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National Health and Nutrition Examination Survey: Overview

National Health and Nutrition Examination Survey: Overview. Clifford Johnson, Director. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics. Objectives. Some NHANES history Survey operations and data collection

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National Health and Nutrition Examination Survey: Overview

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  1. National Health and Nutrition Examination Survey: Overview Clifford Johnson, Director U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

  2. Objectives • Some NHANES history • Survey operations and data collection • Content • Uses and findings • Summary thoughts

  3. NHANES • Objective • To assess the health and nutritional status of adults and children in the United States

  4. Sample • Civilian, non-institutionalized household population • Residents of all states and the District of Columbia • All ages • 5,000 individuals each year

  5. NHANES • Unique in combining a home interview with health examinations conducted in a mobile examination center • Almost 50 years experience conducting survey using direct physical measures

  6. National Health and Nutrition Examination Surveys Survey Dates Ages NHES I 1960-62 18-79 years NHES II 1963-65 6-11 years NHES III 1966-70 12-17 years NHANES I 1971-75 1-74 years NHANES II 1976-80 6 mo.-74 years HHANES 1982-84 6 mo.-74 years NHANES III 1988-94 2 mo. + OP96S025

  7. National Health and Nutrition Examination Surveys Dates Survey Ages NHANES 1999-2000 All ages NHANES 2001-2002 All ages NHANES 2003-2004 All ages NHANES 2005-2006 All ages NHANES 2007-2008 All ages NHANES 2009-2010 All ages NHANES 2011-2012 All ages OP96S025

  8. NHANES response rates 1999-2006 81.4% Interviewed 77.9% MEC examined

  9. Benefits of Participation • Opportunity for community service • Free health measurements and lab studies with report of findings • Numerous lab studies not usually provided during a routine physical examination • Toll free number to discuss abnormal results with the NHANES Medical Officer

  10. Benefits of Participation • Cash remuneration • Reimbursement for travel or free transportation

  11. Data Collection

  12. Participant health interview • Length of interview varies depending on age • Self report -16 years and older and emancipated minors • Proxy report - children under 16 • Demographic and risk factor data

  13. NHANES Examination • Standardized physical exam • Conducted at mobile exam center • Medical & dental exams • Physiological measurements • Laboratory test • Administered by trained medical personnel

  14. NHANES Mobile Exam Center (MEC)

  15. NHANES topics • Cardiovascular disease • Diabetes • Bone status, osteoporosis • Oral health • Vision and eye diseases • Hearing and balance • Fitness and strength • Allergies OP96S035

  16. NHANES topics • Nutrition • Anthropometry • Mental health • Risk behaviors • Reproductive health • Environmental exposures • Infectious diseases • Spirometry OP96S036

  17. Examples of NHANES Findings and Uses

  18. Landmark findings and public health results • High blood lead levels • Lead out of gasoline • Low folate levels • Mandatory food fortification • Rising levels of obesity • Public health action plan • Racial and ethnic disparities in Hepatitis B • Universal vaccination of all infants & children

  19. 2000 CDC Growth Charts: United States OP96065

  20. Trends in Child and Adolescent Overweight Percent Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and 1999-2004, NCHS, CDC.

  21. Trends in Adult Obesity, 20-74 years Percent Note: NHES and NHANES data; Age-adjusted by the direct method to the year 2000 US Bureau of the Census estimates using the age groups 20-39, 40-59 and 60-74 years. Obesity defined as BMI>=30.

  22. Prevalence of Obesity Among Adults ≥ 18 years, United States SOURCE: Hedley, unpublished analyses

  23. Mean Serum Folate Concentrations Females: United States ng/mL NHANES 1999-2000 NHANES III 1988-1994 Years

  24. Trends in Median Serum Folate Levels of Males and Females; United States: 1988-2006 1988-1994 1999-2000 2001-2002 2003-2004

  25. Seroprevalence of measlesAntibody by birth cohort % measles seropositive IgG Threshold for herd immunity Birth Cohort SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES) 1999-2004.

  26. Additional Chemicals in 3rd Report148 chemicals • 38 new chemicals • One new class • Pyrethroid pesticides • Additions w/in class • PAHs • Aldrin, dieldrin, endrin • Phthalate metabolites • Dioxins, furans and PCBs • Pesticides and herbicides www.cdc.gov/exposurereport

  27. 0 0 Lead used in gasoline production andaverage blood lead levels Lead used In gasoline Total lead used per 6 month period (1000 tons) Average blood lead levels (micrograms/deciliter) Average blood lead levels 1976 1977 1978 1979 1980 SOURCE: CDC/NCHS, Second National Health and Nutrition Examination Survey, 1976-80.

  28. Blood lead levels in the U.S. Children Ages 1-5 yrs, 1976 - 2002 16 14 12 10 Blood lead levels(mg/dL) 8 6 4 2 0 2000 2002 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 Year

  29. Exposure to Second Hand Smoke: Nonsmokers with Detectable Cotinine* Levels, Percent with detectable serum cotinine 1988-94 Baseline 1999-2000 2010 Target Mexican American Black, not Hispanic White, not Hispanic Total Ages 4 years and older Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC.

  30. Selected Percentiles of Total Blood Mercury Women 16-49 years NOTE: NHANES 1999-2000 SOURCE: CDC/NCHS

  31. Prevalence of reduced hip bone density among persons 65 years of age and over Osteopenia Percent Osteoporosis 65-74 years 75-84 years 85 years and over 65-74 years 75-84 years 85 years and over Women Men OP96S071 SOURCE: CDC/NCHS, NHANES III 1988-94

  32. Diabetes and Impaired Fasting Glucose, 1999-2000 Percent Percent Impaired fasting glucose Undiagnosed Diagnosed ³60 20-39 40-59 SOURCE: CDC/NCHS, National Nutrition and Health Examination Survey, 1999-2000; National Health Interview Survey, 1999, 2000.

  33. Prevalence of lower extremity disease (LED) in the United States among adults aged > 40 years by type of LED*, symptomatic and diabetes status. NHANES, 1999–2000 Percent Total Non-Diabetic Diabetic * PAD: peripheral arterial disease; PN: peripheral neuropathy REF: Gregg, Sorlie, Paulose-Ram, Gu, Eberhardt, Wolz, Burt, Curtin, Engelgau, Geiss. Diabetes Care. 2004 Jul;27(7):1591-7 Not all estimates meet standard of statistical reliability and precision (relative SE >30%).

  34. NHANES Data Central to Health Policy and Practice • Unique national source of actual measurement data • Ability to integrate findings from each interview and exam component • High quality of data collection, processing and analysis • Responsive and relevant to current and future data needs

  35. NHANES Provides Data for Many Essential Public Health Functions • Prevention initiatives • Monitoring exposure levels—pollutants, chemicals • Food safety and fortification • Disease control • Tracking health behaviors

  36. Other Activities • Future of Health and Nutrition Examination Surveys • Community HANES • Longitudinal Follow-ups • Linked files • Efficiencies • Web tools

  37. Final Thoughts • Many lessons learned over fifty years • We know better when we measure • Focus should be on content, logistical issues and operational methods – everything matters and is important • Survey design important but quality data collection and timely release of results is essential to success

  38. http://www.cdc.gov/nchs/nhanes.htm

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