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Heart Disease and Stroke Data Details

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  • HDS-1 (Developmental) Increase overall cardiovascular health in the U.S. population

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Potential Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    *** Missing ***
    Numerator: 

    *** Missing ***

    Comparable Healthy People 2010 Objective: 
    Not applicable
  • HDS-2 Reduce coronary heart disease deaths

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Bridged-race Population Estimates
    National Vital Statistics System-Mortality
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 100,000 (age adjusted—see Comments)
    Baseline (Year): 
    129.2 (2007)
    Target: 
    103.4
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The HP 2010 target of no more than 156 coronary heart disease deaths per 100,000 population (age adjusted) was achieved in 2004, well in advance of the end of the tracking period (2007). Between 1999 and 2007, there was a 35.4 percent decline in the coronary heart disease death rate, from 194.6 to 126.0 deaths per 100,000 population (age adjusted). Using linear regression, the projected decline in the death rate between 2007 and 2017 is 68.1 percent to 40.2 coronary heart disease deaths per 100,000 population (age adjusted) in 2017. The trend in improvement is likely to continue, although at a slower pace. A 20 percent decline in the coronary heart disease death rate over the decade is proposed.
    Numerator: 

    Number of coronary heart disease-related deaths (ICD-10 codes I20-I25)

    Denominator: 

    Number of persons

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Death due to ischemic heart diseases (acute myocardial infarction, other acute ischemic heart diseases, and other forms of chronic ischemic heart disease), ICD-10 codes: I20-I25.

      FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      FOR MULTIPLE DATA YEARS: Death rates are calculated based on the sum of the resident populations for each of the data years involved (e.g. the denominator of a rate for 2008-2010 combined is the sum of the population estimates for 2008, 2009, and 2010). For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Sex: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Race/Ethnicity: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Country of Birth: <5, 5-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
      • Geographic Location: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Marital Status: 25-34, 35-44, 45-54, 55-64, 65-74, 75+
    Trend Issues: 
    Mortality data by marital status were not available for 60% of Georgia’s records in 2008 and 94% of Georgia’s records in 2009. Therefore, 2008 and 2009 data by marital status should be interpreted with caution.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Bridged-race Population Estimates
    National Vital Statistics System-Mortality
    Measure: 
    per 100,000 (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of coronary heart disease-related deaths (ICD-10 codes I20-I25)

    Denominator: 

    Number of persons

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        Death due to ischemic heart diseases (acute myocardial infarction, other acute ischemic heart diseases, and other forms of chronic ischemic heart disease), ICD-10 codes: I20-I25.

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

        FOR MULTIPLE DATA YEARS: Death rates are calculated based on the sum of the resident populations for each of the data years involved (e.g. the denominator of a rate for 2008-2010 combined is the sum of the population estimates for 2008, 2009, and 2010). For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Sex: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Race/Ethnicity: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Country of Birth: <5, 5-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
      • Geographic Location: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Marital Status: 25-34, 35-44, 45-54, 55-64, 65-74, 75+
    Trend Issues: 
    Mortality data by marital status were not available for 60% of Georgia’s records in 2008 and 94% of Georgia’s records in 2009. Therefore, 2008 and 2009 data by marital status should be interpreted with caution.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 126.0 to 129.2. The target was adjusted from 100.8 to 103.4 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention. Achievements in public health, 1990 1999: Decline in deaths from heart disease and stroke--United States, 1990-1999. MMWR 1999;48(30):649-56.
    2. Centers for Disease Control and Prevention: Heart Disease

  • HDS-3 Reduce stroke deaths

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Bridged-race Population Estimates
    National Vital Statistics System-Mortality
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 100,000 (age adjusted—see Comments)
    Baseline (Year): 
    43.5 (2007)
    Target: 
    34.8
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The HP2010 target of no more than 50 stroke deaths per 100,000 population (age adjusted) was achieved in 2004, well in advance of the end of the tracking period (2007). Between 1999 and 2007, there was a 32.3 percent decline in the stroke death rate, from 61.6 to 42.2 deaths per 100,000 population (age adjusted). Using linear regression, the projected decline in the stroke death rate between 2007 and 2017 is 63.0 percent to 15.6 stroke deaths per 100,000 population (age adjusted) in 2017. The trend in improvement is likely to continue, although at a slower pace. A 20 percent decline in the stroke death rate over the decade is proposed.
    Numerator: 

    Number of stroke deaths (ICD-10 codes I60-I69)

    Denominator: 

    Number of persons

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Death due to cerebrovascular diseases, ICD-10 codes: I60-I69.

      FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      FOR MULTIPLE DATA YEARS: Death rates are calculated based on the sum of the resident populations for each of the data years involved (e.g. the denominator of a rate for 2008-2010 combined is the sum of the population estimates for 2008, 2009, and 2010). For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Age Adjustment Notes: 

      At the National level this Indicator uses Age-Adjustment Groups:

      • Total: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Sex: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Race/Ethnicity: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Country of Birth: <5, 5-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
      • Geographic Location: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Marital Status: 25-34, 35-44, 45-54, 55-64, 65-74, 75+
    Trend Issues: 
    Mortality data by marital status were not available for 60% of Georgia’s records in 2008 and 94% of Georgia’s records in 2009. Therefore, 2008 and 2009 data by marital status should be interpreted with caution.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Bridged-race Population Estimates
    National Vital Statistics System-Mortality
    Measure: 
    per 100,000 (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of stroke deaths (ICD-10 codes I60-I69)

    Denominator: 

    Number of persons

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        Death due to cerebrovascular diseases, ICD-10 codes: I60-I69.

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

        FOR MULTIPLE DATA YEARS: Death rates are calculated based on the sum of the resident populations for each of the data years involved (e.g. the denominator of a rate for 2008-2010 combined is the sum of the population estimates for 2008, 2009, and 2010). For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Age Adjustment Notes: 

      At the National level this Indicator uses Age-Adjustment Groups:

      • Total: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Sex: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Race/Ethnicity: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Country of Birth: <5, 5-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
      • Geographic Location: <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
      • Marital Status: 25-34, 35-44, 45-54, 55-64, 65-74, 75+
    Trend Issues: 
    Mortality data by marital status were not available for 60% of Georgia’s records in 2008 and 94% of Georgia’s records in 2009. Therefore, 2008 and 2009 data by marital status should be interpreted with caution.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 42.2 to 43.5. The target was adjusted from 33.8 to 34.8 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention. Achievements in public health, 1990 1999: Decline in deaths from heart disease and stroke--United States, 1990-1999. MMWR 1999;48(30):649-56.
    2. Centers for Disease Control and Prevention: Stroke

  • HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    90.6 (2008)
    Target: 
    92.6
    Target-Setting Method: 
    2 percentage point improvement
    Target-Setting Method Justification: 
    Current estimates indicate most adults who have had their blood pressure checked within the past 2 years can state their blood pressure level (low, normal, borderline, or high). The baseline value is more than 90 percent and near the maximum achievement level. A 2-percentage point improvement, which is statistically significant, is proposed.
    Numerator: 

    Number of persons aged 18 years and over who had their blood pressure measured within the preceding 2 years and can state level

    Denominator: 

    Number of persons aged 18 years and over

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2008 National Health Interview Survey Heart Disease Supplement:

      [NUMERATOR:]

      About how long has it been since you had your blood pressure checked by a doctor, nurse, or other health professional?

      1. Never
      2. 1-94
      3. 95 or more
      4. Refused
      5. Don’t know

      Enter time period for time since last blood pressure check.

      1. Day(s)
      2. Week(s)
      3. Month(s)
      4. Year(s)
      5. Refused
      6. Don’t know

      At that time, were you told that your blood pressure was high, normal, or low?

      1. Not told
      2. High
      3. Normal
      4. Low
      5. Borderline
      6. Refused
      7. Don’t know
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      An adult was considered to have had their blood pressure measured within the preceding 2 years if they responded that it had been 1-94 days, 1-94 weeks, 1-24 months, or 1-2 years since they had their blood pressure checked by a doctor, nurse, or other health professional based on the first two questions in the NUMERATOR section. They were considered to be able to state their blood pressure level if they responded high, low, normal, or borderline (categories 2-5) to the third question in the NUMERATOR section.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-24, 25-34, 35-44, 45-64, 65+
      • Sex: 18-24, 25-34, 35-44, 45-64, 65+
      • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
      • Educational Attainment: 25-34, 35-44, 45-64, 65+
      • Family Income (percent poverty threshold): 18-24, 25-34, 35-44, 45-64, 65+
      • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
      • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
      • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
      • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
      • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
      • Sexual Orientation: 18-24, 25-34, 35-44, 45-64, 65+
      • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2012, the original baseline was revised from 92.9 to 90.6 due to a revision in a programming error. The target was adjusted from 94.9 to 92.6 to reflect the revised baseline using the original target-setting method.
  • HDS-5 Reduce the proportion of persons in the population with hypertension

    • HDS-5.1 Reduce the proportion of adults with hypertension

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      29.9 (2005–08)
      Target: 
      26.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Are you now taking prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine.

        Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center.

        Blood pressure has been measured with the mercury sphygmomanometer for many years but with new technologies available, alternative blood pressure devices have taken center stage. The rapid pace of the development of automated sphygmomanometers with improving accuracy and reliability combined with increasing affordability has meant that these devices have now replaced the mercury sphygmomanometer in many settings. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-29, 30-39, 40-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the baseline data by obesity status and the confidence intervals were revised due to a change in the methodology. Obesity status was originally coded based on the calculated BMI variable (BMXBMI) and had an error in the 2007-08 dataset. Some records had a missing height or weight but not a missing BMXBMI. To be consistent with NHANES reports, instead of using the calculated BMI variable, BMI is now computed directly from the weight and height variables. In addition, the BMX 2007-2008 updated April 2011 file was used. The method for computing the confidence intervals was revised from the standard Wald method to the Wald method on the log scale.

      References

      Additional resources about the objective

      1. National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      2. National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      3. National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey, 2009-2010, Health Tech/Blood Pressure Procedures Manual. Hyattsville, MD: Centers for Disease Control and Prevention, May 2009.
    • HDS-5.2 Reduce the proportion of children and adolescents with hypertension

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      3.5 (2005–08)
      Target: 
      3.2
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 8 to 17 years, with high blood pressure/hypertension

      Denominator: 

      Number of persons aged 8 to 17 years

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Children and adolescents are defined as having high blood pressure or hypertension if their average systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) is at or above the 95th percentile for sex, age, and height. Sex-specific tables by age and height percentiles are used to estimate the SBP and DBP percentiles.

        Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physician examination in the NHANES mobile examination center.

