CONTEXT: The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets. PROGRAM OR POLICY: We sought to identify and consolidate a practical and annotated listing of those data sets. IMPLEMENTATION AND/OR DISSEMINATION: Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span. EVALUATION: We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies. DISCUSSION: The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.

Over two-thirds of all new cancers are diagnosed among adults aged ≥60 years. As the number of adults living to older ages continues to increase, so too will the number of new cancer cases. Can we do more as a society to reduce cancer risk and preserve health as adults enter their 60s, 70s, and beyond? Cancer development is a multi-step process involving a combination of factors. Each cancer risk factor represents a component of cancer causation, and opportunities to prevent cancer may exist at any time up to the final component, even years after the first. The characteristics of the community in which one lives often shape cancer risk-related behaviors and exposures over time, making communities an ideal setting for efforts to reduce cancer risk at a population level. A comprehensive approach to cancer prevention at older ages would lower exposures to known causes of cancer, promote healthy social and physical environments, expand the appropriate use of clinical preventive services, and engage older adults in these efforts. The collection of articles in this supplement provide innovative insights for exciting new directions in research and practice to expand cancer prevention efforts for older adults. This brief commentary sets the stage for the papers that follow.

INTRODUCTION: Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population. METHODS: We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011-2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). RESULTS: Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. DISCUSSION: This study is the first to document concurrent prevalence of primary dementia subtypes among this US population. The findings can assist in prioritizing dementia research, clinical services, and caregiving resources.

Coexistence of multiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework.

The increasing prevalence of persons with multimorbidity in many countries has sparked strong growth in research on the epidemiology of multimorbidity, in part to help improve approaches to preventing and managing chronic conditions ( 1–6 ). In this issue of the Journal , Garin and colleagues have made a major contribution to this field of research by examining nationally representative data from studies of noninstitutionalized, predominantly older adults in nine countries that represent the socioeconomic spectrum, and by using a common set of 12 chronic conditions to characterize epidemiologic patterns of multimorbidity among older adults in those countries ( 7 ). | Particularly noteworthy are their results for the relation between multimorbidity and sociodemographic factors (age, sex, education, marital status, wealth, and place of residence), as well as the most prevalent comorbid conditions (hypertension, arthritis, and cataract). In addition, their analysis identified selected multimorbidity combinations for each country and across countries, the most common of which are “cardio-respiratory” and “metabolic” patterns.

Landmark articles from the peer-reviewed literature can be used to teach the fundamental principles of geriatric medicine. Three approaches were used in sequential combination to identify landmark articles as a resource for geriatricians and other healthcare practitioners. Candidate articles were identified first through a literature review and expert opinion survey of geriatric medicine faculty. Candidate articles in a winnowed list (n = 30) were then included in a bibliometric analysis that incorporated the journal impact factor and average monthly citation index. Finally, a consensus panel reviewed articles to assess each manuscript's clinical relevance. For each article, a final score was determined by averaging, with equal weight, the opinion survey, bibliometric analysis, and consensus panel review. This process ultimately resulted in the identification of 27 landmark articles. Overall, there was weak correlation between articles that the expert opinion survey and bibliometric analysis both rated highly. This process demonstrates a feasible method combining subjective and objective measures that can be used to identify landmark papers in geriatric medicine for the enhancement of geriatrics education and practice.

In this issue of Mayo Clinic Proceedings, Rocca et al1 report the results of a study of multimorbidity in a patient sample that represents nearly the total population of Olmsted County, Minnesota. (In this context, multimorbidity refers to the situation in which a patient receiving medical care for a sentinel condition has at least one additional chronic condition.) To our knowledge, this is the first report that uses the list of chronic conditions developed by the US Department of Health and Human Services (DHHS) to assist in systematically documenting the epidemiology and burden of chronic multimorbidity at this jurisdictional level.2 Other investigators have reported their use of the DHHS set of conditions to examine the burden of multimorbidity among nationally representative samples of persons in communities and in health care settings.3, 4, 5, 6 In addition, the Centers for Medicare and Medicaid Services has provided statistics on the prevalence of multiple chronic conditions for Medicare beneficiaries at the state, county, and hospital referral region level.7 However, the report by Rocca et al expands this understanding substantially by taking this work directly to the local level through their examination of multimorbidity in the setting of nearly all persons in a single, highly documented county who have had encounters with the health care system.

This is an invited commentary for a special issue on CPPW. In this invited commentary, we review definition frameworks for community health and examine factors having core relevance to shaping the meaning of this term and growing field. We conclude by suggesting a potential framework for conceptualizing and advancing this field of public health practice through improved understanding of the meaning, scope, and science of community health.

PURPOSE: An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS: Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS: Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION: Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.

BACKGROUND: The increasing prevalence of Americans with multiple (2 or more) chronic conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. PURPOSE: In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options. RESULTS: Eleven principles to improve guidelines' attentiveness to the population with multiple chronic conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of multiple chronic conditions; and (3) principles intended to increase focus on patient-centered care. CONCLUSION: This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with multiple chronic conditions. The suggested principles are helping professional societies to improve guidelines' attentiveness to persons with multiple chronic conditions.

