SHADAC Staff

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e shadac@umn.edu

November 10th Webinar - "Overdose Crisis in Transition: Changing Trends in a Widening Drug Death Epidemic"

Speakers

 Colin Planalp, MPA

 SHADAC Senior Research Fellow

 Robert Hest, MPP

 SHADAC Research Fellow 

Event Resources
The Opioid Epidemic (SHADAC Resource Page)
Overdose Crisis in Transition: Changing National and State Trends in a Widening Drug Death Epidemic (Briefs)
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (Infographics)
After drop in 2018, newer data indicate a resurgence in drug overdose deaths

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

October 21st Webinar - Rising Suicide Rates: Examining Trends and Variations through State-level Data

Over the past two decades, the rise in suicide death rates has continued along an accelerating climb. According to new vital statistics data from the Centers for Disease Control and Prevention (CDC), the United States suicide rate reached another historic high of 14.2 per 100,000 people in 2018, up from 14.0 in the previous year. 

This increase in suicide deaths has not followed a consistent trend; rather, growth has accelerated more recently. From 2000 to 2009 the suicide death rate grew by 13 percent, but from 2009 to 2018 the rate grew by 21 percent. While these trends predate the COVID-19 pandemic, early evidence has indicated this crisis is taking a significant toll on mental health, and these data therefore represent an important baseline from which the effects of the pandemic will be measured.

During the webinar, SHADAC Research Fellow Carrie Au-Yeung used national and state-level data on suicide deaths to examine this growing public health issue, highlighting concerning trends and variations in suicide deaths by geographic locations such as regions, states, and metropolitan areas, as well as by specific subpopulation groups such as age, sex, and race/ethnicity.

Ms. Au-Yeung was also joined by SHADAC Research Fellow Robert Hest, who explained how to access and use the data on suicide deaths through SHADAC’s State Health Compare website. Senior Research Fellow Colin Planalp also joined the webinar for a question and discussion session following the presentation.

Related Resources
​Suicide Rates on the Rise: Examining Continuing Trends and Variation across the Nation and in the States from 2000 to 2018 (Briefs)
U.S. Suicide Death Rate Reached Record High in 2018: SHADAC Briefs Examine the Numbers among Subgroups and States 
State Health Compare Data Offer Baseline for Measuring Pandemic's Impact on Suicide, Drug Overdose Death Rates

National Suicide Prevention Lifeline: 1-800-273-8255
If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. For more suicide prevention resources, visit https://suicidepreventionlifeline.org/

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Eleven Updated Measures are Now Available on State Health Compare

Estimates for a majority of measures from several categories (Access to Care, Cost of Care, Health Behaviors, and Health Outcomes) have now been updated on SHADAC’s State Health Compare web tool, from two related surveys conducted by the Centers for Disease Control and Prevention—the Youth Risk Behavior Surveillance System (YRBSS), which surveys U.S. middle and high school students (age 13-17), and the Behavior Risk Factor Surveillance System (BRFSS), which surveys U.S. adults (age 18+).

Measures that have been updated from the YRBSS include:

High School Obesity
This measure indicates the percent of high school students (grades 9-12) in each state who were considered obese (i.e., > 95^th percentile for body mass index, based on sex- and age-specific reference data from 2000 CDC growth charts).
Estimates are available for all states from 2001 through 2019.

High School Smoking
Estimates for this measure denote the percent of high school students (grades 9-12) in each state who have smoked at least one cigarette in the past 30 days; data are available from 2001 through 2019.

High School Physical Activity
This measure provides estimates of the percentage of high school students (grades 9-12) who did engage in the recommended guideline of at least 60 minutes of activity each day, in the previous five days. Data are available for all states from 2011 through 2019.

Measures that have been updated from the BRFSS include:

Adults Who Forgo Needed Medical Care*
The measure indicates the percent of adults (18+) in each state who could not get needed medical care due to cost. Breakdowns by education level and race/ethnicity are available for all states from 2005 through 2010 and 2011 through 2019.

Adults With No Personal Doctor*
This measure presents the percent of adults without a personal doctor and is now available for all states from 2005 through 2010 and 2011 through 2019. Breakdowns by education level and race/ethnicity are also available.

