National Health and Nutrition Examination Survey

Monitoring the Nation’s Health

Kathryn S. Porter, M.D., M.S.Director

Division of Health and Nutrition Examination Surveys

National Center for Health StatisticsDivision of Health and Nutrition Examination Surveys

Objective

To assess the health and nutritional status of adults and children in the United States

NHANES in the News

Goals

U.S. population-based estimates of: •Health conditions• Awareness, treatment and

control of selected diseases• Environmental exposures•Nutrition status and diet

behaviors

Goals of NHANES

History

National Health and Nutrition Examination Surveys

NHES I 1960-62 18-79 yearsNHES II 1963-65 6-11 yearsNHES III 1966-70 12-17 yearsNHANES I 1971-75 1-74 yearsNHANES II 1976-80 6 mo.-74 yearsHHANES 1982-84 6 mo.-74 yearsNHANES III 1988-94 2 mo. +

Survey Dates Ages

National Health and Nutrition Examination Surveys

NHANES 1999-2000 All agesNHANES 2001-2002 All agesNHANES 2003-2004 All agesNHANES 2005-2006 All agesNHANES 2007-2008 All agesNHANES 2009-2010 All agesNHANES 2011-2012 All agesNHANES 2013-2014 All agesNHANES 2015-2016 All ages

Survey Dates Ages

Data Collection

NHANES Sample• Civilian, non-institutionalized

household population in the United States

• Target: 5,000 individuals examined annually

Oversample:• African Americans• Asian Americans• Hispanics• Older persons aged 60+• Low income whites

Stage 4Participants

Stage 1Counties Stage 2

Segments

Stage 3Households

NHANES information flow

Advanceletter Screening In-home

interview Exam

Biologic Specimens

Laboratories CDC/NCHS Participant

Informed consent

Banking facilities

NHANES Home Interview

NHANES Mobile exam center

NHANES Mobile exam center

Mobile exam center entrance

Reception

Cardiovascular health

Hearing and vision

Anthropometry and body composition

Whole body scan – percentage body fat

Sagittal abdominal diameter

Participants 8 years and older

Taste and smell

Private interviews

Oral health

Laboratory

Mobile exam center laboratory

• Complete blood count• Pregnancy test• Specimen processing

• Blood, urine, water, swabs • 500 assays• 24 laboratories

NHANES labs/graders

10

31

NCHS

10

31

NHANES labs/graders

Laboratory tests

• Nutritional biomarkers

• Hormone tests• Diabetes• Lipid profile• Biochemistry

profile• Celiac disease

• Infectious diseases• Hepatitis viruses• Sexually

transmitted infections

• Environmental Chemicals

• Water fluoride levels

Participant remuneration

• Remuneration $125• Transportation (bus, taxi,

mileage) reimbursed• Additional remuneration for

other components

Post exam assessments

Day 2 Dietary RecallHome urine collection

Physical Activity Monitor

24-hour Urine Collection

NHANES Response Rates

2013

Interviewed 72%Interviewed and examined 70%

Information technology architecture

hi

Household interviews Westathome office

T1T1

NCHS

Labs&graders

T1

MEC

64kb

Fieldoffice

NationalFrame Relay

Network

OP96S049

Data release process

• QA/QC • Editing/cleanup• Weighting• Data preparation• Documentation• Confidentiality review

Do we give participants their results?

Initial findings Abnormal values Call for STD resultsw/ pre-set passwords

Final report

Kathryn S. Porter, MD

Yes

Benefits to Participants

Early notification of abnormal results

Interesting story – high mercury

Spanish-speaking family examined. Mom and three kids, the youngest was 3 years old.

All had high levels of mercury

Interesting story, cont.

Monitoring the nation’s health

NHANES data findings

Environmental health

1976 1978 1980 1982 1984 1986 1988 1990 1992

2

4

6

8

10

12

14

16

Blo

od le

ad le

vels

(mg/

dL)

0

1994 1996 1998 2000

Blood lead levels in U.S. childrenAges 1-5 yrs, 1976 - 2002

Year2002

Second hand smoke

Percent of non-smoking U.S. population

exposed to second hand smoke

Source: Pirkle JL et al. Trends in Exposure of Nonsmokers in the U.S. Population to SHS: 1988–2002. Env Hlth Persp. 2006; 114(6): 853–8. CDC. Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999-2008. MMWR. September 7, 2010. 59; 7-12

Pediatric growth charts

Obesity

Americans heavier in 2007-2010 than

in the 1960s

Sources: CDC/NCHS: National Health and Nutrition Examination Survey; www.cdc.gov/nchs/data/ad/ad347.pdf; http://www.cdc.gov/nchs/data/databriefs/db82.htm http://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf (NHESI, NHESII, 2007-2010)

Prevalence of obesity in the US, 2011-2012

• 17% of children & teens 2-19 y

• 35% of adults ≥20 y

Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012; Ogden et al. NCHS Data Brief 2013 and Ogden et al. JAMA 2014

0

5

10

15

20

25

30

35

40

0

5

10

15

20

25

30

35

40

Percent

1960-2 1988-94

PercentTrends in adult obesity, 20-74 years

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.

99-0001-2

03-4

Male

Female

1971-4 1976-8005-6

Federal Aviation Administration

TABLE 2-1. STANDARD AVERAGE PASSENGER WEIGHTS Standard Average Passenger

Weight Per Passenger

Summer Weights Average adult passenger weight 190 lb Average adult male passenger weight 200 lb Average adult female passenger weight 179 lb Child weight (2 years to less than 13 years of age) 82 lb

Winter Weights Average adult passenger weight 195 lb Average adult male passenger weight 205 lb Average adult female passenger weight 184 lb Child weight (2 years to less than 13 years of age) 87 lb

Diet

The 2010 Dietary Guidelines for Americansrecommend a sodium intake of less than 2300 mg per day

Sugary drink consumption70% of boys aged 2-19 years consume sugar drinks on any given day; 60% of girls

Measuring Progress:trans-Fatty Acids Reduction Policies

Birth Defect Prevention

Birth Defect Prevention – Spina Bifida

• 20-50% of cases can be prevented

• Requires adequate intake of folic acid

(400 mcg daily)

Median serum and red blood cell folate concentrations: US females

ages 15-45

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1988-94

1988-94

ng/mL ng/mLSerum folate Red blood cell folate

1988-94

5

10

15

20

4.8

0

50

100

150

200

250

300

160

Median serum and red blood cell folate concentrations: US females

ages 15-45

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1988-94 and 2003-04

1988-94 1999-2000

ng/mL ng/mLSerum folate Red blood cell folate

1988-94 1999-2000

5

10

15

20

4.8

13.0

0

50

100

150

200

250

300

160

264

15

20

25

30

1991 1993 1995 1997 1999 2001 2003 2005

Rate per 100,000

Spina bifida rates United States 1991-2005

NOTE: Excludes data for Maryland, New Mexico, and New York which did not require reporting for spina bifida

for some years. CI is 95% confidence interval.

SOURCE: National Vital Statistics System, NCHS, CDC

Infectious disease

Measuring Progress:HPV Vaccine Effectiveness

Prescription medication use

Prescription antidepressant use

NOTE: The 1988–1994 estimates for men are considered unreliable because the estimates have relative standard errors of 20%–30%.SOURCE: CDC/NCHS, Health, United States, 2013, Figure 25. Data from the National Health and Nutrition Examination Survey.

Chronic disease

Source: 2005–2008 National Health and Nutrition Examination Survey.

Challenges

Translated Materials

Financial considerations

Internal funding Collaborators

Who are our collaborators?

Around 25 partners with various degrees of collaboration

Thank you