With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors-including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia-that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessible and direct care, and focus the health-care system on improving population health.

The objective of this research was to update earlier estimates of prevalence rates of single chronic conditions and multiple (>2) chronic conditions (MCC) among the noninstitutionalized, civilian US adult population. Data from the 2012 National Health Interview Survey (NHIS) were used to generate estimates of MCC for US adults and by select demographic characteristics. Approximately half (117 million) of US adults have at least one of the 10 chronic conditions examined (ie, hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, current asthma, or chronic obstructive pulmonary disease [COPD]). Furthermore, 1 in 4 adults has MCC.

Following the intentional dissemination of B.anthracis through the U.S. Postal Service in 2001, use of the term "naturally occurring" to classify some infectious disease outbreaks has become more evident. However, this term is neither a scientific nor an epidemiologic classification that is helpful in describing either the source or the mode of transmission in outbreaks. In this paper, the authors provide examples of how and when the public health community has recognized potentially flawed or misleading taxonomy in the past and taken steps to improve the taxonomy's accuracy and usefulness. We also offer examples of alternative terms for classifying outbreaks since inaccurate descriptions of outbreaks could potentially lead to a flawed or incomplete set of underlying assumptions about the outbreak's causal factors. This, in turn, could lead to implementing a flawed or incomplete intervention or response strategy which could extend the duration of the outbreak, resulting in avoidable morbidity and mortality.

OBJECTIVES: Individuals with multiple (>2) chronic conditions (MCC) present many challenges to the health care system, such as effective coordination of care and cost containment. To assist health policy makers and to fill research gaps on MCC, we describe state-level variation of MCC among Medicare beneficiaries, with a focus on those with six or more conditions. METHODS: Using Centers for Medicare & Medicaid Services administrative data for 2011, we characterized a beneficiary as having MCC by counting the number of conditions from a set of fifteen conditions, which were identified using diagnosis codes on the claims. The study population included fee-for-service beneficiaries residing in the 50 U.S. states and Washington, DC RESULTS: Among beneficiaries with six or more chronic conditions, prevalence rates were lowest in Alaska and Wyoming (7%) and highest in Florida and New Jersey (18%); readmission rates were lowest in Utah (19%) and highest in Washington, DC (31%); the number of emergency department visits per beneficiary were lowest in New York and Florida (1.6) and highest in Washington, DC (2.7); and Medicare spending per beneficiary was lowest in Hawaii ($24,086) and highest in Maryland, Washington, DC, and Louisiana (over $37,000). CONCLUSION: These findings expand upon prior research on MCC among Medicare beneficiaries at the national level and demonstrate considerable state-level variation in the prevalence, health care utilization, and Medicare spending for beneficiaries with MCC. State-level data on MCC is important for decision making aimed at improved program planning, financing, and delivery of care for individuals with MCC.

INTRODUCTION: Public health and clinical strategies for meeting the emerging challenges of multiple chronic conditions must address the high prevalence of lifestyle-related causes. Our objective was to assess prevalence and trends in the chronic conditions that are leading causes of disease and death among adults in the United States that are amenable to preventive lifestyle interventions. METHODS: We used self-reported data from 196,240 adults aged 25 years or older who participated in the National Health Interview Surveys from 2002 to 2009. We included data on cardiovascular disease (coronary heart disease, angina pectoris, heart attack, and stroke), cancer, chronic obstructive pulmonary disease (emphysema and chronic bronchitis), diabetes, and arthritis. RESULTS: In 2002, an unadjusted 63.6% of participants did not have any of the 5 chronic conditions we assessed; 23.9% had 1, 9.0% had 2, 2.9% had 3, and 0.7% had 4 or 5. By 2009, the distribution of co-occurrence of the 5 chronic conditions had shifted subtly but significantly. From 2002 to 2009, the age-adjusted percentage with 2 or more chronic conditions increased from 12.7% to 14.7% (P < .001), and the number of adults with 2 or more conditions increased from approximately 23.4 million to 30.9 million. CONCLUSION: The prevalence of having 1 or more or 2 or more of the leading lifestyle-related chronic conditions increased steadily from 2002 to 2009. If these increases continue, particularly among younger adults, managing patients with multiple chronic conditions in the aging population will continue to challenge public health and clinical practice.

Current trends in US population growth, age distribution, and disease dynamics foretell rises in the prevalence of chronic diseases and other chronic conditions. These trends include the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, the persistently high prevalence of some risk factors, and the emerging high prevalence of multiple chronic conditions. Although preventing and mitigating the effect of chronic conditions requires sufficient measurement capacities, such measurement has been constrained by lack of consistency in definitions and diagnostic classification schemes and by heterogeneity in data systems and methods of data collection. We outline a conceptual model for improving understanding of and standardizing approaches to defining, identifying, and using information about chronic conditions in the United States. We illustrate this model's operation by applying a standard classification scheme for chronic conditions to 5 national-level data systems.

