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Indicators for Chronic Disease Surveillance — United States, 2013

Prepared by

James B. Holt, PhD1

Sara L. Huston, PhD2,3

Khosrow Heidari, MA, MS, MS4,5

Randy Schwartz, MSPH4

Charles W. Gollmar4

Annie Tran, MPH3

Leah Bryan, MPH1

Yong Liu, MD1

Janet B. Croft, PhD1

1Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC

2Council of State and Territorial Epidemiologists

3University of Southern Maine

4National Association of Chronic Disease Directors

5South Carolina Department of Health and Environmental Control

The material in this report originated in the National Center for Chronic Disease Prevention and Health Promotion, Ursula Bauer, PhD, Director; and the Division of Population Health, Wayne H. Giles, MD, Director. Corresponding preparer: James B. Holt, PhD, National Center for Chronic Disease Prevention and Health Promotion, CDC. Telephone: 770-488-5510; Fax: 770-488-5965; E-mail: jgh4@cdc.gov.

Summary

Chronic diseases are an important public health problem, which can result in morbidity, mortality, disability, and decreased quality of life. Chronic diseases represented seven of the top 10 causes of death in the United States in 2010 (Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013;6. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf). Chronic diseases and risk factors vary by geographic area such as state and county, where essential public health interventions are implemented. The chronic disease indicators (CDIs) were established in the late 1990s through collaboration among CDC, the Council of State and Territorial Epidemiologists, and the Association of State and Territorial Chronic Disease Program Directors (now the National Association of Chronic Disease Directors) to enable public health professionals and policymakers to retrieve data for chronic diseases and risk factors that have a substantial impact on public health. This report describes the latest revisions to the CDIs, which were developed on the basis of a comprehensive review during 2011–2013. The number of indicators is increasing from 97 to 124, with major additions in systems and environmental indicators and additional emphasis on high-impact diseases and conditions as well as emerging topics.

Background and Rationale

Chronic diseases represented seven of the top 10 causes of death in the United States in 2010 (1). Diseases of the heart, malignant neoplasms (cancers), chronic lower respiratory disease, cerebrovascular diseases, diabetes mellitus, Alzheimer's disease, and kidney disease (nephritis, nephrotic syndrome, and nephrosis) together accounted for 65.8% of all deaths among U.S. males and 67.2% of all deaths among U.S. females in 2010 (2). Chronic disease risk factors, including smoking, poor diet, insufficient physical inactivity, and excessive alcohol consumption, were the leading actual causes of death in 2000 (3). To monitor diseases and risk factors over time and to plan and implement effective interventions, public health agencies need access to the most relevant, up-to-date, and uniformly defined chronic disease surveillance data at the state and county level.

The chronic disease indicators (CDIs) are a set of surveillance indicators developed by consensus among CDC, the Council of State and Territorial Epidemiologists (CSTE), and the National Association of Chronic Disease Directors (NACDD) and are available on the Internet. The CDI website enables public health professionals and policymakers to retrieve uniformly defined state-level and selected metropolitan-level data for chronic diseases and risk factors that have a substantial impact on public health. These indicators are essential for surveillance, prioritization, and evaluation of public health interventions for chronic disease. Most, if not all, of the current indicators are available and reported on other websites, either by the data providers or by categorical chronic disease programs. However, the CDI website is the only integrated source for comprehensive access to a wide range of indicators for the surveillance of chronic diseases, conditions, and risk factors at the state level and for selected large metropolitan areas. CDI data are obtained from several primary surveillance data sources including vital statistics, disease registries, national health surveys, inpatient and emergency department databases, Medicare claims data, policy tracking systems, and the U.S. Census. CDC, CSTE, and NACDD jointly agree on the set of diseases, conditions, and risk factors that comprise the CDI set. CDC gathers, reports, and updates data for states and (where available) large metropolitan areas.

The original 73 indicators adopted in 1998 and published in 1999 were formally reviewed for potential updates in 2002. Details of the history of the CDIs and the 2002 update are available elsewhere (4). Beginning in 2011 and continuing through the summer of 2013, CDC, CSTE, and NACDD collaborated to conduct a series of reviews that were informed by subject-matter expert opinion to make recommendations for updating the indicators. The updated indicators will better meet the expanded scope and priorities of chronic disease prevention programs in state health departments. The standardized indicator definitions will also encourage consistency in chronic disease surveillance at the national, state, and local public health levels.

This report outlines the process of the recent review of the indicators, highlights the major areas of change since the previous update (4), lists the indicators by indicator group, and provides consensus definitions for each indicator. The detailed definitions include the following information: demographic group, numerator, denominator, measures of frequency, period of case definition, background, significance, limitations of indicator, data resources, limitations of data resources, related indicators or recommendations, and related CDI topic areas. These definitions will enable public health officials and researchers to create estimates that are consistent with the data that CDC publishes on the CDI website. These indicator definitions might be particularly useful for the development of indicator estimates by jurisdictions at the substate level (e.g., county health departments) for which nationwide substate level estimates are not possible.

Methods

To ensure that the CDIs are comprehensive and relevant to public health priorities such as Healthy People 2020 (5), CDC, CSTE, and NACDD conducted a preliminary review in 2011 to obtain initial input on the need to update the indicators and to solicit comments from subject-matter experts at CDC and state health departments about the CDI website and the use of the indicators. Following this process, a focused review of the CDIs occurred during 2012–2013. CDC provided funding through a cooperative agreement with NACDD to coordinate the review process. The overall review process received guidance by an ad hoc CDI steering committee that was composed of three members: the CDC project manager for the CDIs; the chairperson of the CSTE Chronic Disease, Maternal and Child Health, and Oral Health Committee; and the chairperson of the NACDD Science and Epidemiology Committee. NACDD convened 15 content-specific working groups with representatives from state health departments, CDC program areas, and national public health organizations to update the existing 97 indicators and to consider new indicators.

The NACDD Science and Epidemiology Committee; the CSTE Chronic Disease, Maternal and Child Health, and Oral Health Committee; and CDC nominated and recruited the working group participants. Participants were either nominated on the basis of their chronic disease subject-matter expertise or recruited from state health departments. Efforts were made to have representation from each of the three organizations (CDC, CSTE, and NACDD) on each working group when possible. Working groups also contained representatives with expertise in systems and environmental indicators. Additional participants were individually recruited as needed to ensure adequate subject-matter expertise and a balance of federal and state public health representation for each working group. Chairpersons for each working group were recruited from among the working group members. Seven of the working group chairpersons were from state health departments, five were from CDC, one was from the U.S. Renal Data System, and two were NACDD staff members. Approximately 100 reviewers participated in the process and are listed at the end of this document.

The working group members were asked to provide input on the following: 1) new indicators to be added within existing categories; 2) current indicators that need to be modified; 3) current indicators that should be removed; and 4) new categories of indicators that should be considered. Working groups were asked to consider new population indicators as well as new systems and environmental indicators, which were not contained in previous versions of the CDIs. Furthermore, each recommendation was expected to follow the underlying principles of the CDIs: 1) allow states, territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are related to diseases and conditions with a substantial public health impact; 2) ensure that the data are consistent with Healthy People 2020 goals and objectives (5), if possible; and 3) ensure that the data are available at the state level for the majority of states and preferably for territories and large metropolitan areas.

