Using Health and Family Data from the National Center for Health Statistics to Study Health Disparities

1. Using Health and Family Data from the National Center for Health Statistics to Study Health Disparities Anjani Chandra, Ph.D.

2. Agenda • NCHS mission • Overview of major NCHS data systems • NHANES • NHIS • NHCS • NVSS • Closer look at data sets related to reproductive and perinatal health

3. NCHS Mission To monitor the nation’s health by providing data that are: • accurate • relevant • timely To support the broader CDC mission: SAFER … HEALTHIER … PEOPLE

4. NCHS Data Are Used For • Comparisons across populations, providers, and geographic areas • Planning/assessing public health programs • Identifying health problems, risk factors, and disease patterns

5. Quality Control at Every Stage • Data collection • Instrument design • Interviewer (or data collector) training • Data analysis • Evaluation of data quality • Information dissemination

6. Four Major Data Systems at NCHS • National Health and Nutrition Examination Survey • National Health Interview Survey • National Health Care Survey • National Vital Statistics System and surveys

7. NHANES Data sources • Personal interviews (including ACASI) • Physical examinations • Laboratory tests • Nutritional assessments

8. NHANES sample design 30,000 persons aged 2 months or older Oversample • African Americans • Mexican Americans • Adolescents aged 12-19 • Older persons aged 60+ • Pregnant women OP96031

9. Mobile Examination Center (MEC) Trailer used for NHANES

10. Some Uses of NHANES • Estimate the prevalence and distribution of health conditions and related risk factors in the population • Describe awareness, treatment and control of selected diseases • Monitor trends in health, risk behaviors, and environmental exposures over time OP96023

11. Some Uses of NHANES (cont’d) • Study the relationship of diet, nutrition and health • Develop “growth charts” for evaluating child development • Explore emerging public health issues • Establish a national probability sample of genetic material for future research OP96024

14. National Health Interview Survey (NHIS) Data source • Personal interviews with household members Sample • 41,000 households annually (approximately 110,000 people) • Oversample African Americans and Hispanics

15. NHIS Components • Core questionnaire • Topical modules • Periodic modules

16. NHIS Core Questionnaire Collects minimal information on • Health behaviors • Chronic and acute conditions • Health care utilization • Health status and limitations

17. NHIS Modules Topical modules collect data on: • Emerging problems or specific health problems • Cancer • Healthy People 2000 and 2010 indicators • Diabetes Periodic modules collect more detailed information on one of the four areas of health above.

18. NHIS Module Topics Have Included • Health status and disability • Insurance coverage • Access to care • Use of health services • Immunization • Health behaviors • Family practices

22. The National Health Care Survey(Original Surveys) • National Hospital Discharge Survey • National Ambulatory Medical Care Survey • National Nursing Home Survey • National Health Provider Inventory

23. The National Health Care Survey (Newer Surveys) • National Hospital Ambulatory Medical Care Survey • National Survey of Ambulatory Surgery • National Home and Hospice Care Survey

24. Some Uses of NHCS Data • Prevalence of diagnosis and treatment • Trends in use of services • Characteristics of patients and providers • Patterns of disease • Use of technology drugs, and other treatments • Emergence of alternative care sites

27. Other NCHS Surveys • National Immunization Survey • State and Local Area Integrated Telephone Survey (SLAITS) • National Longitudinal Survey of Aging (LSOA)

28. National Vital Statistics System Data source • State vital registration Sample • All births, deaths, and fetal deaths • Counts of marriages and divorces

29. Hispanic and API Subgroups (since 1990s) Hispanic origin • Mexican, Puerto Rican, Cuban, Central or South American, other/unknown Hispanic group Asian American or Pacific Islander • Chinese, Japanese, Hawaiian, Filipino, Asian Indian, Korean, Vietnamese, Samoan, Guamanian, Other Asian or Pacific Islander1 1 Categories in green are available only for selected States

30. Some Uses of Mortality Data • Life expectancy • Fetal and Infant mortality • Occupational mortality • Causes of death • National Death Index (for mortality ascertainment)

31. Life Expectancy at Birth, by Race and Year Source: National Vital Statistics System - Mortality, CDC, NCHS. Source: Arias E (2002). United States Life Tables, 2000. Nat’l Vital Statistics Reports 51(3). Hyattsville, MD: NCHS.

33. Multiple race Education Marital status Place of death Pregnancy status If transportation injury, decedent’s role with respect to vehicles Tobacco use Revised Death Certificate

34. Some Uses of Natality Data • Birth rates • Nonmarital births • Births to teens • Prenatal care and birthweight • Cesarean delivery • Obstetric complications • Timing of births (incl. delayed childbearing) • Pregnancy rates (along w/other data)

36. Pregnancy, Live Birth, Induced Abortion & Fetal Loss Rates, 1990 & 1995 Rate per 1,000 Women 1995 1990 Source: Ventura et al, 2000

37. More detail on cigarette smoking Method of delivery More height & weight info Congenital anomalies Infertility treatment WIC Infections during preg Maternal morbidity Breast feeding Payment for delivery Revised Birth Certificate Separate worksheets for mother & for facility, to encourage collection from best data sources.

38. Certificate Revision Website(birth & death) For everything you always wanted to know about the revision but were afraid to ask… www.cdc.gov/nchs/vital_certs_rev.htm

39. Other Datasets for Perinatal Health Research In addition to the annual National Natality Datasets: • Linked Birth/Infant Death Files • Matched Multiple Birth File (through RDC) • Fetal Death Files

40. National Survey of Family Growth

41. Uses of NSFG data • Collect periodic data on the “intermediate variables” • “Snapshot” of U.S. fertility, family formation, and reproductive health • Complement vital statistics • Track national health objectives • Evaluate health & social policies • Research: demographic and public health

42. Intermediate variables Intercourse variables: Social factors • Timing of first intercourse • Percent of women who • ever had intercourse • Time spent in marriage • (separation, divorce) • Frequency of intercourse • Race/ethnicity • Religion • Labor force • participation • Education • Income • Access to • health care • Family • background • Community • environment • (economic, • social, etc.) Conception variables: Fertility (live births) • Contraceptive use • Sterilization • Infertility Pregnancy outcome (gestation) variables: • Miscarriage and • stillbirth • Induced abortion

43. NSFG sample (Cycles 1-5) • Nationally representative sample of women • Civilian non-institutionalized population of women 15-44 • Multi-stage probability sample • Oversample black women and starting in 1995, Hispanic women • 1988 & 1995 – based on NHIS sample

44. NSFG Cycles 1-5 Cycle Year N Women 15-44 1 19739,797Ever-married 219768,611 Ever-married 319827,969All 419888,450All 4 (Tel)19905,686Reintv of ‘88 & new teens 5199510,847All

45. Innovations in 1995 NSFG, Cycle 5 • Major changes in questionnaire content and format • Changed mode of data collection to CAPI and Audio CASI • $20 token of appreciation paid to respondents -- maintain response rates with longer, more sensitive interview

46. Selected Findings from the 1995 NSFG

47. Children Ever Born, by Woman’s Education, 1995 Source: Abma et al, 1997, Table 4

48. Percent of Women 18-29 Who Had a Birth Before 18 Percent Median Family Income at Block Level Source: 1995 National Survey of Family Growth, Contextual Data Files

49. Father Figure During Adolescence: U.S. women 15-44 in 1995 Percent Type of Father Figure: Source: Peterson, poster presented at PAA 1998

50. Percent Likelihood that 1st Marriage Dissolves Within Ten Years Percent Age at marriage Source: Bramlett & Mosher, 2002