Transcript No Slide Title

National Health and Nutrition
Examination Survey:
Overview
Clifford Johnson, Director
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Objectives
• Some NHANES history
• Survey operations and data collection
• Content
• Uses and findings
• Summary thoughts
NHANES
Objective
To assess the health and nutritional
status of adults and children in the
United States
Sample
•
Civilian, non-institutionalized
household population
•
Residents of all states and the
District of Columbia
•
•
All ages
5,000 individuals each year
NHANES
• Unique in combining a home interview with
health examinations conducted in a mobile
examination center
• Almost 50 years experience conducting
survey using direct physical measures
National Health and Nutrition
Examination Surveys
Survey
NHES I
NHES II
NHES III
NHANES I
NHANES II
HHANES
NHANES III
Dates
1960-62
1963-65
1966-70
1971-75
1976-80
1982-84
1988-94
Ages
18-79 years
6-11 years
12-17 years
1-74 years
6 mo.-74 years
6 mo.-74 years
2 mo. +
OP96S025
National Health and Nutrition
Examination Surveys
Survey
NHANES
NHANES
NHANES
NHANES
NHANES
NHANES
NHANES
Dates
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
2009-2010
2011-2012
Ages
All ages
All ages
All ages
All ages
All ages
All ages
All ages
OP96S025
NHANES response rates
1999-2006
Interviewed
81.4%
MEC examined
77.9%
Benefits of Participation
•
•
Opportunity for community service
•
Numerous lab studies not usually provided during
a routine physical examination
•
Toll free number to discuss abnormal results with
the NHANES Medical Officer
Free health measurements and lab studies with
report of findings
Benefits of Participation
•
•
Cash remuneration
Reimbursement for travel or free
transportation
Data Collection
Advance Arrangements/Outreach Timeline for Interviews Beginning in June
Task
Advanced Arrangements/Outreach
Identify county demographics
Create county video
Meet w/ local Health Department officials
Identify key community offficials
Mail 1st outreach letter to officials
Mail 2nd outreach letter to officials
Identify county health clinics
Identify interpreter services
Request Endorsement Letters
Health Department
Area Agency on Aging
Others as needed
Media
Create media list
Contact media sources
Send media list to Field Office
First press release
Second press release
Open House
Send invitations to key officials
Contact media
Household interviewing
MEC examinations
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
Participant health interview
•
Length of interview varies depending on
age
•
Self report -16 years and older and
emancipated minors
•
•
Proxy report - children under 16
Demographic and risk factor data
NHANES Examination
•
•
•
Standardized physical exam
Conducted at mobile exam center
• Medical & dental exams
• Physiological measurements
• Laboratory test
Administered by trained medical
personnel
NHANES Mobile Exam Center
(MEC)
NHANES topics
•
•
•
•
•
•
•
•
Cardiovascular disease
Diabetes
Bone status, osteoporosis
Oral health
Vision and eye diseases
Hearing and balance
Fitness and strength
Allergies
OP96S035
NHANES topics
•
•
•
•
•
•
•
•
Nutrition
Anthropometry
Mental health
Risk behaviors
Reproductive health
Environmental exposures
Infectious diseases
Spirometry
OP96S036
Examples of NHANES Findings
and Uses
Landmark findings and
public health results
• High blood lead levels
Lead out of gasoline
• Low folate levels
Mandatory food fortification
• Rising levels of obesity
Public health action plan
• Racial and ethnic disparities in Hepatitis B
Universal vaccination of all infants & children
2000 CDC Growth Charts:
United States
OP96065
Trends in Child and Adolescent Overweight
Percent
20
15
6-11 y
12-19 y
10
5
0
1963-5 1966-70 1971-4 1976-80 1988-94 1999-00 2001-2
2003-4
Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts.
Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination
Surveys I, II, III and 1999-2004, NCHS, CDC.
Trends in Adult Obesity, 20-74 years
Percent
40
30
Male
Female
20
10
0
1960-62
1971-74
1976-80
1988-94
1999-00
2001-2
2003-4
Note: NHES and NHANES data; Age-adjusted by the direct method to the year 2000 US Bureau of the Census estimates
using the age groups 20-39, 40-59 and 60-74 years. Obesity defined as BMI>=30.
Prevalence of Obesity Among Adults ≥ 18
years, United States
35
30
Measured
NHANES 99-02
Self-reported
NHANES 99-02
Self-reported
NHIS 2000
Self-reported
BRFSS 2000
Percent
25
20
15
10
5
0
Total
SOURCE: Hedley, unpublished analyses
Male
Female
Mean Serum Folate Concentrations
Females: United States
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+
Trends in Median Serum Folate
Levels of Males and Females;
United States: 1988-2006
30
25
1988-1994
20
1999-2000
15
2001-2002
2003-2004
10
5
0
Males
Females
Seroprevalence of measles
Antibody by birth cohort
% measles seropositive IgG
100
NH-white
NH- black
Mex. Americans
Threshold for
herd immunity
95
90
85
1949-56 1957-66 1967-76 1977-86 1987-96 1997-98
Birth Cohort
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES) 1999-2004.