Working groups convened independently through a combination of conference calls and e-mail communications. The CDI steering committee met approximately every month by phone with the NACDD consultant to review progress, identify issues, and determine action steps. Working group recommendations were presented by the working group chairperson or designee in Atlanta in September 2012. Following this meeting, the CDI steering committee reviewed the collective input for areas of overlap and omission. During follow-up communication with relevant working groups that occurred during September 2012 through May 2013, a small number of additional indicators were identified for deletion or modification because of overlap, a few new indicators and indicator groups were proposed, and additional details for the indicator definitions were obtained. Reviewers were recruited to discuss additional indicators that were identified by the steering committee, particularly in the areas of reproductive health and multiple chronic conditions. The apparent discrepancy between the number of working groups initially convened and the final number of indicator groups is a result of the subsequent creation of three related categories for school health, mental health, and disability, whose indicators are contained in the other various topic areas and were consolidated by these areas. The expanded set of indicators was compiled for a CSTE position statement (13-CD-01: Revision to the National Chronic Disease Indicators), which was reviewed by the CSTE membership before the annual meeting in June 2013 and voted on and approved for adoption during the meeting. Subsequently, the CSTE-approved set of indicators was posted on the CSTE website (6), and an updated set of these indicators (with additional references and more detailed background information) is included in this report (Appendix).

2013 Revisions to Chronic Disease Indicators

The CDI set increased to 124 indicators in the following 18 topic groups (Table 1): alcohol; arthritis; asthma; cancer; cardiovascular disease; chronic kidney disease; chronic obstructive pulmonary disease; diabetes; immunization; nutrition, physical activity, and weight status; oral health; tobacco; overarching conditions; and new topic areas that include disability, mental health, older adults, reproductive health, and school health. For the first time, the CDI set will include 22 indicators of systems and environmental change. Eleven existing indicators were recommended for deletion or combination (Table 2) because of changes in prevention practice guidelines, changes in relative impact of a condition, substitution of more useful indicators, or lack of available data.

A total of 201 individual measures are included for the recommended 124 indicators (Table 3), many of which overlap multiple chronic disease topic areas or are specific to a certain sex or age group. CDC will make the CDI website more user-friendly by improving the appearance, navigation, and data-retrieval functionality. Because of the close partnership between the states and CDC during the CDI review, these changes directly reflect the priorities and needs of the states.

Data Sources

The expansion of the CDI set necessitates inclusion of new sources of data. Previously, the CDIs relied on data from nine primary sources: the Behavioral Risk Factor Surveillance System (BRFSS), state cancer registries, the American Community Survey (ACS), birth and death certificates data in the National Vital Statistics System (NVSS), the State Tobacco Activities Tracking and Evaluation System, the United States Renal Data System, and the Youth Risk Behavior Surveillance System. The revised CDIs retain the use of data from these sources, and additional data will be obtained from the Pregnancy Risk Assessment Monitoring System, the Alcohol Epidemiologic Data System, the Alcohol Policy Information System, alcohol policy legal research, the National Survey of Children's Health, State Emergency Department Databases, State Inpatient Databases, the Centers for Medicare and Medicaid Services Chronic Condition Warehouse and the Medicare Current Beneficiary Survey, the U.S. Department of Agriculture, the CDC School Health Profiles, Achieving a State of Healthy Weight, Maternal Practices in Infant Nutrition and Care, the Breastfeeding Report Card, the Health Resources and Services Administration Uniform Data System, the National Immunization Survey, and the Water Fluoridation Reporting System. Many of these, such as BRFSS, use complex sampling designs and weights that must be taken into account. Additional details on these data sources are provided (Table 4).

Data Concerns

As with most sources of population health data, several data concerns must be considered. First, in instances in which it is likely that data might be compared across geographic areas and age is an important contributing risk factor, the data should be age standardized. On the CDI website, CDC reports both age-adjusted (using the 2000 U.S. standard population) (7) and crude data values as appropriate. Second, data quality, sample size, and confidentiality considerations might limit the availability of data for certain geographic areas. CDC reports CDI data using the data quality and sample size thresholds stipulated and implemented by the data providers. Therefore, if the data providers suppress data for quality or confidentiality reasons, CDC does not report those particular data elements on the CDI website. CDC follows all data use policies of the data providers. Last, caution must be exercised when comparing estimates for the same indicator over time. Although the presentation of trend data might be valuable, CDC does not present more than the most recent year of available data on the CDI website. For example, one of the major sources of CDI data is BRFSS. Beginning in 2011, BRFSS implemented a major change in its methods, moving from a landline-only telephone survey to a survey that includes both landline and cellular telephones. In addition, BRFSS revised the weighting method. Because of these changes, data collected before 2011 are not directly comparable to data collected in 2011 and subsequent years. Therefore, CDC cannot present multiple years of BRFSS data on the CDI website. In future years, after additional years of survey data are obtained, the approach to trend data might be reassessed.

Future Needs

CDC, CSTE, and NACDD will continue to collaborate to periodically review and revise the CDIs. Such reviews and revisions might focus on technical matters such as the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), which is scheduled to occur on October 1, 2015. This change will necessitate updates to some of the indicator definitions. Continued and frequent reviews of the CDIs also are necessary as conceptual approaches to chronic disease surveillance evolve, especially regarding multiple chronic conditions (MCCs). MCCs create unique health-care challenges while presenting public health prevention opportunities (10). Despite recent estimates that approximately one fourth of U.S. adults are estimated to have MCCs (11), surveillance of MCCs requires an agreed-on conceptual framework and standardized definitions (12). Initial research has been reported on the prevalence of MCCs (11,13,14), and this updated set of CDIs includes an inaugural indicator on the presence of MCCs among older adults, using data from the Centers for Medicare and Medicaid Services. Future revisions of the CDIs will likely include additional MCC indicators as research in this field increases and data become available. In addition, future reviews might address data on health behaviors among younger children and additional data on systems and environmental indicators, should additional data become available.

The CDIs are an example of collaboration among CDC and state health departments in building a consensus set of state-based health surveillance indicators. This update will help ensure that the CDI data remain the most relevant and current collection of chronic disease surveillance data for state epidemiologists, chronic disease program officials, and reproductive health and maternal and child health officials. The newly revised indicators are aligned with Healthy People 2020 objectives (5), the National Oral Health Surveillance System (8,15), and the Preconception Health Indicators (9). CDC will provide timely and up-to-date indicator data on a newly revised CDI website, which is under development. The indicator definitions will continue to serve as a standardized approach to conducting chronic disease surveillance for federal, state, and local public health.

