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National Healthcare Quality Report, 2013

Chapter 2. Effectiveness of Care for Common Clinical Conditions (continued)

HIV and AIDS

Importance

Mortality
Number of deaths of people with AIDS (2010) 15,529 (CDC, 2013b)
Prevalence
Number of people living with HIV infection (2010) 872,990 (CDC, 2013b)
Number of people living with AIDS (2010) 487,692 (CDC, 2013b)
Incidence
Number of new HIV diagnoses (2010) 49,273 (CDC, 2013b)
Number of new AIDS diagnoses (2010) 32,052 (CDC, 2013b)
Cost
Federal spending on HIV/AIDS care, cash and housing assistance, prevention, and research (fiscal year 2014 est.) $23.2 billion (KFF, 2013)

 

HIV is a virus that kills or damages cells of the body's immune system. AIDS is the most advanced stage of HIV infection. HIV can be spread through unprotected sex with an infected person, sharing of drug needles, or contact with the blood of an infected person. In addition, women with HIV can pass the virus to their babies during pregnancy, childbirth, or breastfeeding.

The impact of HIV infection and AIDS is disproportionately higher for racial and ethnic minorities and people of lower income and education levels. Although access to care has improved, Blacks, Hispanics, women, and uninsured people with HIV remain less likely to have access to care and less likely to have optimal patterns of care (Tobias, et al., 2007).

The spread of HIV is linked to complex social and economic factors, including:

  • Poverty.
  • Concentration of the virus in specific geographic areas and smaller sexual networks.
  • Sexual risk behaviors (e.g., unprotected anal intercourse).
  • Sexually transmitted co-infections.
  • Unawareness of infection (people who do not know they are infected contribute to spreading this disease).
  • Stigma (negative attitudes, beliefs, and actions directed at people living with HIV/AIDS or directed at people who engage in behaviors that might put them at risk for HIV).
  • Alcohol, injection and noninjection drug use, and associated behaviors (CDC, 2010).

According to the Centers for Disease Control and Prevention (CDC), HIV and AIDS disproportionately affect Blacks in the United States. In 2010, Blacks represented 14% of the U.S. population but accounted for 44% of all diagnoses of new HIV infections (CDC, 2013b). The HIV/AIDS epidemic is also a serious threat to the Hispanic community. An estimated 21% of new HIV infections occurred among Hispanics in 2009, which is three times the infection rate of Whites (CDC, 2013b). In addition to being seriously affected by HIV, Hispanics continue to face challenges in accessing health care, especially preventive services and HIV treatment.

Undocumented immigrants face an even greater challenge in accessing care and information regarding HIV and AIDS, but data are limited on their HIV infection rates (Carrillo & DeCarlo, 2003). In 2007, HIV/AIDS was the fourth leading cause of death among Hispanic men and women ages 35-44 (CDC, 2011b). Having Medicaid and a usual source of care decreased the likelihood of delaying care for HIV, but research shows that delay in care is still greater for Hispanics and Blacks (Cunningham, et al., 2006).

Another group that is severely affected by HIV includes gay, bisexual, and other men who have sex with men (MSM). MSM represent 2% of the U.S. population and is the only risk group in which new HIV infections have been gradually increasing since the 1990s. MSM have constantly represented the largest percentage of people diagnosed with AIDS and people with an AIDS diagnosis who have died.

In 2010, MSM accounted for more than half (63%) of all new HIV infections in the United States and 78% of infections among all newly infected men. Black MSM accounted for 36% of new HIV infections in 2010.Young MSM are disproportionately affected, with those ages 13-24 accounting for 72% of new HIV infections among all persons ages 13-24 and 30% of new infections among all MSM in 2010 (CDC, 2013a).

The White House Office of National AIDS Policy launched the National HIV/AIDS Strategy (NHAS) in July 2010. The NHAS is a comprehensive plan focused on: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and optimizing health outcomes for people living with HIV, and (3) reducing HIV-related health disparities. The plan serves as a roadmap for policymakers, partners in prevention, and the public on steps the United States must take to lower HIV incidence, get people living with HIV into care, and reduce HIV-related health disparities.

Measures

One measure is presented focusing on the quality of preventive care for HIV-infected individuals:

  • New AIDS cases.

