Eve Powell-Griner, PhD National Center for Health Statistics Centers for Disease Control and Prevention National Center for Health Statistics Overview

Eve Powell-Griner, PhD

National Center for Health Statistics

Centers for Disease Control and PreventionNational Center for Health Statistics

Overview of the National Health Interview

Survey (NHIS)

NHIS purpose

• To collect data on the health status and health services utilization of the US population

• To address specific issues of current public health concern

• To provide national health data to the public

Uses of NHIS data

• “Snapshot” of health of the US population

• Track national health objectives

• Plan and evaluate health policies

• Public health research

NHIS sample design

• Household based

• Representative of U.S. and of four Census regions (non-institutionalized civilian population)

• Provides sampling frame for Medical Expenditures Panel Survey (MEPS)

NHIS sample design

• 2006 design

40,000 households • 100,000 persons• 37,000 Sample Adults• 15,000 Sample Children

Over-samples blacks, Hispanics, Asians, elderly minorities

NHIS questionnaire modules

• Basic Module or Core

Fielded each year

• Supplemental Modules

New topics or more detail on Core topics

Different each year

Health conditions

• Chronic Disease

• Hearing and vision impairment

• Health status compared to year ago

• Injuries/poisonings

• Functional limitation and associated conditions

• Mental health questions (vary by age)

Utilization and access to care• Hospitalizations

• Medical care contacts by provider

• Surgical procedures

• Dental

• Immunizations

• Usual place of care

• Delayed care and why

• Unmet need by type

Health behaviors and risk factors

• Smoking

• Physical activity

• Alcohol

• Height/Weight (BMI)

Socio-demographic variables

• Hispanic ethnicity, race, sex, age

• Family type/structure

• Generational relationships

• Birthplace and citizenship

• Country of birth (only on in-house file) US/not US (on public use file)

• Citizen or non-citizen of US

Economic variables

• Characteristics of family housing unit

• Number of working adults in family

• Education/family income

• Health Insurance Type of coverage Cost/policy holder/source Reason for no coverage

• Work loss/sick days

NHIS Supplements 1998-2006

• 2000: Cancer Control

• 2001: Healthy People 2010, Children’s mental health

• 2002: Healthy People 2010, Complementary and Alternative Med., Children’s mental health

• 2003: Healthy People 2010, Children’s mental health

• 2004: Healthy People 2010 Children’s mental health, adult immunization

• 2005: Healthy People 2010, Cancer control

• 2006: Adult chronic conditions (Stroke, diabetes, arthritis)

NHIS Products

• Microdata files

• Annual reports of estimates

Population; Children; Adults

• Reports on specific topics

• FastStats

• Early Release

Background

• As timeliness of annual MICRODATA release improved, a need for timely release of ESTIMATES

• Expert meeting: Identified key measures

• Determined how to expedite editing and weighting

• Chose to release on Internet only

• First release: April 2001

NHIS Early Release (ER) Program

• 2 reports: main and detailed health insurance

• Releases updated ESTIMATES every 3 months

• Releases occur 6 months after the end of each quarter of data collection (March, June, September, December)

• Internet only release

NHIS ER Program

NHIS ER Program

Objectives

Provide ready and timely access to the most recent NHIS key estimates

Monitor health and health care

Measure progress toward national public health objectives

ER Indicator Selection

• Public health objectives which benefit from timely data

• Healthy People 2010 Leading Health Indicators

• Key areas for the elimination of racial disparities in health

• Stable definitions over past several data years

• Sufficient sample sizes

Main report

1. Health insurance coverage

2. Usual place to go for medical care

3. Obtaining needed medical care

4. Influenza vaccination

5. Pneumococcal vaccination

6. Obesity

7. Leisure-time physical activity

8. Current smoking9. Alcohol consumption10. HIV testing 11. General health status12. Personal care needs 13. Serious psychological distress14. Diabetes15. Asthma

Indicators

Main ER report

Format• Graph of trend since 1997• Graph of current estimates by age group and gender• Graph of current estimates by race/ethnicity • Data tables for all graphs• Extra graph and/or tables as needed• Text highlights

Detailed health insurance ER report Lack of health insurance coverage

• at time of interview• for at least part of the past year• for more than a year

Type of health insurance coverage• public health plan coverage• private health insurance coverage

Noncoverage for selected sociodemographic measures

Annual state-level estimates for large states

Uses of ER data• Cited in other government publications and

Web sites

• Data requests for universities and other government agencies

• Collection of indicators used in methodological research

• Other health measures can be added to ER production to do expedited research

Percentage of persons who had received an influenza

vaccination during the past 12 months, by age group and sex:

United States, 2005

0

20

40

60

0–17 18–49 50–64 65 and over

PercentTotal Male Female

95% confidence interval

Age group (years)

Percentage of adults aged 65 years and over who had

received an influenza vaccination during the past 12 months, by

race/ethnicity: United States, 2005

20

30

40

50

60

70

Hispanic White Black

Percent

Non-Hispanic


Percentage of persons without health insurance, by three measurements and age group; and percentage of persons with health insurance, by coverage type and age group: United States, 2005

Percentage of persons under 65 years of age without health insurance coverage at the time of interview, by age group and sex: United States, 2005

