# Presentation: 692168

## Overview of 

**Overview of **
**National Center for Health Statistics (NCHS)**
**Data Systems**

**Mary Burgess**
**NCHS Librarian**
**Mburgess@cdc.gov**

**Notes:**
How many of you are familiar with NCHS data?
Just to mention that the National Center for Health Statistics has been  part of the Centers for Disease Control and Prevention for 15 years and we have been part of Health and Human Services for over 40 years.
Give you some insight into the kind of data you can expect to get from NCHS publications and the organization that produces that data.  
One of my jobs at NCHS is to try to figure out better ways for us to present our data to you, the user.  Anyone with ideas or suggestions is welcome to contact me.  I have included my email address on this first slide for that purpose.  Please feel free to contact me if you encounter problems or just have questions about NCHS.

## NCHS IS THE NATION’S PRINCIPAL HEALTH STATISTICS AGENCY

- Provides fundamental public health and health policy statistics that meet the needs of a wide range of users
- Tracks changes in health and health care across the nation
- Provides mechanisms for obtaining consistent, uniform statistics

**Notes:**
Data collected includes:
Vital events (birth, death, marriage, divorce, fetal death, and induced termination of pregnancy)
Health status
Lifestyle
Exposure to unhealthy influences (smoking or alcohol)
Onset and diagnosis of illness and disability
Use of health care facilities
Provides fundamental public health and health policy statistics that meet the needs of a wide range of users.

## NCHS DATA USED FOR:

- Comparisons across populations, providers, and geographic areas
- Planning/assessing public health programs
- Identifying health problems, risk factors, and disease patterns
- To contribute to product planning and market research

**Notes:**
Provides statistical information to guide actions and policies to improve the health of the American people.
Tracks changes in health and health care, particularly important at this time as major changes are happening in the private markets, and in the Federal and State policies.
Provides mechanisms for obtaining the consistent, uniform statistics needed to be able to compare across population groups, and types of health care providers
States require consistent statistics for:
Planning, targeting, and assessing the effectiveness of public health programs 
Identification of health problems, risk factors, and disease patterns.
Uniform statistics also allow NCHS to better understand trends and anticipate the future directions of in the health care system and in health behaviors.

## Section 308(d), Public Health Service Act
Freedom of Information Act
Privacy Act

- Freedom of Information Act
- Privacy Act

**DATA CONFIDENTIALITY**

**How NCHS Protects Privacy**

**Legal Provisions that protect NCHS respondents:**

**Notes:**
Data confidentiality is a very big deal at NCHS.
Federal law, good statistical practice, and our ethical obligations to the American people all require the utmost concern for the privacy of those who provide the personal information we collect.
NCHS collects detailed and often highly personal information from its respondents that is used for a variety of important purposes.  It is critical that it be accurate. 
Respondents must be able to trust that information they provide to NCHS will be treated with respect, and that the answers they provide will not put them at risk. For that reason, NCHS takes all steps possible to protect the confidentiality of individually identifiable information.

## NCHS PRIVACY SAFEGUARDS

**NCHS PRIVACY SAFEGUARDS**

**Blocks outside access to confidential information stored in NCHS computers.**
**Requires  nondisclosure affidavit.**
**Data files are routinely cleaned of anything that could directly identify a person or firm.**

**Any personal information release requires the approval of the Center’s Director**
**Confidentiality training for all staff.**
**Random inspections by the NCHS Confidentiality Officer.**

**Notes:**
This slide outlines some of the safeguards NCHS has in place.

## MAJOR DATA SYSTEMS

- National Vital Statistics System and surveys
- National Health Interview Survey
- National Health and Nutrition Examination Survey
- National Health Care Surveys

**Notes:**
NCHS’ four major data systems are the primary workhorses for meeting the data needs of CDC and HHS.
Each of these four data systems has proven value and each is undergoing a significant transformation.
Collectively, these mechanisms gather information :
Through what people can tell us in interviews;  
Through examinations and medical records about information that people don’t know or can’t describe adequately;
Through birth and death records and compilation of data on medical encounters about the circumstances of significant health events.
NCHS has 3 goals for these systems:
Improve timeliness of data;
Update content to reflect new data needs; and
Improve the quality and completeness of data.