Five measures are presented on access to care, retention in care and treatment, and prevention of opportunistic infections in HIV patients:

  • Adult HIV patients who had at least two outpatient visits during the year.
  • Adult HIV patients who received two or more CD4 tests during the year.
  • Adult HIV patients who received highly active antiretroviral therapy (HAART).
  • Eligible patients receiving prophylaxis for Pneumocystis pneumonia (PCP).
  • Eligible patients receiving prophylaxis for Mycobacterium avium complex (MAC).

This year, the report presents one measure on viral load:

  • HIV viral load less than 400.

In addition, one measure is presented on HIV infection deaths.

New! This year, we present data from the Ryan White HIV/AIDS Program (Ryan White Program).xviii It is important to note that not all people living with HIV use the Ryan White Program, so the data are not representative of the entire HIV population, which is estimated to be about 1.4 million people in the United States.

The two measures from the Ryan White Program are:

  • Rate of HIV patients in Ryan White-funded care who were virally suppressed (HIV RNA <200 copies/mL).
  • Rate of HIV patients in Ryan White-funded care who were retained in care (at least two ambulatory visit dates 90 days apart).

Findings

HIV Patients Receiving Care

Management of chronic HIV disease includes outpatient and inpatient services. Without adequate treatment, as HIV disease progresses, CD4 cell counts fall and patients become increasingly susceptible to opportunistic infections.

HIV/AIDS clinical performance measures are indicators for use in monitoring the quality of care provided to adults and adolescents living with HIV. Based on the set of quality measures developed by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), performance can be measured for various HIV prevention and treatment services. Services needed by patients with HIV include:

  • Two or more medical visits in an HIV care setting in the measurement year.
  • Two or more CD4 cell counts performed in the measurement year.
  • HAART for patients with HIV disease.
  • PCP prophylaxis for patients with CD4 cell count under 200.
  • MAC prophylaxis for patients with CD4 cell count under 50.

Outcome: New AIDS Cases

Changes in HIV infection rates reflect changes in behavior by at-risk individuals that may only partly be influenced by the health care system. However, individual and community programs have shown progress in influencing behavior change. Changes in the incidence of new AIDS cases are affected by changes in HIV infection rates, screening and early detection of HIV disease, and availability of appropriate treatments for HIV-infected individuals.

Figure 2.17. New AIDS cases per 100,000 population age 13 and over, by age and sex, 2000-2010

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Source: Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, HIV/AIDS Surveillance System, 2000-2010.
Denominator: U.S. population age 13 and over.
Note: For this measure, lower rates are better.

  • Overall, in 2010, the total rate of new AIDS cases was 11.5 per 100,000 population (Figure 2.17).
  • From 2000 to 2010, rates of new AIDS cases decreased overall, for ages 18-44 and 45-64, and for both sexes.
  • In all years, people ages 18-44 had a higher rate of new AIDS cases than other age groups, and males had a higher rate than females.
  • The 2010 top 5 State achievable benchmark for new AIDS cases was 2.8 per 100,000 population.xix At the current rate, it would take females 8 years to reach the benchmark and males 16 years.

Also, in the NHDR:

  • From 2000 to 2010, rates of new AIDS cases decreased overall and for AI/ANs, Blacks, and Whites.
  • In 2010, Blacks, AI/ANs, Native Hawaiians and Other Pacific Islanders (NHOPIs), and Hispanics had higher rates of new AIDS cases than Whites.

Management: Recommended Care for HIV

HIV measures tracked in the NHQR are from the HIV Research Network, which consists of 18 medical practices across the United States that treat large numbers of patients living with HIV. Data from the voluntary HIV Research Network are not nationally representative of the level of care received by everyone in the United States living with HIV.

HIV Research Network data represent only patients with HIV who are actually receiving care (about 14,000 patients per year) and do not represent patients who do not receive care. Furthermore, data shown below are not representative of the HIV Research Network as a whole because they represent only a subset of network sites that have the most complete data.

Below are data from the HIV Research Network that capture four of the HRSA quality measures. In addition, when CD4 cell counts fall below 50, medicine to prevent development of disseminated MAC infection is routinely recommended (Yeargin, et al., 2003), which is also tracked in the reports.

