Friday, January 18, 2019

Opioid Prescriptions Are More Common in Rural Areas

Rural areas have been hit hard by the opioid epidemic. The injury is, in part, self-inflicted. Primary care physicians in rural areas are more likely than those in urban areas to prescribe opioids for their patients, reports the CDC in a study of opioid prescribing rates.

CDC researchers examined electronic prescriptions written by 31,422 primary health care providers during the January 2014 to March 2017 time period. Their findings document the big differences in opioid prescription rates by a county's urban-rural status...

Percent of patients receiving opioid prescriptions, January 2014—March 2017 average
9.6% in rural counties
9.4% in micropolitan counties
7.7% in small metro areas
6.7% in medium metro areas
5.6% in large fringe metros
5.2% in large central metros

The CDC undertook the study to determine whether the 2016 release of its Guideline for Prescribing Opioids for Chronic Pain had helped to reduce opioid prescriptions. It did. In every type of county, the opioid prescription rate declined over the time period. In rural counties, the percentage of patients who received opioid prescriptions fell from 10.3 percent in 2014 to 9.0 percent during the March 2016 to March 2017 time period. In large central metropolitan counties, the rate fell from 5.4 to 5.0 percent.

"As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction," the researchers conclude, "community health care practices and intervention programs must continue to be tailored to community characteristics."

Source: CDC, Morbidity and Mortality Weekly Report, Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties among Primary Care Providers Using an Electronic Health Record System—United States, 2014–2017

Thursday, January 17, 2019

Below-Replacement Fertility in 48 States

The average woman in the United States will have 1.8 children in her lifetime, according to the age-specific fertility rates of 2017. This calculation, called a "total fertility rate" (TFR), is well below the 2.1 children the average woman would have based on age-specific fertility rates in 2007—the year the number of births in the U.S. peaked. A TFR of 2.1 is considered replacement level—meaning the population will neither grow nor decline, absent immigration. A TFR below 2.1, if extended for decades, will eventually lead to population decline.

Every state had a lower TFR in 2017 than it did a decade earlier. Here are comparisons between then and now...

  • In 2017, only 2 states had at least replacement-level fertility (South Dakota and Utah). In 2007, more than half the states (27) had a TFR of 2.1 or higher. 
  • In 2017, the lowest TFR was in Washington D.C., at 1.4. This was well below the lowest TFR in 2007, which was 1.7 in Vermont. 
  • The highest TFR in 2017 was 2.2 in South Dakota, followed by 2.1 in Utah. In 2007, the highest TFR was 2.6 in Utah.  
  • Between 2007 and 2017, the biggest declines in TFR (more than 20 percent) occurred in eight states: Nevada, Arizona, California, New Mexico, Colorado, Oregon, Georgia, and Texas. 
  • Between 2007 and 2017, the smallest declines in TFR (below 10 percent) occurred in six states: Iowa, Ohio, Kentucky, Michigan, South Dakota, and North Dakota. 

In 2017, non-Hispanic White women had a TFR below the replacement level of 2.1 in every state, according to the National Center for Health Statistics. Black women had a TFR at or above replacement level in 12 states, Hispanic women in 29 states.

Source: National Center for Health Statistics, Birth Data, Total Fertility Rates by State and Race and Hispanic Origin: United States, 2017 and Births: Final Data for 2007

Wednesday, January 16, 2019

44% of Americans Are "Revolvers"

How many Americans carry a credit card balance, and how much do they owe? The answers can be found in a study by economist Joanna Stavins of the Federal Reserve Bank of Boston. She wanted to determine the unique characteristics of credit card users and in particular those who are "revolvers" — meaning they owe a balance on their credit cards.

Stavins examined findings from the Survey of Consumer Payment Choice, comparing revolvers' self-reports of their credit card balances with the Equifax credit bureau records of individual respondents. One of her goals was to determine the accuracy of self-reported balances, and she discovered they aren't all that accurate. Self-reported credit card balances are significantly lower than the balances reported by Equifax. Overall, 44 percent of adults in 2015–16 were revolvers (carrying a credit card balance). The average balance on the credit cards of revolvers was $6,597—25 percent greater than what respondents self-reported. Here are the percentages of Americans who are credit card revolvers by age, and their average credit card balance based on Equifax records...

