Transcript Using Health and Family Data from the National Center for

Using Health and Family
Data from the National
Center for Health Statistics
to Study Health Disparities
Anjani Chandra, Ph.D.
National Center for Health Statistics
CDC
CENTERS FOR DISEASE CONTROL
AND PREVENTION
Agenda
•
•
NCHS mission
Overview of major NCHS data systems
• NHANES
• NHIS
• NHCS
• NVSS
•
Closer look at data sets related to reproductive
and perinatal health
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
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
Quality Control at Every Stage
• Data collection
• Instrument design
• Interviewer (or data collector) training
• Data analysis
• Evaluation of data quality
• Information dissemination
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
NHANES
Data sources
• Personal interviews (including ACASI)
• Physical examinations
• Laboratory tests
• Nutritional assessments
NHANES sample design
30,000 persons aged 2 months or older
Oversample
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African Americans
Mexican Americans
Adolescents aged 12-19
Older persons aged 60+
Pregnant women
OP96031
Mobile Examination Center (MEC) Trailer
used for NHANES
Some Uses of NHANES
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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
Some Uses of NHANES (cont’d)
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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
Mean serum folate concentrations:
Women
ng/mL
25
NHANES III 1988-1994
NHANES 1999-2000
20
15
10
5
0
3-5
6-11
12-19 20-39 40-59
Years
60+
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
NHIS Components
• Core questionnaire
• Topical modules
• Periodic modules
NHIS Core Questionnaire
Collects minimal information on
• Health behaviors
• Chronic and acute conditions
• Health care utilization
• Health status and limitations
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.
NHIS Module Topics Have Included
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Health status and disability
Insurance coverage
Access to care
Use of health services
Immunization
Health behaviors
Family practices
Children aged <18 years with
Public Coverage
United States, 1997- quarter 1 2002
Percent
35
95% confidence interval
30
25
20
15
10
5
0
1997
1998
1999
2000
2001
2002
(Jan.-Mar.)
Age-adjusted percent
27-1a. Current Cigarette Smokers:
Adults 18 and Older
1998
Baseline
45
40
2010 target
2001
35
30
25
20
15
10
5
0
Total
9-11 yrs. HS grad.
College
Education Level*
Poor
Near Poor Mid./High
Family Income Level
Age adjusted to the 2000 Standard Population. I 95% confidence interval. *Preliminary data: January-September 2002.
SOURCE: National Health Interview Survey (NHIS), NCHS, CDC.
Female
Male
Sex
Early cancer detection procedures:
by income level, 2000
Age-adjusted percent
Poor
Near
poor
100
80
76
72 75
55 56
20
0
2010
Target
85
60
40
Middle
/High
25
Mammogram:
Females 40+
(in past 2 years)
Pap Test:
Females 18+
(in past 3 years)
I 95% confidence interval.
* Exam includes sigmoidoscopy, colonoscopy, or proctoscopy.
Note: Data are age adjusted to the 2000 standard population.
Source: National Health Interview Survey (NHIS), CDC, NCHS.
30
37
Fecal Occult Blood Test:
Adults 50+
(in past 2 years)
29
35
43
Exam*:
Adults 50+ (ever)
The National Health Care Survey
(Original Surveys)
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National Hospital Discharge Survey
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National Ambulatory Medical Care Survey
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National Nursing Home Survey
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National Health Provider Inventory
The National Health Care Survey
(Newer Surveys)
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National Hospital Ambulatory Medical
Care Survey
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National Survey of Ambulatory Surgery
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National Home and Hospice Care Survey
Some Uses of NHCS Data
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Prevalence of diagnosis and treatment
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Trends in use of services
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Characteristics of patients and providers
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Patterns of disease
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Use of technology drugs, and other treatments
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Emergence of alternative care sites
Holding
Holdingup
upaamirror
mirrorto
tothe
thehealth
healthcare
care
delivery
system
delivery system
Trends in hospitalizations
(National Hospital Discharge Survey)
Rate per 10,000
180
• Overall hospitalizations
declined from 158 to 103
per 10,000 population
120
60
• Potentially avoidable
hospitalizations increased
from 99 to 134 per 10,000
0
1980
1984
Avoidables
1988
1992
Non-avoidables
1996
1998
Trend in rate of avoidable hospitalizations
for those over 65, by race
(NHDS)
700
Rate per 10,000
600
500
564
Blacks
352.8
400
300
450
Whites
325.2
200
100
0
1980
1984
1988
1992
1996
1998
Other NCHS Surveys
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National Immunization Survey
State and Local Area Integrated Telephone
Survey (SLAITS)
National Longitudinal Survey of Aging
(LSOA)
National Vital Statistics System
Data source
• State vital registration
Sample
• All births, deaths, and fetal deaths
• Counts of marriages and divorces
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
Some Uses of Mortality Data
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Life expectancy
Fetal and Infant mortality
Occupational mortality
Causes of death
National Death Index (for mortality ascertainment)
Life Expectancy at Birth, by Race and Year
80
75
70
65
60
55
50
All
races
White
Black
1960
1970
1980
1990
2000
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.
