Using Data from Across NCHS Sources to Analyze Public Health Issues Diane M' Makuc Annual Meeting of

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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
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Thanks to several individuals who contributed to
this presentation.

• Lara Akinbami
• Amy Bernstein
• Lois Fingerhut
• Yelena Gorina
• Richard Klein
• Kim Lochner
• Patricia Pastor

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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

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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

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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

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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

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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

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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

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2. Healthy People 2010

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

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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

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Prevalence of Diagnosed Diabetes
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 persons of
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
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Proportion of Diabetes Diagnosed
Age-adjusted percent
1988-1994
2001-04
100
2010 Target 78
80
60
40
20
0
Mexican American
Black
White
Male
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
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Diabetes-Related Deaths Among Persons With
Diabetes
Age-adjusted rate per 1,000
11 10 9 8 7 6 5 0
2010 Target 7.8
Male
Total
Female
1999 2000 2001
2002 2003 2004
Obj. 5-7
2004 data are preliminary. NOTE Data are age
adjusted to the 2000 standard population.
SOURCE National Vital Statistics
SystemMortality (NVSS-M), NCHS, CDC.
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Lower Extremity Amputations Among Persons With
Diabetes
Age-adjusted rate per 1,000
1997-99
2002-04
20
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2010 Target 2.9
5
0
Black
White
Female
Male
lt65
65-74
75
Total
Race
Age
Gender
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
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Annual Dilated Eye Exams Among Adults With
Diabetes
Age-adjusted percent
1998
2003
80
2010 Target 76
70
60
50
40
30
0
At least some college
White
Black
Hispanic
High school
Less than High School
Total
Education Level
Race/ethnicity
I 95 confidence interval. Excludes persons
lt25 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
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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

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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
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Current asthma prevalence, by age and gender, US,
annual average 2002-2004 (National Health
Interview Survey)
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Asthma hospitalizations, by age and gender, US,
annual average 2002-2004 (National Hospital
Discharge Survey)
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Asthma deaths among adults, by age and gender,
US, annual average 2001-2003 (National Vital
Statistics System)
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4. Trends in Health and AgingInteractive online
data warehouse for statistics focusing on trends
for persons age 65
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Trends in Health and AgingNCHS data sources

• NAMCS
• NHAMCS
• NHDS
• NHHCS
• NNHS
• NHANES
• NHIS
• NVSS - mortality

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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

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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)

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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

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Faststats Accidents/ Unintentional Injuries

• More data
• Deaths Injuries, 2002
• Health, United States trend tables on injury
• Injury Fact Sheet
• Health Data for All Ages

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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

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6. Injury Data web page
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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

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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

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Example Find information on measures of ADHD
using Catalog

• Step 1 Select Conditions, symptoms, or
  concerns
• Step 2 Select Conditions
• Step 3 Select ADHD

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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

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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.

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NCHS Surveys with Linked Files (Access in
Research Data Center)
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Linked Mortality Data Elements

• Eligibility status
• Assigned vital status
• Date of death
• Age at death
• Underlying and multiple causes of death
• Geography

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Linked Medicare Data Elements

• Denominator file
• Entitlement status
• Beneficiary demographic characteristics
• Monthly enrollment status
• HMO enrollment
• Claims files
• Diagnoses codes, service dates, reimbursement
  amounts

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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)

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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

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For more information on NCHS record linkage
activities

• APHA Session 4128.1
• Tuesday November 7 at 1230PM
• Record linkage for epidemiologic research New
  opportunities and challenges
• Organized by Kimberly Lochner

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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

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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
• rd/nchs_datalinkage/data_linkage_activiti
  es.htm