Download - Secondary Database Analysis II
Secondary Database Analysis II
Sources and Uses of Extant Databases
Last Time – Uses
Secondary Data: Can provide new information on health care delivery (quality;
geographic variation; post-marketing adverse events; cost), on natural the history of disease, and on regulatory matters.
Can save data-collection resources: time, money, personnel, participant burden
Can save researcher resources: your time, your money May permit you to build your CV without anyone’s help or
funds – just your time (but co-authors are a good thing) Can provide preliminary data for a grant proposal May enable research on rare events or difficult populations
Last Time – Precautions Take note of the study design; is it suitable? What are inclusion & exclusion criteria? Why? How does that
affect the sample and generalizability? What bias may be inherent in the database – perhaps from the
population or from the method of measurement? Selection bias: who got included; migration: who was lost/gained and why; other sources of systematic error (bias)
Control for bias – restrict (lose generalizability); match (limited # factors); stratify; adjust with covariates; then discuss potential impact of uncorrected bias on your results; could conduct sensitivity analyses on multivariable models
Risk adjustment – outcome-specific; an index incorporates many predictors – do you need to study some separately?; comorbidity index for case-mix adjustment (e.g., Charlson); other predictors based on your reading of the literature; propensity scores (for treatment choice; good for small datasets, for non-randomized studies of treatment effect)
Data Sources
Financial or Claims Files Electronic Medical Records Survey Data Trial Data
NHLBI Clinical Trialshttp://www.nhlbi.nih.gov/resources/deca/default.htm - National Heart Lung & Blood Institute
Study Name Prepared/Updated ↓
Asymptomatic Cardiac Ischemia Pilot (ACIP) 01/2000
Lung Health Study (LHS) 08/2001
Thrombolysis in Myocardial Infarction Study (TIMI II) 08/2001
Intermittent Positive Pressure Breathing (IPPB) 05/2001
Post Coronary Artery Bypass Graft Study (CABG) 05/2001
Antiarrhythmics Versus Implantable Defibrillators(AVID) 02/2002
Asthma Clinical Research Network: Beta Agonist in Mild Asthma (ACRN: BAGS) 02/2002
Digitalis Investigation Group (DIG) 02/2002
Asthma Clinical Research Network: Colchicine in Moderate Asthma (ACRN: CIMA) 02/2002
Psychophysiological Investigation of Myocardial Ischemia (PIMI) 07/2002
Coronary Artery Surgery Study (CASS) 07/2003
High Frequency Ventilation in Premature Infants Study (HIFI) 07/2003
Multiple Risk Factor Intervention Trial (MRFIT) 07/2003
Raynaud's Treatment Study (RTS) 05/2003
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet 01/03): Lower versus higher tidal volume, lisofylline treatment and ketoconazole treatment (3 study factorial)
07/2003
… etc.
NHLBI Clinical Trials - most recent
Study Name Prepared/Updated ↓
Public Access Defibrillation (PAD) Community Trial 08/2007
Bypass Angioplasty Revascularization Investigation (BARI) 11/2007
Women's Health Initiative: Clinical Trials (WHI-CT) 02/2008
Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial
03/2008
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet02): Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (
LaSRS)
05/2008
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet05): Fluid and Catheter Treatment Trial (FACTT)
05/2008
Viral Activation Transfusion Study (VATS) 05/2008
National Emphysema Treatment Trial (NETT) 08/2008
NHLBI Epidemiology Studies (selected)http://www.nhlbi.nih.gov/resources/deca/directry.htm
Study Name Prepared/Updated
A Case-Control Etiologic Study of Sarcoidosis (ACCESS) 04/2004
Atherosclerosis Risk in Communities Study (ARIC) 01/2008
Bogalusa Heart Study (BHS) 12/2006
Cardiovascular Health Study (CHS) 07/2008
Coronary Artery Risk Development in Young Adults (CARDIA) 11/2007
Cord Blood Transplant Study (COBLT) 01/2007
Framingham Heart Study-Cohort 03/2007
Framingham Heart Study-Offspring 05/2007
Honolulu Heart Program (HHP) 01/2004
Lipid Research Clinics- Prevalence Study (LRCPS) 02/2005
NHLBI Growth and Health Study (NGHS) 09/2005
National Longitudinal Mortality Study (NLMS) 01/2000
Puerto Rico Heart Health Program (PRHHP) 12/2002
Cooperative Study of Sickle Cell Disease (CSSCD) 07/2008
National Center for Health Statistics (NCHS)
http://www.cdc.gov/nchs/
NCHS Public-use Data Files & Documentation
About Public-use data files - http://www.cdc.gov/nchs/datawh/ftpserv/ftpdata/aboutpud.htm Data Release Policy - http://www.cdc.gov/nchs/about/policy/reldata.htm Data Use Restrictions - http://www.cdc.gov/nchs/datawh/dur.htm NHANES III Errata
Data from the National Health and Nutrition Examination Survey (NHANES) What’s New http://www.cdc.gov/nchs/about/major/nhanes/whatsnew.htm Third National Health and Nutrition Examination