References

  1. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013;6. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf.
  2. Heron M. Deaths: leading causes for 2010. Natl Vital Stat Rep 2013;62. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf.
  3. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238–45.
  4. CDC. Indicators for chronic disease surveillance. MMWR 2004;53(No. RR-11).
  5. US Department of Health and Human Services. Healthy people 2020. Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.healthypeople.gov.
  6. Huston SL, Heidari K, Holt JB. Revision to the national chronic disease indicators. Position Statement 13-CD-01. Council of State and Territorial Epidemiologists; 2013; Available at http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/13-CD-01.pdf.
  7. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy people 2010 statistical notes, no. 20. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2001. Available at http://www.cdc.gov/nchs/data/statnt/statnt20.pdf.
  8. CDC. National Oral Health Surveillance System. Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/nohss.
  9. Broussard DL, Sappenfield WB, Fussman C, Kroelinger CD, Grigorescu V. Core state preconception health indicators: a voluntary, multi-state selection process. Matern Child Health J 2011;15:158–68.
  10. Ford ES, Croft JB, Posner SF, Goodman RA, Giles WH. Co-occurrence of leading lifestyle-related chronic conditions among adults in the United States, 2002–2009. [Erratum in Prev Chronic Dis 2013;10. Available at http://www.cdc.gov/pcd/issues/2013/12_0316e.htm.] Prev Chronic Dis 2013;10:120316. DOI: http://dx.doi.org/10.5888/pcd10.120316.
  11. Ward BW, Schiller JS. Prevalence of multiple chronic conditions among U.S. adults: estimates from the National Health Interview Survey, 2010. Prev Chronic Dis 2013;10:120203. DOI: http://dx.doi.org/10.5888/pcd10.120203.
  12. Goodman RA, Posner SF, Huang ES, Parekh AK, Koh KH. Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Prev Chronic Dis 2013;10:120239. DOI: http://dx.doi.org/10.5888/pcd10.120239.
  13. Lochner KA, Cox CS. Prevalence of multiple chronic conditions among Medicare beneficiaries, United States, 2010. Prev Chronic Dis 2013;10:120137. DOI: http://dx.doi.org/10.5888/pcd10.120137.
  14. Ashman JJ, Beresovsky V. Multiple chronic conditions among U.S. adults who visited physician offices: data from the National Ambulatory Medical Care Survey, 2009. Prev Chronic Dis 2013;10:120308. DOI: http://dx.doi.org/10.5888/pcd10.120308.
  15. Reed GM, Duffy R. Proposed new and revised indicators for the National Oral Health Surveillance System. Position Statement 12-CD-01. Council of State and Territorial Epidemiologists; 2012. Available at http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/12-CD-01FINALCORRECTEDOCT201.pdf.

Working Group Members

Alcohol: Katy Gonzales, MPH, Michigan Department of Community Health, Lansing, Michigan. Jim Roeber, MSPH (chairperson), New Mexico Department of Health, Santa Fe, New Mexico. Clark Denny, PhD, Fetal Alcohol Syndrome Prevention Team; Dafna Kanny, PhD, Excessive Alcohol Use Prevention Team, CDC, Atlanta, Georgia.

Arthritis: Randy Tanner, MPA, Utah Department of Health, Salt Lake City, Utah. Charles G. (Chad) Helmick, MD (chairperson), Kristina A. Theis, MPH, Arthritis Program, CDC, Atlanta, Georgia.

Asthma: Wendy Brunner, PhD, Minnesota Department of Health, St. Paul, Minnesota. Sarah Lyon-Callo, PhD (chairperson), Michigan Department of Community Health, Lansing, Michigan. Melissa Lurie, MPH, New York State Department of Health, Albany, New York. Trang Q. Nguyen, MD, DrPH, New York City Department of Health and Mental Hygiene, New York City, New York. Liza Lutzker, MPH, California Department of Public Health, Sacramento, California. Rebekah Buckley, MPH, School Health Branch; Steve Kinchen, Division of Adolescent and School Health; Jeanne E. Moorman, MS, Air Pollution and Respiratory Health Branch, CDC, Atlanta, Georgia.

Cancer: Polly Hager, MSN, Michigan Department of Community Health, Lansing, Michigan. Tara Hylton, MPH, Florida Department of Health, Tallahassee, Florida. Minnie Inzer Muniz, MEd, Idaho Department of Health and Welfare, Boise, Idaho. Lynne Nilson, MPH, MCHES, Utah Department of Health, Salt Lake City, Utah. Donna Williams, DrPH, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana. Djenaba A. Joseph, MD (co-chairperson), Jacqueline W. Miller, MD, Cheryll C. Thomas, MSPH (co-chairperson), Julie Townsend, MS, Division of Cancer Prevention and Control, CDC, Atlanta, Georgia.

Chronic Kidney Disease: David Gilbertson, PhD (chairperson), United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, Minnesota. Patsy Myers, DrPH, South Carolina Department of Health and Environmental Control, Columbia, South Carolina. Brenda Ralls, PhD, Utah Department of Health, Salt Lake City, UT. Xiao-Ying Yu, MD, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland. Nilka Rios Burrows, MPH, Division of Diabetes Translation, CDC, Atlanta, Georgia.

Chronic Obstructive Pulmonary Disease: Tim Flood, MD, Arizona Department of Health Services, Phoenix, Arizona. Harry Herrick, MSPH, MSW, North Carolina Department of Health and Human Services, Raleigh, North Carolina. Roy A. Pleasants, II, PharmD, Duke University School of Medicine and Campbell University College of Pharmacy and Health Sciences, Durham, North Carolina. Xiao-Ying Yu, MD (chairperson), Maryland Department of Health and Mental Hygiene, Baltimore, Maryland. Janet B. Croft, PhD, Anne G. Wheaton, PhD, Division of Population Health, CDC, Atlanta, Georgia.

Cardiovascular Disease: Carrie Daniels, MS, Oklahoma State Department of Health, Oklahoma City, Oklahoma. Joseph Grandpre, PhD (chairperson), Wyoming Department of Health, Cheyenne, Wyoming. Shifan Dai, MD, PhD, Rachel S. Davis, MPH, Jing Fang, MD, Michael Schooley, MPH, Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia.

Diabetes: Joe Grandpre, PhD, Wyoming Department of Health, Cheyenne, Wyoming. Youjie Huang, MD, DrPH, Florida Department of Health, Tallahassee, Florida. Stephanie Poulin, Connecticut Department of Health, Hartford, Connecticutt. Brenda Ralls, PhD, Utah Department of Health, Salt Lake City, Utah. Joan Ware, MSPH (chairperson), National Association of Chronic Disease Directors, Atlanta, Georgia. Lawrence Barker, PhD, Nilka Rios Burrows, MPH, Patricia Shea, MPH, MA, Desmond Williams, MD, PhD, Division of Diabetes Translation; Carolyn Bridges, MD, Immunization Services Division, CDC, Atlanta, Georgia.

Immunization: Sara L. Huston, PhD, Maine Center for Disease Control and Prevention and University of Southern Maine, Augusta, Maine. Donna Lazorik, MS, Massachusetts Department of Public Health, Boston, Massachusetts. Carolyn B. Bridges, MD, Raymond A. Strikas, MD, Walter W. Williams, MD (chairperson), Immunization Services Division, CDC.

Nutrition, Physical Activity, and Weight Status: Renee Calanan, PhD (chairperson), Colorado Department of Public Health and Environment, Denver, Colorado. Youjie Huang, MD, DrPH, Florida Department of Health, Tallahassee, FL. Jessica Irizarry-Ramos, MS, Puerto Rico Department of Health, San Juan, Puerto Rico. Ghazala Perveen, PhD, Kansas Department of Health and Environment, Topeka, Kansas. Susan A. Carlson, MPH, Rosanne P. Farris, PhD, Janet E. Fulton, PhD, Deborah Galuska, PhD, Kirsten Grimm, MPH, Sonia A. Kim, PhD, Kelley S. Scanlon, PhD, Bettylou Sherry, PhD, Division of Nutrition, Physical Activity and Obesity; Steve Kinchen, Division of Adolescent and School Health; Allison Nihiser, MPH, School Health Branch, CDC, Atlanta, Georgia.