## NATIONAL VITAL STATISTICS SYSTEM

- _[http://www.cdc.gov/nchs/nvss.htm](http://www.cdc.gov/nchs/nvss.htm)__ _

**Notes:**
Vital Statistics are among the most fundamental measures used to monitor health at the national, State, and local levels.
A partnership with the states to produce key indicators of health from all birth and death certificates.
Vital statistics data are provided through state-operated registration systems.
Data from the NVSS include:
Life expectancy
Death rates from selected causes
Prenatal care and birth weight
Infant mortality
Unmarried and teen births

## RELATED SURVEYS

**   ****Linked Birth and Infant Death Data Set**
- Monitors and explores the complex interrelationships between infant death and risk factors present at birth.

**  ****National Maternal & Infant Health Survey**
- Tracks factors associated with low birthweight

**Notes:**
In the linked birth and infant death data set the information from the death certificate is linked to the information from the birth certificate for each infant under 1 year of age who dies in the U.S., Puerto Rico, The Virgin Islands, and Guam.
The purpose is to use the many additional variables available from the birth certificate to conduct more detailed analyses of infant mortality patterns.
Linked files are available for the data years 1983-91, 1995, 1999.  
Future data years will be available annually.
Linked file data were not produced for the 1992-94 data years.
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Collects data needed by Federal, State, and private researchers to study factors related to poor pregnancy outcomes, including low birthweight, stillbirth, infant illness, and infant death.  
Provides data on  socioeconomic and demographic characteristics of mothers, prenatal care, pregnancy history, occupational background, health status of mother and infant, and types and sources of medical care received.  T
Last conducted in 1991 and no plans are currently be discussed to repeat it.

## RELATED SURVEYS

- Studies the etiology of disease, demographic trends in mortality, and other health issues.

**National Death Index**
- Facilitates epidemiologic followup studies
- Verification of death for individuals under study

**RELATED SURVEYS**

**Notes:**
The first followback survey in 1961 featured information on hospital and institutional care in the last year of life.
In the 1962-63 survey an extensive analysis of socioeconomic differentials in mortality were examined.
In 1964-65 the survey provided information on the link between smoking and cancer mortality.
In 1986, the survey provided data on co-morbid conditions, disabilities, alcohol use, and access to health care services.
The 1993 survey focused on socioeconomic differentials in mortality; association between risk factors and cause of death; disability; access and utilization of health care facilities in the last year of life; and reliability of items reported on the death certificate.
No plans have been set for future surveys.
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Available to investigators solely for statistical purposes in medical and health research.  Not accessible to organizations or the general public for legal, administrative, or genealogy purposes. 
Central computerized index of death record information (beginning with 1979 deaths) compiled from magnetic tapes submitted by State vital statistics offices. 
Assists investigators in determining whether persons in their studies have died and, if so, provide the names of the States in which those deaths occurred, the dates of death, and the corresponding death certificate numbers.
Death records are added to the NDI file annually, approximately 10 months after the end of a particular calendar year.

## NATIONAL HEALTH INTERVIEW SURVEY

- _[http://www.cdc.gov/nchs/nhis.htm](http://www.cdc.gov/nchs/nhis.htm)_

**Notes:**
Principle source of  information on the health of the civilian noninstitutionalized population.  
Conducted annually using a basic set of data items questions that are repeated each year and additional questions that can change each year to address current health topics.
Traditionally interviews about 40,000 households annually.
Efforts are underway to redesign the NHIS so that it will be operated fundamentally different by mid-decade.
Efforts are underway to identify the sample for  household surveys for the period 2005-2014.
Overhaul of the basic systems for collecting, processing , and making data available to users.
Three major goals for this series transformation are:
Improve timeliness of data;
Continually update the content of key surveys to reflect new data needs; and
Improve the quality and completeness of data.

## RELATED SURVEYS

**National Immunization Survey**

**RELATED SURVEYS**

**Notes:**
Uses telephone interviews
Data from the NHIS personal interviews are used to assess bias associated with telephone interviews
Data used to produce timely estimates of vaccination coverage rates for each of six recommended vaccines for the nation and for each of 78 Immunization Action Plan (IAP) areas, consisting of the 50 states, the District of Columbia, and 27 large urban areas.  
Option for collection of data on other topics, such as demographic characteristics, family resources, and health care utilization.