        Blood pressure has been measured with the mercury sphygmomanometer for many years but with new technologies available, alternative blood pressure devices have taken center stage. The rapid pace of the development of automated sphygmomanometers with improving accuracy and reliability combined with increasing affordability has meant that these devices have now replaced the mercury sphygmomanometer in many settings. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2009-2010, Health Tech/Blood Pressure Procedures Manual. Hyattsville, MD: Centers for Disease Control and Prevention, May 2009.
      2. Prineas R.J.; Ostchega Y.; Carroll M.; Dillon C.; McDowell M. US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2000 Blood Press Monit. 2007 Apr;12(2):75-804.
      3. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Pediatrics 2004;114: 555-576.
  • HDS-6 Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    74.6 (2008)
    Target: 
    82.1
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over who have had their cholesterol checked within 5 years

    Denominator: 

    Number of persons aged 18 years and over

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2008 National Health Interview Survey Heart Disease Supplement:

      [NUMERATOR:]

      About how long has it been since you had your blood cholesterol checked by a doctor, nurse, or other health professional?

      1. Never
      2. 1-94
      3. 95 or more
      4. Refused
      5. Don’t know

      Enter time period for time since last blood cholesterol check.

      1. None
      2. Day(s)
      3. Week(s)
      4. Month(s)
      5. Year(s)
      6. Refused
      7. Don’t know
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      An adult was considered to have had their cholesterol checked within the preceding 5 years if they responded that it had been 1-94 days, 1-94 weeks, 1-60 months, or 1-5 years since they had their blood cholesterol checked by a doctor, nurse, or other health professional based on the questions in the NUMERATOR section.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-24, 25-34, 35-44, 45-64, 65+
      • Sex: 18-24, 25-34, 35-44, 45-64, 65+
      • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
      • Educational Attainment: 25-34, 35-44, 45-64, 65+
      • Family Income (percent poverty threshold): 18-24, 25-34, 35-44, 45-64, 65+
      • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
      • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
      • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
      • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
      • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
      • Sexual Orientation: 18-24, 25-34, 35-44, 45-64, 65+
      • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2012, the baseline data were revised due to a revision in a programming error. The display value for the total line did not change so the target remained the same. Some baseline estimates for population subgroups were revised.
  • HDS-7 Reduce the proportion of adults with high total blood cholesterol levels

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    15.0 (2005–08)
    Target: 
    13.5
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 20 years and over with total blood cholesterol of 240 mg/dL or greater

    Denominator: 

    Number of persons aged 20 years and over

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Total cholesterol is a combination of high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL). Total blood cholesterol is measured enzymatically in a series of coupled reactions. A description of the procedures for the total cholesterol measurement in NHANES has been published by NCHS.

      Blood cholesterol levels less than 200 mg/dL are considered desirable. Levels of 240 mg/dL or above are considered high. Levels of 200-239 mg/dL are considered borderline.

      Individuals who take medication to lower their serum cholesterol levels and whose measured total serum cholesterol levels are below the cut-offs for high and borderline high cholesterol, are not defined as having high or borderline high cholesterol, respectively.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Sex: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 20-29, 30-39, 40-49, 50-59, 60-64
      • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Veteran Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014, the baseline data by obesity status and the confidence intervals were revised due to a change in the methodology. Obesity status was originally coded based on the calculated BMI variable (BMXBMI) and had an error in the 2007-08 dataset. Some records had a missing height or weight but not a missing BMXBMI. To be consistent with NHANES reports, instead of using the calculated BMI variable, BMI is now computed directly from the weight and height variables. In addition, the BMX 2007-2008 updated April 2011 file was used. The method for computing the confidence intervals was revised from the standard Wald method to the Wald method on the log scale.

    References

    Additional resources about the objective

    1. Gunter, E.W.; Lewis, B.G.; and Koncikowski, S.M. Laboratory Procedures Used for the Third National Health and Nutrition Examination Survey (NHANES III), 1988–94. HHS, Public Health Service, CDC, 1996.
    2. National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1998–1994, NHANES III Laboratory Data Files (CD-ROM). Public Use Data File Documentation No. 76200. Hyattsville, MD: Centers for Disease Control and Prevention, 1996.
  • HDS-8 Reduce the mean total blood cholesterol levels among adults

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    mg/dL (age adjusted—see Comments)
    Baseline (Year): 
    197.7 (2005–08)
    Target: 
    177.9
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Sum of all cholesterol values for adults aged 20 years and over

    Denominator: 

    Number of cholesterol measurements for adults aged 20 years and over

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Total cholesterol is a combination of high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL).

      Total blood cholesterol is measured enzymatically in a series of coupled reactions. A description of the laboratory procedures for the total cholesterol measurement in NHANES is published by NCHS.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Sex: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 20-29, 30-39, 40-49, 50-59, 60-64
      • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Veteran Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

    References

    Additional resources about the objective

    1. Gunter, E.W.; Lewis, B.G.; and Koncikowski, S.M. Laboratory Procedures Used for the Third National Health and Nutrition Examination Survey (NHANES III), 1988–94. HHS, Public Health Service, CDC, 1996.
    2. National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1998–1994, NHANES III Laboratory Data Files (CD-ROM). Public Use Data File Documentation No. 76200. Hyattsville, MD: Centers for Disease Control and Prevention, 1996.
  • HDS-9 Increase the proportion of adults with prehypertension who meet the recommended guidelines

    • HDS-9.1 Increase the proportion of adults with prehypertension who meet the recommended guidelines for body mass index (BMI)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      28.7 (2005–08)
      Target: 
      33.0
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target value of 33 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension with a BMI equal to or greater than 18.5 and less than 25.0

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The NHANES obtains measured weights and heights without shoes. BMI is calculated by dividing weight in kilograms by the square of height in meters.

        For blood pressure management among persons with prehypertension it is recommended that they maintain a normal body weight (BMI 18.5-24.9 kg/m²). Systolic blood pressure is reduced by approximately 5–20 mmHg/10kg.

        Adults are defined as having prehypertension if they do not report that they are taking high blood pressure medicine and either: (a) have a measurement of mean systolic blood pressure (SBP) ≥120 and <140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥80 and <90 mm Hg. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      3. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) Express. National Heart, Lung, and Blood Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-2571.
    • HDS-9.2 Increase the proportion of adults with prehypertension who meet the recommended guidelines for saturated fat consumption

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      31.4 (2005–08)
      Target: 
      35.7
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target value of 35.7 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension who report consuming less than 10.0 percent of calories from saturated fat  (based on up to 2 24-hour dietary recalls)

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The NHANES includes 2 nonconsecutive 24-hour dietary recalls interviews to obtain information from participants on their intake of foods and beverages from the previous day. Using detailed databases of the nutrient composition of foods from the U.S. Department of Agriculture, estimates of saturated fat intake were calculated for each participant.

        For blood pressure management among persons with prehypertension it is recommended that they meet the recommendations for saturated fat consumption in the 2005 Dietary Guidelines for Americans as part of the DASH eating plan. This plan includes a diet rich in fruits, vegetables, and low fat dairy products with reduced content of saturated and total fat. This diet is associated with a systolic blood pressure reduction of approximately 8–14 mmHg.

        Adults are defined as having prehypertension if they do not report that they are taking high blood pressure medicine and either: (a) have a measurement of mean systolic blood pressure (SBP) ≥120 and <140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥80 and <90 mm Hg. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable. In 2017, the target was revised from 35.5 to 35.7 due to a computation error.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      3. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) Express. National Heart, Lung, and Blood Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-2571.
    • HDS-9.3 (Developmental) Increase the proportion of adults with prehypertension who meet the recommended guidelines for sodium intake

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent (age adjusted—see Comments)
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension who report consuming less than or equal to 2,300 mg of sodium daily (based on up to 2 24-hour dietary recalls)

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2009-10 and 2011-12 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        Foods and beverages:

        The 2009-10 and 2011-12 NHANES included the collection of 1 day of dietary data for all respondents through in-person 24-hour recalls and collection of a 2nd-day 24-hour recall by telephone. For these analyses, sodium intake from both 24 hour recalls will be used. Each respondent was asked to recall the kinds and amounts of foods and beverages consumed at home and away from home during the previous day (midnight to midnight). Amounts of foods and beverages reported in household measures were then converted to gram amounts, and sodium intake from foods and beverages was estimated with the use of food composition files.

        Plain Drinking Water:

        Plain drinking water intakes were collected directly as part of the dietary intake collection of foods and beverages beginning with the 2005-2006 NHANES. Thus, the dietary intake records from the 2009-10 and 2011-12 NHANES include the sodium provided by drinking water.

        Additional questions used to assess total sodium intake include:

        Dietary supplement use:

        Has (Person) taken any vitamins or minerals in the past month? Please include those that are prescribed by a doctor or dentist and those that are not prescribed.

        1. Yes
        2. No
        3. Refused
        4. Don’t Know

        Has (Person) taken or used any medicines for which a doctor's or dentist's prescription is needed, in the past month? This includes any products which cannot be obtained without a doctor's or dentist's prescription. Include those medicines which you may have already mentioned.

        1. Yes
        2. No
        3. Refused
        4. Don’t Know

        [If yes:]

        May I see the containers for all of the (vitamins and minerals/prescription medicines) (Person) took in the past month?

        Enter complete name of vitamin/mineral from label, or probe respondent:

        • Container seen
        • Container not seen
        • Product furnished by respondent
        • Product name not on container
        • Enter manufacturer's or distributor's name and address (city and State)

        How often did (Person) take (product) in the past month?

        1. ______ Days (Number from 1 to 30)
        2. Refused
        3. Don’t Know

        How much (product) did (Person) take each time (Person) took it?

        1. ______ Number of capsules, tablet/pills; teaspoons; tablespoons; fluid ounces/ounces; drops/droppers; packets/packs/packages; ml.; wafers; other
        2. Refused
        3. Don’t Know

        Antacid use:

        Antacid use:

        Enter complete name of antacid from label or probe respondent:

        1. Antacid seen
        2. Antacid not seen. Product name furnished by respondent.

        How often did you take (antacid) in the past month?

        1. ______ Days (Number from 1 to 30)
        2. Refused
        3. Don’t Know

        How much (antacid) did you take each time you took it?

        1. ______ Number of capsules, tablet/pills; teaspoons; tablespoons; fluid ounces/ounces; drops/droppers; packets/packs/packages; ml.; wafers; other
        2. Refused
        3. Don’t Know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The NHANES includes 2 nonconsecutive 24-hour dietary recalls interviews to obtain information from participants on their intake of foods and beverages from the previous day. Using detailed databases of the nutrient composition of foods from the U.S. Department of Agriculture, estimates of sodium intake were calculated for each participant.

        Excessive dietary sodium consumption increases blood pressure, which increases the risk for stroke, coronary heart disease, heart failure, and renal disease. For blood pressure management among persons with prehypertension it is recommended that they limit sodium intake to no more than 2,300 mg/d, consistent with the 2005 Dietary Guidelines for Americans.

        Adults are defined as having prehypertension if they do not report that they are taking high blood pressure medicine and either: (a) have a measurement of mean systolic blood pressure (SBP) ≥120 and <140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥80 and <90 mm Hg. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Estimates include consideration of several sources of sodium intake: foods, dietary supplements, antacids, tap water, and salt use at the table.