Older Adults: Carol McPhillips-Tangum, MPH, National Association of Chronic Disease Directors, Atlanta, Georgia. Jennifer Mead, MPH, Oregon Department of Human Services, Aging and People with Disabilities, Salem, Oregon. Cora Plass, MSW, South Carolina Department of Health and Environmental Control, Columbia, South Carolina. Lynda A. Anderson, PhD (chairperson), Healthy Aging Program; Richard A. Goodman, MD, JD, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.

Oral Health: Renee Calanan, PhD, Colorado Department of Public Health and Environment, Denver, Colorado. Junhie Oh, MPH (chairperson), Rhode Island Department of Health Oral Health Program, Providence, Rhode Island. Gregg Reed, Division of Family Health MCH/Oral Health, North Dakota Department of Health, Bismarck, ND. Laurie Barker, MSPH, Cassandra Martin Frazier, MPH, Mei Lin, MD, Division of Oral Health, CDC, Atlanta, Georgia.

Overarching Conditions: Elizabeth Barton, Khosrow Heidari, MA, MS, MS (chairperson), South Carolina Department of Health and Environmental Control, Columbia, South Carolina. Chris Maylahn, MPH, New York State Department of Health, Albany, New York. Ann Pobutsky, Hawaii Department of Health, Honolulu, Hawaii. James B. Holt. PhD, Letitia Presley-Cantrell, PhD, Matthew M. Zack, MD, Division of Population Health; Rashid Njai, Division of Community Health, CDC, Atlanta, Georgia.

Reproductive Health: Patricia McKane, DVM, Michigan Department of Community Health, Lansing, Michigan. Adeline Yerkes (chairperson), National Association of Chronic Disease Directors, Atlanta, Georgia. Ana Penman-Aguilar, PhD, Shanna Cox, MSPH, Denise D'Angelo, MPH, Violanda Grigorescu, MD, Division of Reproductive Health, CDC, Atlanta, Georgia.

Tobacco: Dennis Peyton, Kentucky Department of Public Health, Frankfort, Kentucky. Rebekah Buckley, MPH, School Health Branch; Shanta Dube, PhD (chairperson), Erika Fulmer, MHA, Office on Smoking and Health; Steve Kinchen, Division of Adolescent and School Health, CDC, Atlanta, Georgia.

Overall Set of Indicators: Charles W. Gollmar, Randy Schwartz, MSPH, Ann Ussery-Hall, MPH, National Association of Chronic Disease Directors, Atlanta, Georgia. Khosrow Heidari, MA, MS, MS, South Carolina Department of Health and Environmental Control, Columbia, South Carolina. Sara L. Huston, PhD, Maine Center for Disease Control & Prevention and University of Southern Maine, Augusta, Maine. Annie Tran, MPH, Council of State and Territorial Epidemiologists, Atlanta, Georgia. Leah N. Bryan, MPH, James B. Holt, PhD, Yong Liu, MD, Division of Population Health, CDC, Atlanta, Georgia.


TABLE 1. Summary of chronic disease indicators, by indicator group — United States, 2013

Indicator group

Total

Population indicators

Systems and environmental indicators

Individual measures

Additional related measures under other topic groups

Alcohol

10

7

3

14

7

Arthritis

5

5

0

8

5

Asthma

6

6

0

12

4

Cancer

10

10

0

20

17

Cardiovascular disease

11

11

0

18

25

Chronic kidney disease

3

3

0

4

1

Chronic obstructive pulmonary disease

8

8

0

13

5

Diabetes

13

13

0

20

36

Disability

1

1

0

1

3

Immunization

1

1

0

1

16

Mental health

3

3

0

3

0

Nutrition, physical activity, and weight status

22

12

10

38

21

Older adults

4

4

0

5

33

Oral health

5

3

2

9

16

Overarching conditions

8

8

0

16

4

Reproductive health

3

3

0

3

36

School health

0

0

0

0

23

Tobacco

11

4

7

16

19

Total

124

102

22

201


TABLE 2. Rationale for deleting or combining indicators from the 2004 Indicators for Chronic Disease Surveillance* — United States, 2013

Indicator group from the 2004 CDIs

Indicator name from the 2004 CDIs

Rationale

Cancer

Cancer of the bladder (in situ and invasive), incidence

Bladder cancer is the fifth most common cancer among cancers that affect men and women. Among men, it is the fourth most common cancer and the eighth most common cause of cancer death. The 2004 Surgeon General's report on the health consequences of smoking defined tobacco-related cancers as lung and bronchus, oral cavity and pharynx, larynx, esophagus, stomach, pancreas, kidney and renal pelvis, urinary bladder, and cervical cancers and acute myelogenous leukemia. The 2014 Surgeon General's report on the health consequences of smoking also defined liver and colorectal cancer as tobacco-related cancers. Of all these cancers, cancers of the lung and bronchus and of the oral cavity and pharynx are most strongly associated with tobacco use. Rather than including indicators for all tobacco-related cancers, only the indicators for lung and bronchial cancers and for oral cavity and pharyngeal cancers were included, which aligns with the Healthy People 2020 objectives.

Cancer

Cancer of the bladder, mortality

Cancer

Clinical breast examination among women aged ≥40 years

The most recent U.S. Preventive Services Task Force (USPSTF) recommendations regarding screening for breast cancer (information available at http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm) found insufficient evidence to assess the additional benefits and harms of clinical breast examination beyond screening mammography among women aged ≥50 years. The evidence that clinical breast examinations in addition to mammography yields better outcomes than mammography alone is insufficient.

Cancer

Fecal occult blood test among adults aged ≥50 years

USPSTF now recommends that adults aged 50–75 years at average risk for colorectal cancer be screened for colorectal cancer with one of three of options: 1) fecal occult blood test (FOBT) annually, 2) sigmoidoscopy every 5 years with FOBT every 3 years, or 3) colonoscopy every 10 years (information available at http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm). As of 2008, BRFSS data can be used to measure the prevalence of use of each of these options alone. These three indicators were replaced by one single proposed indicator: FOBT, sigmoidoscopy, or colonoscopy among adults aged 50–75 years. The combined measure represents the proportion of respondents that is up-to-date with colorectal cancer screening.

Before 2008, BRFSS data could not be used to assess the prevalence of sigmoidoscopy use and colonoscopy use separately. The current indicator, which measures sigmoidoscopy and colonoscopy use every 5 years, might underestimate screening prevalence with these methods because screening colonoscopy in persons at average risk for colorectal cancer is recommended every 10 years. Starting in 2008, BRFSS data can be used to assess sigmoidoscopy use and colonoscopy use separately, resulting in a more accurate estimate of the use of these test types. These three separate indicators are no longer consistent with USPSTF recommendations for colorectal cancer screening and do not maximize use of currently available data; therefore, they have been replaced with one revised indicator for colorectal screening.

Cancer

Fecal occult blood test or sigmoidoscopy/colonoscopy among adults aged ≥50 years

Cancer

Sigmoidoscopy/colonoscopy among adults ≥50 years

Cardiovascular disease

Hospitalization for cerebrovascular accident or stroke among Medicare-eligible persons aged ≥65 years

Cardiovascular disease can occur in adults aged <65 years; therefore, hospitalization among persons of any age for cerebrovascular accident or stroke is a more applicable indicator.