Figure 2.18. HIV patients who received recommended care, by age and expected payment source, 2010

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Key: HAART = highly active antiretroviral therapy; PCP = Pneumocystis pneumonia; MAC = Mycobacterium avium complex.
Source: Agency for Healthcare Research and Quality, HIV Research Network, 2010.
Note: For HAART measure, adult HIV patients had to be enrolled in an HIV Network clinic, receive at least one CD4 test, and have at least one outpatient visit in addition to having at least one CD4 test result of 350 or less.

  • Overall, in 2010, 89.5% of people with HIV had two or more outpatient visits during the year, and 81.2% of people with HIV had two or more CD4 tests during the year (Figure 2.18). In addition, 94.6% of people with HIV received HAART, 93.6% of people with HIV received PCP prophylaxis, and 91.4% of people with HIV received MAC prophylaxis.
  • In 2010, the percentage of adults with HIV who had two or more outpatient visits, two or more CD4 tests, and HAART was higher for those age 45 and over compared with those ages 18-44.
  • In 2010, the percentage of adults with HIV who had two or more outpatient visits and two or more CD4 tests was higher for those with Medicaid and Medicare/Dual Eligible insurance compared with those with private insurance.

Also, in the NHDR:

  • In 2010, there were no statistically significant differences by race/ethnicity or sex in the percentage of people with HIV receiving recommended services.

New! Outcome: HIV Viral Load Suppression

Low levels of HIV viral load are desired, as they decrease the chances of spreading HIV. Even if an HIV patient's viral load is low, the risk of HIV transmission is not completely prevented. Thus, it is essential for HIV patients to continue to adequately manage the disease, by getting tested and taking any necessary medication.

Figure 2.19. Adult HIV patients with viral load suppression for first test in the year, by age and insurance, 2008-2010

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Source: Agency for Healthcare Research and Quality, HIV Research Network, 2008-2010.
Denominator: Includes adult HIV patients enrolled in an HIV Research Network medical practice prior to the year. Patients who died, did not have an outpatient visit, or did not have a CD4 test in the year are excluded.
Note: Viral load suppression means HIV RNA <400 copies/mL.

  • Overall, in 2010, 73% of adult HIV patients had viral load suppression for the first test in the year (Figure 2.19).
  • In all years, the percentage of adult HIV patients with viral load suppression was higher for those age 45 and over compared with those ages 18-44.
  • In all years, the percentage of adult HIV patients with viral load suppression was lower for those with Medicaid compared with those with private insurance.

Also, in the NHDR:

  • In all years, the percentage of adult HIV patients with viral load suppression was lower for Blacks and Hispanics compared with Whites.
  • In all years, the percentage of adult HIV patients with viral load suppression was higher for males compared with females.

Outcome: Deaths of People With HIV Infection

Improved management of HIV infection has contributed to declines in the number of new AIDS cases in the United States since the 1990s (CDC, 2005). HIV infection deaths reflect a number of factors, including underlying rates of HIV risk behaviors, prevention of HIV transmission, early detection and treatment of HIV disease, and management of AIDS and its complications.

Figure 2.20. HIV infection deaths per 100,000 population, by sex and age, 2000-2010

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Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System—Mortality, 2000-2010.
Denominator: U.S. population.
Note: For this measure, lower rates are better. Rates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted. Respondents for which age is not reported are not included in the age adjustment calculations and are excluded from numerators.

  • Overall, in 2010, the total rate of HIV infection deaths was 2.6 per 100,000 population (Figure 2.20).
  • HIV infection death rates are decreasing overall, for both sexes, and for people ages 18-44 and 45-64.
  • In all years, the rate of HIV infection deaths was higher for males than for females.
  • From 2000 to 2010, the rate of HIV infection deaths was higher for adults ages 45-64 than for those ages 18-44. The rate was lower for those age 65 and over compared with those ages 18-44.
  • The 2008 top 4 State achievable benchmark for HIV deaths was 0.9 per 100,000 population.xx Females would take 5 years and males 7 years to reach the benchmark.

Also, in the NHDR:

  • From 2000 to 2010, HIV infection death rates were higher for Blacks than for Whites. APIs had lower rates than Whites in all years.
  • In all years, HIV infection death rates were higher for Hispanics than for Whites.