http://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm Reference Manuals and Reports/Plan and Operations http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/main.pdfAnalytic Guidelines http://www.cdc.gov/nchs/data/nhanes/nhanes3/nh3gui.pdfNHANES I Epidemiologic Followup Study (NHEFS)
http://www.cdc.gov/nchs/products/elec_prods/subject/nhefs.htm
Longitudinal Studies of Aging (LSOA ) http://www.cdc.gov/nchs/lsoa.htm - available on CD
National Health Interview Survey (NHIS)http://www.cdc.gov/nchs/nhis.htm
National Center for Health Statistics (NCHS)
National Ambulatory Medical Care Survey (NAMCS), 1993-2000http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Ambulatory Medical Care Survey (NAMCS), 1973-1992http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992-2000 http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Hospital Discharge Survey (NHDS), 1996-2000& National Survey of Ambulatory Surgery (NSAS), 1994-1996
http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm
National Home and Hospice Care Survey (NHHCS), 1996http://www.cdc.gov/nchs/nhhcs.htm
National Nursing Home Survey (NNHS), 1995 and 1997http://www.cdc.gov/nchs/nnhs.htm
NCHS
Behavioral Risk Factor Surveillance System (BRFSS)
http://www.cdc.gov/brfss/ Datasets are large – ASCII version may be
15Mb for a single year Documentation is online with data 24 years of data available at
http://www.cdc.gov/brfss/technical_infodata/surveydata.htm
Don’t forget the citation! http://www.cdc.gov/brfss/suggestedcitation.htm
VA Data
Data descriptions and access details are documented (http://www.virec.research.va.gov) No public use files; must be VA employee/WOC Data: administrative, hospital/facility level data, medical record information, patient-level medical care data including procedures, surgeries, radiography, laboratory (some), pharmacy, and diagnoses, all in SAS datafiles 5.5 million patients with incentive to stay in the system
Healthcare Cost and Utilization Project (HCUP)
Largest collection of all-payer longitudinal hospital data in US available for release to researchers
Family of administrative databases and tools maintained by AHRQ
As of 2002 data, 35 state-level data organizations contribute data on hospital stays including Texas
http://www.hcup-us.ahrq.gov/home.jsp What's New – right-hand insetWhat is HCUPHCUP Products (data are not free)HCUP Services
FACT SHEET – very informativeNote the Clinical Classifications Software (CCS) & Comorbidity Software (this is free)
HCUP DatabasesState Inpatient Databases (SID)State Ambulatory Surgery Databases (SASD)State Emergency Department Databases (SEDD)Nationwide Inpatient Sample (NIS)Kids' Inpatient Database (KID)
Healthcare Cost & Utilization Project (HCUP)
Another AHRQ product - http://www.meps.ahrq.gov/
Overview: MEPS Web SiteThe Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States.
MEPS Web SiteSurveys used, data available, canned reports, data FAQ’s, MEPSnet query tools, etc.
http://www.meps.ahrq.gov/mepsweb/data_stats/data_overview.jsp
Medical Expenditure Panel Survey (MEPS)
DATA from Substance Abuse and Mental Health Data Archives (SAMHDA)
http://www.icpsr.umich.edu/SAMHDA/ "A national resource providing public data
access and online analysis"SAMHDA Helpline: 1-888-741-7242
Local: (734) 615-9524Fax: (734) 647-8200e-mail: [email protected]
CTS Surveys: from HSC, funded by RWJF, stored at ICPSR
- Household Survey, Employer Survey, Physician SurveyTo provide an in-depth look at the issues and challenges physicians face in the rapidly changing health care system, HSC's Community Tracking Study includes a Physician Survey.
http://www.hschange.org/index.cgi?data=04 Get data from ICPSR http://www.icpsr.umich.edu/HMCA/
Health Medical & Care Archive (HMCA) - Health System Change (HSC) – The Robert Wood Johnson Foundation – ICPSR Archives
SEER: Surveillance Epidemiology & End Results
http://seer.cancer.gov/registries/ SEER*Stat software:
http://seer.cancer.gov/seerstat/
Websites with Database Lists
AHRQ http://www.ahrq.gov/ NLM http://www.nlm.nih.gov/ CDC http://www.cdc.gov/ VIREC http://www.virec.research.va.gov/ HERC http://www.herc.research.va.gov/ ICPSR http://www.icpsr.umich.edu/ Census & CDC: http://dataferrett.census.gov/
Who Will Fund Your Analyses?
Your institution has a listserv: [email protected] NIH has career development awards : http://grants1.nih.gov/training/ -- and RFAsAnd there are Program Announcements that are pertinent, e.g., these from NIAAA:
Secondary Analysis of Existing Alcohol Epidemiology Data (R21): PA-08-168 http://grants.nih.gov/grants/guide/pa-files/PA-08-168.html
Secondary Analysis of Existing Alcohol Epidemiology Data (R03): PA-08-169 http://grants.nih.gov/grants/guide/pa-files/PA-08-169.html
VA HSR&D has grants (PI must be or become 5/8+ VA) http://www.hsrd.research.va.gov/for_researchers/ Foundations have grants (ADA, AHRQ, Hogg, NARSAD, etc.) Local pots of money