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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Demography:The
country's population grew 13 % over the last decade from 249 million people
in 1990 to 281 million in 2000. Throughout the 1990s, the United States has
been going through a process of "Latin Americanization" that is changing the
ethnic makeup of the population. In fiscal year 1996, among the top ten countries
providing the greatest numbers of immigrants, Mexico was by far the leading
contributor with 163,572 immigrants. This process was further fortified by the
relatively high fertility rate of the Hispanic population in the United States
, far exceeding that of any other ethnic group. In 2000, Latinos made up 12.5%
of the population and is now the largest minority group in the United States
. In 1997, the fringe counties surrounding large metropolitan areas in all regions
of the United States had the lowest levels of poverty, 7 % to 9%. This was less
than half the poverty rates found in the central metropolitan areas. Only in
the South was the greatest poverty rate of 19% found in the most rural of counties.
Nationwide, in 1998 central metropolitan county populations consisted of 54%
White non-Hispanic, 21% Hispanic, 19% Black non-Hispanic and 6% Asian or Pacific
Islander. In contrast, 80% of the population in the fringe counties were White.
In 1998, 16 % of the population or 44.3 million
people were without any health insurance coverage. Among those living in poverty,
32 % had no health coverage in-spite of government health insurance such as
Medicaid. From 1995 to 1999 crude birth rates varied between 4.5 and 4.8 live
births per 1,000 population and fertility rates fluctuated between 65 and 66
live births per 1,000 women 15 - 45 years of age. Life expectancy continued
to improve through the 90s, increasing from 75.8 in 1995 to 76.7 in 1998. Women's
life expectancy was 5 ˝ years longer than men's in 1999. Those of Black ethnicity
still averaged 6 years less than non-Hispanic Whites in 1999.
Economy: The Gross Domestic Product grew 37.6%
from 1990 to 1999. In contrast to this substantial growth in the economy, the
percentage of the population living in poverty declined more slowly, from 13.5%
of the population in 1990 to 12.5% in 2000. As the gross domestic product grew
over the 90's, so did the inequalities in personal income distributions. From
1993 to 1998, the Gini coefficient stayed around 0.393 to 0.394, and then increased
in 1999 to 0.399. From 1997 to 1999, there was a small, yet perceptible, shift
towards more decentralization and privatization of financial responsibilities
for health. In 1997, the federal government covered 33.0 % of all national health
expenditures. This declined to 31.8% by 1999. Meanwhile, state and local governments
slightly increased their share of the responsibility from 13.2% to 13.5% and
the private sector increased from 53.8% to 54.7%. In 1996, there were 4.6 million
families on welfare. With welfare reform, by June 2000 this number dropped to
2.2 million families.
Mortality:
In 1999, the crude death rate in the United States was 877 per 100,000 population,
a 14% increase from the 1998 figure of 865. Death rates increased for people
45 - 54 years and for those older than 74 years of age. Death rates for those
85 years and older increased by 2.4%, the largest rate increase of any age group.
Death rates for other age groups dropped. The 5-14 year olds had the largest
death rate drop with a reduction of 3.5%. The leading causes of death in 1999
were cardiovascular and neoplasms for both males and females. Males were 13%
more likely to die of cancer than females primarily because more males smoked
tobacco, the leading cause of lung cancer and other respiratory cancers. Males
were also almost twice as likely to die in an accident, more than four times
likely to commit suicide, and more than three times likely to be a victim of
homicide than females.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years of age): Almost
a fifth of all children under the age of 6 years were living in poverty in 1999.