Chronic Disease Prevalence*
Data for this measure captures the percent of adults who reported having one or more common chronic conditions such as diabetes, cardiovascular disease, heart attack, stroke, and asthma, in each state. Estimates are now available for all states from 2005 through 2010 and 2011 through 2019.

Adult Unhealthy Days
There are a multitude of options for this measure, which shows the average number of days when an adult's physical health or mental health was not good during the past 30 days. Users can view estimates solely by reported mentally unhealthy days, physically unhealthy days, or a composite of both—though the combination of both physical and mental unhealthy days is capped at a total of 30 days. Estimates for each version of this measure are available for 2011 to 2019 and possible breakdowns include age, health insurance coverage, household income categories, disability status, education levels, and race/ethnicity.

Activities Limited due to Health Difficulty*
This measure reports the average number of days (in the last 30 days) for which an adult indicated their activity were limited stemming from either mental or physical health difficulties, and data is available for all states from 2005 through 2010 and 2011 through 2019.

Adult Obesity*
The measure is an indication of the prevalence of obesity (defined for adults as a Body Mass Index [BMI] > 30) among the U.S. population 18 years of age and over. It is now available for all states from 2005 through 2010 and 2011 through 2019.

Adult Binge Drinking*
This measure indicates the percent of adults who have consumed at least four drinks (women) or five (men) or more on one occasion during the past 30 days. Now available for all states from 2005 through 2010 and 2011 through 2019, the measure includes breakdowns by education level and race/ethnicity.

Adult Smoking*
This measure indicates the percent of adults over 18 years of age who have smoked 100 or more cigarettes in their lifetime, and who currently smoke at least some days or every day. Estimates are available for all states from 2005 through 2010, and 2011 through 2019, with breakdowns by education level and race/ethnicity.

Notes
All measures marked with an “*”: This indicates a break in series due to the BRFSS implementing cell phone sampling and an advanced weighting method in 2011.

Click here to explore these updated estimates on State Health Compare!

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

New Subsidized Marketplace Data and Other Data Tables Now Available from the 2019 American Community Survey (ACS)

The U.S. Census Bureau recently released 2019 estimates of income, poverty, and health insurance coverage from both the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS).

Along with the new estimates, several new data sets and features from the surveys are also now available for this year, including new estimates of subsidized marketplace insurance coverage, which is the main subject of this post.

New Data
In 2019, for the first time, the American Community Survey (ACS) asked respondents if they or a family member received a “tax credit or subsidy based on family income” to help pay for their coverage.¹ These subsidies are only available through the Affordable Care Act (ACA) marketplaces for individuals who are eligible based on their family income. By adding this question, researchers at the Census Bureau and other data users are now able to create estimates for the number and percent of the population who receive subsidized ACA marketplace coverage.

As part of a high-level analysis, SHADAC researchers found that at the national level, approximately 1.6% of the civilian noninstitutionalized population reported having subsidized marketplace coverage—representing nearly 5.3 million individuals.

Across the states, rates of subsidized marketplace coverage ranged significantly from a low of 0.7% in West Virginia and D.C. to a high of 3.4% in Florida and Utah. 

The five states with the largest populations of individuals with subsidized marketplace coverage were California, Florida New York, North Carolina, and Texas. More than 40% of total marketplace enrollees lived in one of these five states, and of that subsection of enrollees, nearly 3 in 5 lived in either California or Florida.

Eleven states (Florida, Idaho, Maine, Montana, Nebraska, North Carolina, South Carolina, South Dakota, Utah, Wisconsin, and Wyoming) had rates of subsidized marketplace coverage that were significantly higher than the national rate in 2019. Of these states, only Montana and Maine had implemented Medicaid expansion for the majority of 2019, which expands the portion of the population eligible for ACA subsidies. (Montana implemented Medicaid expansion as of January 1, 2019, and Maine implemented expansion on January 10, 2019.)

Twenty states (Alaska, Arizona, Arkansas, Connecticut, Delaware, Hawaii, Iowa, Illinois, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Minnesota, Mississippi, New Mexico, New York, Ohio, Washington, and West Virginia) and D.C. had rates of subsidized marketplace coverage that were significantly lower than the national rate in 2019. Of these 20 states and D.C., only Mississippi had chosen not to expand Medicaid as of January 1, 2019.