        Estimation of Sodium Intake from Salt Use at the Table:

        Regarding salt use at the table, sea salt, flavored salts such as garlic, onion, and celery salt, and seasoning salts were counted as ordinary salts. Lite salt was labeled as such and has a reduced sodium content of at least 50%. Salt substitutes do not contain sodium. To obtain a daily amount for each person, the amount of sodium depending on salt type was multiplied by the frequency value. (Sodium in type of salt x frequency amount of sodium from table salt added per day. See table below).

        Type of salt:

        For "ordinary salt," sodium intake from salt use at the table was estimated based on a 1991 study that estimated mean sodium intake for adults to be about 580 mg. Specifically, 580 mg of sodium (which is about 1500 mg or ¼ teaspoon of salt) for the "very often" code was assigned for persons aged 2 years and older. For "lite" salt which contains at least half the amount of sodium as "ordinary salt," 290 mg of sodium was assigned. A zero sodium value was assigned for "salt substitute," "other" or "don't use."

        Frequency of salt use:

        For "rarely," the sodium value was multiplied by 0.25; for "occasionally," the sodium value was multiplied by 0.50; for "very often," the sodium value was multiplied by 1. The frequency question was not asked if response to type of salt was "don't use" or "don’t know." For "don't use" responses, a zero value was assigned; for "don't know" responses, ordinary salt was assumed and 290 mg of sodium was assigned based on an assumed frequency of "occasionally."

        The following table summarizes the amount of sodium added:

        Assignment of Sodium Values

        Type Rarely Occasionally Very often DK* Missing**
        Ordinary 145 290 580 290 --
        Lite 73 145 290 145 --
        Salt Substitute 0 0 0 0 --
        Other 145 290 580 290 --
        Don't use 0 0 0 0 0
        Don't know 0 0 0 0 290

        * DK= Don't Know
        ** Missing= Not Asked

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      References

      Additional resources about the objective

      1. Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. 1st ed. Washington, DC: The National Academies Press; 2004.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      3. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) Express. National Heart, Lung, and Blood Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-2571.
    • HDS-9.4 Increase the proportion of adults with prehypertension who meet the recommended guidelines for physical activity

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      37.4 (2007–10)
      Target: 
      42.1
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target value of 42.1 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension who report moderate physical activity for at least 150 minutes per week or vigorous physical activity for at least 75 minutes per week or an equivalent combination

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with prehypertension

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        Transportation

        {Do you/Does SP} walk or use a bicycle for at least 10 minutes continuously to get to and from places?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        In a typical week, on how many days {do you/does SP} walk or bicycle for at least 10 minutes continuously to get to and from places?

        • _______ Days

        How much time {do you/does SP} spend walking or bicycling for travel on a typical day?

        • _______ Minutes

        Moderate activity

        {Do you/Does SP} do any moderate-intensity sports, fitness, or recreational activities that cause a small increase in breathing or heart rate such as brisk walking, bicycling, swimming, or golf for at least 10 minutes continuously?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        In a typical week, on how many days {do you/does SP} do moderate-intensity sports, fitness or recreational activities?

        • _______ Days

        How much time {do you/does SP} spend doing moderate-intensity sports, fitness or recreational activities on a typical day?

        • _______ Minutes

        Vigorous activity

        {Do you/Does SP} do any vigorous-intensity sports, fitness, or recreational activities that cause large increases in breathing or heart rate like running or basketball for at least 10 minutes continuously?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        In a typical week, on how many days {do you/does SP} do vigorous-intensity sports, fitness or recreational activities?

        • _______ Days

        How much time {do you/does SP} spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?

        • _______ Minutes
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        For blood pressure management among persons with prehypertension it is recommended that they engage in regular aerobic physical activity as defined by the Federal physical activity guidelines. Adults are classified as meeting the objective if they participate in at least 150 minutes of moderate activity per week (including walking or biking for transportation), 75 minutes of vigorous activity, or 150 minutes per week of an equivalent combination of activity. Total minutes per week of moderate-intensity activity are calculated by multiplying the days per week adults report participating in moderate-intensity activity by the number of minutes reported. Total minutes per week of vigorous-intensity activity are calculated by multiplying the days per week adults report participating in vigorous-intensity activity by the number of minutes reported. To calculate minutes per week for the equivalent combination of moderate and vigorous-intensity activity, minutes per week of moderate-intensity activity are added to two times the minutes per week of vigorous-intensity activity.

        If responses meet the criteria for one activity (vigorous or moderate) but the status of the other activity is unknown, the record is included in the numerator and the denominator. If responses do not meet the criteria for one activity and the status of the other activity is unknown, the record is dropped from the analysis.

        Adults are defined as having prehypertension if they do not report that they are taking high blood pressure medicine and either: (a) have a measurement of mean systolic blood pressure (SBP) ≥120 and <140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥80 and <90 mm Hg. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable.

      References

      Additional resources about the objective

      1. Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. 1st ed. Washington, DC: The National Academies Press; 2004.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      3. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Physical Activity Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
    • HDS-9.5 (Developmental) Increase the proportion of adults with prehypertension who meet the recommended guidelines for moderate alcohol consumption

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent (age adjusted—see Comments)
      Numerator: 

      Number of persons aged 20 years and over, excluding pregnant women, with prehypertension who report moderate alcohol consumption (no more than one drink per day for women and two drinks for men)

      Denominator: 

      Number of persons aged 20 years and over, excluding pregnant women, with prehypertension

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        In the past 12 months, how often did {you/SP} drink any type of alcoholic beverage?

        In the past 12 months, on those days that {you/SP} drank alcoholic beverages, on the average, how many drinks did {you/he/she} have?

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        For blood pressure management among persons with prehypertension it is recommended that they limit consumption to no more than 1 drink per day in women (0.5 oz of ethanol, e.g., 12 oz beer, 5 oz wine, or 1.5 oz 80-proof whiskey) and no more than 2 drinks per day in men.

        Adults are defined as having prehypertension if they do not report that they are taking high blood pressure medicine and either: (a) have a measurement of mean systolic blood pressure (SBP) ≥120 and <140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥80 and <90 mm Hg. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-49, 50-59, 60-69, 70-79, 80+
        • Sex: 20-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 20-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 20-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 20-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 20-49, 50-59, 60-64
        • Diabetes Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure Data Documentation, Codebook, and Frequencies. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      3. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure Data Documentation, Codebook, and Frequencies. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
  • HDS-10 Increase the proportion of adults with hypertension who meet the recommended guidelines

    • HDS-10.1 Increase the proportion of adults with hypertension who meet the recommended guidelines for body mass index (BMI)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      18.0 (2005–08)
      Target: 
      21.6
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target setting method used was Minimal Statistical Significance. The target value of 21.6 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension with a BMI equal to or greater than 18.5 and less than 25.0

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Are you now taking prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The NHANES obtains measured weights and heights without shoes. BMI is calculated by dividing weight in kilograms by the square of height in meters.

        For blood pressure management among persons with hypertension it is recommended that they maintain a normal body weight (BMI 18.5-24.9 kg/m2). Systolic blood pressure is reduced by approximately 5–20 mmHg/10kg.

        Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-11 in that this objective which tracks adults with high blood pressure/hypertension who meet the recommended guidelines for healthy BMI is a product of several components of the Healthy People 2010 objective, which tracked adults with high blood pressure who report taking action to help control blood their blood pressure, namely diet and exercise. The data source was changed from the National Health Interview Survey to the National Health and Nutrition Examination Survey to enable direct measurement of BMI.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      3. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) Express. National Heart, Lung, and Blood Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-2571.
    • HDS-10.2 Increase the proportion of adults with hypertension who meet the recommended guidelines for saturated fat consumption

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      30.5 (2005–08)
      Target: 
      35.7
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target value of 35.7 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension who report consuming less than 10.0 percent of calories from saturated fat (based on up to 2 24-hour dietary recalls)

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Are you now taking prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The NHANES includes 2 nonconsecutive 24-hour dietary recalls interviews to obtain information from participants on their intake of foods and beverages from the previous day. Using detailed databases of the nutrient composition of foods from the U.S. Department of Agriculture, estimates of saturated fat intake were calculated for each participant.

        For blood pressure management among persons with hypertension it is recommended that they meet the recommendations for saturated fat consumption in the 2005 Dietary Guidelines for Americans as part of the DASH eating plan. This plan includes a diet rich in fruits, vegetables, and low fat dairy products with reduced content of saturated and total fat. This diet is associated with a systolic blood pressure reduction of approximately 8–14 mmHg.

        Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-11 in that this objective which tracks adults with high blood pressure/hypertension who meet the recommended guidelines for saturated fat consumption is a component of the Healthy People 2010 objective, which tracked adults with high blood pressure who report taking action to help control blood their blood pressure through diet, sodium and alcohol reduction, exercise, or high blood pressure medication. The data source was changed from the National Health Interview Survey to the National Health and Nutrition Examination Survey to enable more accurate measurement of dietary intake in reference to specific dietary guidelines.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      2. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344 :3-10.
      3. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) Express. National Heart, Lung, and Blood Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-2571.
    • HDS-10.3 Increase the proportion of adults with hypertension who meet the recommended guidelines for sodium intake

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      0.66 (2009–12)
      Target: 
      1.19
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target setting method used was Minimal Statistical Significance. The target value of 1.19 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension who report consuming less than or equal to 1,500 mg of sodium daily  (based on up to 2 24-hour dietary recalls)

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Are you now taking prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The NHANES includes 2 nonconsecutive 24-hour dietary recalls interviews to obtain information from participants on their intake of foods and beverages from the previous day. Using detailed databases of the nutrient composition of foods from the U.S. Department of Agriculture, estimates of sodium intake were calculated for each participant.

        Excessive dietary sodium consumption increases blood pressure, which increases the risk for stroke, coronary heart disease, heart failure, and renal disease. For blood pressure management among persons with hypertension it is recommended that they limit sodium intake to no more than 1,500 mg/d, consistent with the 2005 Dietary Guidelines for Americans.

        Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-11 in that this objective which tracks adults with high blood pressure/hypertension who meet the recommended guidelines for sodium intake is a component of the Healthy People 2010 objective, which tracked adults with high blood pressure who report taking action to help control blood their blood pressure through diet, sodium and alcohol reduction, exercise, or high blood pressure medication. The data source was changed from the National Health Interview Survey to the National Health and Nutrition Examination Survey to enable more accurate measurement of dietary intake in reference to specific dietary guidelines.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable. In 2017, the target was revised from 1.23 to 1.19 due to a computation error.

      References

      Additional resources about the objective

      1. Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. 1st ed. Washington, DC: The National Academies Press; 2004.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure Data Documentation, Codebook, and Frequencies. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      3. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) Express. National Heart, Lung, and Blood Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-2571.
    • HDS-10.4 Increase the proportion of adults with hypertension who meet the recommended guidelines for physical activity

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      28.0 (2007–10)
      Target: 
      33.7
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target value of 33.7 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension who report moderate physical activity for at least 150 minutes per week or vigorous physical activity for at least 75 minutes per week or an equivalent combination

      Denominator: 

      Number of persons aged 18 years and over, excluding pregnant women, with high blood pressure/hypertension

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        Transportation

        {Do you/Does SP} walk or use a bicycle for at least 10 minutes continuously to get to and from places?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        In a typical week, on how many days {do you/does SP} walk or bicycle for at least 10 minutes continuously to get to and from places?