In 1998, infant mortality was 7.2 infant deaths per 1,000 live births. The five
leading causes of infant death in 1998 were congenital anomalies (22 % of all
infant deaths), disorders relating to short gestation and unspecified low birthweight
(15%), Sudden Infant Death Syndrome (10%), maternal complications of pregnancy
(5%) and respiratory distress syndrome (4%). Washington , D.C. had a substantially
higher infant mortality rate than any state at 15.0 infant deaths per 1,000
live births. From 1995 to 1997 neonatal mortality rates decreased from 4.9 to
4.8 neonatal deaths per 1,000 live births. Like infant mortality, this rate
also remained unchanged from 1997 to 1998. For postneonatals, mortality rates
dropped from 2.6 postneonatal deaths per 1,000 live births in 1995 to 2.4 in
1997. From 1997 to 1998 they remained unchanged. In 1998 the death rate of 1-4
year olds was 35 deaths per 100,000. The highest rates were among Black children
at 62 deaths per 100,000 children in this age group. The leading cause of death
for these children in 1998 was unintentional injuries at close to 26 deaths
per 100,000, responsible for 37% of all deaths among 1-4 year olds. The second
leading cause of death for this age group was birth defects at 4 deaths per
100,000, representing 11% of all deaths. The next three leading causes of death
for these children were homicide (8% of all 1-4 year old deaths), cancer (7%)
and heart disease (4%). The sixth leading cause of death was the first infectious
diseases pneumonia and influenza, representing 3% of all the deaths in this
age group.
Schoolchildren (5-9 years of age): Schoolchildren
of ages 5-9 years had the lowest death rate of any age group. The death rate
for this group dropped slightly during 1998 - 1999. The leading cause of death
for these children was external causes and most of these deaths were due to
motor vehicle accidents. In 1998, 1 out of 6 children of all ages were estimated
to suffer from asthma. In 2000, about a million children in the U.S. under the
age of 6 had blood lead levels high enough to adversely affect their development,
behavior and ability to learn.
Adolescence (10-14 and 15-19 years of age):In 1998, 17% of all adolescents came from families
living in poverty and another 20 % came from families near poverty. Among 17-18
year-old high school seniors', illicit drug use dropped from 26 % to 25 %. However,
the use of MDMA, called ecstasy, increased in both groups. Adolescent alcohol
use is of particular importance because of its association with increased vehicular
injuries and fatalities. Alcohol use by high school seniors dropped from 53
% to 50 % between 1997 and 2000. In 1976-80, 5 % of all 12-19 year olds were
overweight. By 1988-94, almost 11 % were overweight. In 1999, one-half of all
high school students were sexually active. The number of male adolescent AIDS
cases declined by 11% to 126 cases in 1999, new female adolescents AIDS cases
increased by 17% to 168 cases. Female adolescents ages 12-19 years were four
times more likely to be victims of reported sexual assault and rape than all
other age groups of females. In 1999, a fifth of all high school students reported
that they had seriously contemplated suicide. Suicide was reportedly attempted
by 8 % of all high school students, ages 14-18, in the prior 12 months.
Adults (20-59 years of age): The
broad age group of adults ages 20-59 makes up the majority of the U.S. population.
In 1999 deaths caused by diseases of the circulatory system for 25-34 year olds
totaled 4,700. The 45-54 years olds had 48,600 deaths due to diseases of the
circulatory system. Deaths due to neoplasms for 25-34 year olds totaled only
4,200 in that same year while in the year 1999, neoplasm deaths for 45-54 year
olds totaled 90,200.
Elderly (60 years and older): Older
adults suffered more from chronic diseases such as osteoporosis, arthritis and
Alzheimer's disease. There was a disproportionately high percentage of persons
suffering from depression and suicide tendencies. Leading causes of death for
the elderly were cardiovascular disease and cancer that accounted for 60% of
all deaths in this population. Chronic obstructive pulmonary disease, diabetes
mellitus, and pneumonia and influenza were also important causes of death.
Family health: In
the year 2000, female heads-of-household families with children approached a
quarter of all families in the U.S.