Cardiovascular disease

Hospitalization for congestive heart failure

Usually occurs in adults aged ≥65 years; therefore, more appropriate indicators are: hospitalization for heart failure among Medicare-eligible persons aged ≥65 years; and Medicare-eligible persons aged ≥65 years hospitalized for heart failure.

Cardiovascular disease

Medicare-eligible persons
aged ≥65 years hospitalized for cerebrovascular accident or stroke

Cardiovascular disease can occur in adults aged <65 years; therefore, hospitalization for cerebrovascular accident or stroke is a more applicable indicator.

Cardiovascular disease

Medicare-eligible persons aged ≥65 years hospitalized for heart failure

This indicator is not needed. An existing indicator (hospitalization for heart failure among Medicare-eligible persons aged ≥65 years) provides similar information.

Other diseases and risk factors

Teeth cleaning among adults aged ≥18 years

BRFSS has not included a question about dental cleaning since 2010; therefore ongoing monitoring of this health event is not possible. If BRFSS reinstates this question in future surveys, the oral health workgroup will reconsider the inclusion of this indicator.

Abbreviation: CDIs = chronic disease indicators.

* Source: CDC. Indicators for chronic disease surveillance. MMWR 2004;53(No. RR-11).

Medicare is the only data source from which data can be obtained at the state level for persons aged ≥65 years (both enrollment data and claims). The Medicare data represents all Medicare-eligible persons aged ≥65 years.


TABLE 3. Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Alcohol

1.1

Alcohol use among youths

Existing

YRBSS

Alcohol

1.2

Alcohol use before pregnancy

New

PRAMS

Alcohol

2.1

Binge drinking prevalence among youths

Existing

YRBSS

Alcohol

2.2

Binge drinking prevalence among adults aged ≥18 years

Existing

BRFSS

Alcohol

2.3

Binge drinking prevalence among women aged 18–44 years

Existing

BRFSS

Alcohol

3

Binge drinking frequency among adults aged ≥18 years who binge drink

New

BRFSS

Alcohol

4

Binge drinking intensity among adults aged ≥18 years who binge drink

New

BRFSS

Alcohol

5.1

Heavy drinking among adults aged ≥18 years

Revised

BRFSS

Alcohol

5.2

Heavy drinking among women aged 18–44 years

New

BRFSS

Alcohol

6

Chronic liver disease mortality

Existing

NVSS, mortality

Alcohol

7

Per capita alcohol consumption among persons aged ≥14 years

New

AEDS

Alcohol

8

Amount of alcohol excise tax by beverage type

New

APIS

Alcohol

9

Commercial host (dram shop) liability laws

New

Legal research*

Alcohol

10

Local authority to regulate alcohol outlet density

New

Legal research

Arthritis

1.1

Arthritis among adults aged ≥18 years

Existing

BRFSS

Arthritis

1.2

Arthritis among adults aged ≥18 years who are obese

Existing

BRFSS

Arthritis

1.3

Arthritis among adults aged ≥18 years who have diabetes

Existing

BRFSS

Arthritis

1.4

Arthritis among adults aged ≥18 years who have heart disease

Existing

BRFSS

Arthritis

2

Activity limitation because of arthritis among adults aged ≥18 years

Existing

BRFSS

Arthritis

3

Physical inactivity among adults aged ≥18 years with arthritis

Existing

BRFSS

Arthritis

4

Fair or poor health among adults aged ≥18 years with arthritis

Existing

BRFSS

Arthritis

5

Adults aged ≥18 years with arthritis who have taken a class to learn how to manage arthritis symptoms

Existing

BRFSS

Asthma

1.1

Current asthma prevalence

New

BRFSS/NSCH

Asthma

1.2

Asthma prevalence among women aged 18–44 years

New

BRFSS

Asthma

2.1

Emergency department visit rate for asthma

New

SEDD

Asthma

2.2

Risk-based emergency department visit rate for asthma

New

SEDD; BRFSS; NSCH

Asthma

3.1

Hospitalizations for asthma

Existing

SID

Asthma

3.2

Risk-based hospital discharge rate for asthma

New

SID; BRFSS; NSCH

Asthma

4.1

Asthma mortality rate

Existing

NVSS, mortality

Asthma

4.2

Risk-based asthma mortality rate

New

NVSS, mortality, BRFSS; NSCH

Asthma

5.1

Influenza vaccination among noninstitutionalized adults aged 18–64 years with asthma

New

BRFSS

Asthma

5.2

Influenza vaccination among noninstitutionalized adults aged ≥65 years with asthma

New

BRFSS

Asthma

6.1

Pneumococcal vaccination among noninstitutionalized adults aged 18–64 years with asthma

New

BRFSS

Asthma

6.2

Pneumococcal vaccination among noninstitutionalized adults aged ≥65 years with asthma

New

BRFSS

Cancer

1

Mammography use among women aged 50–74 years

Revised

BRFSS

Cancer

2.1

Papanicolaou testing among adult women aged 21–65 years

Revised

BRFSS

Cancer

2.2

Recent Papanicolaou testing among women aged 21–44 years

New

BRFSS

Cancer

3

Fecal occult blood test, sigmoidoscopy, or colonoscopy among adults aged 50–75 years

Revised

BRFSS

Cancer

4.1

Invasive cancer (all sites combined), incidence

Existing

Statewide central cancer registries

Cancer

4.2

Invasive cancer (all sites combined), mortality

Existing

NVSS, mortality

Cancer

5.1

Invasive cancer of the female breast, incidence

Existing

Statewide central cancer registries

Cancer

5.2

Cancer of the female breast, mortality

Existing

NVSS, mortality

Cancer

6.1

Invasive cancer of the cervix, incidence

Existing

Statewide central cancer registries

Cancer

6.2

Cancer of the female cervix, mortality

Existing

NVSS, mortality

Cancer

7.1

Cancer of the colon and rectum (colorectal), incidence

Existing

Statewide central cancer registries


TABLE 3. (Continued) Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Cancer

7.2

Cancer of the colon and rectum (colorectal), mortality

Existing

NVSS, mortality

Cancer

8.1

Cancer of the lung and bronchus, incidence

Existing

Statewide central cancer registries

Cancer

8.2

Cancer of the lung and bronchus, mortality

Existing

NVSS, mortality

Cancer

9.1

Invasive melanoma, incidence

Existing

Statewide central cancer registries

Cancer

9.2

Melanoma, mortality

Existing

NVSS, mortality

Cancer

10.1

Invasive cancer of the oral cavity or pharynx, incidence

Existing

Statewide central cancer registries

Cancer

10.2

Cancer of the oral cavity and pharynx, mortality

Existing

NVSS, mortality

Cancer

11.1

Invasive cancer of the prostate, incidence

Existing

Statewide central cancer registries

Cancer

11.2

Cancer of the prostate, mortality

Existing

NVSS, mortality

Cardiovascular disease

1.1

Mortality from total cardiovascular diseases

Revised

NVSS, mortality

Cardiovascular disease

1.2

Mortality from diseases of the heart

Existing

NVSS, mortality

Cardiovascular disease

1.3

Mortality from coronary heart disease

Existing

NVSS, mortality

Cardiovascular disease

1.4

Mortality from heart failure

Revised

NVSS, mortality

Cardiovascular disease

1.5

Mortality from cerebrovascular disease (stroke)