        • _______ Days

        How much time {do you/does SP} spend walking or bicycling for travel on a typical day?

        • _______ Minutes

        Moderate activity

        {Do you/Does SP} do any moderate-intensity sports, fitness, or recreational activities that cause a small increase in breathing or heart rate such as brisk walking, bicycling, swimming, or golf for at least 10 minutes continuously?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        In a typical week, on how many days {do you/does SP} do moderate-intensity sports, fitness or recreational activities?

        • _______ Days

        How much time {do you/does SP} spend doing moderate-intensity sports, fitness or recreational activities on a typical day?

        • _______ Minutes

        Vigorous activity

        {Do you/Does SP} do any vigorous-intensity sports, fitness, or recreational activities that cause large increases in breathing or heart rate like running or basketball for at least 10 minutes continuously?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        In a typical week, on how many days {do you/does SP} do vigorous-intensity sports, fitness or recreational activities?

        • _______ Days

        How much time {do you/does SP} spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?

        • _______ Minutes
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        For blood pressure management among persons with hypertension it is recommended that they engage in regular aerobic physical activity as defined by the Federal physical activity guidelines. Adults are classified as meeting the objective if they participate in at least 150 minutes of moderate activity per week (including walking or biking for transportation), 75 minutes of vigorous activity, or 150 minutes per week of an equivalent combination of activity. Total minutes per week of moderate-intensity activity are calculated by multiplying the days per week adults report participating in moderate-intensity activity by the number of minutes reported. Total minutes per week of vigorous-intensity activity are calculated by multiplying the days per week adults report participating in vigorous-intensity activity by the number of minutes reported. To calculate minutes per week for the equivalent combination of moderate and vigorous-intensity activity, minutes per week of moderate-intensity activity are added to two times the minutes per week of vigorous-intensity activity.

        If responses meet the criteria for one activity (vigorous or moderate) but the status of the other activity is unknown, the record is included in the numerator and the denominator. If responses do not meet the criteria for one activity and the status of the other activity is unknown, the record is dropped from the analysis.

        Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-49, 50-59, 60-69, 70-79, 80+
        • Sex: 18-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 18-49, 50-59, 60-64
        • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-11 in that this objective which tracks adults with high blood pressure/hypertension who meet the recommended guidelines for physical activity is a component of the Healthy People 2010 objective, which tracked adults with high blood pressure who report taking action to help control blood their blood pressure through diet, sodium and alcohol reduction, exercise, or high blood pressure medication. The data source was changed from the National Health Interview Survey to the National Health and Nutrition Examination Survey to enable more precise measurement of physical activity in reference to specific guidelines.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Physical Activity Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
      3. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2009-2010, Health Tech/Blood Pressure Procedures Manual. Hyattsville, MD: Centers for Disease Control and Prevention, May 2009.
    • HDS-10.5 (Developmental) Increase the proportion of adults with hypertension who meet the recommended guidelines for moderate alcohol consumption

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent (age adjusted—see Comments)
      Numerator: 

      Number of persons aged 20 years and over, excluding pregnant women, with high blood pressure/hypertension who report moderate alcohol consumption (no more than one drink per day for women and two drinks for men)

      Denominator: 

      Number of persons aged 20 years and over, excluding pregnant women, with high blood pressure/hypertension

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        In the past 12 months, how often did {you/SP} drink any type of alcoholic beverage?

        In the past 12 months, on those days that {you/SP} drank alcoholic beverages, on the average, how many drinks did {you/he/she} have?

        [NUMERATOR AND DENOMINATOR:]

        Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Are you now taking prescribed medication?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        For blood pressure management among persons with hypertension it is recommended that they limit consumption to no more than 1 drink per day in women (0.5 oz of ethanol, e.g., 12 oz beer, 5 oz wine, or 1.5 oz 80-proof whiskey) and no more than 2 drinks per day in men.

        Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-49, 50-59, 60-69, 70-79, 80+
        • Sex: 20-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 20-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 20-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 20-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 20-49, 50-59, 60-64
        • Diabetes Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-11 in that this objective which tracks adults with high blood pressure/hypertension who meet the recommended guidelines for moderate alcohol consumption is a component of the Healthy People 2010 objective, which tracked adults with high blood pressure who report taking action to help control blood their blood pressure through diet, sodium and alcohol reduction, exercise, or high blood pressure medication. The data source was changed from the National Health Interview Survey to the National Health and Nutrition Examination Survey to enable more precise measurement of alcohol consumption in reference to specific guidelines.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
      2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: CDC, September 2009.
      3. Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: A meta-analysis of randomized controlled trials. Hypertension 2001;38:1112-7.
  • HDS-11 Increase the proportion of adults with hypertension who are taking the prescribed medications to lower their blood pressure

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    63.2 (2005–08)
    Target: 
    69.5
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over with high blood pressure/hypertension who are taking high blood pressure medications

    Denominator: 

    Number of persons aged 18 years and over with high blood pressure/hypertension

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

      [NUMERATOR AND DENOMINATOR:]

      Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

      1. Yes
      2. No
      3. Refused
      4. Don't know

      Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

      1. Yes
      2. No
      3. Refused
      4. Don't know

      Are you now taking prescribed medication?

      1. Yes
      2. No
      3. Refused
      4. Don't know
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report that they are taking high blood pressure medicine.

      Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center.

      Blood pressure has been measured with the mercury sphygmomanometer for many years but with new technologies available, alternative blood pressure devices have taken center stage. The rapid pace of the development of automated sphygmomanometers with improving accuracy and reliability combined with increasing affordability has meant that these devices have now replaced the mercury sphygmomanometer in many settings. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-49, 50-59, 60-69, 70-79, 80+
      • Sex: 18-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
      • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 18-49, 50-59, 60-64
      • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
      • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 12-11 in that it is a component of the Healthy People 2010 objective. Healthy People 2010 objective 12-11 tracked adults with high blood pressure who were taking action to help control blood their blood pressure through diet, sodium and alcohol reduction, exercise, or high blood pressure medication. This objective tracks those adults with high blood pressure/hypertension who are taking high blood pressure medication. The data source was changed from the National Health Interview Survey to the National Health and Nutrition Examination Survey to enable direct measurement of some of the action components tracked by other Healthy People 2020 objectives.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2012, the original baseline was revised from 70.4 to 63.2 due to a programming error. The original data were accidentally not age adjusted. The target was adjusted from 77.4 to 69.5 to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Medical Conditions Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
  • HDS-12 Increase the proportion of adults with hypertension whose blood pressure is under control
    LHI

    Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    43.7 (2005–08)
    Target: 
    61.2
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The proportion of adults with hypertension whose blood pressure is controlled improved by 55 percent between 1999–2000 and 2007–08, from 30.5 percent to 47.4 percent. Using linear regression based on these trend data, the projected rate in 2017–18 is 66.2 percent (age adjusted), or a 40-percent improvement. Based on this percent improvement and the baseline value for 2005–2008, the proposed HP2020 target is 61.2 percent (age adjusted).
    Numerator: 

    Number of persons aged 18 years and over, excluding pregnant women, with hypertension whose mean systolic blood pressure is less than 140 mm Hg and mean diastolic blood pressure is less than 90 mm Hg

    Denominator: 

    Number of persons with high blood pressure/hypertension aged 18 years and over, excluding pregnant women

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

      [NUMERATOR AND DENOMINATOR:]

      Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

      1. Yes
      2. No
      3. Refused
      4. Don't know

      Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

      1. Yes
      2. No
      3. Refused
      4. Don't know

      Are you now taking prescribed medication?

      1. Yes
      2. No
      3. Refused
      4. Don't know
    Data Collection Frequency: 
    Periodic
    Leading Health Indicator:
    Methodology Notes: 

      Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report they are taking high blood pressure medicine.

      Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center

      Blood pressure has been measured with the mercury sphygmomanometer for many years but with new technologies available, alternative blood pressure devices have taken center stage. The rapid pace of the development of automated sphygmomanometers with improving accuracy and reliability combined with increasing affordability has meant that these devices have now replaced the mercury sphygmomanometer in many settings. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups for four-year data:

      • Total: 18-49, 50-59, 60-69, 70-79, 80+
      • Sex: 18-49, 50-59, 60-69, 70-79, 80+
      • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
      • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
      • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
      • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
      • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Health Insurance Status: 18-49, 50-59, 60-64
      • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
      • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
      • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
      • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      This Indicator uses Age-Adjustment Groups for two-year data:

      • Total: 18-39, 40-59, 60+
      • Sex: 18-39, 40-59, 60+
      • Race/Ethnicity: 18-39, 40-59, 60+
      • Educational Attainment: 25-39, 40-59, 60+
      • Family Income (percent poverty threshold): 18-39, 40-59, 60+
      • Country of Birth: 18-39, 40-59, 60+
      • Disability Status: 20-39, 40-59, 60+
      • Health Insurance Status: 18-39, 40-59, 60-64
      • Diabetes Status: 18-39, 40-59, 60+
      • Marital Status: 20-39, 40-59, 60+
      • Veteran Status: 18-39, 40-59, 60+
      • Obesity Status: 20-39, 40-59, 60+
    Trend Issues: 
    Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Different age adjustment groups are used for the two year and four year data. Two-year estimates are generally less stable and reliable than four-year estimates.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014, the baseline data by obesity status and the confidence intervals were revised due to a change in the methodology. Obesity status was originally coded based on the calculated BMI variable (BMXBMI) and had an error in the 2007-08 dataset. Some records had a missing height or weight but not a missing BMXBMI. To be consistent with NHANES reports, instead of using the calculated BMI variable, BMI is now computed directly from the weight and height variables. In addition, the BMX 2007-2008 updated April 2011 file was used. The method for computing the confidence intervals was revised from the standard Wald method to the Wald method on the log scale.

    References

    Additional resources about the objective

    1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
    2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
    3. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2009-2010, Health Tech/Blood Pressure Procedures Manual. Hyattsville, MD: Centers for Disease Control and Prevention, May 2009.
  • HDS-13 (Developmental) Increase the proportion of adults with elevated LDL cholesterol who have been advised by a health care provider regarding cholesterol-lowering management, including lifestyle changes and, if indicated, medication

  • HDS-14 (Developmental) Increase the proportion of adults with elevated LDL-cholesterol who adhere to the prescribed LDL-cholesterol lowering management lifestyle changes and, if indicated, medication

  • HDS-15 Increase aspirin use as recommended among adults with no history of cardiovascular disease

    • HDS-15.1 Increase aspirin use as recommended among women aged 55 to 79 years with no history of cardiovascular disease

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Ambulatory Medical Care Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      17.7 (2006–07)
      Target: 
      24.8
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target is the smallest improvement that results in a statistically significant difference when tested against the baseline value, assuming the same standard error for the target as the baseline.
      Numerator: 

      Number of visits by women aged 55 to 79 years with no history of cardiovascular disease (ICD-9-CM codes 410-414, 429.2, 433-438, 440.1, 440.2, 444, 445, V12.54, V45.81, and V45.82) to non-Federal physicians in office-based practices where aspirin or other antiplatelet medication was ordered, supplied, administered, or continued.