New! Ryan White Program Overview

Over the past 23 years, the Ryan White Program has provided funds for primary care and support services for people living with and affected by HIV disease. Working with States, cities, and local community organizations, the Ryan White Program strives to improve the quality of HIV-related care to those who do not have sufficient health care coverage or financial resources for coping with HIV disease. In 2010, the Ryan White Program served a total of 556,175 non-ADAP clients.

The Ryan White Program, as authorized by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87), is administered by HHS, HRSA, HAB. HRSA and HAB support the NHAS and its goals to reduce HIV incidence, increase access to care, optimize health outcomes, and reduce HIV-related health disparities.

Annually, Ryan White-funded programs are required to report to HRSA HAB how the funds have been used to provide services to HIV-positive individuals and their families who lack sufficient health care coverage or financial resources. The Ryan White Program Services Report (RSR) is the annual reporting instrument that agencies and organizations receiving funds complete to describe organizational characteristics, number and characteristics of clients served, types of services provided, number of clients receiving services, and number of client visits by type of service.

All clients served by the Ryan White Program received some type of Ryan White service, not just medical care. Of the 556,175 clients served in 2010, 68.5% were male, 30.7% female, and 0.8% transgenderxxi (including male-to-female and female-to-male). Individuals under age 13 years accounted for 2.1% of the Ryan White population, followed by age 65 and over (2.9%), 13-24 (6.6%), 55-64 (13.7%), 25-34 (15.0%), 35-44 (25.7%), and 45-54 (33.9%). The racial/ethnic groups represented most commonly include non-Hispanic Black (47.2%), non-Hispanic White (28%), and Hispanic/Latino (22.1%); all other racial/ethnic groups are 1% or less.

In the RSR, HIV status is reported only for individuals who receive case management or medical care services. There were 313,170 HIV-positive individuals (56% of Ryan White clients) who received Ryan White-funded HIV medical care. Due to missing data on HIV medical care visits, viral load tests, and antiretroviral therapy for some of the 313,170 HIV-positive individuals, the following data have different denominators.

The number of HIV-positive clients with at least one HIV medical care visit and at least one viral load available was 255,172. The number of HIV-positive clients with at least one HIV medical service and at least one HIV medical care visit date available during the year was 297,042.

Figure 2.21. HIV clients in Ryan White-funded care who were virally suppressed (most recent HIV RNA <200 copies/mL), by current gender identity and health insurance, 2010

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Source: Health Resources and Services Administration, 2010.
Denominator: HIV-positive clients all ages who received Ryan White-funded HIV care during the year and had visit date and viral load data available. Clients with missing viral load data are excluded.

  • In 2010, 69.5% of HIV-positive clients in Ryan White-funded care were virally suppressed (Figure 2.21).
  • In 2010, female (66.3%) and transgender (61.5%) HIV-positive clients were less likely to be virally suppressed than male (70.9%) HIV-positive clients.
  • In 2010, HIV-positive clients with Medicaid (64.6%) and those without insurance (65.4%) were less likely to be virally suppressed than those with private insurance (76.9%).

Also, in the NHDR:

  • In 2010, Black, NHOPI, AI/AN, and Hispanic HIV-positive clients were less likely to be virally suppressed compared with White HIV-positive clients. Asian HIV-positive clients were more likely than White HIV-positive clients to be virally suppressed.
  • In 2010, HIV-positive clients from poor households were less likely to be virally suppressed than those from high-income households. HIV-positive clients from low-income and middle-income households were more likely to be virally suppressed than those from high-income households.

Figure 2.22. HIV clients in Ryan White-funded care who were retained in HIV care (at least 2 ambulatory visits at least 90 days apart), by gender identity and insurance, 2010.

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Source: Health Resources and Services Administration, 2010.
Denominator: Total estimated number of HIV-positive clients all ages who received at least one Ryan White-funded care visit during the year and have visit dates available.

  • In 2010, 75.7% of HIV-positive clients in Ryan White-funded care were retained in care (Figure 2.22).
  • In 2010, transgender HIV-positive clients (70.6%) were less likely to be retained in care compared with male HIV-positive clients (75.2%).
  • In 2010, HIV-positive clients with Medicaid (75.2%) and those without insurance (72.8%) were less likely to be retained in care compared with those with private insurance (78.4%).