Existing

NVSS, mortality

Cardiovascular disease

2

Hospitalization for heart failure among Medicare-eligible persons aged ≥65 years

Revised

CMS Part A claims data; CMS Medicare population estimates

Cardiovascular disease

3.1

Hospitalization for stroke

Revised

SID

Cardiovascular disease

3.2

Hospitalization for acute myocardial infarction

Revised

SID

Cardiovascular disease

4

Cholesterol screening among adults aged ≥18 years

Existing

BRFSS

Cardiovascular disease

5

High cholesterol prevalence among adults aged ≥18 years

New

BRFSS

Cardiovascular disease

6.1

Awareness of high blood pressure among adults aged ≥18 years

Existing

BRFSS

Cardiovascular disease

6.2

Awareness of high blood pressure among women aged 18–44 years

New

BRFSS

Cardiovascular disease

7

Taking medicine for high blood pressure control among adults aged ≥18 years with high blood pressure

Existing

BRFSS

Cardiovascular disease

8

Prepregnancy hypertension

New

PRAMS

Cardiovascular disease

9.1

Influenza vaccination among noninstitutionalized adults aged 18–64 years with a history of coronary heart disease or stroke

New

BRFSS

Cardiovascular disease

9.2

Influenza vaccination among noninstitutionalized adults aged ≥65 years with a history of coronary heart disease or stroke

New

BRFSS

Cardiovascular disease

10.1

Pneumococcal vaccination among noninstitutionalized adults aged 18–64 years with a history of coronary heart disease

New

BRFSS

Cardiovascular disease

10.2

Pneumococcal vaccination among noninstitutionalized adults aged ≥65 years with a history of coronary heart disease

New

BRFSS

Chronic kidney disease

1

Mortality with end-stage renal disease

Existing

NVSS, mortality

Chronic kidney disease

2.1

Incidence of treated end-stage renal disease

Existing

USRDS

Chronic kidney disease

2.2

Incidence of treated end-stage renal disease attributed to diabetes

Existing

USRDS

Chronic kidney disease

3

Prevalence of chronic kidney disease among adults aged ≥18 years

New

BRFSS


TABLE 3. (Continued) Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Chronic obstructive pulmonary disease

1.1

Mortality with chronic obstructive pulmonary disease as underlying cause among adults aged ≥45 years

Revised

NVSS, mortality

Chronic obstructive pulmonary disease

1.2

Mortality with chronic obstructive pulmonary disease as underlying or contributing cause among adults aged ≥45 years

Revised

NVSS, mortality

Chronic obstructive pulmonary disease

2

Prevalence of chronic obstructive pulmonary disease among adults

New

BRFSS

Chronic obstructive pulmonary disease

3

Prevalence of current smoking among adults with diagnosed chronic obstructive pulmonary disease

New

BRFSS

Chronic obstructive pulmonary disease

4

Prevalence of activity limitation among adults with diagnosed chronic obstructive pulmonary disease

New

BRFSS

Chronic obstructive pulmonary disease

5.1

Hospitalization for chronic obstructive pulmonary disease as first-listed diagnosis

New

SID

Chronic obstructive pulmonary disease

5.2

Hospitalization for chronic obstructive pulmonary disease as any diagnosis

New

SID

Chronic obstructive pulmonary disease

5.3

Hospitalization for chronic obstructive pulmonary disease as first-listed diagnosis among Medicare-eligible persons aged ≥65 years

New

CMS Part A claims data; CMS Medicare population estimates

Chronic obstructive pulmonary disease

5.4

Hospitalization for chronic obstructive pulmonary disease as any diagnosis among Medicare-eligible persons aged ≥65 years

New

CMS Part A claims data; CMS Medicare population estimates

Chronic obstructive pulmonary disease

6.1

Emergency department visits rate for chronic obstructive pulmonary disease as first-listed diagnosis

New

SEDD; SID

Chronic obstructive pulmonary disease

6.2

Emergency department visits rate for chronic obstructive pulmonary disease as any diagnosis

New

SEDD; SID

Chronic obstructive pulmonary disease

7

Influenza vaccination among noninstitutionalized adults aged ≥45 years with chronic obstructive pulmonary disease

New

BRFSS

Chronic obstructive pulmonary disease

8

Pneumococcal vaccination among adults aged ≥45 years with chronic obstructive pulmonary disease

New

BRFSS

Diabetes

1.1

Mortality from diabetes reported as any listed cause of death

Revised

NVSS, mortality

Diabetes

1.2

Mortality with diabetic ketoacidosis reported as any listed cause of death

New

NVSS, mortality

Diabetes

2.1

Prevalence of diagnosed diabetes among adults aged ≥18 years

Existing

BRFSS

Diabetes

2.2

Diabetes prevalence among women aged 18–44 years

New

BRFSS

Diabetes

3.1

Prevalence of prepregnancy diabetes

New

PRAMS

Diabetes

3.2

Prevalence of gestational diabetes

New

NVSS, natality

Diabetes

4

Amputation of a lower extremity attributable to diabetes

Existing

SID

Diabetes

5

Foot examination among adults aged ≥18 years with diagnosed diabetes

Existing

BRFSS


TABLE 3. (Continued) Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Diabetes

6

Glycosylated hemoglobin measurement among adults aged ≥18 years with diagnosed diabetes

Revised

BRFSS

Diabetes

7

Dilated eye examination among adults aged ≥18 years with diagnosed diabetes

Existing

BRFSS

Diabetes

8

Visits to dentist or dental clinic among adults aged ≥18 years with diagnosed diabetes

New

BRFSS

Diabetes

9

Hospitalization with diabetes as a listed diagnosis

Existing

SID

Diabetes

10

Adults with diagnosed diabetes aged ≥18 years who have taken a diabetes self-management course

New

BRFSS

Diabetes

11.1

Prevalence of high cholesterol among adults aged ≥18 years with diagnosed diabetes

New

BRFSS

Diabetes

11.2

Prevalence of high blood pressure among adults aged ≥18 years with diagnosed diabetes

New

BRFSS

Diabetes

11.3

Prevalence of depressive disorders among adults aged ≥18 years with diagnosed diabetes

New

BRFSS

Diabetes

12.1

Influenza vaccination among noninstitutionalized adults aged 18–64 years with diagnosed diabetes

Revised

BRFSS

Diabetes

12.2

Influenza vaccination among noninstitutionalized adults aged ≥65 years with diagnosed diabetes

Revised

BRFSS

Diabetes

13.1

Pneumococcal vaccination among noninstitutionalized adults aged 18–64 years with diagnosed diabetes

Revised

BRFSS

Diabetes

13.2

Pneumococcal vaccination among noninstitutionalized adults aged ≥65 years with diagnosed diabetes

