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Health, United States, 2013 - Preface

Health, United States, 2013 is the 37th report on the health status of the nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). The National Committee on Vital and Health Statistics served in a review capacity.

The Health, United States series presents an annual overview of national trends in health statistics. The report contains a Chartbook that assesses the nation's health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization and access, health risk factors, prevention, health insurance, and personal health care expenditures. This year's Chartbook includes a Special Feature on Prescription Drugs. The report also contains 135 Trend Tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures. A companion product—Health, United States: In Brief—features information extracted from the full report. The complete report, In Brief, and related data products are available on the Health, United States website.

The 2013 Edition

Health, United States, 2013 contains a summary At a Glance table that displays selected indicators of health and their determinants, cross-referenced to charts and tables in the report. This is followed by a Highlights section, a Chartbook, detailed Trend Tables, two detailed Appendixes, and an Index. The major sections of the 2013 report are described below.


The 2013 Chartbook contains 29 charts, including 10 charts on this year's Special Feature on Prescription Drugs (Figures 20-29 ). This Special Feature provides an overview of prescription drug use in the United States. Data are presented on the number and classes of drugs used by Americans. Access problems—those who did not receive needed prescription drugs in the past 12 months due to cost—are presented by insurance and poverty status. The impact of specific groups of drugs used to control chronic disease (i.e., antiretrovirals to treat HIV disease and antidepressant drugs) is presented. Quality issues are examined by looking at the misuse of antibiotics to treat cold symptoms, deaths from misuse of opioid analgesic drugs, and the adoption by providers of electronic health record systems, which are designed to improve safety. And finally, the growth in national spending on prescription drugs is shown.

Trend Tables

The Chartbook is followed by 135 detailed Trend Tables that highlight major trends in health statistics. Comparability across editions of Health, United States is fostered by including similar Trend Tables in each volume, and timeliness is maintained by improving the content of tables to reflect key topics in public health. An important criterion used in selecting these tables is the availability of comparable national data over a period of several years.


Appendix I. Data Sources describes each data source used in Health, United States and provides references for further information about the sources. Data sources are listed alphabetically within two broad categories: Government Sources, and Private and Global Sources.

Appendix II. Definitions and Methods is an alphabetical listing of selected terms used in Health, United States. It also contains information on the statistical methodologies used in the report.


The Index to the Trend Tables and figures is a useful tool for locating data by topic. Tables and figures are cross-referenced by such topics as child and adolescent health; older population aged 65 and over; women's health; men's health; state data; American Indian and Alaska Native, Asian, black or African American, and Hispanic-origin populations; education; injury; disability; and metropolitan and nonmetropolitan data. Many of the Index topics are also available as conveniently grouped data packages on the Health, United States website.

Data Considerations

Racial and Ethnic Data

Many tables in Health, United States present data according to race and Hispanic origin, consistent with a department-wide emphasis on expanding racial and ethnic detail when presenting health data. Trend data on race and ethnicity are presented in the greatest detail possible after taking into account the quality of the data, the amount of missing data, and the number of observations. These issues significantly affect the availability of reportable data for certain populations, such as the Native Hawaiian and Other Pacific Islander population and the American Indian and Alaska Native population. Standards for the classification of federal data on race and ethnicity are described in an appendix (See Appendix II, Race ).

Education and Income Data

Many Trend Tables in Health, United States present data according to socioeconomic status, using education and family income as proxy measures. Education and income data are generally obtained directly from survey respondents and are not usually available from records-based data collection systems. (See Appendix II, Education; Family income; Poverty.)