Workers health: From
1980 to 1995 there were 93,338 work-related deaths in the U.S. Leading causes
of job-related deaths were motor vehicle accidents, homicides, machine-related
accidents, falls, electrocutions, and falling objects. Men were 11 times more
likely to die than women during work. Older workers 65 years and older had the
highest work-related fatality rate of any age group in any occupation. Women
were also the victims of two-thirds of the nonfatal assault injuries at the
workplace.
Indigenous groups: African-American
death rates were higher than those for Whites for most leading causes of death.
African-Americans had lower death rates for suicide and chronic obstructive
disease than non-Hispanic Whites. Southeast Asian men suffered more lung cancer
than the majority male population. Older Filipino men in California have elevated
rates of high blood pressure compared to other Californian men of the same age.
Southeast Asian immigrants are 40 times more likely to have tuberculosis and
hepatitis B than the general population.
Analysis by type of health problem Natural disasters: The
year 2000 presented a major reduction in hurricanes and tornadoes, but increases
in numbers of less-potent but still destructive storms. Only 5 states suffered
declared major disasters due to tornadoes and none faced a hurricane. Winter
storms caused major disaster declarations in 14 states and Washington, D.C.
A total of 16 states also suffered other seasonal storms and three states had
flooding, all leading to major disaster declarations. Three states had major
destruction due to wildfires. California dealt with a substantial earthquake.
Vector -borne diseases: Out
of the reported 1,544 cases of malaria in 1997, only 5 were infected in the
U.S. One person acquired malaria from blood transfusion, one from a needle stick,
and three congenitally. There were 1,666 cases of malaria reported in 1999,
an 8 % increase from 1997. Out of the four species of malaria, more than 90%
of the cases reported in the U.S. were Plasmodium vivax in 1997. Only 1 case
of yellow fever was reported in the United States in the year 1999. There were
only 9 reported cases of plague in the same year.
Immune-preventable diseases: Between
1997 and 1999 the number of cases of poliomyelitis, diptheria, pertussis, hepatitis
B, mumps, rubeola and tetanus all decreased. No cases of poliomyelitis and only
1 case of diptheria were reported in 1999. Cases of invasive Haemophilus influenza
(Hi) and rubella decreased. Though rubella peaked in 1998, the count in 1999
was higher than 1997. Measles, as of March 2000, was no longer considered endemic
in the United States .
Cholera and other intestinal infectious diseases:
During the 1990s there was somewhere between
6.5 and 33 million cases annually of food-borne gastro-intestinal illnesses,
and roughly 9,000 of these people died each year. Between 1995 and 1999 there
were 53 laboratory-confirmed cases of Vibrio cholerae 01. There were 17,521
reported cases of shigellosis reported in the United States in 1999. A total
of 4,513 cases of Escherichia coli 0157:H7-diagnosed illnesses were reported
in the U.S. in 1999. The bacteria campylobacter may have caused an estimated
2 million illnesses a year. In 1994, the public water supply of the city of
Milwaukee , Wisconsin , was contaminated with cryptosporidium. Over 400,000
cases of cryptosporidium illness were reported in this outbreak.
Chronic communicable diseases: In 1992, 26,673
new Tuberculosis (TB) cases were reported with an incident rate of 10.5 cases
per 100,000 population. By year 2000 the numbers of new TB cases dropped to
16,377 and the rate declined to 5.8 per 100,000. In 1999 the incidence rate
of leprosy was .04 for every 100,000 population or 108 reported cases total.
Acute respiratory infections: Pneumonia inflicted
a death rate of 23.4 per 100,000 population in the US in 1999. Influenza was
responsible for the death of 0.6 per 100,000 population in 1999.
Rabies:In
1996 there were only 3 reported human cases of rabies in the U.S. In 1999, there
were none.
AIDS: The number of AIDS cases dropped 30 %
and AIDS death rates dropped more than half between 1996 and 1998. Approximately
320,000 persons were living with AIDS in the year 2000. A convergence occurring
between U.S. AIDS rates for males and females is due to increases in rates of
HIV transmission through heterosexual sex and through injection drug use. An
estimated 12,000 women became newly infected with HIV each year.