Credit card revolvers by age, 2015–16 (and Equifax credit card balance)
Total adults: 44% ($6,597)
Under age 25: 26% ($2,913)
Aged 25 to 34: 44% ($4,472)
Aged 35 to 44: 49% ($7,192)
Aged 45 to 54: 51% ($8,336)
Aged 55 to 64: 48% ($7,493)
Aged 65-plus: 35% ($6,261)

Actual credit card balances are higher than self-reported balances in every age group. The biggest difference is among people aged 65 or older, who report an average balance of $3,795 while Equifax data show an average balance of $6,261.

Source: Federal Reserve Bank of Boston, Credit Card Debt and Consumer Payment Choice: What Can We Learn from Credit Bureau Data?

Tuesday, January 15, 2019

How Many Americans Have Ever Been Homeless?

More than half a million Americans are homeless on a given night, according to the Department of Housing and Urban Development. An annual survey, which is taken on a January night each year, counted 552,830 people homeless or in shelters in the United States in 2018.

Half a million people is a small fraction of the population on any one night. A much larger share of Americans experience homelessness at some point in their life. Among Boomers, the figure is 6.2 percent, according to a study in Demography.

The Demography study analyzed data from the Health and Retirement Study—a longitudinal survey of people aged 50 or older, which included a question about homelessness ("Have you ever been homeless or lived in a shelter?") in 2012 and 2014. The researchers calculated the lifetime prevalence of homelessness for people born from 1946 through 1964 (Boomers) as a whole and by race and Hispanic origin...

Percentage of Boomers who have ever been homeless
Total: 6.2%
Blacks: 16.8%
Hispanics: 8.1%
Non-Hispanic Whites: 4.8%

After controlling for socioeconomic characteristics, the difference in the experience of homelessness between Hispanics and non-Hispanic Whites disappears, report the researchers. Not so the difference between Blacks and non-Hispanic Whites. Black Boomers are three times as likely as non-Hispanic White Boomers to have experienced homelessness at some point in their lives, the researchers find.

"Do experiences of homelessness contribute to racial disparities in health?" they ask. "Do health disparities contribute to differences in the prevalence of homelessness? Are the two mutually reinforcing, or do they covary as products of social discrimination or economic inequalities? Future research might aim to better understand these complex pathways."

Source: Demography, Racial and Ethnic Disparities in the Prevalence of Homelessness in the United States, Vol. 55, No. 6 ($39.95)

Monday, January 14, 2019

36% Have Used Ride-Sharing Services

The percentage of Americans who use ride-sharing services such as Uber and Lyft more than doubled between 2015 and 2018, according to a Pew Research Center survey, climbing from 15 to 36 percent. Just 3 percent of the public had not heard of these services in 2018, down from a substantial 33 percent in 2015. Not surprisingly, young adults are most likely to have ever used a ride-sharing service...

Percent who have ever used a ride-sharing service, 2018
Aged 18 to 29: 51%
Aged 30 to 49: 43%
Aged 50-plus: 24%

Among those who use ride-sharing services, 10 percent say they use them at least weekly, 22 percent monthly, and 67 percent less often.

Source: Pew Research Center, More Americans Are Using Ride-Hailing Apps

Friday, January 11, 2019

40% of Women Under Age 30 Want to Leave U.S.

"Ideally, if you had the opportunity, would you like to move PERMANENTLY to another country, or would you prefer to continue living in this country?" Sixteen percent of Americans aged 15 or older say they would like to move to another country, larger than the share who wanted to move during the Obama (10 percent) or George W. Bush (11 percent) administrations.

Politics are a big factor in the desire to leave the United States. Among those who disapprove of Trump, 22 percent want to move. Among those who approve, only 7 percent want to get out.

There are also big differences by age and sex. The percentage who would like to move out of the U.S. is higher among women (20 percent) than men (13 percent). It is higher among adults under age 30 than older adults...

Desire to leave the U.S. by age
Aged 15 to 29: 30%
Aged 30 to 49: 19%
Aged 50-plus: 8%

Among women under age 30, fully 40 percent say they would like to leave the United States versus 20 percent of their male counterparts.

Source: Gallup, Record Numbers of Americans Want to Leave the U.S.

