# Presentation: 304129

## Evaluation of Alternative Matching Criteria by Race/Ethnicity and Sexin NHIS-NDI Linked Mortality files

- Gloria Wheatcroft and Jennifer Parker
- Office of Analysis and Epidemiology

**Centers for Disease Control and Prevention**
**National Center for Health Statistics**

## Background

- Individual demographic, behavioral, and health characteristics are strongly associated with mortality
- These factors may also be associated with the presence and accuracy of survey information used for matching to the NDI
- Inferences from studies that use survey data linked to mortality data to examine the correlates of mortality could be affected by differential matching

## Prior matching evaluation  

- Liao et al.  (AJPH 1998) evaluated three criteria for matching using the1986-1990 NHIS linked to NDI through 1991
- Exact social security number (SSN) match
- (A) or SSN unknown and matching score for demographic items > recommended cutoffs
- (A) or SSN unknown and *either* 8 or more demographic items match *or* fewer than 8 match but with high matching score, >=32.5

## Liao et al (AJPH1998): Death Rates Men, 45-64 years

- A Exact match on social security
- B  (A) or SSN unknown and score for demographic items > recommended cutoffs
- C (A) or SSN unknown and *either* >7 items match *or* < than 8 match but with high score

## Liao et al (AJPH1998): Death Rate Ratios for Hispanic, relative to Non-Hispanic White, Men age 45-64 years

- A Exact match on social security
- B  (A) or SSN unknown and score for demographic items > recommended cutoffs
- C (A) or SSN unknown and *either* >7 items match *or* < than 8 match but with high score

## Objective

- To examine effects of alternative matching criteria on mortality estimates obtained using NHIS-NDI Linked Mortality files
- Death rates
- Ratios between groups defined by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), age, and sex
- Comparison by nativity and health status

## Methods

- NHIS-NDI Linked Mortality files
- NHIS1989-1994 linked to NDI through 2002
- Mortality ascertained using four matching criteria
- Least conservative, Current NCHS recommendation, Moderately conservative, Most conservative
- Death rates and hazard ratios were calculated using survival analysis programs in Stata
- Standard errors were not estimated but cell sizes were reasonably large

## Matching Criteria

| Matching criteria | Class | Score | Deaths |
| --- | --- | --- | --- |
| 1- Least conservative | 1
2
3
4 | All
>=43
>=41
>=36 | 36,345
10,415
12,595
4,787 |
| 2 – Current recommendation | 1
2
3
4 | All
>= 47
>=45
>=40 | 36,345
10,273
11,855
2,548 |
| 3 – Moderately conservative | 1
2
3
4 | All
>=51
>=49
>=44 | 36,345
10,038
10,817
1,291 |
| 4 – Most conservative | 1
2
3
4 | All
All
>=45
None | 36,345
10,734
11,855
----- |

## Number of Deaths by Matching Criteria

**Non-Hispanic white**

**Non-Hispanic black**

**Hispanic**

- Least conservative criteria
- Current NCHS criteria
- Moderately conservative criteria
- Most conservative criteria

## Male versus Female Death Rate Ratios, by Age and Race/Ethnicity

**Death Rate Ratio**

**Non-Hispanic black**

**Hispanic**

## Death Rate Ratios for Race/Ethnicity, by AgeMales

**Rate Ratios **

**Non-Hispanic black relative**
** ****to non-Hispanic white**

**Hispanic relative to**
**non-Hispanic white**

## Death Rate Ratios for Race/Ethnicity, by Age Females

**Rate Ratio**

**Non-Hispanic black relative**
** ****to non-Hispanic white**

**Hispanic relative to**
**non-Hispanic white**

## Hazard Ratios* for Hispanic Females, by Education (Relative to Non-Hispanic White Females)

- * Hazard Ratios controlled for age

**Hazard Ratio**** ****(Cox proportional hazards****)**

## Hazard Ratios* for Hispanic Females, by Health Status (Relative to Non-Hispanic White Females)

- *Hazard Ratios controlled for age

**Hazard Ratio ****(Cox proportional hazards****)**

## Hazard Ratios* for Hispanic Females, by Years in the United States(Relative to Non-Hispanic White Females)

- *Hazard Ratios controlled for age

**Hazard ratio **** ****(Cox proportional hazards****)**

## Previous study

- Finch BK et al “Validity of Self-rated Health among Latino(a)s” Am J Epidemiol 2002
- Examined whether self-rated health had differential mortality risks for Latino(a) adults by acculturation
- Concluded that self-reported poor health status was a weaker marker of mortality for the less acculturated
- Used 1989-1994 NHIS linked to the NDI through 1997

## Finch et al (AJE 2002):  Hazard ratio for Health Status, Hispanics (Poor/Fair Health relative to Good/Excellent Health)

**Adjusted for age, sex, marital status, education, employment, origin and income**
**NHIS-NDI 1989-1994/1997**

**Hazard ratio **** ****(Cox proportional hazards****)**

## Hazard ratio* by Health Status, Hispanics (Poor/Fair Health relative to Good/Excellent Health)

*** Adjusted for age, sex, marital status, education and income**
**** Finch et al used NHIS/NDI 1989-1994/1989-1997, also adjusted for employment and origin**

**Hazard ratio**** ****(Cox proportional hazards****)**

## Summary

- Matching criteria differentially affect mortality estimates by race/ethnicity, sex, and age
- Groups most affected are Hispanics, especially Hispanic females and younger Hispanics
- Differential matching may affect inferences
-  Education, Health status, Nativity

## Summary

- Different criteria change number of matched deaths by about +/- 5%
- Small effect of different criteria on many inferences
- Non-Hispanic black, non-Hispanic white
- Older Hispanics
- Hispanics who have lived in the U.S. for a long time

## Conclusions

- Overall associations likely to be robust to different matching criteria
- No current “gold” standard
- Sensitivity analysis would be appropriate for some studies