Also, in the NHDR:

  • In 2010, NHOPI and AI/AN HIV-positive clients were less likely to be retained in care compared with White HIV-positive clients.
  • In 2010, HIV-positive clients from poor households were less likely to be retained in care than those from high-income households.

Return to Contents

Mental Health and Substance Abuse

Importance

Mortality
Number of deaths due to suicide (2011 prelim.) 38,285 (Hoyert & Xu, 2012)
Rank among causes of death in the United States—suicide (2011 prelim.) 10th (Hoyert & Xu, 2012)
Rank of suicide among people ages 12-17 (2010) 2nd (CDC, 2011d)
Alcohol-impaired driving fatalities (2012) 10,322 (NHTSA, 2013)
Overdose of prescription painkillers (2011) 15,500 (NCIPC, 2011)
Prevalence
People age 12 and over with alcohol and/or illicit drug dependence or abuse in the past year (2011) 20.6 million (8.0%) (CBHSQ, 2012b)
Children ages 6-17 who had depression or anxiety in their
lifetime (2007-2008 est. based on parent report)
3.8 million (7.8%) (Ghandour, et al., 2012)
Youths ages 12-17 with a major depressive episode during the past year (2011) 2.0 million (8.2%) (CBHSQ, 2012a)
Adults age 18 and over with a major depressive episode during the past year (2011) 15.2 million (6.6%) (CBHSQ, 2012a)
Adults with at least one major depressive episode in their lifetime (2006) 30.4 million (13.9%) (CBHSQ, 2007)
Cost
National expenditures for treatment of mental health and substance abuse disorders (2014 est.) $239 billion (CBHSQ, 2008)
Cost-effectiveness of screening and brief counseling for problem drinking $0-$14,000/QALY (Maciosek, et al., 2006)

Measures

The NHQR and NHDR track measures of the quality of treatment for major depression and substance abuse. Mental health treatment includes counseling, inpatient care, outpatient care, and prescription medications. This section highlights four measures of mental health and substance abuse treatment:

  • Treatment for depression.
  • Suicide deaths.
  • Treatment for illicit drug use or alcohol problem.
  • Completion of substance abuse treatment.

Findings

Treatment for Depression

Treatment for depression can be very effective in reducing symptoms and associated illnesses and returning individuals to a productive lifestyle. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, funded by the National Institute of Mental Health, was the largest clinical trial ever conducted to help determine the most effective treatment strategies for major depressive disorder. It involved both primary care and specialty care settings. Participants included people with complex health conditions, such as multiple concurrent medical and psychiatric conditions.

This study found that between 28% and 33% of participants achieved a symptom-free state after the first round of medication, and nearly 70% achieved remission after 12 months (Insel & Wang, 2009). Strategies for treating depression in primary care settings, such as the collaborative care model, have also been shown to generate positive net social benefits in cost-benefit analyses compared with usual care (Glied, et al., 2010).

Barriers to high-quality mental health care include cost of care, lack of sufficient insurance for mental health services, discrimination and negative attitudes toward mental health problems, fragmented organization of services, and mistrust of providers. In rural and remote areas, limited availability of skilled care providers is also a major problem. For racial and ethnic populations, these problems are compounded by the lack of culturally and linguistically competent providers.

Barriers can exist for patients across the lifespan. The National Survey of Children's Health (HRSA, 2010) showed that among children with emotional, developmental, or behavioral conditions, 45.6% were receiving needed mental health services, and about half were taking medications. Recent data indicate, however, that service use for mental health is increasing among children (Pfuntner, et al., 2013).

Figure 2.23. Adults with a major depressive episode in the past year who received treatment for depression in the past year, by sex, 2008-2011

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Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2011.
Denominator: Adults age 18 and over with a major depressive episode in the past year.
Note: Major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression.

  • In 2011, only 68% of adults with a major depressive episode received treatment for depression (Figure 2.23).
  • In all years, adult males were less likely than adult females to receive treatment for depression.

Also, in the NHDR:

  • In all years, Black adults were less likely to receive treatment for depression than White adults.