## RELATED SURVEYS

**National Survey Of Family Growth**

**RELATED SURVEYS**

**Notes:**
Has been conducted 5 times previously, on an irregular schedule, it is now planned to be conducted every 3 to 4 years.
Cycle 6 is currently underway and for the first time will include men.
Uses personal interviews to collect data.
The questionnaires being administered to men and women are similar but not identical, covering questions on schooling, work, marriage and divorce, having and raising children, and related medical care.
Cycle 7 is scheduled for 2005.

## State & Local Area Integrated Telephone Surveys

**State & Local Area Integrated Telephone Surveys**

**RELATED SURVEYS**

**Notes:**
Funded through sponsorship of specific questionnaire modules.
SLAITS facilitates additional collaboration leading to more complete data for informed public health policy decisions. 
Research areas may range from health insurance coverage and access to care to perceived health status and utilization of services to measures of child well being. 
Addresses State-specific data needs with customized questions and specific domains of interest. 

## RELATED SURVEYS

- Studies children with special needs

**National Asthma Survey**

- Studies Asthma prevalence, management, and medication use

**RELATED SURVEYS**

**Notes:**
Utilizes the SLAITS mechanism of data collection.
Sponsored and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration.
Looks at health care utilization and barriers and health insurance coverage.  Looking specifically at State run health insurance programs
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Sponsored by the National Center for Environmental Health, CDC.
Unspecified periodic implementation subject to funding.
Example of use of SLAITS for rapid data collection

## NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

- _[http://www.cdc.gov/nchs/](http://www.cdc.gov/nchs/nhanes.htm)__[nhanes](http://www.cdc.gov/nchs/nhanes.htm)__[.htm](http://www.cdc.gov/nchs/nhanes.htm)_

**Notes:**
NHANES is the cornerstone of the National Nutrition Monitoring and Related Research Program.    
In 1999, the new NHANES took a different direction from previous versions of the survey.  
Implemented as a continuous, annual survey, linked to related Federal Government data collections conducted on  the general US population.  In particular is is linked to the National Health Interview Survey and potentially, the US Department of Agriculture’s food  consumption surveys.
Provides data for nutrition monitoring, food fortification policy, establishing dietary guidelines, and assessing government programs and initiatives such as Healthy People 2000 and 2010 objectives.
Provides data on heart disease, diabetes, osteoporosis, environmental exposures, children’s growth and development, and data on overweight/physical fitness.  
Provides total prevalence of disease or conditions including those unrecognized or undetected.
Nhanes is an annual survey with the capability of longtitudinal followup.

## NATIONAL HEALTH CARE SURVEYS

- _[http://www.cdc.gov/nchs/](http://www.cdc.gov/nchs/nhcs.htm)__[nhcs](http://www.cdc.gov/nchs/nhcs.htm)__[.htm](http://www.cdc.gov/nchs/nhcs.htm)_

**Notes:**
Group of record based  surveys designed to meet the health statistics needs of the future.  
Provides data on health care settings such as hospitals, ambulatory surgical centers, hospital outpatient departments, emergency departments, nursing homes, hospices, and home health agencies.  
Source of a wide range of data on the health care field and a significant resource for monitoring health care use, the impact of medical technology, and the quality of care provided to a changing American population.

## National Hospital Discharge Survey

- Provides detailed data on patient characteristics and length of hospital stay
- Provides info on diagnosis, and surgical and diagnostic procedures**.**

**RELATED SURVEYS**

**Notes:**
Data collected from hospital records and other computerized data sources.
Principal source of information on inpatient utilization of hospitals.  Conducted annually.  
Provides data on the use of non-Federal short-stay hospitals, on their size, location, and ownership as well as data on diagnosis, surgical procedures, length of stay, expected source of payment, and patient characteristics.  
Used to track specific diseases, the introduction of new technologies, and the impact of changes in the healthcare financing systems.  
Based on data  abstracted form a national probability sample of about 270,000 inpatient records from about 500 short-stay non-Federal hospitals.
Conducted annually.

## RELATED SURVEYS

- Provides data on patient characteristics.
- Information on diagnosis and the surgical and diagnostic procedures performed.