Age-adjusted rate per
100,000 standard population
Motor vehicle crash deaths and homicides
Motor vehicle
crash deaths
20
15
10
Homicides
2010
target
5
2010
target
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Note: Data are age adjusted to the 2000 standard population.
Source: National Vital Statistics System - Mortality, CDC, NCHS.
Revised Death Certificate
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Multiple race
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If transportation
injury, decedent’s role
with respect to
vehicles
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Tobacco use
Education
Marital status
Place of death
Pregnancy status
Some Uses of Natality Data
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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)
140
Birth Rates for Teenagers by Age
United States, 1970 - 2001
120 Rates per 1,000 Women
100
80
18-19
60
40
15-19
20
15-17
0
1970
1975
1980
1985
1990
1995
2000
Pregnancy, Live Birth, Induced Abortion & Fetal Loss Rates,
1990 & 1995
Rate per 1,000 Women
200
180
160
67
140
120
100
80
60
40
20
35
34
58
21
20
15
63
24
89
108
14
15
21
58
75
20
Fetal
loss
105
Live
birth
0
NonNonHispanic
Hispanic Hispanic
White
Black
1990
Source: Ventura et al, 2000
NonNonHispanic
Hispanic Hispanic
White
Black
1995
Induced
Abortion
Revised Birth Certificate
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More detail on
cigarette smoking
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Method of delivery
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Congenital anomalies
More height & weight
info
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Infertility treatment
WIC
Infections during preg
Maternal morbidity
Breast feeding
Payment for delivery
Separate worksheets for mother & for facility, to encourage collection
from best data sources.
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
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
National Survey of Family Growth
Uses of NSFG data
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Collect periodic data on the “intermediate
variables”
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“Snapshot” of U.S. fertility, family formation, and
reproductive health
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Complement vital statistics
Track national health objectives
Evaluate health & social policies
Research: demographic and public health
Intermediate variables
Social factors
•Race/ethnicity
•Religion
•Labor force
participation
•Education
•Income
•Access to
health care
•Family
background
•Community
environment
(economic,
social, etc.)