Nineteen states had rates of subsidized marketplace coverage that were not statistically different from the national rate.

New Data Tables and Geographic Breakdowns
Along with the new question and corresponding data table on subsidized coverage discussed above, other new data tables available from the ACS this year include:

• Population: a new table on place of birth shows the year of entry among the foreign-born population for the nine largest country of birth groups. Estimates are divided between year of entry before 2010 and year of entry beginning 2010 and later.
• Households and Families: two new tables provide information regarding (1) couples who live together with biological children, stepchildren, or adopted children of the main householder who are under 18 and have not been married; and (2) married couples, cohabiting couples, and single householders (male or female) with no spouse or partner present who also live with either relatives or their own children under 18.
• Quality Measure: this new table provides the unweighted total population sample for the nation, states, counties, and places.

Extensive modifications have also been made to existing ACS data tables, a full listing of which can be found here.

In addition to data table changes, the Census Bureau has also created an updated posting regarding geographic entities of varying sizes and designations (cities, towns, townships, school districts, Native American reservations, etc.) that have either come into existence, been absorbed into other entities, or have been dissolved in 2019. A full listing of all new, modified, or removed geographic breakdowns used for the 2019 ACS estimates can be found here.

2019 ACS Tables: State and County Uninsured Rates, with Comparison Year 2018

September 2020:

The interactive map on this page links to tables containing state and county uninsurance estimates for 2019. These estimates come from the 2019 American Community Survey (ACS) via the U.S. Census Bureau's data.census.gov tool.

Click on a state below to see state and county uninsurance rates by characteristics (for example, age, race/ethnicity, and poverty level) for 2019 and comparison year 2018. Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
 

Click here to view uninsurance estimates for the United States.
Click here to view uninsurance estimates for Puerto Rico and its municipios.

Note: These tables present uninsured rates, which indicate the share of the population that is uninsured. For example, a 10 percent uninsured rate for adult women indicates that 10 percent of all adult women are uninsured.

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Additional Estimates (50-State Comparisons)

Maps & Tables of Private, Public, & Uninsured Changes from 2018 to 2019
Private Coverage Rates by State, Change from 2018 to 2019, for All People
Public Coverage Rates by State, Change from 2018 to 2019, for All People
Uninsurance Rates by State, Change from 2018 to 2019, for All People

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About the ACS
The ACS is a household survey that began in 2005 and produces annually updated data on a variety of population characteristics, including health insurance coverage. In total, the ACS surveys approximately three million US households each year. An important feature of the ACS is that it includes a large enough sample for state‐level and sub‐state estimates.

The ACS began asking survey respondents about health insurance coverage during the 2008 calendar year. Specifically, the survey asks respondents about current coverage for each person in the respondent’s household. A person is categorized as “insured” if he or she has coverage at the point in time at which the survey is administered.

Why Aren’t Estimates Provided for All Counties?
Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000. 

How Are These Estimates Different from the Estimates that SHADAC Publishes Using Census Bureau Micro-Data Files?
Two definitions used by the Census Bureau to generate the tabulations above differ from those that SHADAC uses to generate tabulations for State Health Compare. The definitional differences are as follows:

Family

• The Census Bureau defines a family as all related people in a household.
• SHADAC defines a family using a measure called the “Health Insurance Unit” (HIU), which includes all individuals who would likely be considered a family unit in determining eligibility for either private or public coverage.
• To learn more about the 2020 update of SHADAC's Health Insurance Unit (HIU) click here.

Family Income

• The Census Bureau determines family income as a percentage of the Federal Poverty Level (FPL), which is a definition of poverty used primarily for statistical purposes. For example, FPL is used to estimate the number of Americans living in poverty each year.
• SHADAC determines family income as a percentage of the U.S. Department of Health and Human Services’ Federal Poverty Guidelines (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
• To learn more about the difference between FPL and FPG click here.

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Related ACS Materials:

• New Subsidized Marketplace Data and Other Data Tables Now Available from the 2019 American Community Survey (ACS)
• 2019 ACS: Rising National Uninsured Rate Echoed Across 19 States; Virginia Only State to See Decrease (Infographics)
• 2019 ACS: Insurance Coverage Overall Fell Nationwide and among the States, with Private and Public Coverage Declines Seen at the State Level