Thursday, January 10, 2019

Household Growth Will be Slower, According to New Projections

Between 2018 and 2028, the number of households in the United States is projected to increase by 12.2 million, according to the Joint Center for Housing Studies (JCHS). This figure is 1.4 million less than the household growth projected by JCHS a few years ago.

Why the decline? The primary reason for the decline is that the Census Bureau issued new population projections, updating its 2014 vintage with a 2017 series. The Census Bureau's 2017 projections forecast slower population growth than the earlier series, says Daniel McCue of the JCHS and author of the report. The bureau's population projections form the basis of the JCHS household projection series.

Change in number of households by age of householder, 2018 to 2028 (in 000s)
   number (in 000s)
Total households          12,174
Under age 25                 21
Aged 25 to 34                 64
Aged 35 to 44            2,855
Aged 45 to 54              -401
Aged 55 to 64           -1,513
Aged 65 to 74             4,361
Aged 75 or older             6,787

As shown above, the greatest growth in the number of households in the decade ahead—accounting for more than half the increase—will occur in the 75-plus age group. Households headed by people aged 45 to 64 will decline as the small Generation X passes through. Very little growth is forecast in the number of households headed by adults under age 35.

Behind the Census Bureau's scaled back 2017 vintage projections—and behind the slower household growth forecast by JCHS—is lower immigration. Rather than gaining a net of 1.27 international immigrants per year during the coming decade (the assumption of the bureau's 2014 projections), the annual gain will be just 1.0 million. Fewer immigrants will slow the growth of the Asian and Hispanic populations and reduce the number of young adults establishing households in the years ahead.

Because of lower immigration, the JCHS projects that the total baseline demand for new housing in the 2018-to-2028 decade will be 1.51 million units a year, down from 1.69 million a year projected in its earlier series. The report cautions, however, that the new projection may not be conservative enough: "Given the strong steps taken by the Trump administration to curtail immigration, it remains to be seen whether there will be further declines going forward."

Source: Joint Center for Housing Studies of Harvard University, Updated Household Growth Projections: 2018–2028 and 2028–2038

Wednesday, January 09, 2019

Most Older Workers Experience Involuntary Job Loss

If you think you've got a retirement plan, think again. A study by the Urban Institute finds that more than half of older full-time workers—seasoned employees—are likely to lose their job before they turn 65, with dire consequences for earnings, household income, and retirement savings.

Examining Health and Retirement Study data from 1992 to 2016, the Urban Institute researchers tracked full-time workers aged 51 to 54 who had been with their current employer or self-employed for at least five years. Respondents were followed from their early 50s until at least age 65 to determine how many experienced an involuntary job separation—defined as an employer-related separation that resulted in at least six consecutive months of nonemployment or that reduced weekly earnings by 50 percent or more for at least two years.

Most of these seasoned older workers lost their job at some point during those years, with some losing a long-term job more than once. Fully 56 percent experienced at least one employer-related involuntary job separation. Demographics do not explain these derailments. There were few differences in the percentage of workers who experienced an employer-related job separation by sex, race, Hispanic origin, education, industry, or region of the country. Losing a steady job appears to be the norm for workers as they age.

The consequences of this kind of job loss are ugly. Only 10 percent of those who lost their job ever again earned as much as they had on the job, report the researchers. Median household income fell 42 percent after the job separation, with little difference in the extent of decline by demographic characteristic. At age 65, those who had experienced a job separation had a significantly lower household income than those who did not have a job separation, whereas the incomes of the two groups at ages 51 to 54 were essentially the same.

"Employment becomes increasingly precarious as workers age," conclude the researchers. "The steady earnings that many people count on in their 50s and 60s to build their retirement savings and ensure some financial security in later life can vanish, upending retirement expectations and creating economic hardship."

Source: Urban Institute, How Secure is Employment at Older Ages?

Tuesday, January 08, 2019

Attitudes toward Public Transit by Metropolitan Area

How many metro residents are happy with their public transit system? It depends on where they live, according to the 2017 American Housing Survey, which was fielded nationally and in 15 metropolitan areas. One of the questions asked by the survey is whether residents agree or disagree that their neighborhood has "good bus, subway, or commuter bus service." Here is the percentage of respondents who agree by metropolitan area...