Intercourse variables:
•Timing of first intercourse
•Percent of women who
ever had intercourse
•Time spent in marriage
(separation, divorce)
•Frequency of intercourse
Conception variables:
•Contraceptive use
•Sterilization
•Infertility
Pregnancy outcome
(gestation) variables:
•Miscarriage and
stillbirth
•Induced abortion
Fertility
(live
births)
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
NSFG Cycles 1-5
Cycle
Year
N
Women 15-44
1
2
3
4
4 (Tel)
1973
1976
1982
1988
1990
9,797
8,611
7,969
8,450
5,686
5
1995
10,847
Ever-married
Ever-married
All
All
Reintv of ‘88
& new teens
All
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
Selected Findings from the
1995 NSFG
Children Ever Born, by Woman’s Education, 1995
100%
80%
60%
3 or more births
40%
2 births
20%
1 birth
0%
Less than High High School Some college
School
diploma/GED
Source: Abma et al, 1997, Table 4
Bachelor's
degree or
higher
0 births
Percent of Women 18-29 Who Had a Birth Before 18
Percent
50
45
All women
40
33
35
Non-Hispanic White
30
18
20
15
10
Non-Hispanic Black
21
25
8
15
10
5
9
6
3 2 2
$20,000$49,999
$50,000 &
up
5
0
All
Incomes
Under
$20,000
Median Family Income at Block Level
Source: 1995 National Survey of Family Growth, Contextual Data Files
Father Figure During Adolescence: U.S. women 15-44 in 1995
Percent
100
90
3
4
7
80
11
7
6
10
7
10
70
None
60
50
Type of
Father
Figure:
87
40
80
Relative/
other
68
30
20
Stepfather
10
0
Own father
Non-Hispanic
White
Non-Hispanic
Black
Source: Peterson, poster presented at PAA 1998
Hispanic
Percent Likelihood that 1st Marriage Dissolves Within Ten Years
Percent
100
90
80
70
60
50
40
30
20
10
0
Age
at
marriage
Under 18
18-19
20-24
Over 24
All Races
Source: Bramlett & Mosher, 2002
Non-Hispanic
White
Non-Hispanic
Black
Type of Contraceptive Used Among Women 15-44
Who Currently Use Contraception: U.S., 1995
14%
4%
28%
20%
Method:
Female
sterilization
Male sterilization
Pill
11%
27%
Condom
Other
Implant/injectable
Source: Piccinino & Mosher, 1998
One-Year Failure Rates by Method: US, 1995
(Chance of Having an Unintended Pregnancy in 1 Year of
Using the Method)
25
20
15
13
8
10
3
Periodic
Abstinence
Male
Condom
OC Pill
Shot
(Injectable)
(Depo)
0
All Methods
Percent
30
Current contraceptors 20-44 who are using female
sterilization
Hispanic
Non-Hispanic White
Non-Hispanic Black
60
50
40
Percent 30
20
10
0
Lower
income
Middle
income
Higher
income
Median income at block level
Source: Mosher et al., 2003, Table 9
Percent of Babies Born 1990-94 who were Breast-fed at all
Percent
Non-Hispanic White
Non-Hispanic Black
90
80
70
60
50
40
30
20
10
0
Lower income
Middle
income
Median income at block level
Source: Mosher et al., 2003, Table 15
Higher
income
Payment for Delivery for Women’s Most Recent Birth, 1991-5
100%
90%
80%
70%
6
7
9
26
41
60%
65
50%
40%
30%
20%
8
68
75
Private
insurance
Medicaid
52
10%
26
17
25-29
30-44
0%
Under 20
20-24
Mother’s Age at Delivery
Source: Abma et al, 1997, Table 69
Other
Percent of Recent Births that were Intended
at Conception
Age at
birth
Under 20
20-29
30-44
100
80
60
40
20
0
Hispanic
NonNonHispanic Hispanic
White
Black
Race and Hispanic Origin
Source: Abma et al., 1997, Table 14
Use of Family Planning or Medical Services in Past
Year Among Women 15-44: U.S., 1995
Percent
100
90
80
70
62
61
60
50
33
40
30
21
17
16
20
8
10
0
fam
Any
t
r
isit
v
xam
mea
y tes
e
g
s
c
n
c
i
n
i
p
n
a
v
n
Pa
lan
Pel
Preg
ily p
Source: Abma et al, 1997, Table 74
f
test
V
r STD n/pelv in
I
e
H
h
t
ro
g/uri
a
v
TT fo
r
TT fo
Percent of Women 15-44 Ever Treated for PID
Percent
16
Age at
first sex
14
Under
15
15-17
12
10
8
18-19
6
Over 19
4
2
0
All women NH White
NH Black
Hispanic
Race and Hispanic Origin
Source: Abma et al, 1997, Table 89
Percent Uninsured Among Women 15-44
Percent
25
Married
20
Unmarried
15
10
5
0
Hispanic
Non-Hispanic
White
Non-Hispanic
Black
Race and Hispanic Origin
Source: 1995 National Survey of Family Growth
Non-Hispanic
Other
Percent of Unmarried Women Reporting 4 or More Male Sexual
Partners in Past Year, Interviewer versus Self-administered mode
Percent
25
20
15
15
10
5
10
9
3
3
3
Interviewer
Administered
Audio selfadministered
7
3
2 5
0
Total
Less than High
school
High School
diploma/GED
Education
Source: Abma et al, 1997, Table 27
Some college
Bachelor's
degree or
higher
Using the 1995 NSFG