Revised

BRFSS

Disability

1

Disability among adults aged ≥65 years

New

ACS 1-year estimates

Immunization

1

Influenza vaccination among noninstitutionalized adults aged ≥18 years

Revised

BRFSS

Mental health

1

Recent mentally unhealthy days among adults aged ≥18 years

Existing

BRFSS

Mental health

2

At least 14 recent mentally unhealthy days among women aged 18–44 years

New

BRFSS

Mental health

3

Postpartum depressive symptoms

New

PRAMS

Nutrition, physical activity, and weight status

1.1

Obesity among adults aged ≥18 years

Existing

BRFSS

Nutrition, physical activity, and weight status

1.2

Obesity among high school students

Revised

YRBSS

Nutrition, physical activity, and weight status

2.1

Overweight or obesity among adults aged ≥18 years

Existing

BRFSS

Nutrition, physical activity, and weight status

2.2

Overweight or obesity among high school students

New

YRBSS

Nutrition, physical activity, and weight status

2.3

Overweight or obesity among women aged 18–44 years

New

BRFSS

Nutrition, physical activity, and weight status

2.4

Pre-pregnancy overweight or obesity

New

NVSS, natality

Nutrition, physical activity, and weight status

3.1

Healthy weight among adults aged ≥18 years

New

BRFSS

Nutrition, physical activity, and weight status

3.2

Healthy weight among high school students

New

YRBSS

Nutrition, physical activity, and weight status

4.1

Median daily frequency of fruit consumption among high school students

Revised

YRBSS

Nutrition, physical activity, and weight status

4.2

Median daily frequency of fruit consumption among adults aged ≥18 years

Revised

BRFSS

Nutrition, physical activity, and weight status

5.1

Median daily frequency of vegetable consumption among high school students

Revised

YRBSS


TABLE 3. (Continued) Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Nutrition, physical activity, and weight status

5.2

Median daily frequency of vegetable consumption among adults aged ≥18 years

Revised

BRFSS

Nutrition, physical activity, and weight status

6

Census tracts with healthier food retailers within 1/2 mile of boundary

New

InfoUSA; USDA

Nutrition, physical activity, and weight status

7.1

Farmers markets that accept Women and Infant Children (WIC) farmers market nutrition program coupons

New

USDA National Farmers' Market Directory

Nutrition, physical activity, and weight status

7.2

Farmers markets that accept Supplemental Nutrition Assistance Program (SNAP) benefits

New

USDA National Farmers' Market Directory

Nutrition, physical activity, and weight status

8

Number of farmers markets per 100,000 residents

New

USDA National Farmers' Market Directory

Nutrition, physical activity, and weight status

9.1

Presence of regulations pertaining to serving fruit in early care and education settings

New

ASHW

Nutrition, physical activity, and weight status

9.2

Presence of regulations pertaining to serving vegetables in early care and education settings

New

ASHW

Nutrition, physical activity, and weight status

10

No leisure-time physical activity among adults aged ≥18 years

New

BRFSS

Nutrition, physical activity, and weight status

11.1

Meeting aerobic physical activity guidelines for substantial health benefits among adults aged ≥18 years

Revised

BRFSS

Nutrition, physical activity, and weight status

11.2

Meeting aerobic physical activity guidelines for substantial health benefits and for muscle-strengthening activity among adults aged ≥18 years

New

BRFSS

Nutrition, physical activity, and weight status

11.3

Meeting aerobic physical activity guidelines for additional and more extensive health benefits among adults aged ≥18 years

New

BRFSS

Nutrition, physical activity, and weight status

11.4

Meeting aerobic physical activity guidelines among high school students

Revised

YRBSS

Nutrition, physical activity, and weight status

12.1

Participation in daily school physical education classes among high school students

New

YRBSS

Nutrition, physical activity, and weight status

12.2

Soda consumption among high school students

New

YRBSS

Nutrition, physical activity, and weight status

13.1

Secondary schools that allow community-sponsored use of physical activity facilities by youth outside of normal school hours

New

CDC School Health Profiles

Nutrition, physical activity, and weight status

13.2

Secondary schools that allow students to purchase soda or fruit drinks

New

CDC School Health Profiles

Nutrition, physical activity, and weight status

13.3

Secondary schools that allow students to purchase sports drinks

New

CDC School Health Profiles

Nutrition, physical activity, and weight status

13.4

Secondary schools that offer less healthy foods as competitive foods

New

CDC School Health Profiles

Nutrition, physical activity, and weight status

14

Presence of regulations pertaining to screen time in early care and education settings

New

ASWH

Nutrition, physical activity, and weight status

15

Infants breastfed at 6 months

New

National Immunization Survey


TABLE 3. (Continued) Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Nutrition, physical activity, and weight status

16

Receiving formula supplementation within the first 2 days of life among breastfed infants

New

National Immunization Survey

Nutrition, physical activity, and weight status

17

Mean mPINC score

New

mPINC

Nutrition, physical activity, and weight status

18

Live births occurring at Baby Friendly Facilities

New

CDC Breastfeeding Report Card

Nutrition, physical activity, and weight status

19

State child care regulation supports onsite breastfeeding

New

ASHW

Nutrition, physical activity, and weight status

20

Television viewing among high school students

Revised

YRBSS

Nutrition, physical activity, and weight status

21

Computer use among high school students

New

YRBSS

Nutrition, physical activity, and weight status

22

Presence of regulations pertaining to avoiding sugar in early care and education settings

New

ASHW

Older adults

1

Hospitalization for hip fracture among Medicare-eligible persons aged ≥65 years

Existing

CMS Part A claims data; CMS Medicare population estimates

Older adults

2

Percentage of female Medicare beneficiaries aged ≥65 years who reported not ever being screened for osteoporosis with a bone mass or bone density measurement

New

MCBS

Older adults

3.1

Proportion of older adults aged ≥65 years who are up to date on a core set of clinical preventive services

New

BRFSS

Older adults

3.2

Proportion of older adults aged 50–64 years who are up to date on a core set of clinical preventive services

New

BRFSS

Older adults

4

Prevalence of 2 or more chronic conditions among Medicare-enrolled persons aged ≥65 years

New

CMS CCW

Oral health

1.1

Visits to dentist or dental clinic among adults aged ≥18 years

Existing

BRFSS

Oral health

1.2

Dental visits among children and adolescents aged 1–17 years

New

NSCH

Oral health

2.1

Preventive dental visits among children and adolescents aged 1–17 years

New

NSCH

Oral health

2.2

Preventive dental care before pregnancy

New

PRAMS

Oral health

3

Oral health services at Federally Qualified Health Centers

New

UDS

Oral health

4.1

All teeth lost among adults aged ≥65 years

Existing

BRFSS

Oral health

4.2

Six or more teeth lost among adults aged ≥65 years

New

BRFSS

Oral health

4.3

No tooth loss among adults aged 18–64 years

New

BRFSS

Oral health

5

Population served by community water systems that receive optimally fluoridated drinking water

New

WFRS

Overarching conditions

1.1

Current lack of health insurance among adults aged 18–64 years

Existing

BRFSS

Overarching conditions

1.2

Current health care coverage among women aged 18–44 years

New

BRFSS

Overarching conditions

1.3

Health insurance coverage before pregnancy

New

PRAMS

Overarching conditions

2.1

High school completion among adults aged 18–24 years

Existing

ACS

Overarching conditions

2.2

High school completion among women aged 18–44 years

New

ACS

Overarching conditions

3.1

Poverty

Existing

ACS

Overarching conditions

3.2

Poverty among women aged 18–44 years

New

CPS/ASEC

Overarching conditions

4.1

Life expectancy at birth

Existing

NVSS, mortality


TABLE 3. (Continued) Individual chronic disease indicator measures, by indicator group