      Denominator: 

      Number of visits by women aged 55 to 79 years with no history of cardiovascular disease to non-Federal physicians in office-based practices.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2006 and 2007 National Ambulatory Medical Care Survey patient record:

        [NUMERATOR:]

        Include Rx and OTC drugs, immunizations, allergy shots, anesthetics, chemotherapy, and dietary supplements that were ordered, supplied, administered or continued during the visit.

        [NUMERATOR AND DENOMINATOR:]

        (Question 5a) As specifically as possible, list diagnoses related to this visit including chronic conditions.

        1. Primary Diagnosis:_______________
        2. Other: _______________
        3. Other: _______________
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objective of this analysis was to estimate the prevalence of physician-prescribed aspirin and other antiplatelet medications among women aged 55 to 79 years with no history of cardiovascular disease as recommended by the U.S. Preventive Services Task Force and other major guidelines. Pregnant women (ICD-9-CM codes: V22, V23, and V28), visits for pre- or postsurgery follow-up, patients with documented contraindications to chronic aspirin use (coagulation defects, purpura and other hemorrhagic conditions, subarachnoid hemorrhage, intracerebral hemorrhage, acute hepatic failure, and gastrointestinal hemorrhage), and persons prescribed anticoagulant medication (warfarin, heparin, or low molecular weight heparins) were excluded from this analysis of patients. The unit of analysis for NAMCS is the patient visit.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable. In 2017, the baseline was revised from 17.9 to 17.7 by excluding data from community health centers from the analysis for comparability with the 2012-2013 dataset which did not include data from community health centers. The target remained the same.

      References

      Additional resources about the objective

      1. George MG, Tong X, Sonnenfeld N, Hong Y. Recommended use of aspirin and other antiplatelet medications among adults--National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005-2008. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61 Suppl:11-8.
    • HDS-15.2 Increase aspirin use as recommended among men aged 45 to 79 years with no history of cardiovascular disease

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Ambulatory Medical Care Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      15.9 (2006–07)
      Target: 
      19.5
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target is the smallest improvement that results in a statistically significant difference when tested against the baseline value, assuming the same standard error for the target as the baseline.
      Numerator: 

      Number of visits by men aged 45 to 79 years with no history of cardiovascular disease (ICD-9-CM codes 410-414, 429.2, 433-438, 440.1, 440.2, 444, 445, V12.54, V45.81, and V45.82) to non-Federal physicians in office-based practices where aspirin or other antiplatelet medication was ordered, supplied, administered, or continued.

      Denominator: 

      Number of visits by men aged 45 to 79 years with no history of cardiovascular disease to non-Federal physicians in office-based practices.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2006 and 2007 National Ambulatory Medical Care Survey patient record:

        [NUMERATOR:]

        Include Rx and OTC drugs, immunizations, allergy shots, anesthetics, chemotherapy, and dietary supplements that were ordered, supplied, administered or continued during the visit.

        [NUMERATOR AND DENOMINATOR:]

        (Question 5a) As specifically as possible, list diagnoses related to this visit including chronic conditions.

        1. Primary Diagnosis:_______________
        2. Other: _______________
        3. Other: _______________
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objective of this analysis was to estimate the prevalence of physician-prescribed aspirin and other antiplatelet medications among men aged 45 to 79 years with no history of cardiovascular disease as recommended by the U.S. Preventive Services Task Force and other major guidelines. Visits for pre- or postsurgery follow-up, patients with documented contraindications to chronic aspirin use (coagulation defects, purpura and other hemorrhagic conditions, subarachnoid hemorrhage, intracerebral hemorrhage, acute hepatic failure, and gastrointestinal hemorrhage), and persons prescribed anticoagulant medication (warfarin, heparin, or low molecular weight heparins) were excluded from this analysis of patients. The unit of analysis for NAMCS is the patient visit.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable. In 2017, the baseline was revised from 15.8 to 15.9 by excluding data from community health centers from the analysis for comparability with the 2012-2013 dataset which did not include data from community health centers. The target was adjusted from 19.3 to 19.5 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. George MG, Tong X, Sonnenfeld N, Hong Y. Recommended use of aspirin and other antiplatelet medications among adults--National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005-2008. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61 Suppl:11-8.
  • HDS-16 Increase the proportion of adults aged 20 years and older who are aware of the symptoms of and how to respond to a heart attack

    • HDS-16.1 Increase the proportion of adults aged 20 years and older who are aware of the early warning symptoms and signs of a heart attack and the importance of accessing rapid emergency care by calling 9–1–1 or another emergency number

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      37.2 (2008)
      Target: 
      40.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 20 years and over who were aware of the early warning symptoms and signs of a heart attack and the importance of accessing rapid emergency care by calling 9-1-1 or another emergency number

      Denominator: 

      Number of persons aged 20 years and over

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey Heart Disease Supplement:

        [NUMERATOR:]

        Which of the following would you say are the symptoms that someone may be having a heart attack?

        Pain or discomfort in the jaw, neck or back.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Feeling weak, lightheaded or faint.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Chest pain or discomfort.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Pain or discomfort in the arms or shoulder.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Shortness of breath.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        If you thought someone was having a heart attack, what is the BEST thing to do right away?

        1. Advise them to drive to the hospital
        2. Advise them to call their physician
        3. Call 9-1-1 (or another emergency number)
        4. Call spouse or family member
        5. Other
        6. Refused
        7. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to be aware of the early warning symptoms and signs of a heart attack and the importance of calling 9-1-1 if they respond
        “yes” to all the symptom questions listed in the NUMERATOR section and indicate that the best thing to do is call 9-1-1 (or another
        emergency number).

        Persons are considered to be unaware of the early warning symptoms and signs of a heart attack and the importance of
        calling 9-1-1 if they respond “no” or “don’t know” to any of the symptom questions listed in the NUMERATOR section or indicate that the best
        thing to do is "advise them to drive to the hospital," "advise them to call their physician," "call spouse or family member," "other," or "don’t know."

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-24, 25-34, 35-44, 45-64, 65+
        • Sex: 20-24, 25-34, 35-44, 45-64, 65+
        • Race/Ethnicity: 20-24, 25-34, 35-44, 45-64, 65+
        • Educational Attainment: 25-34, 35-44, 45-64, 65+
        • Family Income (percent poverty threshold): 20-24, 25-34, 35-44, 45-64, 65+
        • Family Type: 20-24, 25-34, 35-44, 45-64, 65+
        • Country of Birth: 20-24, 25-34, 35-44, 45-64, 65+
        • Disability Status: 20-24, 25-34, 35-44, 45-64, 65+
        • Geographic Location: 20-24, 25-34, 35-44, 45-64, 65+
        • Health Insurance Status: 20-24, 25-34, 35-44, 45-64
        • Sexual Orientation: 20-24, 25-34, 35-44, 45-64, 65+
        • Marital Status: 20-24, 25-34, 35-44, 45-64, 65+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the original baseline was revised from 39.2 to 37.2 percent due to changes in how the response “don’t know” is handled. Previously responses of “don’t know” were excluded, but they are now included as lack of awareness. The target was proportionally adjusted from 43.1 percent to 40.9 percent to reflect the revised baseline using the original target-setting method.
    • HDS-16.2 Increase the proportion of adults aged 20 years and older who are aware of the early warning symptoms and signs of a heart attack

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      39.6 (2008)
      Target: 
      43.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 20 years and over who were aware of the early warning symptoms and signs of a heart attack

      Denominator: 

      Number of persons aged 20 years and over

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey Heart Disease Supplement:

        [NUMERATOR:]

        Which of the following would you say are the symptoms that someone may be having a heart attack?

        Pain or discomfort in the jaw, neck or back.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Feeling weak, lightheaded or faint.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Chest pain or discomfort.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Pain or discomfort in the arms or shoulder.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Shortness of breath.

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to be aware of the early warning symptoms and signs of a heart attack if they respond “yes” to all the symptom questions listed in the NUMERATOR section. Persons are considered to be unaware of the early warning symptoms and signs of a heart attack if they respond “no” or “don’t know” to any of the symptom questions listed in the NUMERATOR section.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-24, 25-34, 35-44, 45-64, 65+
        • Sex: 20-24, 25-34, 35-44, 45-64, 65+
        • Race/Ethnicity: 20-24, 25-34, 35-44, 45-64, 65+
        • Educational Attainment: 25-34, 35-44, 45-64, 65+
        • Family Income (percent poverty threshold): 20-24, 25-34, 35-44, 45-64, 65+
        • Family Type: 20-24, 25-34, 35-44, 45-64, 65+
        • Country of Birth: 20-24, 25-34, 35-44, 45-64, 65+
        • Disability Status: 20-24, 25-34, 35-44, 45-64, 65+
        • Geographic Location: 20-24, 25-34, 35-44, 45-64, 65+
        • Health Insurance Status: 20-24, 25-34, 35-44, 45-64
        • Sexual Orientation: 20-24, 25-34, 35-44, 45-64, 65+
        • Marital Status: 20-24, 25-34, 35-44, 45-64, 65+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-2 that tracked knowledge of heart attack symptoms and the importance of calling 9-1-1 in that this objective separately tracks the first knowledge component, heart attack symptoms.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the original baseline was revised from 42.0 to 39.6 percent due to changes in how the response “don’t know” is handled. Previously responses of “don’t know” were excluded, but they are now included as lack of awareness. The target was proportionally adjusted from 46.2 percent to 43.6 percent to reflect the revised baseline using the original target-setting method.
    • HDS-16.3 Increase the proportion of adults aged 20 years and older who are aware of the importance of accessing rapid emergency care for a heart attack by calling 9–1–1 or another emergency number

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      91.8 (2008)
      Target: 
      93.8
      Target-Setting Method: 
      2 percentage point improvement
      Target-Setting Method Justification: 
      Current estimates indicate that most adults are aware of the importance of accessing rapid emergency care by calling 9—1—1. The baseline value is more than 90 percent and near the maximum achievement level. A 2-percentage point improvement, which is statistically significant, is proposed.
      Numerator: 

      Number of persons aged 20 years and over who were aware of the importance of accessing rapid emergency care by calling 9-1-1 or another emergency number

      Denominator: 

      Number of persons aged 20 years and over

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey Heart Disease Supplement:

        [NUMERATOR:]

        If you thought someone was having a heart attack, what is the BEST thing to do right away?

        1. Advise them to drive to the hospital
        2. Advise them to call their physician
        3. Call 9-1-1 (or another emergency number)
        4. Call spouse or family member
        5. Other
        6. Refused
        7. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to be aware of the importance of calling 9-1-1 if they indicate that the best thing to do is call 9-1-1 (or another
        emergency number). Persons are considered to be unaware of the importance of calling 9-1-1 if they indicate that the best
        thing to do is advise them to drive to the hospital, advise them to call their physician, call spouse or family member, other, or don’t know.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-24, 25-34, 35-44, 45-64, 65+
        • Sex: 20-24, 25-34, 35-44, 45-64, 65+
        • Race/Ethnicity: 20-24, 25-34, 35-44, 45-64, 65+
        • Educational Attainment: 25-34, 35-44, 45-64, 65+
        • Family Income (percent poverty threshold): 20-24, 25-34, 35-44, 45-64, 65+
        • Family Type: 20-24, 25-34, 35-44, 45-64, 65+
        • Country of Birth: 20-24, 25-34, 35-44, 45-64, 65+
        • Disability Status: 20-24, 25-34, 35-44, 45-64, 65+
        • Geographic Location: 20-24, 25-34, 35-44, 45-64, 65+
        • Health Insurance Status: 20-24, 25-34, 35-44, 45-64
        • Sexual Orientation: 20-24, 25-34, 35-44, 45-64, 65+
        • Marital Status: 20-24, 25-34, 35-44, 45-64, 65+
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-2 that tracked knowledge of heart attack symptoms and the importance of calling 9-1-1 in that this objective separately tracks the second knowledge component, the importance of calling 9-1-1.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the original baseline was revised from 92.9 to 91.8 percent due to changes in how the response “don’t know” is handled. Previously responses of “don’t know” were excluded, but they are now included as lack of awareness. The target was adjusted from 94.9 percent to 93.8 percent to reflect the revised baseline using the original target-setting method.
  • HDS-17 Increase the proportion of adults aged 20 years and older who are aware of the symptoms of and how to respond to a stroke

    • HDS-17.1 Increase the proportion of adults aged 20 years and older who are aware of the early warning symptoms and signs of a stroke and the importance of accessing rapid emergency care by calling 9–1–1 or another emergency number

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      51.3 (2009)
      Target: 
      56.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 20 years and over who were aware of the early warning symptoms and signs of a stroke and the importance of accessing rapid emergency care by calling 9-1-1 or another emergency number

      Denominator: 

      Number of persons aged 20 years and over

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2009 National Health Interview Survey Stroke Supplement:

        [NUMERATOR:]

        Which of the following would you say are the symptoms that someone may be having a stroke?

        Sudden numbness or weakness of face, arm, or leg, especially on one side.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden confusion or trouble speaking.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden trouble seeing in one or both eyes.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden trouble walking, dizziness, or loss of balance.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden severe headache with no known cause.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        If you thought someone was having a stroke, what is the BEST thing to do right away?

        1. Advise them to drive to the hospital
        2. Advise them to call their physician
        3. Call 9-1-1 (or another emergency number)
        4. Call spouse or family member
        5. Other
        6. Refused
        7. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to be aware of the early warning symptoms and signs of a stroke and the importance of calling 9-1-1 if they respond “yes” to all of the symptom questions listed in the NUMERATOR section and indicate that the best thing to do is call 9-1-1 (or another emergency number).

        Persons are considered to be unaware of the early warning symptoms and signs of a stroke and the importance of calling 9-1-1 if they respond “no” or “don’t know” to any of the symptom questions listed above in the NUMERATOR section or indicate that the best thing to do is advise them to drive to the hospital, advise them to call their physician, call spouse or family member, other, or don’t know.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-24, 25-34, 35-44, 45-64, 65+
        • Sex: 20-24, 25-34, 35-44, 45-64, 65+
        • Race/Ethnicity: 20-24, 25-34, 35-44, 45-64, 65+
        • Educational Attainment: 25-34, 35-44, 45-64, 65+
        • Family Income (percent poverty threshold): 20-24, 25-34, 35-44, 45-64, 65+
        • Family Type: 20-24, 25-34, 35-44, 45-64, 65+
        • Country of Birth: 20-24, 25-34, 35-44, 45-64, 65+
        • Disability Status: 20-24, 25-34, 35-44, 45-64, 65+
        • Geographic Location: 20-24, 25-34, 35-44, 45-64, 65+
        • Health Insurance Status: 20-24, 25-34, 35-44, 45-64
        • Sexual Orientation: 20-24, 25-34, 35-44, 45-64, 65+
        • Marital Status: 20-24, 25-34, 35-44, 45-64, 65+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The objective was moved from developmental to measurable May 16, 2012.
    • HDS-17.2 Increase the proportion of adults aged 20 years and older who are aware of the early warning symptoms and signs of a stroke

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      53.9 (2009)
      Target: 
      59.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 20 years and over who were aware of the early warning symptoms and signs of a stroke

      Denominator: 

      Number of persons aged 20 years and over

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2009 National Health Interview Survey Stroke Supplement:

        [NUMERATOR:]

        Which of the following would you say are the symptoms that someone may be having a stroke?

        Sudden numbness or weakness of face, arm, or leg, especially on one side.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden confusion or trouble speaking.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden trouble seeing in one or both eyes.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden trouble walking, dizziness, or loss of balance.

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Sudden severe headache with no known cause.

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to be aware of the early warning symptoms and signs of a stroke if they respond “yes” to all of the questions listed in the NUMERATOR section. Persons are considered to be unaware of the early warning symptoms and signs of a stroke if they respond “no” or “don’t know” to any of the questions listed above in the NUMERATOR section.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-24, 25-34, 35-44, 45-64, 65+
        • Sex: 20-24, 25-34, 35-44, 45-64, 65+
        • Race/Ethnicity: 20-24, 25-34, 35-44, 45-64, 65+
        • Educational Attainment: 25-34, 35-44, 45-64, 65+
        • Family Income (percent poverty threshold): 20-24, 25-34, 35-44, 45-64, 65+
        • Family Type: 20-24, 25-34, 35-44, 45-64, 65+
        • Country of Birth: 20-24, 25-34, 35-44, 45-64, 65+
        • Disability Status: 20-24, 25-34, 35-44, 45-64, 65+
        • Geographic Location: 20-24, 25-34, 35-44, 45-64, 65+
        • Health Insurance Status: 20-24, 25-34, 35-44, 45-64
        • Sexual Orientation: 20-24, 25-34, 35-44, 45-64, 65+
        • Marital Status: 20-24, 25-34, 35-44, 45-64, 65+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The objective was moved from developmental to measurable May 16, 2012.
    • HDS-17.3 Increase the proportion of adults aged 20 years and older who are aware of the importance of accessing rapid emergency care for a stroke by calling 9–1–1 or another emergency number

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      92.7 (2009)
      Target: 
      94.7
      Target-Setting Method: 
      2 percentage point improvement
      Target-Setting Method Justification: 
      The Workgroup proposes to use two percentage point improvement consistent with the target setting method used for the counterpart objectives for heart disease (HDS–16.3 Increase the proportion of adults aged 20 years and older who are aware of the importance of accessing rapid emergency care by calling 9–1–1 or another emergency number).Current estimates indicate that most adults are aware of the importance of accessing rapid emergency care by calling 9–1–1. The baseline value is more than 90 percent and near the maximum achievement level. A two percentage point improvement, which is statistically significant, is proposed.
      Numerator: 

      Number of persons aged 20 years and over who were aware of the importance of accessing rapid emergency care by calling 9-1-1 or another emergency number

      Denominator: 

      Number of persons aged 20 years and over

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2009 National Health Interview Survey Stroke Supplement:

        [NUMERATOR:]

        If you thought someone was having a stroke, what is the BEST thing to do right away?

        1. Advise them to drive to the hospital
        2. Advise them to call their physician
        3. Call 9-1-1 (or another emergency number)
        4. Call spouse or family member
        5. Other
        6. Refused
        7. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Persons are considered to be aware of the importance of calling 9-1-1 if they indicate that the best thing to do is call 9-1-1 (or another emergency number). Persons are considered to be unaware of the importance of calling 9-1-1 if they indicate that the best thing to do is advise them to drive to the hospital, advise them to call their physician, call spouse or family member, other, or don’t know.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-24, 25-34, 35-44, 45-64, 65+
        • Sex: 20-24, 25-34, 35-44, 45-64, 65+
        • Race/Ethnicity: 20-24, 25-34, 35-44, 45-64, 65+
        • Educational Attainment: 25-34, 35-44, 45-64, 65+
        • Family Income (percent poverty threshold): 20-24, 25-34, 35-44, 45-64, 65+
        • Family Type: 20-24, 25-34, 35-44, 45-64, 65+
        • Country of Birth: 20-24, 25-34, 35-44, 45-64, 65+
        • Disability Status: 20-24, 25-34, 35-44, 45-64, 65+
        • Geographic Location: 20-24, 25-34, 35-44, 45-64, 65+
        • Health Insurance Status: 20-24, 25-34, 35-44, 45-64
        • Sexual Orientation: 20-24, 25-34, 35-44, 45-64, 65+
        • Marital Status: 20-24, 25-34, 35-44, 45-64, 65+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The objective was moved from developmental to measurable May 16, 2012.
  • HDS-18 (Developmental) Increase the proportion of out-of-hospital cardiac arrests in which appropriate bystander and emergency medical services (EMS) were administered

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Numerator: 

    *** Missing ***

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Periodic
  • HDS-19 Increase the proportion of eligible patients with heart attacks or strokes who receive timely artery-opening therapy as specified by current guidelines

    • HDS-19.1 Increase the proportion of eligible patients with heart attacks who receive fibrinolytic therapy within 30 minutes of hospital arrival

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Acute Coronary Treatment and Intervention Outcomes Network Registry
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      70.0 (2009)
      Target: 
      77.0
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of eligible (STEMI) patients with heart attacks who receive fibrinolytic therapy within 30 minutes of hospital arrival

      Denominator: 

      Number of eligible (STEMI) patients with heart attacks

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The measure definition follows the guidelines in the American College of Cardiology/American Heart Association Guidelines for the Management of Patients with (ST-Elevation) Myocardial Infarction. The time-to-treatment recommendations in these Guidelines start with when the patient presents to the medical system.

