Gloria Wheatcroft and Jennifer Parker Office of Analysis and Epidemiology

1. Evaluation of Alternative Matching Criteria by Race/Ethnicity and Sexin NHIS-NDI Linked Mortality files Gloria Wheatcroft and Jennifer Parker Office of Analysis and Epidemiology Centers for Disease Control and Prevention National Center for Health Statistics

2. Background • Individual demographic, behavioral, and health characteristics are strongly associated with mortality • These factors may also be associated with the presence and accuracy of survey information used for matching to the NDI • Inferences from studies that use survey data linked to mortality data to examine the correlates of mortality could be affected by differential matching

3. Prior matching evaluation • Liao et al. (AJPH 1998) evaluated three criteria for matching using the1986-1990 NHIS linked to NDI through 1991 • Exact social security number (SSN) match • (A) or SSN unknown and matching score for demographic items > recommended cutoffs • (A) or SSN unknown and either 8 or more demographic items match or fewer than 8 match but with high matching score, >=32.5

4. Liao et al (AJPH1998): Death Rates Men, 45-64 years A Exact match on social security B (A) or SSN unknown and score for demographic items > recommended cutoffs C (A) or SSN unknown and either >7 items match or < than 8 match but with high score

5. Liao et al (AJPH1998): Death Rate Ratios for Hispanic, relative to Non-Hispanic White, Men age 45-64 years A Exact match on social security B (A) or SSN unknown and score for demographic items > recommended cutoffs C (A) or SSN unknown and either >7 items match or < than 8 match but with high score

6. Objective • To examine effects of alternative matching criteria on mortality estimates obtained using NHIS-NDI Linked Mortality files • Death rates • Ratios between groups defined by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), age, and sex • Comparison by nativity and health status

7. Methods • NHIS-NDI Linked Mortality files • NHIS1989-1994 linked to NDI through 2002 • Mortality ascertained using four matching criteria • Least conservative, Current NCHS recommendation, Moderately conservative, Most conservative • Death rates and hazard ratios were calculated using survival analysis programs in Stata • Standard errors were not estimated but cell sizes were reasonably large

8. Matching Criteria

9. Number of Deaths by Matching Criteria Non-Hispanic white Non-Hispanic black Hispanic Least conservative criteria Current NCHS criteria Moderately conservative criteria Most conservative criteria

10. Male versus Female Death Rate Ratios, by Age and Race/Ethnicity Non-Hispanic black Hispanic Death Rate Ratio

11. Death Rate Ratios for Race/Ethnicity, by AgeMales Non-Hispanic black relative to non-Hispanic white Hispanic relative to non-Hispanic white Rate Ratios

12. Death Rate Ratios for Race/Ethnicity, by Age Females Non-Hispanic black relative to non-Hispanic white Hispanic relative to non-Hispanic white Rate Ratio

13. Hazard Ratios* for Hispanic Females, by Education (Relative to Non-Hispanic White Females) Hazard Ratio(Cox proportional hazards) * Hazard Ratios controlled for age

14. Hazard Ratios* for Hispanic Females, by Health Status(Relative to Non-Hispanic White Females) Hazard Ratio (Cox proportional hazards) *Hazard Ratios controlled for age

15. Hazard Ratios* for Hispanic Females, by Years in the United States(Relative to Non-Hispanic White Females) Hazard ratio (Cox proportional hazards) *Hazard Ratios controlled for age

16. Previous study • Finch BK et al “Validity of Self-rated Health among Latino(a)s” Am J Epidemiol 2002 • Examined whether self-rated health had differential mortality risks for Latino(a) adults by acculturation • Concluded that self-reported poor health status was a weaker marker of mortality for the less acculturated • Used 1989-1994 NHIS linked to the NDI through 1997

17. Finch et al (AJE 2002): Hazard ratio for Health Status, Hispanics(Poor/Fair Health relative to Good/Excellent Health) Hazard ratio (Cox proportional hazards) • Adjusted for age, sex, marital status, education, employment, origin and income • NHIS-NDI 1989-1994/1997

18. Hazard ratio* by Health Status, Hispanics(Poor/Fair Health relative to Good/Excellent Health) Hazard ratio(Cox proportional hazards) * Adjusted for age, sex, marital status, education and income ** Finch et al used NHIS/NDI 1989-1994/1989-1997, also adjusted for employment and origin

19. Summary • Matching criteria differentially affect mortality estimates by race/ethnicity, sex, and age • Groups most affected are Hispanics, especially Hispanic females and younger Hispanics • Differential matching may affect inferences • Education, Health status, Nativity

20. Summary • Different criteria change number of matched deaths by about +/- 5% • Small effect of different criteria on many inferences • Non-Hispanic black, non-Hispanic white • Older Hispanics • Hispanics who have lived in the U.S. for a long time

21. Conclusions • Overall associations likely to be robust to different matching criteria • No current “gold” standard • Sensitivity analysis would be appropriate for some studies