using data from across nchs sources to analyze public health issues diane m. makuc annual meeting of...
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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
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