        STEMI patients were excluded if they were transferred in or had a non-system reason to delay fibrinolytic therapy.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-3a in that this objective tracks eligible (STEMI) patients with heart attacks who receive fibrinolytic therapy within 30 minutes of hospital arrival instead of within an hour of symptom onset. The data source has been changed from the National Registry of Myocardial Infarction (NRMI–4) to the Acute Coronary Treatment and Intervention Outcomes Network Registry.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, race/ethnicity data were displayed for all groups for which statistically reliable data are available. Some race/ethnicity groups were mistakenly suppressed at the launch due to a database error. In 2015, the baseline was revised from 68.3% to 70.0% due to data file updates. Hospitals can resubmit data as they discover new records or revise records already submitted. The target was adjusted from 75.1% to 77.0% to reflect the revised baseline using the original target-setting method. In 2018, the data source name was changed from Acute Coronary Treatment and Intervention Outcomes Network-Get With the Guidelines to Acute Coronary Treatment and Intervention Outcomes Network Registry.
    • HDS-19.2 Increase the proportion of eligible patients with heart attacks who receive percutaneous intervention (PCI) within 90 minutes of hospital arrival

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Acute Coronary Treatment and Intervention Outcomes Network Registry
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      90.4 (2009)
      Target: 
      99.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of eligible (STEMI) patients with heart attacks who receive percutaneous intervention (PCI) within 90 minutes of hospital arrival

      Denominator: 

      Number of eligible (STEMI) patients with heart attacks

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The measure definition follows the guidelines in the American College of Cardiology/American Heart Association Guidelines for the Management of Patients with (ST-Elevation) Myocardial Infarction. The time-to-treatment recommendations in these Guidelines start with when the patient presents to the medical system. The Guidelines recommend 90 minutes (from medical system contact) to treatment with PCI, longer than the recommendation for time-to-treatment with fibrinolytics. The longer time frame for PCI in the updated Guidelines recognizes the logistical maneuvers hospitals must set in motion when a patient requires PCI, including summoning the treatment team, transferring the patient from the emergency department to the cardiac catheterization laboratory, and performing the procedure.

        STEMI patients were excluded if they were transferred in, received rescue or facilitated PCI, or if they had a non-system reason to delay primary PCI.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-3b in that this objective tracks eligible (STEMI) patients with heart attacks who receive percutaneous intervention (PCI) within 90 minutes of hospital arrival instead of within 90 minutes of symptom onset. The data source has been changed from the National Registry of Myocardial Infarction (NRMI–4) to the Acute Coronary Treatment and Intervention Outcomes Network Registry.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, race/ethnicity data were displayed for all groups for which statistically reliable data are available. Some race/ethnicity groups were mistakenly suppressed at the launch due to a database error. In 2015, the baseline was revised from 88.6% to 90.4% due to data file updates. Hospitals can resubmit data as they discover new records or revise records already submitted. The target was adjusted from 97.5% to 99.4% to reflect the revised baseline using the original target-setting method. In 2018, the data source name was changed from Acute Coronary Treatment and Intervention Outcomes Network-Get With the Guidelines to Acute Coronary Treatment and Intervention Outcomes Network Registry.
    • HDS-19.3 Increase the proportion of eligible patients with strokes who receive acute reperfusion therapy within 3 hours from symptom onset

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Get With the Guidelines-Stroke
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      74.1 (2009)
      Target: 
      81.5
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of ischemic stroke (ICD-9-CM 433.x, 434.x and 436) patients who received acute reperfusion therapy [Intravenous recombinant tissue plasminogen activator (IV tPA)] within 3 hours from symptom onset

      Denominator: 

      Number of ischemic stroke patients eligible for acute reperfusion therapy [Intravenous recombinant tissue plasminogen activator (IV tPA)]

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Patients who are admitted within 2h of symptom onset are eligible to receive tPA, which must be delivered within 3h of symptom onset. If patients arrive later or with unknown time of onset, they are not included in the analysis because they are not considered eligible to meet the 3h window.

        Inclusion - Eligible stroke patients are those admitted for acute ischemic strokes. Exclusion - documented contraindications or warnings for not initiating IV thrombolytic in the 3hr treatment window or other hospital related factors such as delay in patient arrival, in-hospital time delay, delay in stroke diagnosis, or no IV access

        [delete old notes? Exclusion - 1) Transfer-in patients 2) Patients with a non-system reason for delay to fibrinolytic therapy 3) Patients with intracerebral hemorrhage strokes or subarachnoid hemorrhage strokes.]

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable.

      References

      Additional resources about the objective

      1. Fonarow GC, Reeves MJ, Smith EE, Saver JL, Zhao X, Olson DW, Hernandez AF, Peterson ED, Schwamm LH. Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke. Circ Cardiovasc Qual Outcomes 2010; 3(3):291-302. http://circoutcomes.ahajournals.org/content/3/3/291.full.pdf+html
  • HDS-20 Increase the proportion of adults with coronary heart disease or stroke who have their low-density lipoprotein (LDL) cholesterol level at or below recommended levels

    • HDS-20.1 Increase the proportion of adults with coronary heart disease who have their low-density lipoprotein (LDL) cholesterol at or below recommended levels

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      52.3 (2005–08)
      Target: 
      67.5
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target setting method used was Minimal Statistical Significance. The target value of 67.5% represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 20 years and over with coronary heart disease who have low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL

      Denominator: 

      Number of persons aged 20 years and over with coronary heart disease

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [NUMERATOR AND DENOMINATOR:]

        For persons aged 20 years and over:

        Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had coronary heart disease?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had angina, also called angina pectoris?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had a heart attack (also called myocardial infarction)?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        For persons aged 40 years and over:

        {Have you/Has SP} ever had any pain or discomfort in {your/her/his} chest?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        {Do you/Does she/Does he} get it when {you/she/he} walk uphill or hurry?

        1. Yes
        2. No
        3. Never walks uphill or hurries
        4. Refused
        5. Don't know

        {Do you/Does she/Does he} get it when {you/she/he} walk at an ordinary pace on level ground?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        What {do you/does she/does he} do if {you/she/he} get it while {you/she/he} are walking? {Do you/Does she/Does he} stop or slow down or continue at the same pace?

        1. Stop or slow down
        2. Continue at the same pace
        3. Refused
        4. Don't know

        If {you/she/he} stand still, what happens to it? Is the pain or discomfort relieved or not relieved?

        1. Relieved
        2. Not Relieved
        3. Refused
        4. Don't know

        How soon is the pain relieved? Would you say...

        1. 10 minutes or less
        2. More than 10 minutes
        3. Refused
        4. Don't know

        Please look at this card and show me where the pain or discomfort is located.

        1. Pain in right arm
        2. Pain in right chest

        3. Pain in neck
        4. Pain in upper sternum
        5. Pain in lower sternum
        6. Pain in left chest
        7. Pain in left arm
        8. Pain in epigastric area
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Most of the circulating cholesterol is found in three major lipoprotein fractions: very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). LDL cholesterol is calculated from measured values of total cholesterol, triglycerides, and HDL cholesterol according to the Friedewald calculation: [LDL cholesterol] = [total cholesterol] - [HDL cholesterol] - [triglycerides/5] where [triglycerides/5] is an estimate of VLDL cholesterol and all values are expressed in mg/dL.

        LDL carries most of the circulating cholesterol and, when elevated, contributes to the development of coronary atherosclerosis. LDL- cholesterol is measured to assess risk for CHD and to follow the progress of patients being treated to lower LDL cholesterol concentrations.

        Desirable levels of LDL cholesterol are below 100 mg/dL; borderline low from 100-129 mg/dL; borderline high is from 130-159 mg/dL; high is from 160-189 mg/dL; and very high LDL- cholesterol is greater than or equal to 190 mg/dL.

        Coronary heart disease is defined based on a health care professional's diagnosis of coronary heart disease, angina, or heart attack (also called myocardial infarction) or meeting the criteria for grade 1 angina by the Rose questionnaire assessment. The Rose questionnaire is only administered to survey participants aged 40 years and over. Grade 1 angina is defined based on a positive response to ever having had pain or discomfort in chest and ever getting pain or discomfort in chest when walking up hill or in a hurry (but not getting pain or discomfort in chest when walking at an ordinary pace on level ground) and stopping or slowing down if get it while walking and pain or discomfort relieved when standing still, and pain relieved in 10 minutes or less, plus either pain or discomfort located in upper sternum, lower sternum, or left chest and left arm.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-49, 50-59, 60-69, 70-79, 80+
        • Sex: 20-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 20-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 20-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 20-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 20-49, 50-59, 60-64
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable. In 2017, the target was revised from 66.5% to 67.5% due to a computation error.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Medical Conditions Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
    • HDS-20.2 Increase the proportion of adults who have had a stroke who have their low-density lipoprotein (LDL) cholesterol at or below recommended levels

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      33.4 (2005–08)
      Target: 
      56.1
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      The target setting method used was Minimal Statistical Significance. The target value of 56.1 percent represents the smallest change that will result in a statistically meaningful improvement over the baseline value and would yield a realistic, probably attainable target value.
      Numerator: 

      Number of persons aged 20 years and over who have had a stroke who have low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL

      Denominator: 

      Number of persons aged 20 years and over who have had a stroke

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

        [DENOMINATOR:]

        Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had a stroke?

        1. Yes
        2. No
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Most of the circulating cholesterol is found in three major lipoprotein fractions: very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). LDL cholesterol is calculated from measured values of total cholesterol, triglycerides, and HDL cholesterol according to the Friedewald calculation: [LDL cholesterol] = [total cholesterol] - [HDL cholesterol] - [triglycerides/5] where [triglycerides/5] is an estimate of VLDL cholesterol and all values are expressed in mg/dL.

        LDL carries most of the circulating cholesterol and, when elevated, contributes to the development of coronary atherosclerosis. LDL- cholesterol is measured to assess risk for CHD and to follow the progress of patients being treated to lower LDL cholesterol concentrations.

        Desirable levels of LDL cholesterol are below 100 mg/dL; borderline low from 100-129 mg/dL; borderline high is from 130-159 mg/dL; high is from 160-189 mg/dL; and very high LDL cholesterol is greater than or equal to 190 mg/dL.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 20-49, 50-59, 60-69, 70-79, 80+
        • Sex: 20-49, 50-59, 60-69, 70-79, 80+
        • Race/Ethnicity: 20-49, 50-59, 60-69, 70-79, 80+
        • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
        • Family Income (percent poverty threshold): 20-49, 50-59, 60-69, 70-79, 80+
        • Country of Birth: 20-49, 50-59, 60-69, 70-79, 80+
        • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Health Insurance Status: 20-49, 50-59, 60-64
        • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Veteran Status: 20-49, 50-59, 60-69, 70-79, 80+
        • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, this objective became measurable. In 2017, the target was revised from 55.0% to 56.1% due to a computation error.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Medical Conditions Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
  • HDS-21 Increase the proportion of adults with a history of cardiovascular disease who are using aspirin or antiplatelet therapy to prevent recurrent cardiovascular events

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Ambulatory Medical Care Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    45.7 (2006–07)
    Target: 
    51.9
    Target-Setting Method: 
    Minimal statistical significance
    Target-Setting Method Justification: 
    The target is the smallest improvement that results in a statistically significant difference when tested against the baseline value, assuming the same standard error for the target as the baseline.
    Numerator: 

    Number of visits by adults aged 18 years and over with a history of cardiovascular disease (ICD-9-CM codes 410-414, 429.2, 433-438, 440.1, 440.2, 444, 445, V12.54, V45.81, and V45.82) to non-Federal physicians in office-based practices where aspirin or other antiplatelet medication was ordered, supplied, administered, or continued.

    Denominator: 

    Number of visits by adults aged 18 years and over with a history of cardiovascular disease to non-Federal physicians in office-based practices.

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2006 and 2007 National Ambulatory Medical Care Survey patient record:

      [NUMERATOR:]

      Include Rx and OTC drugs, immunizations, allergy shots, anesthetics, chemotherapy, and dietary supplements that were ordered, supplied, administered or continued during the visit.

      [NUMERATOR AND DENOMINATOR:]

      (Question 5a) As specifically as possible, list diagnoses related to this visit including chronic conditions.

      1. Primary Diagnosis:_______________
      2. Other: _______________
      3. Other: _______________
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The primary objective of this analysis was to estimate the prevalence of physician-prescribed aspirin and other antiplatelet medications among adults aged 18 years and over with a history of cardiovascular disease to prevent recurrent cardiovascular events as recommended by the U.S. Preventive Services Task Force and other major guidelines. Pregnant women (ICD-9-CM codes: V22, V23, and V28), visits for pre- or postsurgery follow-up, patients with documented contraindications to chronic aspirin use (coagulation defects, purpura and other hemorrhagic conditions, subarachnoid hemorrhage, intracerebral hemorrhage, acute hepatic failure, and gastrointestinal hemorrhage), and persons prescribed anticoagulant medication (warfarin, heparin, or low molecular weight heparins) were excluded from this analysis of patients. The unit of analysis for NAMCS is the patient visit.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, this objective became measurable. In 2017, the baseline was revised from 46.0 to 45.7 by excluding data from community health centers from the analysis for comparability with the 2012-2013 dataset which did not include data from community health centers. The target was adjusted from 52.1 to 51.9 to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. George MG, Tong X, Sonnenfeld N, Hong Y. Recommended use of aspirin and other antiplatelet medications among adults--National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005-2008. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61 Suppl:11-8.
  • HDS-22 Increase the proportion of adult heart attack survivors who are referred to a cardiac rehabilitation program at discharge

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Acute Coronary Treatment and Intervention Outcomes Network Registry
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    77.1 (2009)
    Target: 
    84.8
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of adult heart attack survivors who are referred to a cardiac rehabilitation program at discharge

    Denominator: 

    Number of adult heart attack survivors

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Cohort included eligible patients discharged with a primary diagnosis of ST-segment or non–ST-segment myocardial infarction who were referred to cardiac rehabilitation. Cardiac rehabilitation referral was defined as “an official communication between the health care provider and the patient to recommend and carry out a referral order to an early outpatient cardiac rehabilitation program. This includes the provision of all necessary information to the patient that will allow the patient to enroll in an early outpatient cardiac rehabilitation program. This also includes a communication between the health care provider or health care system and the cardiac rehabilitation program that includes the patient’s referral information for the program.

      Patients excluded were those with incomplete MI information, in-hospital death, transferred, cardiac rehabilitation referral missing or those discharged to nursing home, hospice or who left against medical advice. Patient ineligible were also not included. Ineligibility was defined as documented patient-based barriers, patient based criteria, or healthcare system barriers.

    Caveats and Limitations: 
    The ACTION Registry is a voluntary registry and may not be representative of hospitals lacking the resources or desire to contribute. Results may overestimate referral to cardiac rehab (CR) and may not be fully generalizable. Data are drawn solely from inpatient medical records abstracted for the registry. Misclassification of CR eligibility could have occurred. The registry’s liberal definition of referral may overestimate meaningful referral. Finally, interhospital variation in what constitutes CR referral and eligibility may be present.
    Trend Issues: 
    The ACTION Registry is a voluntary registry and the number and specific participating hospitals may differ over time.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2016, this objective became measurable. In 2018, the data source name was changed from Acute Coronary Treatment and Intervention Outcomes Network-Get With the Guidelines to Acute Coronary Treatment and Intervention Outcomes Network Registry.
  • HDS-23 Increase the proportion of adult stroke survivors who are assessed for and/or referred to rehabilitation services.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Get With the Guidelines-Stroke
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    96.2 (2009)
    Target: 
    Not applicable
    Target-Setting Method: 
    This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
    Target-Setting Method Justification: 
    The current measurement exceeds 95%, making it difficult to measure progress. The workgroup proposes tracking solely for informational purposes.
    Numerator: 

    Number of adult stroke survivors who were assessed for and/or referred to a stroke rehabilitation program at discharge

    Denominator: 

    Number of adult stroke survivors

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Stroke survivors include persons diagnosed with ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage based on ICD-9-CM codes 433.x, 434.x, 436, 430.x, 431.x, 432.x.

      Inclusion - patients with diagnosed ischemic or hemorrhagic stroke. Exclusion - patients who died in-hospital, left the acute hospital against medical advice, discontinued care, or were missing a discharge code or date or those transferred in from another acute care facility or out to another acute or specialty were excluded because of inability to confirm eligibility for an acute assessment of rehabilitation, ineligible diagnoses (non-stroke or TIA).

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, this objective became measurable. The objective text was modified from "Increase the proportion of adult stroke survivors who are referred to a stroke rehabilitation program at discharge" to "Increase the proportion of adult stroke survivors who are assessed for and/or referred to rehabilitation services." These changes were made to better align with current data collection and performance metrics.

    References

    Additional resources about the objective

    1. Prvu Bettger JA, Kaltenbach L, Reeves MJ, Smith EE, Fonarow GC, Schwamm LH , Peterson ED. Assessing stroke patients for rehabilitation during the acute hospitalization: findings from the get with the guidelines-stroke program. Arch Phys Med Rehabil 2013; 94(1):38-45.
  • HDS-24 Reduce hospitalizations of older adults with heart failure as the principal diagnosis.

    • HDS-24.1 Reduce hospitalizations of adults aged 65 to 74 years with heart failure as the principal diagnosis

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Hospital Discharge Survey
      Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000
      Baseline (Year): 
      10.4 (2007)
      Target: 
      9.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of discharges among adults aged 65 to 74 years with a principal diagnosis of heart failure (ICD-9-CM code 428)

      Denominator: 

      Number of adults aged 65 to 74 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Principal diagnosis is the diagnosis chiefly responsible for admission of the person to the hospital.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-6c in that the principal diagnosis for hospitalization was expanded from congestive heart failure (ICD-9-CM code 428.0) to heart failure (ICD-9-CM code 428).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the data source was revised from the Chronic Conditions Warehouse, CMS to the National Hospital Discharge Survey (NHDS), CDC/NCHS to be more representative of the population aged 65 and over. NHDS was used in Healthy People 2010 for the comparable objectives on heart failure hospitalizations. Thus, the original baseline was revised from 9.8 to 10.4. The target was adjusted from 8.8 to 9.4 to reflect the revised baseline using the original target-setting method.
    • HDS-24.2 Reduce hospitalizations of adults aged 75 to 84 years with heart failure as the principal diagnosis

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Hospital Discharge Survey
      Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000
      Baseline (Year): 
      23.4 (2007)
      Target: 
      21.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of discharges among adults aged 75 to 84 years with a principal diagnosis of heart failure (ICD-9-CM code 428)

      Denominator: 

      Number of adults aged 75 to 84 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Principal diagnosis is the diagnosis chiefly responsible for admission of the person to the hospital.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-6c in that the principal diagnosis for hospitalization was expanded from congestive heart failure (ICD-9-CM code 428.0) to heart failure (ICD-9-CM code 428).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      IN 2015, the data source was revised from the Chronic Conditions Warehouse, CMS to the National Hospital Discharge Survey (NHDS), CDC/NCHS to be more representative of the population aged 65 and over. NHDS was used in Healthy People 2010 for the comparable objectives on heart failure hospitalizations. Thus, the original baseline was revised from 22.4 to 23.4. The target was adjusted from 20.2 to 21.1 to reflect the revised baseline using the original target-setting method.
    • HDS-24.3 Reduce hospitalizations of adults aged 85 years and older with heart failure as the principal diagnosis

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Hospital Discharge Survey
      Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000
      Baseline (Year): 
      38.7 (2007)
      Target: 
      34.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of discharges among adults aged 85 years and over with a principal diagnosis of heart failure (ICD-9-CM code 428)

      Denominator: 

      Number of adults aged 85 years and over

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Principal diagnosis is the diagnosis chiefly responsible for admission of the person to the hospital.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 12-6c in that the principal diagnosis for hospitalization was expanded from congestive heart failure (ICD-9-CM code 428.0) to heart failure (ICD-9-CM code 428).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the data source was revised from the Chronic Conditions Warehouse, CMS to the National Hospital Discharge Survey (NHDS), CDC/NCHS to be more representative of the population aged 65 and over. NHDS was used in Healthy People 2010 for the comparable objectives on heart failure hospitalizations. Thus, the original baseline was revised from 42.9 to 38.7. The target was adjusted from 38.6 to 34.8 to reflect the revised baseline using the original target-setting method.
  • HDS-25 Increase the proportion of patients with hypertension in clinical health systems whose blood pressure is under control

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Ambulatory Medical Care Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    58.3 (2006–07)
    Target: 
    64.1
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of ambulatory care visits by patients aged 18 years and over, excluding visits by pregnant women, with hypertension whose mean systolic blood pressure is less than 140 mm Hg and mean diastolic blood pressure is less than 90 mm Hg

    Denominator: 

    Number of ambulatory care visits by adults aged 18 years and over with high blood pressure/hypertension, excluding visits by pregnant women

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2006 and 2007 National Ambulatory Medical Care Survey patient record:

      [NUMERATOR:]

      (Question 6.4) VITAL SIGNS: Blood Pressure

      1. Systolic:_______________
      2. Diastolic:_______________

      [NUMERATOR AND DENOMINATOR:]

      (Question 5a) As specifically as possible, list diagnoses related to this visit including chronic conditions.

      1. Primary Diagnosis:_______________
      2. Other: _______________
      3. Other: _______________

      (Question 5b) Regardless of the diagnosis written in 5a, does the patient now have: (A list of 15 conditions is provided for the physicians to check. Condition relevant to this question is: has hypertension.)

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The primary objective of this analysis was to estimate the proportion of ambulatory care visits by adults where blood pressure is controlled. The unit of analysis for NAMCS the patient visit. All visits for hypertension with measured blood pressure levels were included in the analyses. All hypertension-related visits were identified by any ICD-9-CM code for hypertension (401–405) from up to three physician diagnoses or by “reason for visits” listed as “hypertension.” Pregnant women were excluded. Blood pressure was abstracted from recorded measurements of systolic and diastolic fields. Hypertension-related visits were then classified by measured blood pressure level as either controlled hypertension (systolic blood pressure

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014 this objective was added as a new Developmental objective for the HDS topic area. This objective appeared in the Fall/Winter public comment period, and permanently on HealthyPeople.gov in 2015. In 2015, this objective became measurable. In 2017, the baseline was revised from 58.1 to 58.3 by excluding data from community health centers from the analysis for comparability with the 2012-2013 dataset which did not include data from community health centers. The target was adjusted from 63.9 to 64.1 to reflect the revised baseline using the original target-setting method.