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

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

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

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

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

Resources for accessing data from across NCHS sources 1. Health, United States 2. Healthy People Health Data for All Ages 4. Trends in Health and Aging 5. Faststats 6. Injury Data web page 7. Child & Adolescent Mental Health Metadata

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

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

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

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

Total Obj Age-adjusted rate per 1,000 population 2010 Target: 25 Prevalence of Diagnosed Diabetes Decrease desired American Indian/ Alaska Native Black Hispanic White Asian 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.

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

Obj * Age-adjusted rate per 1, Target: 7.8 Decrease desired Male Female 2004 data are preliminary. NOTE: Data are age adjusted to the 2000 standard population. SOURCE: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Diabetes-Related Deaths Among Persons With Diabetes Total

Black 5 Age-adjusted rate per 1, Obj 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 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. Race * 0 White Female Male< Age † Total * Lower Extremity Amputations Among Persons With Diabetes Gender * Decrease desired 2010 Target: 2.9

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. High school 30 Age-adjusted percent Obj Education Level * 0 Less than High School At least some college Total 60 Increase desired Annual Dilated Eye Exams Among Adults With Diabetes BlackHispanic White Race/ethnicity 2010 Target: 76

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

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

Current asthma prevalence, by age and gender, US, annual average (National Health Interview Survey)

Asthma hospitalizations, by age and gender, US, annual average (National Hospital Discharge Survey)

Asthma deaths among adults, by age and gender, US, annual average (National Vital Statistics System)

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

Trends in Health and Aging NCHS data sources NAMCS NHAMCS NHDS NHHCS NNHS NHANES NHIS NVSS - mortality

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

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)

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

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

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

6. Injury Data web page

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

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”

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

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

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.

NCHS Surveys with Linked Files (Access in Research Data Center) XXNNHS 1985 XXXNHANES III XXNHANES II XXXNHANES I XXXLSOA II XXXNHIS XNHIS Retirement & Disability (SSA) Medicare (CMS) Mortality (NDI)

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

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

Linked Social Security Data Elements RSDI information Master Beneficiary Record RSDI program eligibility, benefit amount, payment status, dual entitlement Payment History Update System RSDI benefit payment amounts, including withholding information for Medicare Part B premiums Actual benefit payment in a given month (Form 1099)

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

For more information on NCHS record linkage activities APHA Session Tuesday November 7 at 12:30PM Record linkage for epidemiologic research: New opportunities and challenges Organized by Kimberly Lochner

Web addresses 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

Web addresses 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