crashes and estimate the prevalence of seat belt use. FARS, a census of U.S. motor-vehicle crashes involving one or more deaths, was used to identify passenger-vehicle-occupant deaths among adults aged ≥18 years. Passenger-vehicle occupants were defined as persons driving or riding in passenger cars, light trucks, vans, or sport utility vehicles. Death rates per 100,000 population, age-adjusted to the 2000 U.S. standard population and the proportion of occupants who were unrestrained at the time of the fatal crash, were calculated. BRFSS, an annual, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years, was used to estimate prevalence of seat belt use. FARS and BRFSS data were analyzed by a six-level rural-urban designation, based on the U.S. Department of Agriculture 2013 rural-urban continuum codes, and stratified by census region and type of state seat belt enforcement law (primary or secondary).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Within each census region, age-adjusted passenger-vehicle-occupant death rates per 100,000 population increased with increasing rurality, from the most urban to the most rural counties: South, 6.8 to 29.2; Midwest, 5.3 to 25.8; West, 3.9 to 40.0; and Northeast, 3.5 to 10.8. (For the Northeast, data for the most rural counties were not reported because of suppression criteria; comparison is for the most urban to the second-most rural counties.) Similarly, the proportion of occupants who were unrestrained at the time of the fatal crash increased as rurality increased. Self-reported seat belt use in the United States decreased with increasing rurality, ranging from 88.8% in the most urban counties to 74.7% in the most rural counties. Similar differences in age-adjusted death rates and seat belt use were observed in states with primary and secondary seat belt enforcement laws.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Rurality was associated with higher age-adjusted passenger-vehicle-occupant death rates, a higher proportion of unrestrained passenger-vehicle-occupant deaths, and lower seat belt use among adults in all census regions and regardless of state seat belt enforcement type.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Public health actions: &lt;/strong&gt;Seat belt use decreases and age-adjusted passenger-vehicle-occupant death rates increase with increasing levels of rurality. Improving seat belt use","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 17","pages":"1-13"},"PeriodicalIF":24.9,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35533678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2013 and 2014.","authors":"Sonya Gamble, Tebitha Mawokomatanda, Fang Xu, Pranesh P Chowdhury, Carol Pierannunzi, David Flegel, William Garvin, Machell Town","doi":"10.15585/mmwr.ss6616a1","DOIUrl":"10.15585/mmwr.ss6616a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem: &lt;/strong&gt;Chronic diseases and conditions (e.g., heart diseases, stroke, arthritis, and diabetes) are the leading causes of morbidity and mortality in the United States. These conditions are costly to the U.S. economy, yet they are often preventable or controllable. Behavioral risk factors (e.g., excessive alcohol consumption, tobacco use, poor diet, frequent mental distress, and insufficient sleep) are linked to the leading causes of morbidity and mortality. Adopting positive health behaviors (e.g., staying physically active, quitting tobacco use, obtaining routine physical checkups, and checking blood pressure and cholesterol levels) can reduce morbidity and mortality from chronic diseases and conditions. Monitoring the health risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services at multilevel public health points (states, territories, and metropolitan and micropolitan statistical areas [MMSA]) can provide important information for development and evaluation of health intervention programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Reporting period: &lt;/strong&gt;2013 and 2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of the system: &lt;/strong&gt;The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services and practices related to the leading causes of death and disability in the United States and participating territories. This is the first BRFSS report to include age-adjusted prevalence estimates. For 2013 and 2014, these age-adjusted prevalence estimates are presented for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, and selected MMSA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Age-adjusted prevalence estimates of health status indicators, health care access and preventive practices, health risk behaviors, chronic diseases and conditions, and cardiovascular conditions vary by state, territory, and MMSA. Each set of proportions presented refers to the range of age-adjusted prevalence estimates of selected BRFSS measures as reported by survey respondents. The following are estimates for 2013. Adults reporting frequent mental distress: 7.7%-15.2% in states and territories and 6.3%-19.4% in MMSA. Adults with inadequate sleep: 27.6%-49.2% in states and territories and 26.5%-44.4% in MMSA. Adults aged 18-64 years having health care coverage: 66.9%-92.4% in states and territories and 60.5%-97.6% in MMSA. Adults identifying as current cigarette smokers: 10.1%-28.8% in states and territories and 6.1%-33.6% in MMSA. Adults reporting binge drinking during the past month: 10.5%-25.2% in states and territories and 7.2%-25.3% in MMSA. Adults with obesity: 