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The Health of the Nation: Special Public Health Watch Report

JUN 30, 2017 | BRIAN P. DUNLEAVY
When it comes to mortality resulting from infectious diseases in the United States, there’s good news and bad news.
 
The good news: Deaths caused by influenza and pneumonia have declined over the past 40 years in the United States.
 
The bad news: Influenza and pneumonia remain among the top 10 leading causes of death in the 50 states, despite increased uptake of the influenza vaccine.
 
This news is among the findings of Health, United States, 2016, the 40th annual report on the health of the nation, which is presented by the Secretary of Health and Human Services (HHS) to the President and Congress. The new edition of the report, released by the Centers for Disease Control and Prevention (CDC) on June 28, 2017, includes a “Chartbook on Long-Term Trends in health and health care delivery,” with 27 charts and 114 tables.
 
As noted in the preface of the report, “The Health, United States series presents an annual overview of national trends in health statistics.”
 
Overall, the report notes, life expectancy increased for the total population of the country between 1975 and 2015; however, the assessment revealed that the important metric for health actually declined between 2014 and 2015, by 0.1 years, for the total population. Meanwhile, infant mortality rate dropped by 63% over the 40-year period.
 
Not surprisingly, heart disease remains the leading cause of death in the United States, responsible for 23.4% of deaths in 2015, according to the report—despite the fact that the age-adjusted heart disease death rate dropped 61% percent, from 431.2 to 168.5 deaths per 100,000 population, from 1975 to 2015. In comparison, influenza and pneumonia caused only 2.1% of deaths in 2015, down roughly 50% from 40 years ago.
 
HIV, the only other infectious disease broken out into its own category in the report, has experienced sharp declines in age-adjusted death rate as well, thanks in large part to the advent improved diagnostics and more effective treatments, including prophylaxis. In 1990, for example, HIV caused 10.2 deaths per 100,000 population in the United States; in 2015, that number dropped to 1.9 per 100,000 population.
 
Interestingly, the HHS analysis found that prescription drug use increased for all age groups between 1988 to 1994 and 2013 to 2014, and was particularly pronounced among those 65 years of age and older. And, although the number of Americans who reported overnight hospital stays was lower in 2015 compared to 1975, the figures remained essentially unchanged for those 75 years of age and older.
 
However, arguably the timeliest of the CDC/HHS findings outlined in the report, given the ongoing debate on Capitol Hill, highlights that healthcare expenditures have risen exponentially over the past 40 years. For example, over the analysis period, the share of personal health care expenditures earmarked for hospital care increased from 38.1% to 45.3%, while funds allocated to prescription drugs (7.1% to 11.9%) also increased over the same time.
 
Whether this data will add fuel to the fire of Senate deliberations over the proposed American Health Care Act, the possible replacement for the Affordable Care Act or “Obamacare,” remains to be seen.
 
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition. 
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