Prevalence of current smoking among adults aged 18 years and over: United States, 1997– March 2005

10

15

20

25

30

1997 1998 1999 2000 2001 2002 2003 2004 2005

Percent 95% confidence interval

(Jan.–March)

Prevalence of obesity among adults aged 20 years and over: United States, 1997–2005

10

15

20

25

30

1997 1998 1999 2000 2001 2002 2003 2004 2005

Percent95% confidence interval

0

10

20

30

40

Excellent Very good Good Fair Poor



Health status

Percent distribution of respondent-assessed health status, by sex for all ages: United States, 2005

Prevalence of current asthma among persons of all ages, by age group and sex: United States, 2005

2

4

6

8

10

12

14

0–14 15–34 35 and over


Age group (years)

0


Sex-adjusted prevalence of current asthma among persons of all ages, by age group and race/ethnicity: United States, 2005

0

5

10

15

20

Hispanic White Black

Percent

0–14 years 15 years and over

Non-Hispanic


Other examples of NHIS Estimates

Percentage of adults aged 18 years and over who engaged in any leisure-time strengthening activity, by sex and age group — United States, 2005

0

5

10

15

20

25

30

35

40

Sex

Pe

rce

nt

Men

Women

0

5

10

15

20

25

30

35

40

Age group (years)

Pe

rce

nt

18–2425–4445–6465–7475 and over

National Health Interview Survey

Percentage of adults aged 18 years and over who had received an Percentage of adults aged 18 years and over who had received an influenza vaccination during the past 12 months, by age group influenza vaccination during the past 12 months, by age group and quarter and quarter — — United States, 1997–2005 United States, 1997–2005

0

20

40

60

80Percent

65 years and over

50–64 years

18–49 years

Year (quarter)

1998 20001999 2001 200420031997 2002 2005


Annual rate of nonfatal, medically attended fall injury episodes Annual rate of nonfatal, medically attended fall injury episodes among noninstitutionalized adults aged 65 years and over among noninstitutionalized adults aged 65 years and over —— United States, 2001United States, 2001––20032003

0

20

40

60

80

100

120

140

65–74 75–84 85 and over

Ra

te p

er

1,0

00

po

pu

lati

on

Men Women

Age group (years)National Health Interview Survey

Percentage of foreign-born Hispanic adults aged 18 years and over with selected health conditions, by length of time living in the United States, 1998–2003

16.113.4

3.5

22.019.8

5.4

0

5

10

15

20

25

Obesity Hypertension Cardiovasculardisease

Condition

Perc

en

t

Less than 5 years 5 years or more


Cigarette smoking prevalence among adults aged 18 years and over who have ever spent >24 hours on the streets, in a shelter, or in a jail or prison, by sex — United States, 2004

20.9 23.518.6

56.2 56.9 54.4

0

20

40

60

Both sexes Men Women

Pe

rce

nt

All adults

Adults who had ever spent >24 hours on the streets, in a shelter, or in a jail orprison


0

2

4

6

8

10

12

14

16

18

2001 2002 2003 2004Year

Pe

rce

nt

Black non-Hispanic boys Black non-Hispanic girls

White non-Hispanic boys White non-Hispanic girls

Percentage of children under 18 years of age with current asthma, by race/ethnicity and sex — United States, 2001–2004


65.3 64.5 64.8 65.8 64.7 68.6 69.4

010203040506070

1998 1999 2000 2001 2002 2003 2004Year

Pe

rce

nt

Percentage of young adults aged 18–24 years who never Percentage of young adults aged 18–24 years who never smoked cigarettes smoked cigarettes —— United States, 1998 United States, 1998––2004 2004


Percentage of teens aged 14Percentage of teens aged 14––17 years who used 17 years who used indoor tanning devices during the preceding 12 indoor tanning devices during the preceding 12 months, by sex and age months, by sex and age —— United States, 2005 United States, 2005

0

2

4

6

8

10

12

14

16

18

20

Sex

Pe

rce

nt

Male Female

0

2

4

6

8

10

12

14

16

18

20

Age

Pe

rce

nt

14 years 15 years

16 years 17 years


Distribution of type of health insurance for working age Distribution of type of health insurance for working age adults (18 – 64 years), United States 2005adults (18 – 64 years), United States 2005

Uninsured 19.1% Private HMO

29.9%

Private non-HMO 40.7%

Medicaid HMO 5.3%

Medicaid non-HMO 1.6%

Other 3.0%

Source: estimates for health insurance type are calculated using the person file

NHIS Strengths• Large, representative sample

• In-person survey

• Broad range of information

• Demographic detail

• Ongoing annual survey

• Topical supplementary information

• Relatively high response rates

• Links to NDI, MEPS

NCHS Web site:

http://www.cdc.gov/nchs

Information Showcase

NHIS Web site:

http://www.cdc.gov/nchs/nhis.htm

What’s New

listserv

Where to find NHIS Products

http://www.cdc.gov/nchs

http://www.cdc.gov/nchs/nhis.htm

Documents

Eve Powell-Griner, PhD National Center for Health Statistics Centers for Disease Control and Prevention National Center for Health Statistics Overview