Neighborhood has good bus, subway, or commuter bus service, 2017 (percent agreeing)
75.4% in San Francisco
75.4% in New York City
67.3% in Los Angeles—Long Beach
65.1% in Boston
65.1% in Washington, DC
64.5% in Chicago
62.1% in Riverside—San Bernardino
61.6% in Philadelphia
59.7% in Seattle
56.2% in Miami
47.6% in Phoenix
40.4% in Detroit
36.5% in Dallas
35.6% in Houston
32.7% in Atlanta

Attitudes toward public transit vary not only by metro area but also by homeownership status within metros. Near the top of the list is New York, for example, where 87 percent of renters and 64 percent of homeowners say public transit in their neighborhood is good. At the bottom of the list is Atlanta, where only 50 percent of renters and 22 percent of homeowners give their public transit a thumbs-up.

Nationally, 42 percent of Americans think their neighborhood has good bus, subway, or commuter bus service—57 percent of renters and 35 percent of homeowners.

Source: Demo Memo analysis of the 2017 American Housing Survey

Monday, January 07, 2019

Wireless-Only Now the Majority in 45-to-64 Age Group

The 55 percent majority of Americans aged 18 or older live in a wireless-only household, according to January-June 2018 estimates by the National Center for Health Statistics. Another 37 percent have both cell phones and a landline phone in their household. Just 5 percent are landline-only, and 3 percent are phoneless.

The percentage of adults who live in a wireless-only household became the majority in 2016. The wireless-only share grows each year as older age groups abandon landlines through generational replacement and/or technological surrender. Here are the percentages of adults by age who lived in a wireless-only household in the first half of 2018 (and 2015)...

Adults who live in a wireless-only household, January-June 2018 (and 2015)
Total, 18-plus: 55.2% (46.7%)
Aged 18 to 24: 65.0% (59.4%)
Aged 25 to 29: 77.3% (71.3%)
Aged 30 to 34: 77.3% (67.8%)
Aged 35 to 44: 65.7% (56.6%)
Aged 45 to 64: 50.7% (40.8%)
Aged 65-plus: 29.2% (19.3%)

Source: National Center for Health Statistics, National Health Interview Survey, Wireless Substitution: Early Release of Estimates from the National Health Interview Survey, January—June 2018

Friday, January 04, 2019

Median Household Income Rises in November 2018

Median household income in November 2018 climbed to $63,554, reports Sentier Research. This is the highest median recorded by Sentier since the January 2000 start of its monthly household income series. The November 2018 median was 3.2 percent higher than the November 2017 median, after adjusting for inflation. Sentier's estimates are derived from the Census Bureau's Current Population Survey and track the economic wellbeing of households on a monthly basis. 

"We are at a point now where real median household income is 4.3 percent higher than January 2000, the beginning of this statistical series," reports Sentier's Gordon Green. "Not an impressive performance by any means over a period spanning almost two decades, but the trend line has been positive for about seven years." More impressive is the 15.4 percent rise in median household income since the post-Great Recession low reached in June 2011—two years after the official end of the Great Recession.

Sentier's Household Income Index in November 2018 was 104.3 (January 2000 = 100.0). To stay on top of these trends, look for the next monthly update from Sentier.

Source: Sentier ResearchHousehold Income Trends: November 2018

Thursday, January 03, 2019

10 Questions: An Update (Part 2)

Two years ago Demo Memo presented 10 vital demographic questions and asked how many answers to these questions we would have once we had more data in hand. Two years later, the same questions are still of great importance. We have more data. So how much more do we know? Questions 1 through 5 were examined in this post. Here's a look at the rest...

6. Is the average American getting richer? With the benefit of hindsight, the answer to this question is yes and no. The wealth of American households plunged in the aftermath of the Great Recession. Median household net worth fell from $139,700 in 2007 to a post-Great Recession low of $83,700 in 2013, then climbed to $97,300 in 2016, after adjusting for inflation—still 30 percent below the 2007 peak. An analysis by the Federal Reserve Bank of St. Louis finds that the wealth of Americans born in the 1950s and earlier has recovered from the Great Recession losses, while the wealth of those born in the 1960s, 1970s, and 1980s has not.