Additional Chemicals in 3rd Report
148 chemicals
 38 new chemicals
 One new class
– Pyrethroid pesticides
 Additions w/in class
–
–
–
–
–
PAHs
Aldrin, dieldrin, endrin
Phthalate metabolites
Dioxins, furans and PCBs
Pesticides and herbicides
www.cdc.gov/exposurereport
OH9900
Lead used in gasoline production and
average blood lead levels
17
110
Total lead used per 6 month
period (1000 tons)
Lead used
In gasoline
90
80
15
14
13
Average blood
lead levels
70
12
11
60
10
50
400
1976
9
1977
1978
1979
SOURCE: CDC/NCHS, Second National Health and Nutrition Examination Survey, 1976-80.
0
8
1980
Average blood lead levels
(micrograms/deciliter)
16
100
Blood lead levels in the U.S. Children
Ages 1-5 yrs, 1976 - 2002
Blood lead levels (mg/dL)
16
14
12
10
8
6
4
2
0
1976 1978 1980 1982 1984 1986 1988 1990 1992
Year
1994 1996 1998
2000 2002
Exposure to Second Hand Smoke:
Nonsmokers with Detectable Cotinine* Levels,
Percent with detectable serum cotinine
1988-94 Baseline
100
90
1999-2000
93.9
88.1
87.8
83.4
80
72.0
70
60
53.9
50
52.0
2010 Target
44.1
40
30
20
10
0
Total
Mexican American
Black, not Hispanic
Ages 4 years and older
Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC.
White, not Hispanic
Selected Percentiles of Total Blood Mercury
Women 16-49 years
No fish or
shellfish
Only shellfish
Blood Hg (ug/L)
12
10
8
Only fish
6
Both fish and
shellfish
4
2
0
0
25
50
75
Percentile
NOTE: NHANES 1999-2000
SOURCE: CDC/NCHS
100
Prevalence of reduced hip bone
density among persons 65 years of
age and over
Osteopenia
Osteoporosis
Percent
100
80
60
40
20
0
65-74
years
75-84
years
85 years
and over
Women
SOURCE: CDC/NCHS, NHANES III 1988-94
65-74
years
75-84
years
85 years
and over
Men
OP96S071
Diabetes and Impaired Fasting
Glucose, 1999-2000
Percent
40
Percent
16
12
8
6.2
Impaired
fasting
glucose
2.5
Undiagnosed 20
4
6.1
0
33.9
Diagnosed
30
15.5
10
3.8
0
20-39
SOURCE: CDC/NCHS, National Nutrition and Health Examination Survey, 1999-2000;
National Health Interview Survey, 1999, 2000.
40-59
60
Prevalence of lower extremity disease (LED) in the United States
among adults aged > 40 years by type of LED*, symptomatic and
diabetes status. NHANES, 1999–2000
Percent
35
30
Assymptomatic
Symptomatic
25
20
15
10
5
0
PAD PN Any
LED
Total
PAD PN Any
LED
Non-Diabetic
PAD PN Any
LED
Diabetic
* PAD: peripheral arterial disease; PN: peripheral neuropathy
REF: Gregg, Sorlie, Paulose-Ram, Gu, Eberhardt, Wolz, Burt, Curtin, Engelgau, Geiss. Diabetes Care. 2004 Jul;27(7):1591-7
OH9900
Not all estimates meet standard of statistical reliability and precision (relative SE >30%).
OH9900
NHANES Data Central to Health
Policy and Practice
•
Unique national source of actual
measurement data
•
Ability to integrate findings from each
interview and exam component
•
High quality of data collection, processing
and analysis
•
Responsive and relevant to current and
future data needs
NHANES Provides Data for Many
Essential Public Health Functions
•
•
Prevention initiatives
•
•
•
Food safety and fortification
Monitoring exposure levels—
pollutants, chemicals
Disease control
Tracking health behaviors
Other Activities
•
Future of Health and Nutrition
Examination Surveys
• Community HANES
• Longitudinal Follow-ups
• Linked files
• Efficiencies
• Web tools
Final Thoughts
•
•
•
Many lessons learned over fifty years
•
Survey design important but quality data
collection and timely release of results is
essential to success
We know better when we measure
Focus should be on content, logistical
issues and operational methods –
everything matters and is important
http://www.cdc.gov/nchs/nhanes.htm