Figure 2.24. Adolescents with a major depressive episode in the past year who received treatment for depression in the past year, by sex, 2008-2011

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Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2011.
Denominator: Adolescents ages 12-17 with a major depressive episode in the past year.
Note: Major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression.

  • In 2011, only 38% of adolescents with a major depressive episode received treatment for depression (Figure 2.24).
  • In 2009 and 2010, adolescent males were less likely than adolescent females to receive treatment for depression; in 2008 and 2011, this difference was not statistically significant.

Also, in the NHDR:

  • In all years, Black adolescents were less likely to receive treatment for depression than White adolescents.

Outcome: Suicide Deaths

Most individuals who die by suicide have mental illnesses, such as depression or schizophrenia, or have substance abuse problems (Moscicki, 2001). Suicide may be prevented when its warning signs are detected and treated. Identification of suicidal ideas and plans among individuals being treated for depression is expected to increase with the growing use of standardized screening instruments and electronic medical records. A National Institute of Mental Health (NIMH)-supported study recently reported that positive response to the final item ("thoughts that you would be better off dead, or of hurting yourself in some way") on the widely used Patient Health Questionnaire for depression (PHQ-9) was found to be a strong predictor of suicide attempts and completed suicides over the following year (Simon, et al., 2013.)

The increasing use of technology to enhance the quality of mental health care is growing by delivering treatment services via the Internet to supplement routine face-to-face care and occasionally to replace it. Ongoing NIMH-supported research is showing promising results for Internet-based cognitive-behavioral therapy and psychoeducation in the treatment of individuals dealing with conditions such as mood, eating, and sleep disorders (Thorndike, et al., 2013). As such "mobile health" interventions become more sophisticated, they can be adapted to be culturally specific and sensitive (Burns, et al. 2013).

Suicide prevention is multifaceted and other methods include educating physicians and keeping lethal weapons away from suicidal people (Mann, et al., 2005), as well as:

  • Cognitive-behavioral therapy (Tarrier, et al., 2008).
  • Universal strategies that target entire populations (e.g., public education and awareness programs), selective strategies that address at-risk populations (e.g., peer "natural helpers" and accessible crisis services), and indicated strategies that address specific high-risk individuals (e.g., case management and parent-supported programs) (Nordentoft, 2011).

Figure 2.25. Suicide deaths per 100,000 population age 12 and over, by age and residence location, 2008-2010

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2008 Achievable Benchmark: 9 per 100,000

Key: MSA = metropolitan statistical area.
Source:Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System—Mortality, 2008-2010.
Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 U.S. standard population.

  • In 2010, the overall suicide death rate was 14.6 per 100,000 population age 12 and over (Figure 2.25).
  • In all years, adolescents ages 12-17 had lower suicide death rates than adults ages 18-44. However, suicide is the second leading cause of death for youth ages 12-17 (CDC, 2011d). Adults ages 45-64 had higher suicide death rates than adults ages 18-44.
  • In all years, residents of medium and small metropolitan areas, micropolitan areas, and noncore areas (the most rural) had higher suicide death rates than residents of large fringe metropolitan areas (suburbs).
  • The 2008 top 5 State achievable benchmark was 9 suicide deaths per 100,000 population.xxii Data are insufficient to assess progress toward the benchmark.

Also, in the NHDR:

  • In all years, Blacks, APIs, and AI/ANs had lower suicide death rates than Whites, and Hispanics had lower suicide death rates than non-Hispanic Whites.

Treatment for Illicit Drug Use or Alcohol Problem

Use of illicit drugsxxiii can lead to addiction and other medical problems that can have a direct toxic effect on a number of bodily organs and exacerbate numerous physical and mental health conditions. Alcohol problems also can lead to serious health risks. Heavy drinking can increase the risk of certain cancers and cause damage to the liver, brain, and other organs. In addition, alcohol can cause birth defects, including fetal alcohol spectrum disorders. Alcoholism and illicit drug use increase the risk of death from car crashes and other injuries (Ringold, et al., 2006).

The Drug Abuse Warning Network (DAWN) estimates that in 2011, 2.5 million emergency department (ED) visits resulted from medical emergencies involving drug misuse or abuse (1.25 million involved illicit drugs, 1.24 million involved nonmedical use of pharmaceuticals, and 0.61 million involved drugs combined with alcohol (SAMHSA, 2013). Illicit drug use and alcohol problems can be effectively treated at specialty facilities (e.g., hospitals [inpatient], drug or alcohol rehabilitation [inpatient or outpatient facilities], or mental health centers).