**RELATED SURVEYS**

**Notes:**
Data based on abstract forms completed by facility staff.
Provides detailed data on the use of freestanding and hospital-based ambulatory surgery in the US.  
Data are available on patient characteristics including age and sex; administrative information including patient disposition, expected source of payment, and region of the country where surgery was performed.  
Also available are data on medical information, including diagnosis, surgical operations, and diagnostic procedures performed.  
Conducted annually through 1996 and periodically thereafter.  A survey was recently completed and future plans are under discussion.

## RELATED SURVEYS

**National Ambulatory Medical Care Survey**

**RELATED SURVEYS**

**Notes:**
Data is collected from encounter forms completed by physicians practicing in private offices.
Provides an analytic base that expands information of a ambulatory care collected through other surveys.  
Conducted annually.

## RELATED SURVEYS

- Characteristics of patients’ visits to hospital outpatient departments (OPD) and emergency departments
- Diagnosis and treatments

**RELATED SURVEYS**

**Notes:**
Data is collected from encounter forms completed by physicians and other hospital staff.
Provides data representing the experience of the US population in hospital emergency departments and outpatient departments.
Data collected annually.

## RELATED SURVEYS

- Functional status of nursing home residents
- Number of people discharged from nursing homes
- Characteristics of nursing homes themselves

**National Nursing Home Survey**

**RELATED SURVEYS**

**Notes:**
Provides information on nursing homes from two perspectives – that of the long term care provider and that of the recipient.  
Data includes characteristics of long term care provider facilities such as size, ownership, Medicare and/or Medicaid certification, occupancy rate, service provided, and expenses.  
Survey conducted bi-annually.  
A survey redesign occurred in 2001 so survey schedule was delayed.  New survey scheduled for 2003.

## RELATED SURVEYS

- Number and functional status of patients
- Number of patients discharged.
- Characteristics of home health agencies, hospices and their patients

**RELATED SURVEYS**

**Notes:**
Provides data on home health agencies and hospices and their current patients and discharges.  
Established in response to the rapid growth in the number of home health agencies and hospices throughout the US and the need to assess the availability and utilization of these services. 
Data are collected from Home health agencies and hospices.
Conducted bi-annually.  Last conducted in 2000.
Survey re-design currently in progress.  Survey will resume once this is completed.

## Develops and tests NCHS data collection instruments. 
Supports methodological research on questionnaires and response 
Questionnaire design research program

- Supports methodological research on questionnaires and response
- Questionnaire design research program

**Office Of Research And Methodology**

**Other NCHS Activities**

**Notes:**
Supports a questionnaire design research program in collaboration with university scientists by means of research contracts.
Supports methodological research on questionnaires and response by applying cognitive methods in questionnaire design research. 
Statistical methods research undertaken on analytic methods applicable to the NCHS registration systems and sample surveys.
Program of contract and intramural research on automated statistical and graphical technology.
Survey Design program which involves the design and evaluation of the sample selection plans for NCHS population-based and establishment based surveys to     improve efficiency and analytic capabilities.

## Other NCHS Activities

**Research Data Center**

**Other NCHS Activities**

**Notes:**
 The continuing demand for analyses that require restricted data with lower levels of geography such as States, counties, and smaller areas, but without confidential identifiers such as names or social security numbers, has been the impetus for the creation of the Research Data Center .
Prospective researchers must submit a research proposal that will be reviewed and approved by a committee whose judgment is based upon the availability of RDC resources, consistency with the mission of NCHS, general scientific soundness, and the feasibility of the project.

## Data Users Conference

- Opportunities for the discussion of technical and philosophical issues
- Forum for the sharing of information from Federal, State, and local governments, as well as from universities and professional associations

**Other NCHS Activities**

**Notes:**
NCHS sponsors a conference every other year for current and potential data users.  
This diverse gathering lends the Conference a rich variety of perspectives on current issues concerning health information in the US.  These conferences are held locally and are free to all attendees.