Indicator group

Indicator number

Individual measure

Existing, revised, or new

Data source

Overarching conditions

4.2

Life expectancy at age 65 years

Existing

NVSS, mortality

Overarching conditions

5

Premature mortality among adults aged 45–64 years

Existing

NVSS, mortality

Overarching conditions

6.1

Fair or poor self-rated health status among adults aged ≥18 years

Existing

BRFSS

Overarching conditions

6.2

Self-rated health status among women aged 18–44 years

New

BRFSS

Overarching conditions

7.1

Recent physically unhealthy days among adults aged ≥18 years

Existing

BRFSS

Overarching conditions

7.2

Recent activity limitation among adults aged ≥18 years

Existing

BRFSS

Overarching conditions

8

Prevalence of sufficient sleep among adults aged ≥18 years

New

BRFSS

Overarching conditions

9

Gini index of income inequality

New

ACS

Reproductive health

1

Timeliness of routine health care checkup among women aged 18–44 years

New

BRFSS

Reproductive health

2

Postpartum checkup

New

PRAMS

Reproductive health

3

Folic acid supplementation

New

PRAMS

Tobacco

1.1

Current cigarette smoking among youths

Existing

YRBSS

Tobacco

1.2

Current smoking among adults aged ≥18 years

Revised

BRFSS

Tobacco

1.3

Current cigarette smoking among women aged 18–44 years

New

BRFSS

Tobacco

1.4

Cigarette smoking before pregnancy

New

PRAMS

Tobacco

2.1

Current smokeless tobacco use among youths

Existing

YRBSS

Tobacco

2.2

Current smokeless tobacco use among adults aged ≥18 years

New

BRFSS

Tobacco

3

Quit attempts in the past year among current smokers

New

BRFSS

Tobacco

4

States that allow stronger local tobacco control and prevention laws

New

STATE

Tobacco

5

States with strong policies that require retail licenses to sell tobacco products

New

STATE

Tobacco

6

Proportion of the population protected by a comprehensive smoke-free policy prohibiting smoking in all indoor areas of workplaces and public places, including restaurants and bars

New

STATE

Tobacco

7

Amount of tobacco product excise tax

New

STATE

Tobacco

8

Percentage tobacco revenue to fund at CDC-recommended level

New

STATE

Tobacco

9

Tobacco-free schools

New

CDC School Health Profiles

Tobacco

10

Sale of cigarette packs

Existing

STATE

Tobacco

11.1

Pneumococcal vaccination among noninstitutionalized adults aged 18–64 years who smoke

New

BRFSS

Tobacco

11.2

Pneumococcal vaccination among noninstitutionalized adults aged ≥65 years who smoke

New

BRFSS

Abbreviations: ACS = American Community Survey; ASHW = Achieving a State of Healthy Weight: A National Assessment of Obesity Prevention Terminology in Child Care Regulations; AEDS = Alcohol Epidemiologic Data System; APIS = Alcohol Policy Information System; BRFSS = Behavioral Risk Factor Surveillance System; CMS = Centers for Medicare & Medicaid Services; CMS CCW = CMS Chronic Conditions Warehouse; CPS/ASEC = Annual Social and Economic Supplement of the Current Population Survey; MCBS = Medicare Current Beneficiary Survey; mPINC = Maternity Practices in Infant Nutrition and Care; NSCH = National Survey of Children's Health; NVSS = National Vital Statistics System; PRAMS = Pregnancy Risk Assessment Monitoring System; SEDD = State Emergency Department Database; SID = State Inpatient Database; STATE = State Tobacco Activities Tracking and Evaluation System; UDS = Uniform Data System; USDA = U.S. Department of Agriculture; USRDS = U.S. Renal Data System; WFRS = Water Fluoridation Reporting System; YRBSS = Youth Risk Behavior Surveillance System.

* Mosher JF, Cohen EN, Jernigan DH. Commercial host (dram shop) liability: current status and trends. Am J Prev Med 2013;45:347–53.

Mosher JF, Treffer R. State preemption, local control, and the regulation of alcohol retail outlet density. Am J Prev Med 2013;44:399–405.


TABLE 4. Data sources for chronic disease indicators

Name

Acronym

Agency

Link

Youth Risk Behavior Surveillance System

YRBSS

CDC

http://www.cdc.gov/YRBSS

Pregnancy Risk Assessment Monitoring System

PRAMS

CDC

http://www.cdc.gov/PRAMS/CPONDER.htm

Behavioral Risk Factor Surveillance System

BRFSS

CDC

http://www.cdc.gov/brfss

Alcohol Epidemiologic Data System

AEDS

NIAAA

http://pubs.niaaa.nih.gov/publications/Surveillance95/CONS10.pdf

Alcohol Policy Information System

APIS

NIAAA

http://alcoholpolicy.niaaa.nih.gov

Alcohol Policy Legal Research*,†

NA

CDC

NA

National Survey of Children's Health

NSCH

CDC

http://www.cdc.gov/nchs/slaits/nsch.htm

State Emergency Department Databases

SEDD

AHRQ

http://www.hcup-us.ahrq.gov/databases.jsp

State Inpatient Databases

SID

AHRQ

http://www.hcup-us.ahrq.gov/databases.jsp

National Vital Statistics System

NVSS

CDC

http://www.cdc.gov/nchs/nvss.htm

Centers for Medicare and Medicaid Services

CMS

CMS

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html

U.S. Renal Data System

USRDS

NIDDK

http://www.usrds.org

American Community Survey

ACS

U.S. Census Bureau

http://www.census.gov/acs/www

Annual Social and Economic Supplement of the Current Population Survey

CPS/ASEC

U.S. Census Bureau

http://www.census.gov/cps/data/cpstablecreator.html

U.S. Department of Agriculture

USDA

USDA

http://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap

Achieving a State of Healthy Weight

ASHW

HRSA

http://nrckids.org/ASHW/ASHW%202011-Final-8-1.pdf

School Health Profiles

SHP

CDC

http://www.cdc.gov/HealthyYouth/profiles

Maternal Practices in Infant Nutrition and Care

mPINC

CDC

http://www.cdc.gov/breastfeeding/data/mpinc/index.htm

Breastfeeding Report Card

NA

CDC

http://www.cdc.gov/breastfeeding/data/reportcard.htm

Medicare Current Beneficiary Survey

MCBS

CMS

http://www.cms.gov/mcbs

CMS Chronic Condition Data Warehouse

CMS CCW

CMS

https://www.ccwdata.org/web/guest/condition-categories

Uniform Data System

UDS

HRSA

http://bphc.hrsa.gov/healthcenterdatastatistics/index.html

Water Fluoridation Reporting System

WFRS

CDC

http://www.cdc.gov/fluoridation/statistics/index.htm

State Tobacco Activities Tracking and Evaluation System

STATE

CDC

http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx

Abbreviations: AHRQ = Agency for Healthcare Research and Quality; CMS = Centers for Medicare & Medicaid Services; HRSA = Health Resources and Services Administration; NIAAA = National Institute on Alcohol Abuse and Alcoholism; NIDDK = National Institute of Diabetes and Digestive and Kidney Diseases; USDA = US Department of Agriculture.

* Mosher JF, Treffers RD. State preemption, local control, and the regulation of alcohol retail outlet density. Am J Prev Med 2013;44:399–405.

Mosher JF, Cohen EN, Jernigan DH. Commercial host (dram shop) liability: current status and trends. Am J Prev Med 2013;45:347–53.



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