The Second Longitudinal Study of Aging

1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics The Second Longitudinal Study of Aging Julie Dawson Weeks, Ph.D. LSOAs Project Director

2. LSOA II Staff Survey Team Sylvia Ellison Cordell Golden Keith Zevallos Data Linkage Team Chris Cox Donna Miller Jim Brittain

3. Presentation Topics • LSOA II background and purpose • Review the Longitudinal Studies of Aging • LSOA II methodology • Sample selection • Survey design • Interview data source & structure • LSOA II interview data file contents • Linkage activities & data file contents

4. Sponsors • A collaborative project of the… • National Institute on Aging, NIH • National Center for Health Statistics, CDC • With additional funding from… • Office of the Assistant Secretary for Planning and Evaluation, DHHS • Robert Wood Johnson Foundation

5. Objectives The LSOA II was designed to… • Describe the continuum from functional, community-dwelling independence through dependence, including institutionalization, to death; • Describe the covariates associated with changes in functional status; • Replicate the first LSOA in order to determine whether there have been changes in the disability and impairment process across the decades.

6. The Longitudinal Studies of Aging(LSOAs) • A family of surveys… • 1984 Supplement on Aging (SOA) • 1984-1990 Longitudinal Study of Aging (LSOA) • 1994 Second Supplement on Aging (SOA II) • 1994-2000 Second Longitudinal Study of Aging • (LSOA II)

7. Relationship Between the Surveys LSOA 1984 1986 1988 1990 SOA W2 W3 W4 LSOA II 1994-96 1997-98 1999-2000 SOA II W2 W3

8. LSOA II Sample Characteristics • Based on the 1994 NHIS • Complex, multistage area probability design • Civilian, non-institutionalized population • Persons 70 years of age and over in 1995 • N = 9,447 persons

9. 1994 NHIS Core (n=116,179) SOA II Design Supplements Immunization Year 2000 objectives AIDS Non-disabled, age 70+ Family resources Disability Supplement Phase I (HIS-2) (n=107,469) Non-disabled Age <70 Disabled Disability Supplement Phase 2 Second Supplement On Aging (DFS-3) Age 70+ (n=4,519) DFS-2 DFS-1 Age <18 (n~4,200) Age 18-70 (n=11,102) Age 70+ (n=4,928) SOA II Sample (n=9,447)

10. LSOA II Methodological Characteristics Baseline interview: 1994-1996 • In-person, SP’s home • Census Bureau Follow-up interviews: 1997-98 and 1999-2000 • Telephone • NORC • Institutionalized & decedent IWs conducted Self-response (unless SP incapacitated)

11. LSOA IIResponse Rates Interview Conditional on Eligibility Cumulative NHIS Core 94.1 % n/a SOA II Baseline 92.9 % 87.4 % LSOA II Wave 2 84.9 % 74.2 % LSOA II Wave 3 76.3 % 56.6 % Note: Response rates may change slightly once final LSOA II Version 3.0 data files are released for public use.

12. Survivors Decedents LSOA II Data Sources 1994 NHIS Supplements: Family Resources Disability Supplement 1994 NHIS: Core Questionnaire SOA II 1997-1998 Wave 2 Interview 1999-2000 Wave 3 Interview Administrative Record Linkages Survivors NDI Decedents CMS SSA

13. NHIS Core Sex Age (DOB) Race / Ethnicity Marital status Veteran status Education Family income Family Resources Access to care Reasons for no care Disability Supplement Mental health Depression RA Disability LSOA II Content Other Baseline Data Sources

14. Housing characteristics Transportation Social activities Family structure Family interactions Living arrangements Employment history Community services LSOA II Content Baseline SOA II

15. LSOA II Content Baseline SOA II, continued • Health behaviors • Chronic conditions • Assistive devices • Physical functioning • Personal assistance • Health insurance • Prescription use • LTC Utilization

16. Migration and reasons for moves Cognitive functioning (HRS) Income questions (HRS) Home health care utilization Preventive services Information on the spouse Symptomatic conditions Nutrition and use of supplements LSOA II Content Additions at Waves 2 and 3

17. EOL and LYOL transitions Eligibility: deaths subsequent to SOA II Conducted at Waves 2 and 3 Respondent rule Wave 2 n = 938 Wave 3 n = 906 LSOA II Content Decedent Interviews

18. Most of the Survivor questions repeated Reference periods changed Cognitive functioning for proxies (HRS) Place of death, prior living arrangements Changes in functioning prior to death Directives and durable POA LSOA II Content Decedent Interviews

19. LSOA IIAdministrative Record LinkagesChristine S. CoxNCHS Special Assistant for Record Linkage

20. LSOA II Data Linkage Activities Centers for Medicare & Medicaid Services (CMS) • Medicare-covered utilization & expenditures • Enrollment status Social Security Administration (SSA) • SSDI & SSI eligibility • Disabling condition National Death Index (NDI) • Date of death • Cause of death

21. LSOA II CMS File Linkage Medicare Enrollment File • Match methodology • Two sample issues: eligibility vs. match success Standard Analytic Files (1991-2000) • Hospital inpatient and outpatient • Physician / supplier • Durable medical equipment • Home health agency • Hospice

22. LSOA II CMS Variables Annual payment & utilization data • Inpatient hospital care & outpatient services • Skilled nursing facility care • Physician services • Durable medical equipment • Home health care • Hospice care For each hospital stay • Date of admission & length of stay • Diagnoses & procedures • ICU, CCU, and DRG codes

23. LSOA II SSA File Linkage Master Beneficiary Record • Enumeration Verification System • Additional matching algorithms • SSN verification status • Two sample issues: eligibility vs. match success Supplemental Security Income Record (SSI) Disability Control File (SSDI)

24. LSOA II SSA Variables For both SSDI & SSI beneficiaries (1991-2000) • Disability determination date • Primary disabling condition • Whether R ever applied for benefits • Whether R was ever denied benefits For SSDI beneficiaries (1991-2000) • Type of SSDI claim (worker, disabled, widow / widower, adult disabled as child)

25. LSOA II NDI File Linkage Death certificate data (1994-2002) • Probabilistic match process • Outcome statuses: presumed dead, presumed alive, ineligible File variables • NDI match status, score and class • Date (mm/dd/yyyy) of birth and death • Age at death / age last known alive • Underlying cause of death (ICD & recodes) • Multiple causes of death (record & entity)

26. NCHS Research Data Center (RDC) Purpose • To provide access to internal data files (those restricted from public use) Accessibility • On-site access - NCHS, Hyattsville, MD • Off-site access - User’s remote location

27. NCHS Research Data Center (RDC) User procedures • Submit a research proposal for review and receive approval • Sign an affidavit of confidentiality • Submit (in advance) data files to be linked with NCHS internal data (all linkages occur at NCHS) • Subject all output and/or materials removed from the RDC to a disclosure limitation review

28. NCHS Research Data Center (RDC) Contact Information For general questions • rdca@cdc.gov (301) 458-4732 For on-site access information • Negasi Beyene • nbeyene@cdc.gov (301) 458-4097 For remote access information • Vijay Gambhir • vgambhir@cdc.gov (301) 458-4226

29. Additional Information on the LSOA II • Survey Website • Documentation and data files • http://www.cdc.gov/nchs/lsoa.htm • Survey Email • lsoa@cdc.gov