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Centers for Disease Control and Prevention National Center for Health Statistics

Using Data from Across NCHS Sources to Analyze Public Health Issues Diane M. Makuc Annual Meeting of the American Public Health Association 11/4/06. Centers for Disease Control and Prevention National Center for Health Statistics.

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Centers for Disease Control and Prevention National Center for Health Statistics

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  1. Using Data from Across NCHS Sources to Analyze Public Health IssuesDiane M. MakucAnnual Meeting of the American Public Health Association 11/4/06 Centers for Disease Control and Prevention National Center for Health Statistics

  2. Thanks to several individuals who contributed to this presentation. Lara Akinbami Amy Bernstein Lois Fingerhut Yelena Gorina Richard Klein Kim Lochner Patricia Pastor

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 2. Healthy People 2010 • 467 health objectives • Data track progress towards year 2010 targets for each objective. • 21 major and 150 total data sources

  10. 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

  11. Prevalence of Diagnosed Diabetes Decrease desired Age-adjusted rate per 1,000 population 120 100 80 60 40 20 0 American Indian/ Alaska Native Black Hispanic Total White Asian 2010 Target: 25 1999 2000 2001 2002 2003 2004 2005 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 personsof 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. Obj. 5-3

  12. Proportion of Diabetes Diagnosed Increase desired Age-adjusted percent 1988-1994 2001-04 100 2010 Target: 78 80 60 40 20 0 Mexican American Male White Black Female Total Race/ethnicity Gender 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. Obj. 5-4

  13. Diabetes-Related Deaths Among Persons With Diabetes Decrease desired Age-adjusted rate per 1,000 11 10 9 8 7 6 5 0 2010 Target: 7.8 Male Total Female 1999 2000 20012002 2003 2004* 2004 data are preliminary. NOTE: Data are age adjusted to the 2000 standard population. SOURCE: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj. 5-7

  14. Lower Extremity Amputations Among Persons With Diabetes Decrease desired Age-adjusted rate per 1,000 1997-99 2002-04 20 15 10 2010 Target: 2.9 5 0 Female White Black 75+ Male <65 65-74 Total* Race* Gender* Age† 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. Obj. 5-10

  15. Annual Dilated Eye Exams Among Adults With Diabetes Increase desired Age-adjusted percent 1998 2003 80 2010 Target: 76 70 60 50 40 30 0 White At least some college Hispanic Black Total Less than High School High school Race/ethnicity Education Level* 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. Obj. 5-13

  16. 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

  17. 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

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

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

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

  21. 4. Trends in Health and AgingInteractive online data warehouse for statistics focusing on trends for persons age 65+

  22. Trends in Health and AgingNCHS data sources • NAMCS • NHAMCS • NHDS • NHHCS • NNHS • NHANES • NHIS • NVSS - mortality

  23. 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

  24. 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)

  25. 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: 5 Source: Deaths: Preliminary Data for 2004, table 2

  26. Faststats Accidents/ Unintentional Injuries More data • Deaths: Injuries, 2002 • Health, United States trend tables on injury • Injury Fact Sheet • Health Data for All Ages

  27. Faststats Accidents/ Unintentional Injuries Related links • National Ambulatory Medical Care Survey • National Hospital Ambulatory Medical Care Survey • Mortality data • International Collaborative Effort (ICE) on Injury Statistics

  28. 6. Injury Data web page

  29. 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

  30. 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”

  31. Example: Find information on measures of ADHD using Catalog • Step 1: Select “Conditions, symptoms, or concerns” • Step 2: Select “Conditions” • Step 3: Select “ADHD”

  32. 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

  33. 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.

  34. Mortality (NDI) Medicare (CMS) Retirement & Disability (SSA) NHIS 1986-2000 X NHIS 1994-1998 X X X LSOA II X X X NHANES I X X X NHANES II X X NHANES III X X X NNHS 1985 X X NCHS Surveys with Linked Files (Access in Research Data Center)

  35. Linked Mortality Data Elements • Eligibility status • Assigned vital status • Date of death • Age at death • Underlying and multiple causes of death • Geography

  36. Linked Medicare Data Elements • Denominator file • Entitlement status • Beneficiary demographic characteristics • Monthly enrollment status • HMO enrollment • Claims files • Diagnoses codes, service dates, reimbursement amounts

  37. 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)

  38. 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

  39. 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

  40. 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 aging agingact.htm

  41. 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

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