21.0%-35.2% in states and territories and 12.1%-37.1% in MMSA. Adults aged ≥45 years w","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 16","pages":"1-144"},"PeriodicalIF":37.3,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10264661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas - United States, 2009-2014.","authors":"Katherine Kolor,&nbsp;Zhuo Chen,&nbsp;Scott D Grosse,&nbsp;Juan L Rodriguez,&nbsp;Ridgely Fisk Green,&nbsp;W David Dotson,&nbsp;M Scott Bowen,&nbsp;Julie A Lynch,&nbsp;Muin J Khoury","doi":"10.15585/mmwr.ss6615a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6615a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2009-2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA testing and receipt of preventive interventions after BRCA testing among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 2009 to 2014, BRCA testing rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA testing in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Possible explanations for the 47% decrease in the relative difference in BRCA testing rates over the study period include increased access to genetic services in nonmetropolitan areas and increased demand nationally as a result of publicity. The relative differences in metropolitan and nonmetropolitan BRCA testing rates were smaller among women at younger ages compared with older ages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Public health action: &lt;/strong&gt;Improved data sources and surveillance tools are needed to gather comprehensive data on BRCA testing in the United States, monitor adherence to evidence-based guidelines for BRCA testing, and assess receipt of preventive interventions for women with BRCA mutations. Programs can build on the recent decrease in geographic disparities in receipt of BRCA testing while sim","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 15","pages":"1-11"},"PeriodicalIF":24.9,"publicationDate":"2017-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35382016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Cancer Incidence, 2004-2013, and Deaths, 2006-2015, in Nonmetropolitan and Metropolitan Counties - United States.","authors":"S Jane Henley,&nbsp;Robert N Anderson,&nbsp;Cheryll C Thomas,&nbsp;Greta M Massetti,&nbsp;Brandy Peaker,&nbsp;Lisa C Richardson","doi":"10.15585/mmwr.ss6614a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6614a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Previous reports have shown that persons living in nonmetropolitan (rural or urban) areas in the United States have higher death rates from all cancers combined than persons living in metropolitan areas. Disparities might vary by cancer type and between occurrence and death from the disease. This report provides a comprehensive assessment of cancer incidence and deaths by cancer type in nonmetropolitan and metropolitan counties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Reporting period: &lt;/strong&gt;2004-2015.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2009-2013 and trends in annual age-adjusted incidence rates for 2004-2013. Cancer mortality data from the National Vital Statistics System were used to calculate average annual age-adjusted death rates for 2011-2015 and trends in annual age-adjusted death rates for 2006-2015. For 5-year average annual rates, counties were classified into four categories (nonmetropolitan rural, nonmetropolitan urban, metropolitan with population &lt;1 million, and metropolitan with population ≥1 million). For the trend analysis, which used annual rates, these categories were combined into two categories (nonmetropolitan and metropolitan). Rates by county classification were examined by sex, age, race/ethnicity, U.S. census region, and cancer site. Trends in rates were examined by county classification and cancer site.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the most recent 5-year period for which data were available, nonmetropolitan rural areas had lower average annual age-adjusted cancer incidence rates for all anatomic cancer sites combined but higher death rates than metropolitan areas. During 2006-2015, the annual age-adjusted death rates for all cancer sites combined decreased at a slower pace in nonmetropolitan areas (-1.0% per year) than in metropolitan areas (-1.6% per year), increasing the differences in these rates. In contrast, annual age-adjusted incidence rates for all cancer sites combined decreased approximately 1% per year during 2004-2013 both in nonmetropolitan and metropolitan counties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;This report provides the first comprehensive description of cancer incidence and mortality in nonmetropolitan and metropolitan counties in the United States. Nonmetropolitan rural counties had higher incidence of and deaths from several cancers related to tobacco use and cancers that can be prevented by screening. Differences between nonmetropolitan and metropolitan counties in cancer incidence might reflect differences in risk factors such as cigarette smoking, obesity, and physical inactivity, whereas differences in cancer death rates might reflect disparities in access to health care and timely diagnosis and treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Public h","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 14","pages":"1-13"},"PeriodicalIF":24.9,"publicationDate":"2017-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35148803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}