Public health readiness has increased at all jurisdictional levels because of increased sensitivity to threats. Since 2001, with billions of dollars invested to bolster the public health system's capacity, the public expects that public health will identify the etiology of and respond to events more rapidly. However, when etiologies are unknown at the onset of the investigation but interventions must be implemented, public health practitioners must benefit from past investigations' lessons to strengthen preparedness for emerging threats. We have identified such potentially actionable lessons learned from historically important public health events that occurred primarily as syndromes for which the etiological agent initially was unknown. Ongoing analysis of investigations can advance our capability to recognize and investigate syndromes and other problems and implement the most appropriate interventions.

This issue of the Annals, as well as the previous one, confronts the enormous public health challenges of multimorbidity. More than 1 in 4 Americans has multiple (2 or more) chronic conditions, including physical and behavioral health problems, accounting for an estimated two-thirds of total US health care spending.1 An individual’s risks for a variety of adverse health outcomes (eg, poor functional status, unnecessary hospitalizations, and adverse drug events) rise as the number of multiple chronic conditions increases.2 | The Centers for Medicare and Medicaid Services (CMS) has just released even more detailed information with respect to its Medicare fee-for-service populations,3 exposing the exceptional complexity and sheer burden that multiple chronic conditions pose for patients, health facilities, payers, and clinicians. In its recently released chart book Chronic Conditions Among Medicare Beneficiaries,3 CMS describes detailed demographics and prevalence measures of multiple medical conditions in this population and the dramatic impact on service utilization and spending. Examples of key findings are that two-thirds (20.7 million beneficiaries) had at least 2 or more chronic conditions; about 50% of beneficiaries with stroke or heart failure had 5 or more additional chronic conditions; beneficiaries with 6 or more chronic conditions accounted for about one-half of Medicare spending on hospitalizations; more than one-quarter of beneficiaries with 6 or more chronic conditions had a hospital readmission within 30 days; and the 12% of beneficiaries with 6 or more chronic conditions accounted for 43% of Medicare spending. For health systems that have traditionally focused on research and treatment of single conditions, these tremendous challenges have forced many to escalate efforts to identify and implement solutions.

Never before has the global population included as many older adults as it does today. Over the past century in the United States alone, the proportion of persons aged 65 years or older increased more than threefold, from 4.1% to 12.9%.1 This issue of the Journal devoted to “Healthy Aging” opens a dialogue for examining innovative roles for public health and the health care system in relation to a broad spectrum of priorities involving the aging population. Despite the acknowledged challenges of limited resources and economic uncertainty, as this issue's articles suggest, opportunities abound to improve the health and functioning of older adults and enhance intergenerational programs and policies that enrich all of society. Additional articles for this series will be published in subsequent Journal issues over the coming years.

MMWR was established to disseminate the results of public health surveillance and owes much of its existence to the founder of modern surveillance, William Farr (1807--1883). In 1878, under the sway of Farr, Lemuel Shattuck, and other pioneers of surveillance, the U.S. government created the first precursor of MMWR and entered the business of publishing surveillance statistics. Farr's influence touched MMWR again in 1961 when one of his adherents, Alexander D. Langmuir (Figure 1), brought MMWR to Atlanta and CDC from a federal office in Washington, D.C. (1). Since its beginnings, MMWR has played a unique role in addressing emerging public health problems by working with state and local health departments to announce problems even before their cause is known, rapidly disseminating new knowledge about them weeks or months before articles appear in the medical literature, and publishing recommendations for their control and prevention. MMWR has played this role time after time---the discovery of Legionnaires disease in the 1970s, AIDS and toxic-shock syndrome in the 1980s, hantavirus pulmonary syndrome in the 1990s, and severe acute respiratory syndrome (SARS) in the 2000s. At the same time, MMWR also has reported on nearly all the major noninfectious public health problems of the day---environmental emergencies, chronic diseases, injuries, and new public health technologies. To a great extent, the history of MMWR is the history of disease and injury prevention and control in the United States

METHODS: The Centers for Disease Control and Prevention and the Association of State and Territorial Health Officials selected 17 state and large local jurisdictions on the basis of their proximity to federal quarantine stations and collaborated with their state health department legal counsel to conduct formulaic self-assessments of social distancing legal authorities, create tables of authority, and test and report on the laws' sufficiency (ie, scope and breadth). Select jurisdictions also held tabletop exercises to test public health and law enforcement officials' understanding and implementation of pertinent laws. This report presents findings for Michigan, which completed the legal assessment and tabletop exercise and made several recommendations for change as a result. RESULTS: Officials in Michigan concluded that there are sufficient existing laws to support social distancing measures but that a spectrum of questions remained regarding implementation of these legal authorities. Based on the findings of this assessment, Michigan initiated actions to address areas for improvement. CONCLUSIONS: The results of this project highlighted the value of integrally involving the state health department's legal counsel-those most familiar with and who advise on a given state's public health laws-in the periodic identification, assessment, and testing of the state's legal authorities for social distancing and other measures used in response to many public health emergencies.