1. Part 1: Data Sources Frank Porell
Data and Methodology
Part 1: Data Sources
Frank Porell

2. Data Sources
The great majority of healthy aging indicators were derived from three primary data sources:
The American Community Survey (ACS) of the U.S. Census Bureau was the major source of demographic, socioeconomic status, and housing data for cities, towns, and neighborhoods within Manchester and Nashua.
The Medicare Master Beneficiary Summary File ( ) of the Centers for Medicare and Medicaid Services (CMS) was the major source of data on prevalence rates of chronic disease and disabling conditions, and Medicare service utilization rates.
The Behavioral Risk Factor Surveillance System ( ) of the Centers for Disease Control and Prevention was the major source of data for health risk behaviors, preventive health practices, and health care access.

3. Other Data Sources
Medicare Compare website ( geographic access to Medicare providers)
Federal Bureau of Investigation Uniform Crime Reports. (crime rates)
U.S Department of Agriculture Food Access Research Atlas website (food deserts)
The AirNow website of the U.S. Environmental Protection Agency (air quality)
The Elder Economic Security Standard™ Index. ( living costs)
New Hampshire Elections Division, Secretary of the Commonwealth (voting rates)
New Hampshire Department of Health and Human Services (community health and adult day centers)

4. Data Sources
The American Community Survey (ACS)
for cities, towns, and neighborhoods within Manchester and Nashua.
Data downloaded from U.S. Census Bureau Fact Finder website ( for all 259 individual cities and towns. In addition, census tract data were downloaded and aggregated for 5 neighborhoods within the city of Manchester. Data were downloaded for 4 zip code areas in Nashua
The downloaded ACS data are estimates of counts persons in NH towns, census tracts, or zip codes. Reported ACS indicators were either person counts or percentages derived from persons counts without any statistical adjustments.

5. Data Sources The Medicare Master Beneficiary Summary File (2014-2015)
The Master Beneficiary Summary File (MBSF) is a set of four annual data files created by the Chronic Conditions Warehouse for CMS that contain person-level summary records derived from Medicare claims for all persons eligible for Medicare for at least one month during any calendar year.
MBSF data for NH contains individual records for all persons who were age 65 years or older on January 1st of the either calendar year, and had a state residence code of New Hampshire for either year.

6. Data Sources The four MBSF data files contain:
(1) A/B/D file- Medicare program administrative data such as age, sex, monthly data on eligibility, Medicaid dual status, Medicare Advantage enrollment status, date of death
(2) Chronic conditions- includes prevalent chronic disease indicators derived from algorithms applied to diagnostic codes on individual Medicare fee-for-service provider claims for 27 prevalent chronic conditions
(3) Disabling conditions- includes prevalent indicators derived from algorithms applied to diagnostic codes on individual Medicare fee-for-service provider claims for 39 chronic health, mental health, substance abuse, and potentially disabling conditions.
(4) Cost and use- includes summaries of annual service utilization and reimbursements for Medicare services (e.g., inpatient hospitalizations, physician visits, home health visits, skilled nursing facility stays, emergency room visits, and filled Part D prescriptions).

7. Data Sources
A major strength of the MBSF data is that they contains records for 100% of persons 65 years or older with at least one month of Medicare eligibility and New Hampshire residence.
100% coverage allows for estimation of prevalence rate indicators for relatively small towns.
A shortcoming of the MBSF data is that chronic disease and disabling condition indicators are derived from Medicare claims data and can only be measured for Medicare beneficiaries who receive their care from fee-for-service providers.
For example, no indicators can be measured for Medicare Advantage enrollees because Medicare does not receive claims for these beneficiaries.

8. Data Sources The Behavioral Risk Factor Surveillance System
Respondent-level BRFSS data obtained from the New Hampshire Department of Health and Human Services that contained information on the residence town and zip code of each respondent allowing for estimation of indicators for cities and towns within the state.
A major strength of the BRFSS data is its rich information on individual health behaviors such as smoking, excessive drinking, obesity, and preventive health service use.

9. Data Sources Behavioral Risk Factor Surveillance System
Two shortcomings of the BRFSS
Survey design developed for state-level estimates– not cities and towns. The sample size of respondents 60 years or older in any particular town is too small for estimating town-level rates.
Overall sample size of respondents 60 years or older in NH state is small- ranged from 2,867 in 2013 to 3,622 in 2015.
Two steps were taken to increase estimation sample sizes for subareas of the state:
3 years of BRFSS data were pooled together (e.g., )
Cities and towns were spatially aggregated together forming larger geographic areas

10. The End