Using Data from Across NCHS Sources to

Analyze Public Health Issues

Diane M. Makuc

Annual Meeting of the American Public Health

Association 11/4/06Centers for Disease Control and Prevention

National Center for Health Statistics

Thanks to several individuals who contributed to this presentation.

Lara Akinbami

Amy Bernstein

Lois Fingerhut

Yelena Gorina

Richard Klein

Kim Lochner

Patricia Pastor

Outline

•Types of NCHS data sources

•Reasons for using multiple sources

•Resources for accessing data from across NCHS sources

•Examples of using these resources

•NCHS record linkage activities

Types of NCHS data sources

•National vital statistics system

•Births and deaths

•Surveys of people

•NHIS, NHANES, others

•Surveys of health care establishments

•NHCS - 6 component surveys

Reasons for using multiple sources

•Monitor health and health care

•Assess a public health issue from multiple perspectives

• Investigate research questions that cannot be addressed using 1 source

•Methodologic studies

Resources for accessing data from across NCHS sources

1. Health, United States

2. Healthy People 2010

3. Health Data for All Ages

4. Trends in Health and Aging

5. Faststats

6. Injury Data web page

7. Child & Adolescent Mental Health Metadata

1. Health United States

Annual report (since 1975) on national trends in:

•Health status and determinants

•Use of health care

•Health resources

•Health care costs and financing

• Includes data from 55 sources

Example: Examine heart disease trends using data

from Health, US

•Death rates – NVSS deaths

•Risk factors – NHANES, NHIS

•Health care use•Drugs prescribed – NAMCS,NHAMCS•Home health / hospice care – NHHCS•Hospital stays, procedures – NHDS

2. Healthy People 2010

•467 health objectives

•Data track progress towards year 2010 targets for each objective.

•21 major and 150 total data sources

Example: Track progress towards Healthy People 2010

objectives Excerpts from October Progress Review

on diabetes objectives

•Prevalence– NHIS, NHANES

•Diabetes-related deaths among persons with diabetes – NVSS deaths and NHIS

•Lower extremity amputations– NHDS, NHIS

•Dilated eye exams - NHIS

Total

Obj. 5-3

1999 2000 2001 2002 2003 2004 2005

120

100

80

60

40

20

0

Age-adjusted rate per 1,000 population

2010 Target: 25

Prevalence of Diagnosed Diabetes

Decrease desired

American Indian/ Alaska Native

Black

Hispanic

White

Asian

NOTE: 1999 data for the American Indian/Alaska Native group and all data for the Native Hawaiian/Pacific Islander group are statistically unreliable and are suppressed. Data are age adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), NCHS, CDC.

Black

40

Age-adjusted percent

60

80

Obj. 5-4

Race/ethnicity

0White Male Female

1988-1994

Total

2001-04

100

Gender

Proportion of Diabetes Diagnosed

Mexican American

NOTE: Data are for adults aged 20 years and over and are age adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Prior to 1999, respondents were asked to select one race category; selection of more than one race was not an option. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. SOURCE: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

20

Increase desired2010 Target: 78

Obj. 5-7

1999 2000 2001 2002 2003 2004*

11

10

9

8

7

6

5

0

Age-adjusted rate per 1,000

2010 Target: 7.8

Decrease desired

Male

Female

2004 data are preliminary. NOTE: Data are age adjusted to the 2000 standard population. SOURCE: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC.

Diabetes-Related Deaths Among Persons With Diabetes

Total

Black

5

Age-adjusted rate per 1,000

10

15

Obj. 5-10

I = 95% confidence interval. *Age adjusted to the 2000 standard population. †Age-specific rates are not age-adjusted. NOTE: Includes any amputation of lower limb. For NHDS data prior to 2000, only one race category was recorded; reporting more than one race was not an option. For NHIS data prior to 1999, respondents reported one or more races and identified one race as best representing their race. Respondents were asked to select one or more races starting in 1999 (NHIS) or 2000 (NHDS), although more than one race selection was not used for 1999 NHIS data in order to be consistent with 1997-1998 data. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Hospital Discharge Survey (NHDS) and National Health Interview Survey (NHIS), CDC, NCHS.

Race*

0White Female Male <65 65-74

Age†

1997-99

Total* 75+

2002-0420

Lower Extremity Amputations Among Persons With Diabetes

Gender*

Decrease desired

2010 Target: 2.9

I = 95% confidence interval. * Excludes persons <25 years old. NOTE: Data are age adjusted to the 2000 standard population. Data for the American Indian or Alaska Native, Asian, and Native Hawaiian or Pacific Islander groups are statistically unreliable and are suppressed. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Prior to 1999, respondents were asked to select one or more races and identify one race as best representing their race. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), CDC, NCHS.