Sexually-Transmitted diseases: The
primary and secondary syphilis rate in 1999 was a new record low, at 2.5 cases
per 100,000 population. In contrast, during 1996-99 chlamydia rates increased
32% and gonorrhea rates increased by 8%. The most common of these three STD's
was chlamydia with rates of 254 cases per 100,000 in 1999. Gonorrhea was second
with 133 per 100,000 and all syphilis-related disease at a distant third with
13 per 100,000. Studies found up to 15% of sexually-active teenagers were infected
with human papillomavirus. In 1997, HPV-related cervical cancer adjusted rates
were 8 per 100.000.
Nutrition and metabolic diseases: The
U.S. faced an obesity epidemic in the 1990s. In 1990 the median percent of the
adult population that was obese (body mass index > 30) by state was
12%. With steady increases, in 2000 this median percentage was 20%. From 1991
to 2000, there was a 49% increase in persons with diabetes. It is estimated
that almost 10% of all US adults have diabetes.
Cardiovascular disease: Cardiovascular
disease, primarily ischemic heart disease and stroke, is the leading cause of
death in the United States . It accounts for about 40% of all deaths annually.
It is estimated that more than 58 million people in the U.S. have some form
of cardiovascular disease.
Malignant tumors: A
quarter of all deaths are due to cancer in the United States . Among men, the
most common cancers diagnosed in 2000 were prostate, lung and bronchus, and
colon and rectum. Among women, the most common cancers diagnosed were breast,
lung and bronchus, and colon and rectum. Overall incidence of cancer rates has
declined an average of over 2% every year from 1992 to 1996. Lung cancer was
the leading cause of cancer deaths among men and women. In 2000, an estimated
89,300 men and 67,600 women died of lung cancer.
Accidents and violence: During
1994-1999, almost 30 % of all patients in hospital trauma programs were involved
in motor vehicle accidents. Falls made up just over 28% of all trauma patients.
More than 3% of the patients died from their falls. Gunshot wounds was the third
most frequent reason for admission into a trauma center, making up 7 % of all
trauma patients, followed by stab wounds at more than 6 %. There were 506 violent
crimes (murder, forcible rape, robbery, and aggravated assault) committed for
every 100,000 population in the year 2000. From 1999 to 2000, the violent crime
rate dropped only 0.1%. However, the violent crime rate in the year 2000 was
down close to 16% from 1996 and down almost 21 % from 1991.
Oral health:
In a national survey conducted in 1999, 46 % of those living in poverty reported
visiting a dentist within a year. For the near poor, almost 49 % visited a dentist.
Among the non-poor, 72 % saw a dentist. In the United States , the South region
had the lowest percentage of residents visiting the dentist within a year, close
to 61% in 1999.
Emerging and remerging diseases: In
1999, there were 16,273 reported cases of Lyme's disease. In 1999, there was
a West Nile virus epidemic with 62 laboratory-confirmed human cases and 7 deaths.
Thousands of birds including at least 26 different species and 29 horses were
confirmed as having West Nile virus.
RESPONSE OF THE HEALTH SYSTEM The federal government provided the impetus for a
continuation of a comprehensive health campaign called 'Healthy People'. 'Healthy
People 2010', released in 1998, sets a comprehensive nationwide health promotion
and disease prevention agenda for the first decade of the 21st century. Its
overarching goals are to 1) increase quality and years of healthy life, and
2) eliminate health disparities. The single most important health-related event
in the late nineties was the litigation against the tobacco industry that lead
to the 1997 landmark agreement between attorney generals from 46 states and
5 U.S. territories and the tobacco industry. This agreement obligated the tobacco
industry to pay US$368 billion in health-related damages due to tobacco use,
to eliminate tobacco advertising billboards, and to retire the advertising cartoon
character Joe Camel.