7. Who voted in the 2016 election? This question was answered by the Census Bureau's survey of voting and registration, released in the spring of 2017. We now know that the number of older non-Hispanic White voters surged in 2016. Largely because of the aging of the baby-boom generation, 2.8 million more non-Hispanic Whites aged 65 or older voted in 2016 than in 2012. This trend is only going to intensify as the baby-boom generation continues to fill the 65-plus age group. While minorities will become the majority of the population in 2044, they will not become the majority of voters until 2064.

8. Are we back to square one with health insurance? Although Republican efforts to repeal the Affordable Care Act have not been successful, this question still matters after a federal judge in Texas declared the entire Affordable Care Act invalid—a case that may be headed for the Supreme Court. Meanwhile, a growing share of the public has a favorable view of the ACA, the figure rising from 43 percent in November 2016 to 53 percent in November 2018. This battle is ongoing.

9. How big is the gig economy? Are gig workers a tiny and stable fraction of the workforce, or are they an enormous and growing share of workers—24 percent according to one study and 31 percent according to another? We still don't know. In the past year, the BLS failed in its attempt to measure the gig economy, but nevertheless claimed gig workers to be few, far between, and not growing as a share of workers. Researchers scoffed at the BLS findings, theorizing that the Current Population Survey's labor force questions failed to capture gig work. The BLS fired back with a defense of the CPS. As the dust settles from this kerfuffle, all we know is that the size of the gig economy ranges from negligible to enormous.

10. Are we over the automobile? The evidence is building that we are past the point of peak transportation spending. The percentage of the household budget devoted to transportation is well below the all-time high of 19-plus percent of the mid-1980s and early 2000s. In 2017, transportation consumed a smaller 15.9 percent of the household budget. With transportation the second biggest expense for the average household, helping Americans cut their transportation costs is a no-brainer for both businesses and governments. It also helps explain the appeal of cities: urban households spend much less than their rural counterparts on transportation.

Wednesday, January 02, 2019

10 Questions: An Update (Part 1)

Two years ago Demo Memo presented 10 vital demographic questions and asked how many answers to these questions we would have once we had more data in hand. Two years later, the same questions are still of great importance. We have more data. So how much more do we know? Let's take a look...

1. When will the baby bust end? We now know it might not end. The decline in births since the 2007 peak is as great as the decline in the aftermath of the Great Depression (a 10.7 percent drop). But this may be more than a dip in the road. An analysis by the Center for Retirement Research suggests the fertility decline may be permanent, driven by structural changes in childbearing patterns. The United States appears to be adopting the low-fertility regime common in other developed countries.

2. Why is life expectancy declining? In two of the past three years, life expectancy in the United States has declined. We now know that the declines in 2015 and 2017 were due in large part to rising mortality rates among people under age 65—primarily from drug overdoses and suicides. The biggest increases in drug overdoses and suicide rates have occurred in rural areas—see Question 4, below.

3. Will homeownership make a comeback? The homeownership rate hit a post-Great Recession low of 63.4 percent in 2016, then climbed to 63.9 percent in 2017—the first statistically significant rise in more than a decade. While the increase is encouraging, the homeownership rate is unlikely to return to the highs of the early 2000s. The Millennial generation—now at the age of first-time home buying—is burdened by student loan payments. Student loans delay homeownership by 7 years, according to the National Association of Realtors. Consequently, the age of first-time home buying (the age at which the homeownership rate first surpasses 50 percent) has shifted from the early to the late thirties.

4. What will save small town and rural America? Corporate America will not be coming to the rescue, judging by Amazon's choice to place its second headquarters in two of the largest and richest metropolitan areas in the country. The continuing allure of urban areas makes this question more important than ever—and we don't yet have any answers. But we may know more about why rural areas are falling behind. A statistical concept called "gambler's ruin" explains it, says economist and New York Times columnist Paul Krugman. The gambler (small town or rural area) who starts with the fewest pennies (economic opportunities) is the one most likely to go bankrupt. Small towns and rural America have a shrinking pile of pennies to play with and are increasingly likely to face ruin because of it. We still don't know how to solve this problem or even if we can.

5. When will Millennials marry? The median age at first marriage continues to rise, reaching a new record high in 2017 of 27.8 years for women and 29.8 years for men. Why are Millennials delaying marriage? One reason is that a much larger share of them go to college, which delays marriage and childbearing. Another reason is student loan debt, which not only delays homeownership but also marriage, according to the National Association of Realtors.

To be continued tomorrow...