High school

30

Age-adjusted percent

40

50

Obj. 5-13

Education Level*

0Less than

High School

At least some

college

Total

60

Increase desired

Annual Dilated Eye ExamsAmong Adults With Diabetes

1998 2003

70

80

BlackHispanic

White

Race/ethnicity

2010 Target: 76

Where to find Healthy People 2010 tracking data

•Data2010 – online database with quarterly updates

•Monthly progress reviews provide data on a different focus area each month

•2006 Midcourse Review – summarizes progress for all objectives

3. Health Data for All Ages (HDAA)

Example: Examine gender and age differences in asthma using HDAA

An interactive online data warehouse that presents statistics across NCHS systems

Current asthma prevalence, by age and gender, US, annual average 2002-2004 (National Health Interview Survey)

Asthma hospitalizations, by age and gender, US, annual average 2002-2004 (National Hospital Discharge Survey)

Asthma deaths among adults, by age and gender, US, annual average 2001-2003 (National Vital Statistics System)

4. Trends in Health and AgingInteractive online data warehouse for statistics

focusing on trends for persons age 65+

Trends in Health and AgingNCHS data sources

• NAMCS

• NHAMCS

• NHDS

• NHHCS

• NNHS

• NHANES

• NHIS

• NVSS - mortality

5. Faststats

• Provides quick web access to statistics on topics of public health importance using multiple data sources and publications

• Organized alphabetically by topic

• Links to:

•Source publications

•Publications with more data

•Related web pages

Example: Find information on accidents/ unintentional injuries using Faststats

Health care use

• Number visits to office-based physicians: 58.3 million (NAMCS, 2004)

• Number of hospital outpatient department visits: 5.1 million (NHAMCS, 2004)

• Number of emergency department visits: 28.1 million (NHAMCS, 2004)

Faststats Accidents/ Unintentional

Injuries

Mortality

All unintentional injury deaths

• Number of deaths: 108,694

• Deaths per 100,000 population: 37.0

• Cause of death rank: 5Source: Deaths: Preliminary Data for 2004,

table 2

Faststats Accidents/ Unintentional

Injuries

More data

•Deaths: Injuries, 2002

•Health, United States trend tables on injury

•Injury Fact Sheet

•Health Data for All Ages

Faststats Accidents/ Unintentional

InjuriesRelated links

•National Ambulatory Medical Care Survey

•National Hospital Ambulatory Medical Care Survey

•Mortality data

•International Collaborative Effort (ICE) on Injury Statistics

6. Injury Data web page

7. NCHS Survey Measures Catalog of Child and

Adolescent Mental Health•Searchable database of child and

adolescent mental health measures in 7 NCHS surveys

•Provides “metadata” about specific survey questions and scales

•Provides links to relevant documentation and downloadable datafiles

NCHS Survey Measures Catalog of Child and

Adolescent Mental Health

User makes topic choices sequentially to identify specific survey questions of interest

Catalog includes information about:

•“Conditions, symptoms, or concerns”

• “Service use or needs”

Example: Find information on measures of ADHD using Catalog

•Step 1: Select “Conditions, symptoms, or concerns”

•Step 2: Select “Conditions”

•Step 3: Select “ADHD”

Measures Summary for ADHD

NCHS Survey Measures Catalog of Child and Adolescent Mental

Health

•Information from 3 NCHS surveys (NHIS, NSCH, NHANES) with measures of ADHD

•Question text and related information for ADHD question

•Links to questionnaire, data file, documentation, and other information

NCHS Record Linkage Activities

•NCHS survey data files are linked to other files to enhance their usefulness for research and policy analysis.

•File linkage adds data on morbidity, health care use, program eligibility and benefits, and mortality to cross-sectional and longitudinal surveys.

NCHS Surveys with Linked Files (Access in Research Data Center)

XXNNHS 1985

XXXNHANES III

XXNHANES II

XXXNHANES I

XXXLSOA II

XXXNHIS 1994-1998

XNHIS 1986-2000

Retirement & Disability (SSA)

Medicare (CMS)

Mortality (NDI)

Linked Mortality Data Elements

•Eligibility status

•Assigned vital status

•Date of death

•Age at death

•Underlying and multiple causes of death

•Geography

Linked Medicare Data Elements

•Denominator file

•Entitlement status

•Beneficiary demographic characteristics

•Monthly enrollment status

•HMO enrollment

•Claims files

•Diagnoses codes, service dates, reimbursement amounts

Linked Social Security Data Elements

•RSDI information

•Master Beneficiary Record 1962 - 2003•RSDI program eligibility, benefit amount, payment status, dual entitlement

•Payment History Update System 1984-2003•RSDI benefit payment amounts, including withholding information for Medicare Part B premiums

•Actual benefit payment in a given month (Form 1099)

Linked Files: Potential Research Topics

• Risk Factors

•Diabetes, hypertension and obesity related mortality

• Disparities

•Medicare service utilization by race/ethnicity and socioecnomic status

• Health Services

•Health insurance coverage and risk of mortality from preventable causes of death

For more information on NCHS record linkage activities

APHA Session 4128.1

Tuesday November 7 at 12:30PM

Record linkage for epidemiologic research: New opportunities and challenges

Organized by Kimberly Lochner

Web addresses http://www.cdc.gov/nchs/...

Health, United States

hus.htm

Healthy People 2010

hphome.htm

Health data for all ages

health_data_for_all_ages.htm

Trends in health and agingagingact.htm

Web addresseshttp://www.cdc.gov/nchs/...

FASTSTATS

fastats/Default.htm

Injury data web page

injury.htm

Child & adolescent mental health metadata

measurescatalog/camh.htm

Record linkage activites

r&d/nchs_datalinkage/data_linkage_activities.htm