Figure 2.26. People age 12 and over who needed treatment for illicit drug use or an alcohol problem and who received such treatment at a specialty facility in the last 12 months, by age and education, 2008-2011

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2011 Achievable Benchmark: 15%

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2011.
Denominator: Civilian noninstitutionalized population age 12 and over who needed treatment for any illicit drug use or an alcohol problem.
Note: Total includes people age 65 and over, but data were not statistically reliable enough to produce specific estimates for this group. Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient hospital setting, or mental health center.

  • In 2011, only 11% of people age 12 and over who needed treatment for illicit drug use or an alcohol problem received such treatment at a specialty facility in the last 12 months (Figure 2.26).
  • In all years, people with any college education were less likely to receive needed treatment for illicit drug use or an alcohol problem than people with less than a high school education. Individuals with a lower socioeconomic status may be more likely to receive needed substance abuse treatment due to linkages in service delivery between substance abuse and public assistance services in many States.
  • In 3 of 4 years, adolescents ages 12-17 were less likely to receive treatment than adults ages 45-64.
  • The 2011 top 5 State achievable benchmark was 15%.xxiv People with less than a high school education have achieved this benchmark and adults ages 45-64 are within 2 years of achieving this benchmark. Other groups, as well as the overall population of people age 12 and over, would need 20 to 30 years to achieve this benchmark.

Also, in the NHDR:

  • From 2002 to 2007, Blacks were more likely to receive needed treatment for illicit drug use or an alcohol problem than Whites. There were no statistically significant differences between Blacks and Whites from 2008 to 2011.
  • From 2007 to 2010, Hispanics were less likely to receive treatment than Whites.

Treatment: Completion of Substance Abuse Treatment

Completion of substance abuse treatment is strongly associated with improved outcomes, such as long-term abstinence from substance use. Dropout from treatment often leads to relapse and return to substance use.

Figure 2.27. People age 12 and over treated for substance abuse who completed treatment course, by age and sex, 2005-2010

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2008 Achievable Benchmark: 74%

Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set, Discharge Data Set, 2005-2010.
Denominator: Discharges age 12 and over from publicly funded substance abuse treatment facilities.

  • In 2010, only 44% of people age 12 and over treated for substance abuse completed their treatment course (Figure 2.27).
  • In all years, people ages 12-19 and 20-39 were less likely than those age 40 and over to complete substance abuse treatment. Females who were treated for substance abuse were significantly less likely than males to complete treatment.
  • The 2008 top 5 State achievable benchmark was 74%.xxv No group showed progress toward the benchmark.

Also, in the NHDR:

  • In all years, people with less than a high school education who were treated for substance abuse were significantly less likely than people with any college education to complete treatment.

xviii Data on clients who solely receive assistance from the AIDS Drug Assistance Program (ADAP) were not included in this analysis because they are reported into a different data system.
xix The top 5 States that contributed to the achievable benchmark are Iowa, Maine, South Dakota, Utah, and Wisconsin.
xx The top 4 States that contributed to the achievable benchmark are Kansas, Minnesota, Oregon, and Wisconsin.
xxi Transgender is defined as an individual whose gender identity is not congruent with his or her biologic gender, regardless of the status of surgical and hormonal gender reassignment processes.
xxii The top 5 States that contributed to the achievable benchmark are Connecticut, District of Columbia, Massachusetts, New Jersey, and New York.
xxiii Illicit drugs included in this measure are marijuana/hashish, cocaine (including crack), inhalants (e.g., inhalation of various substances other than for intended use, such as toluene), hallucinogens, heroin, and prescription-type psychotherapeutic drugs (nonmedical use).
xxiv The top 5 States that contributed to the achievable benchmark are Alabama, Delaware, Maryland, Oregon, and Utah.
xxv The top 5 States that contributed to the achievable benchmark are Colorado, Connecticut, District of Columbia, Mississippi, and Texas.
 


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Page last reviewed May 2014
Page originally created May 2014

 

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AHRQ Advancing Excellence in Health Care