## International Collaboration

- Maintains health statistics programs with developed and developing countries around the world
- Sponsors international meetings and     symposiums
- Contributes to other international forums through scientific articles and presentations

**Other NCHS Activities**

**Notes:**
Program is carried out in collaboration with other countries and with other agencies of the Public Health Service.  
An important part of this research is carried out through International Collaborative Efforts (ICE), which bring together domestic and foreign experts to focus on specific health issues of mutual interest to the participating countries.
Current topics are perinatal and infant mortality, health and health care of the elderly, and injuries.
Directly supports the World Health Organization (WHO) in worldwide health statistics activities by promoting domestic and international development and use of the International Classification of Diseases and the International Classification of Impairments, Disabilities, and Handicaps. 
This is accomplished through the WHO Collaborating Center for Classification of Diseases for North America, and the WHO Collaborating Center for Health and Nutrition Examination Surveys, helping to disseminate its unique capabilities in complex health survey design and health examination data collection and analysis.  Both are housed at NCHS

## DATA DISSEMINATION

**NCHS Survey Data Are Presented In A Variety Of Publication Formats:**

-    Published Reports
-    Journal Articles
-    Chartbooks
-    Electronic Products

**Notes:**
A central component of the mission of NCHS is to disseminate its vital and health statistics and research findings to as wide an audience as possible.
To assist data users, NCHS operates a full-service centralized information program that provides reference, inquiry, and referral service to help users locate and use NCHS data and to identify other data sources.
Our information telephone number is (301) 458-4636.  It appears on on the back the ruler available for you to pick up.

## PUBLISHED REPORT SERIES

- Vital & Health Statistics Series
- Advance Data Reports
- National Vital Statistics Reports
- Health, United States
- Chartbooks
- Miscellaneous Reports

**Available In Printed & Electronic Formats:**

**Notes:**
Available in printed form, on the web and on CD-ROM.

## HEALTH, UNITED STATES

- Annual Report on the Nation’s Health
- Published in conjunction with a different special topics chartbook each year

**Available In Printed & Electronic Formats**

**Notes:**
Presents national trends in health statistics on such topics as birth and death rates, infant mortality, life expectancy, morbidity, and health status, risk factors, use of ambulatory care and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, and other health topics.

## JOURNAL ARTICLES

- NCHS staff, individually and collaboratively, publish throughout the year in a variety of statistical and medical journals and newsletters.
- A bibliography is available online at the NCHS website.

## MISCELLANEOUS PUBLICATIONS

- Healthy People 2000/2010
- America’s Children
- ICE on Injuries
- Atlas of Mortality
- Chartbooks
- Reports to Congress

- CASM Proceedings
- International Health Reference Guide

**Available In Printed & Electronic Formats**

**Notes:**
All NCHS publications are available through the website and are downloadable using adobe acrobat.

## ELECTRONIC PRODUCTS

**Extensive Program Of Microdata Release Through Electronic Media Including:**
- Internet  _[http://www.cdc.gov/nchs/](http://www.cdc.gov/nchs/)_
- CD-ROMS with statistical software
- CD-ROMS with text retrieval software
- Public use data on CD-ROM

**Notes:**
NCHS has an extensive program of data release through electronic media. 
The CD-ROMs contain detailed data files and the associated documentation.  Many CD’s are available in both an ASCII and SETS format.
SETS, Statistical Export and Tabulation System,  is the statistical software developed by NCHS to provide an avenue for users to access data without the use of complicated commercial  statistical software programs.
The public use data tapes are in the process of being converted to CD-ROM format.

## OTHER OPPORTUNITIES FOR SPREADING THE WORD

- University lectures and seminars
- Data system and special topic seminars
- Presentation of research findings at annual association meetings, conferences, workshops, and symposiums
- Staffing of exhibit booths at annual meetings and conferences
- Ad hoc visits to assist in unique
-     problem solutions

## WHAT CAN I FIND ON THE WEBSITE?

- FastStats
- Press and data releases
- Links to other health & statistical agencies and organizations
- Published Products
- Microdata
- Coming Events
- e-mail link for specific questions

**Notes:**
Provides links to the latest social statistics from Federal agencies, a link to FEDSTATS with over 70 contacts to other Federal statistical agencies, a data warehouse with detailed statistical tables, links to CDC’s WONDER data retrieval system, Bureau of Census’ FERRET, and other data sites, news releases and fact sheets, a section on what’s new, coming events, and NCHS products.
Provides full–text access to all NCHS publications and catalogs.  These files may be viewed, searched, printed, and downloaded.

## THANK YOU FOR COMING

**Visit NCHS on the WEB**
_**[http://www.cdc.gov/nchs/](http://www.cdc.gov/nchs/)**_