• Several data files available
• Common CASEID allows linkage of
information across files
• Access procedures vary due to
confidentiality and sensitivity of data
1995 NSFG data files available
• Public Use Files
• Respondent file
• Pregnancy (interval) file
• Omitted Items File
• Fieldwork File
• Contextual Data Files
NSFG - variance estimation
•
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Complex sample design must be accounted for to
make accurate inferences
Requirements for accurate estimation in 1995 NSFG
• Fully adjusted weight (POST_WT)
• Collapsed strata variable (COL_STR)
• Panel identifier (PANEL)
For reference and further details: Series 2, #124
NSFG Public Use Data Files
• Available on cartridge tape and CD-ROM (1982
NSFG CDROM coming soon)
• 1995: extensive documentation (also on web)
• User’s Guide
• Codebook
• CAPI Reference Questionnaire
1995 NSFG - Contextual data files
• Restricted use (contact NCHS RDC)
• Community characteristics (over 1000)
• 4 levels of aggregation (state, county,
census tract, block group)
• 3 points in time (1990, 1993, 1995)
• Rich potential for descriptive as well as
detailed multilevel analyses.
NSFG related files available through
NCHS Research Data Center
• Contextual data files
• State level indicators (user-supplied)
• NHIS linked analyses (1988 & 1995)
RDC Contact: Kenneth Harris
Email:
[email protected]
Cycle 6 and beyond
• Shorter intervals between Cycles
• Cycle 6 in 2002
• Cycle 7 planned for 2005 or 2006
• Sample independent from NHIS
• Contextual data
• Inclusion of males 15-44
• Moving toward continuous interviewing in
Cycle 7
Inclusion of males 15-44
• Other half of fertility and family formation
equation
• 1996 Welfare Reform Act
• Fatherhood Initiative (federal interagency
effort)
• Information collected directly
Male NSFG will shed light on:
• Father involvement & activities
• Child support
• Male reporting of
• pregnancies/births
• sexual partnerships
• contraceptive behavior
• infertility
• Male role in unintended pregnancy
• STD/HIV risk & transmission
Female NSFG in Cycle 6
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•
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All core topics maintained from Cycle 5
Expanded Audio CASI
Streamlined event histories
Other selected enhancements based on
questionnaire design research
2002 NSFG – Preliminary Counts
Female
Male
Total
Total
7,646
4,929
12,575
15-19
1,150
1,122
2,272
20-24
1,364
938
2,302
25-44
5,132
2,869
8,001
Data collection ended in March 2003. Final counts will be
slightly lower, post-data editing & cleaning.
2002 NSFG (Cycle 6)
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Public use data files & documentation target =
Summer 2004
• Web-based documentation
• CDROM for data files
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•
Contextual data about a year later
Watch our webpage for updates:
www.cdc.gov/nchs/nsfg.htm
Quality Control Strategies in 2002 NSFG
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Full “dress rehearsal” Pretest in 2001 (n=600)
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Rigorous protocol for Spanish translation
•
Verification interviews
Extensive input from research & policy world
Cognitive testing of questionnaire components
with key subpopulations
Interviewer training modules on cultural
sensitivity and refusal aversion
Let’s take a step back and
consider other concerns
about surveys …
All surveys are facing challenges…
• People are harder to find and talk to
• People are more reluctant to participate
 Survey response rates suffer, or they
cost more to maintain.
All surveys are facing challenges…
Computerization of survey instruments can
simplify interviewers’ job to some extent, but…
•
Survey questionnaires tend to become more
complex
•
Innovative data collection strategies (including
ACASI) require considerably higher cost in
programming and testing
 Overall survey costs increase
All surveys are facing challenges…
Controlling survey costs requires
•
Collection and use of process data in directing
effort of interviewers in the field
•
Real time modeling to balance cost control with
response rate and error reduction goals
YOU, as data users, need to be aware of these
survey management issues, as they may impact
on your research.
Questions?
Comments?