Disability Data

Disability can include the presence of physical or mental impairments that limit a person's ability to perform an important activity and affect the use of or need for support, accommodation, or intervention to improve functioning. Information on disability in the U.S. population is critical to health planning and policy. Several initiatives are currently under way to coordinate and standardize the measurement of disability across federal data systems. Health, United States, 2009 introduced the first detailed Trend Table using data from the National Health Interview Survey to create disability measures consistent with two of the conceptual components that have been identified in disability models and legislation: basic actions difficulty and complex activity limitation. Basic actions difficulty captures limitations or difficulties in movement and sensory, emotional, or mental functioning that are associated with a health problem. Complex activity limitation describes limitations or restrictions in a person's ability to participate fully in social role activities such as working or maintaining a household. Health, United States, 2010 expanded the use of these measures to many of the tables from the National Health Interview Survey. Health, United States, 2013 includes the following disability-related information for the civilian noninstitutionalized population: basic actions difficulty and complex activity limitation (Tables 49 , 53, and 54 ), vision and hearing limitations for adults (Tables 50 and 51), and disability-related information for Medicare enrollees 129), Medicaid recipients (130), and veterans with service-connected disabilities (132). For more information on disability statistics, see Altman and Bernstein (1).

Statistical Significance

All statements in the text describing differences, or lack thereof, in estimates indicate that statistical testing was performed. Differences between two point estimates were determined to be statistically significant at the 0.05 level using two-sided significance tests (z tests). In the text, the standard terminology used when a difference between two point estimates was tested is, "Between (estimate 1) and (estimate 2)." For example, the statement "Between 2011 and 2012" indicates that the difference between the point estimate for 2011 and that for 2012 was tested for statistical significance.

The statistical significance of a time trend was assessed using weighted least squares regression applied to data for all years in the time period. (For a description of the trend testing technique, see the Technical Notes that follow the Chartbook.) The terminology used in the text to indicate testing of a trend is "During (time period 1) through (time period 2)." For example, the statement "During 2002 through 2012" indicates that a statistical test of trend was conducted that included estimates for all 11 years in the time period. Because statistically significant differences or trends are partly a function of sample size (i.e., the larger the sample, the smaller the change that can be detected), statistically significant differences or trends do not necessarily have public health significance (2).

Terms such as "similar," "stable," and "no difference" indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between statistics does not necessarily suggest that the difference was tested and found to not be significant.

Overall estimates generally have relatively small standard errors, but estimates for certain population subgroups may be based on small numbers and have relatively large standard errors. Although numbers of births and deaths from the Vital Statistics System represent complete counts (except for births in those states where data are based on a 50% sample for selected years) and are not subject to sampling error, the counts are subject to random variation, which means that the number of events that actually occur in a given year may be considered as one of a large series of possible results that could have arisen under the same circumstances. When the number of events is small and the probability of such an event is small, considerable caution must be observed in interpreting the conditions described by the estimates. Estimates that are unreliable because of large standard errors or small numbers of events are noted with an asterisk. The criteria used to designate or suppress unreliable estimates are indicated in the table footnotes.

For NCHS surveys, point estimates and their corresponding variances were calculated using the SUDAAN software package (3), which takes into consideration the complex survey design. Standard errors for other surveys or data sets were computed using the methodology recommended by the programs providing the data or were provided directly by those programs. Standard errors are available for selected tables in the spreadsheet version on the Health, United States website.

Accessing Health, United States

Health, United States can be accessed in its entirety at the Health, United States website. The website is a user-friendly resource for Health, United States and related products. In addition to the full report, the website contains the In Brief companion report in PDF format. Also found on the website are data conveniently organized and grouped by topic. The Chartbook figures are provided as PowerPoint slides, and the Trend Tables and Chartbook data tables are provided as spreadsheet files and individual PDFs. Many spreadsheet files include additional years of data not shown in the printed report, along with standard errors where available. Spreadsheet files for selected tables will be updated on the website when new data are available. Visitors to the website can join the Health, United States e-mail list to receive announcements about release dates and notices of table updates. Previous editions of Health, United States, and their Chartbooks, can also be accessed from the website.

Printed copies of Health, United States can be purchased from the U.S. Government Printing Office.


If you have questions about Health, United States or related data products, please contact:

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  1. Altman B, Bernstein A. Disability and health in the United States, 2001-2005 [PDF - 625 KB]. Hyattsville, MD: NCHS; 2008.
  2. Youth Risk Behavior Surveillance System (YRBSS). Interpretation of YRBS trend data [PDF - 250 KB]. CDC; 2012.
  3. SUDAAN, release 11.0.0 [computer software]. Research Triangle Park, NC: RTI International; 2012.