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National Health Interview Survey 2019 Content Redesign – Analytic Implications
Sarah Lessem, Renee Gindi, Stephen Blumberg,
Aaron Maitland, Benjamin Zablotsky, Lindsey Black,
Emily Zammitti
FCSM Meeting
March 9, 2018
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National Health Interview Survey
▪ Agency: Department of Health and Human Services (DHHS); Centers for Disease Control and Prevention (CDC); National Center for Health Statistics (NCHS)
▪ Purpose: To monitor the health of the US population through the collection and analysis of data on a broad range of health topics
▪ Sample: Address-based, multi-stage, clustered national sample of housing units from every state, to be representative of the civilian noninstitutionalized US population
▪ Mode: In-person interviews - follow-up by telephone if needed
▪ Data collection: Continuous by Census field representatives
▪ Target sample size: Complete interviews of 35,000+ households
▪ Content redesign start: January 2019
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Goals of the NHIS Questionnaire Redesign
▪ Improve the relevance of covered health topics, better meeting the needs of the Department of Health and Human Services and other data users
▪ Focus on leading causes of morbidity/mortality, their known risk and protective factors, and targets of health promotion initiatives
– Health insurance and health care access
▪ Harmonize overlapping content with other federal heath surveys
▪ Reduce respondent burden and improve data quality
– Shorten questionnaire and reduce variation in interview times
– Eliminate or reduce content better covered by other methods
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Distribution of Length of Completed Interviews (in minutes): NHIS, 2015
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50th percentile: 92 minutes 75th percentile: 115 minutes 90th percentile: 141 minutes
Time (minutes)
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Distribution of Length of Completed Interviews: Goal for NHIS Redesign
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Changes: Rotating Core
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Current NHIS
▪ Consistent content asked annually
▪ Variation in length because of sponsored supplements
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Redesigned NHIS: the Quilt
▪ Annual core
– Key measures
– Sociodemographics
▪ Rotating core
– Newer topic areas
– Expanded detail
– Varying periodicity
▪ Sponsored supplements
– 5 min or less
2019 2020 2021 2022 2023 2024 2025 2026 2027
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Changes: Family Interview
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Current NHIS
Roster/Family Interview ▪ General information on all family members ▪ Family-level data ▪ Proxy response ▪ Fielded each year
Sample Adult Interview ▪ Self-response (unless unable)
▪ Fielded each year
Sample Child Interview ▪ Knowledgeable adult responds for child ▪ Fielded each year
Demographics
Family relationships
Family income
Health insurance
Proxy health data
Health utilization
Health conditions
Health behaviors
Additional demographics
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Redesigned NHIS
Roster ▪ Proxy response ▪ Annual
Sample Adult Interview ▪ Self-response (unless unable)
▪ Family-level data ▪ Annual and Rotating Core
Sample Child Interview ▪ Knowledgeable adult responds for child ▪ Family-level data ▪ Annual and Rotating Core
Demographics
Family identification
Demographics
Martial/cohabitating relationships
Family income
Health insurance
Health utilization
Health conditions
Health behaviors
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Changes: Content
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Eliminated
▪ Questions about rare conditions • Less than 2%, must combine years
▪ Better captured elsewhere • Surveys, medical records, administrative claims, registries
▪ Infrequently used questions • Based on literature reviews, public comments
▪ Proxy about all family members • No health data about family members
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Changes to Order or Wording
▪ Move to rotating − Details with core
− Long sections
− Stable over time
− Order changes − Health conditions first
− Sensitive content last
− Rotating throughout
▪ Harmonize with other surveys − Matching similar questions on
multiple CDC surveys
▪ Spanish translation process − Clarification both ways
▪ Cognitive testing − Better understanding by respondents
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Added Content
▪ Expert advice − Technical Expert Panels (TEPs)
− Social determinants of health
− Mental health batteries
▪ Public comment − Ex. Dental health
▪ Agency priorities − Emerging topic areas
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What does the redesigned NHIS let us do?
Analytic Implications
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Population level estimates
▪ Population estimates can be made for questions asked of children and adults
– Sample Adult and Sample Child content rotate together
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Implications for Accuracy and Precision
▪ No proxy health data
– Health insurance
– Other health conditions
▪ Smaller sample size
– Wider confidence intervals
▪ Reduced measurement error
– Sample adult responses for self
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Dyads: An Opportunity for Studying Family Health
▪ In 2016, 29% of families in the NHIS had one or more children.
– In 67% of these families, a parent was also the sample adult
– Nearly 20% of all families have a sample adult/sample child dyad
▪ Data users cannot currently make nationally representative estimates using associations between the health of sample adult and sample child
• Matched pairs are not representative of population
▪ Creating paired weights to represent population of eligible pairs
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Identifying Family Context Covariates
Still able to identify:
▪ Multi-racial families
▪ Many but not all same-sex couples
▪ Educational attainment of family members
▪ Whether the child’s parents were born outside of the United States
No longer able to identify:
▪ Multigenerational or extended families
▪ Families with one or more disabled members
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Files to be released
▪ Sample Adult file with weights and family-level variables
▪ Sample Child file with weights and family-level variables
▪ Dyad weights
▪ Linkages will still be available at Research Data Center
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Contact us: [email protected] For More Information
http://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm