National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Lester R. Curtin, Ph.D., Acting Associate Director for

Research and Methodology

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Data Standards,

Program Development, and Extramural Programs

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

W. Edward Bacon, Ph.D., Director, Division of Health Care

Statistics

Phillip R. Beattie, Director, Division of Data Services

Mary Anne Freedman, Director, Division of Vital Statistics

Ann M. Hardy, Dr.P.H., Acting Director, Division of Health

Interview Statistics

Delton Atkinson, Director, Division of Data Processing

Jennifer H. Madans, Ph.D., Director, Division of

Epidemiology

Diane M. Makuc, Dr.P.H., Director, Division of Health and

Utilization Analysis

Clifford L. Johnson, Acting Director, Division of Health

Examination Statistics

Diane K. Wagener, Ph.D., Acting Director, Division of

Health Promotion and Statistics
Contents

National Center for Health Statistics organization chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Overview and Background ...................................................................... 1

Surveys and Data Systems ...................................................................... 1

National Vital Statistics System ............................................................. 1

National Maternal and Infant Health Survey ............................................. 1

National Mortality Followback Survey.................................................... 2

Linked Files of Live Birth and Infant Death Records ...................................... 2

National Death Index ................................................................... 2

National Survey of Family Growth ........................................................... 2

National Health Interview Survey ........................................................... 2

National Health and Nutrition Examination Survey ........................................... 3

National Hispanic Health and Nutrition Examination Survey .............................. 4

National Health and Nutrition Examination Survey (NHANES) I

Epidemiologic Follow-up Study ........................................................ 4

National Health Care Survey ................................................................ 4

National Hospital Discharge Survey...................................................... 4

National Ambulatory Medical Care Survey ............................................... 4

National Survey of Ambulatory Surgery .................................................. 4

National Hospital Ambulatory Medical Care Survey ....................................... 5

National Home and Hospice Care Survey ................................................. 5

National Nursing Home Survey.......................................................... 5

National Health Provider Inventory ...................................................... 5

National Employer Health Insurance Survey ................................................. 5

National Immunization Survey .............................................................. 5

State and Local Area Integrated Telephone Survey ............................................ 5

Research and Methods .......................................................................... 6

Cognition and Survey Measurement.......................................................... 6

Statistical Methods ......................................................................... 6

Statistical Technology ....................................................................... 6

Survey Design .............................................................................. 6

Automation Activities ....................................................................... 6

Analytical Products and Dissemination .......................................................... 7

Electronic Products ......................................................................... 7

Major Publications .......................................................................... 7

Interaction with Users and Collaborators ........................................................ 8

National Committee on Vital and Health Statistics ............................................ 8

DHHS Data Council ........................................................................ 8

Nutrition Monitoring........................................................................ 8

NCHS Data Users Conference and Public Health Conference on Records and Statistics .......... 9

Reimbursable Work Program ................................................................ 9

Technical Assistance ........................................................................ 9

Minority Statistics and Grants............................................................... 9

International Collaboration.................................................................. 9

Appendix

I. Summary of Surveys and Data Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

iii

Overview and Background

The National Center for Health Statistics (NCHS) is a unique public resource for health information. As the

Nation’s principal health statistics agency, NCHS provides statistical information to guide actions and policies to

improve the health of the American people. NCHS’s mission is to monitor America’s health, and our activities

mirror the multi-faceted aspects of health care.

NCHS surveys and data systems provide fundamental public health and health policy statistics that meet the

needs of a wide range of users. NCHS data are used to track changes in health and health care, particularly as

major changes are occurring in private markets and in Federal and State policy. NCHS provides mechanisms for

obtaining consistent, uniform statistics that allow for comparison across population groups, types of health care

providers, and States; for planning, targeting, and assessing the effectiveness of public health programs, and for

identifying health problems, risk factors, and disease patterns. This type of information is important to

understanding trends that allow NCHS to anticipate the future directions in the health care system and in health

behaviors.

In 1960 the National Office of Vital Statistics and the National Health Survey merged to form NCHS. Since

1987 NCHS has been a part of the Centers for Disease Control and Prevention. Under Sections 304, 306, and 308

of the Public Health Service Act, NCHS has legislative authority for its programs. The Act authorizes data

collection, analysis, and dissemination of a broad range of health and health-related areas and provides specific

legislative authority to enable the Center to protect the confidentiality of information received in its surveys. In

addition the Act provides for NCHS to undertake and support research, demonstrations, and evaluations

regarding survey methods and to provide technical assistance to State and local jurisdictions.

Surveys and Data Systems

Information plays a critical role in public health

and health policy. NCHS obtains statistics through a

broad-based program of ongoing and special studies,

including household interview surveys, examination

surveys, surveys of health care providers, and collection of statistics on birth and death in partnership

with State government. For additional information on

NCHS data systems and programs, refer to the appendix in the back of this publication.

National Vital Statistics System

The National Vital Statistics System is responsible

for the Nation’s official vital statistics. These vital

statistics are provided through State-operated registration systems and are based on vital records filed in

State vital statistics offices. The registration of vital

events—births, deaths, marriages, divorces, fetal

deaths, and induced terminations of pregnancy—is a

State function. NCHS cooperates with the States to

develop and recommend standard forms for data collection and model procedures to ensure uniform registration of the events. The Center shares the costs

incurred by the States in providing vital statistics data

for national use.

Detailed annual data on births, deaths (including

infant deaths), fetal deaths, and terminations of pregnancy are available for the United States and for

States, counties, and other local areas. Monthly provisional data are available for the United States and

each State. For marriage and divorce, monthly totals

are available.

National Maternal and Infant Health Survey—

The objective of the survey is to collect 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.

It 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. Information is based on data collected

from questionnaires administered to mothers, physicians, hospitals, and other medical providers associated with outcomes.

The 1988 survey expanded on information available for birth, fetal death, and infant death vital

records, and was the first national survey that included

data on those three pregnancy outcomes simulta1
neously. A 1991 longitudinal followup of respondents

in the NMIHS was conducted to obtain national estimates and health status information on a nationally

representative sample of 3-year old children.

Earlier studies included National Natality Surveys in 1963, 1964–66, 1968–69, 1972, and 1980. A

National Fetal Mortality Survey was conducted in

1980, and a National Infant Mortality Survey was

conducted in 1964–66.

National Mortality Followback Survey—

Information from this survey expands information on

the death certificate to help researchers identify how

lifestyles affect health and the extent of the burden of

illness in the last year of life. The data provide information on socioeconomic characteristics of deceased

persons, use of and payment for hospitals and institutional care during the last year of life, and factors

related to health status, such as smoking habits.

The survey was conducted annually from 1961 to

1968 and then in 1986. The 1986 survey sample was

approximately 1 percent of U.S. resident deaths of

persons 25 years of age and over. If death occurred in a

hospital or institution, a questionnaire was also sent

to the facility.

The most recent survey was initiated in 1993 and

it is the first survey to collect information from medical examiners and coroners for external causes of

death.

Linked Files of Live Birth and Infant Death

Records—The purpose of this data set is to provide

information needed for detailed analyses of infant

mortality trends and differentials in the United States.

In the linked birth/infant death data set the death

certificate is linked to the corresponding birth certificate for each infant under 1 year of age who dies in the

United States. The purpose of the linkage is to use the

many additional variables available from the birth

certificate in infant mortality analyses. The linked

birth/infant death data set is the only source of national

record-based data on infant mortality by birthweight,

gestational age, prenatal care utilization, cause of

death, and on maternal characteristics such as age,

education, marital status, and smoking and alcohol

use during pregnancy. Infant mortality rates for detailed

race and Hispanic-origin subgroups are available from

this data set, which permits use of the more accurate

race and Hispanic origin data from the birth certificate. Unit record linked file data are available on

public-use data tapes for 1983–91 birth cohorts and on

CD-ROM for the 1985–91 birth cohorts.

National Death Index—Working with State offices,

NCHS established the National Death Index (NDI) as

a resource to aid epidemiologists and other health and

medical investigators with their mortality ascertainment activities. The NDI is a central computerized

index of death record information compiled from magnetic tapes submitted by State vital statistics offices.

Beginning with 1979 deaths, death records are added

to the NDI file annually, approximately 10 months

after the end of a particular calendar year.

The index assists investigators in determining

whether persons in their studies have died and, if so,

provides the names of the States in which those deaths

occurred, the dates of death, and the corresponding

death certificate numbers. Investigators also will soon

be able to receive the coded causes of death or (as in

the past) can arrange with the appropriate State

offices to obtain copies of death certificates.

The index is available to investigators solely for

statistical purposes in medical and health research. It

is not accessible to organizations or the general public

for legal, administrative, or genealogy purposes. To

use the system, investigators must first submit an

NDI application form to NCHS. Applicants should

allow about 2 months for their applications to be

reviewed and approved. Once approved for NDI file

searches, users may submit records of their study

subjects to NCHS on magnetic tape or floppy disk.

Users should submit as many of the following data

items as possible for each study subject first and last

name, middle initial, father’s surname, social security

number, date of birth, sex, race, marital status, State

of last known residence, State of birth, and age at

death (if known).

National Survey of Family Growth

The National Survey of Family Growth (NSFG) is

a multipurpose survey based on personal interviews

with a national sample of women 15–44 years of age in

the civilian noninstitutionalized population of the

United States. Its main function is to collect data on

factors affecting pregnancy and women’s health in the

United States. Previous NSFG surveys were conducted in 1973, 1976, 1982, 1988, and 1990. The latest

survey was conducted in 1995.

National Health Interview Survey

The National Health Interview Survey (NHIS) is a

principal source of information on the health of the

civilian noninstitutionalized population. The survey,

conducted annually since 1957, collects information

from approximately 40,000 households and 100,000

people on health status, access to care and insurance,

health services utilization, health behaviors, and other

topics. The survey consists of a set of basic data items

that are repeated each year and additional questions

that can change each year to address current health

topics.

Basic annual data are collected on the incidence of

acute conditions, episodes of persons injured, prevalence

of chronic conditions and impairments, restriction in

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activity due to impairment or health problems,

respondent-assessed health status, utilization of health

care services involving physician care, health insurance,

and demographic and socioeconomic characteristics.

Supplemental questions addressing major health

issues have included a variety of topics. Questions

on AIDS knowledge and attitudes have been included

annually as a special health topic since 1987. Other

special topics have included immunization, family

resources and health insurance, cancer control, cancer epidemiology, disability, youth risk behaviors,

and data items to measure national progress toward

achieving the objectives set in Healthy People 2000:

National Health Promotion and Disease Prevention

Objectives.

NHIS is a major part of the Department of Health

and Human Services’ (DHHS) integration plan, an

effort to improve the quality, efficiency, and timeliness

of data by integrating surveys. The NHIS national

sample is used as the sampling frame for other DHHS

surveys including the National Medical Expenditures

Panel Survey, and is linked to the sample of the

National Health and Nutrition Examination Survey

and the National Survey of Family Growth.

As part of the integration plan, NHIS has been

redesigned to give more emphasis to personal health

characteristics such as disability and less emphasis to

medical events such as hospitalization. It will obtain

information on fewer types of chronic conditions than

in the past, but will produce more reliable estimates

for the conditions it does cover. More complete information on injuries and on children will also be available. The data collected will be more useful for disease

and risk factor surveillance and will be better able to

address emerging health issues.

Concurrent with the survey redesign, NHIS has

changed from traditional paper and pencil for data

collection to computer-assisted personal interviewing.

This will significantly reduce the time between collecting and disseminating the data.

Targeted population studies—In targeted population studies, persons or families are selected from

NHIS participants, and additional health-related information is obtained by reinterviewing them or by obtaining information from linking NHIS data files with

other health data files. This approach facilitates the

collection of detailed information from the target population over time and may be used for studies requiring

more detail about prevalence of selected conditions or

diseases.

Targeted population studies undertaken by NCHS

and collaborating agencies have included the following:

+ The Longitudinal Study of Aging (LSOA)-1, based

on the 1984 NHIS Supplement on Aging, and the

LSOA-2, based on the 1994 NHIS, both conducted

jointly with the National Institute on Aging.

+ The Teenage Attitudes and Practices Survey, conducted jointly with the Office on Smoking and

Health with data collected during the 1989–90

school year.

+ The Access to Care Followup study, a 1994 telephone survey including segments of the general

population and those persons with asthma or

ischemic heart disease. This study was conducted

jointly with the Robert Wood Johnson Foundation.

+ The Disability Followup Survey, a 1994–95 survey

including adults, children, and polio survivors, conducted jointly with a number of other organizations including the DHHS Office of the Assistant

Secretary for Planning and Evaluation, the Social

Security Administration, the Institute for Disability and Rehabilitation Services, and the Robert

Wood Johnson Foundation.

National Health and Nutrition

Examination Survey

Since 1960 NCHS has collected information on the

health of Americans through a combination of interviews and direct physical examinations. For the

National Health and Nutrition Examination Survey

(NHANES), standardized medical examinations are

conducted and physical measurements are taken on a

nationally representative population.

The goals of the survey are as follows:

+ To estimate the number and percent of persons in

the U.S. population and designated subgroups with

selected diseases and risk factors

+ To monitor trends in the prevalence, treatment,

and control of selected diseases

+ To investigate risk factors for selected diseases

+ To monitor trends in risk behaviors and environmental exposures

+ To study the relationship between diet, nutrition,

and health

+ To explore emerging public health issues

NHANES III is the most recent of seven health

examination surveys and was completed in 1994. It

provides information on 30 topics including blood pressure, blood cholesterol, obesity, passive smoking, lung

disease, osteoporosis, HIV, hepatitis, immunization status, diabetes, allergies, growth and development, blood

lead, anemia as well as information on nutritional

status, dietary intake and nutritional blood measures.

The eligible population for this survey was the

U.S. civilian noninstitutionalized population aged 2

months and over. Forty-thousand persons of all races

were selected from 81 counties, which were selected

from 26 States. About 30,000 people agreed to participate in the medical examination. Children, older persons, African Americans, and Mexican Americans were

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oversampled to provide precise estimates for these

relatively small subsets of the populations.

Planning is currently underway for NHANES IV

to be conducted beginning in 1998 and continuing

through 2004. Numerous organizations are participating in the planning including virtually all Federal

health agencies, the academic community, and the

private sector.

National Hispanic Health and Nutrition Examination Survey—This one-time health examination survey

focused on three major subgroups of the Hispanic

population—Mexican Americans in the Southwest,

Cubans in Miami (Dade County), Florida, and Puerto

Ricans in the New York City area. This survey was

conducted from 1982 to 1984 and provides health and

nutrition data on a 12,000-person sample.

NHANES I Epidemiologic Follow-Up Study—

Using information gathered in NHANES I, conducted

1971–75, researchers are investigating the relationship between selected clinical, nutritional and behavioral factors and subsequent morbidity, mortality, and

institutionalization. The NHANES I Epidemiologic

Follow-Up Study is a collaborative project involving

NCHS and other organizations in the Centers for

Disease Control and Prevention, the National Institute on Aging and other components of the National

Institutes of Health, and the Substance Abuse and

Mental Health Administration.

The NHANES I Epidemiologic Follow-Up Study

includes the 14,407 participants who were 25–74 years

of age when first examined. The first wave of data

collection was conducted in 1982–84. It included tracing all participants and conducting face-to-face interviews with found participants or their proxies. For all

participants, hospital and nursing home records of

overnight stays were collected. For those who were

alive, pulse rate, weight, and blood pressure were

taken. For those participants who were deceased, death

certificates were obtained.

Subsequent followups used similar design and data

collection procedures, with the following exceptions: A

30-minute computer-assisted telephone interview was

used instead of face-to-face interview; no physical measurements were taken; in 1986 the study included

those who were aged 55–74 years during the NHANES

I and who were not known to be deceased; and in 1987

and 1992, the study was conducted on all living

participants.

National Health Care Survey

To meet the health statistics needs of the future, a

number of the Center’s record-based surveys were

merged and expanded into one survey of health care

providers called the National Health Care Survey

(NHCS). The NHCS provides data on health care

settings such as hospitals, ambulatory surgical centers, hospital outpatient departments, emergency

departments, nursing homes, hospices, and home health

agencies. Thus the survey is a 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.

NHCS was built upon three NCHS surveys: the

National Hospital Discharge Survey, the National

Ambulatory Medical Care Survey, and the National

Nursing Home Survey. These were complemented by

three new surveys; the National Survey of Ambulatory

Surgery, the National Hospital Ambulatory Medical

Care Survey, and the National Home and Hospice

Care Survey.

National Hospital Discharge Survey—The National

Hospital Discharge Survey is the principal source of

information on inpatient utilization of hospitals. Conducted annually since 1965, the survey provides data

on the use of non-Federal short-stay hospitals, on their

size, location and ownership as well as data on diagnoses, surgical procedures, length of stay, expected

source of payment and patient characteristics. Data

from the NHDS are useful for tracking specific diseases, the introduction of new technologies, and the

impact of changes in the financing systems. The survey is based on data abstracted from 274,000 records

from 500 hospitals.

National Ambulatory Medical Care Survey—The

National Ambulatory Medical Care Survey provides

data on visits to physicians, including information on

patient characteristics, diagnostic procedures, patient

management, and planned future treatment. The survey was conducted annually from 1974–81, in 1985,

and annually since 1989.

Data are collected using encounter forms from

approximately 3,000 physicians from a sample of 40,000

visits. Data collection from the physician, rather than

from the patient, provides an analytic base that expands

information on ambulatory care collected through other

NCHS surveys.

National Survey of Ambulatory Surgery—

Although data have been available for three decades

for surgery on inpatients, advances in medical technology permit a wide variety of surgical and diagnostic

treatments outside the inpatient setting. The National

Survey of Ambulatory Surgery provides detailed data

on the use of free-standing and hospital-based ambulatory surgery in the United States.

Data collection began in 1994 and data are available on patient characteristics including age and sex;

administrative information including patient disposition, expected sources of payment, and region of the

country where surgery was performed; and medical

information including diagnoses, surgical operations,

and diagnostic procedures performed.

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National Hospital Ambulatory Medical Care

Survey—The National Hospital Ambulatory Medical

Care Survey provides data representing the experience of the U.S. population in hospital emergency

departments and outpatient departments. Specifically,

the survey provides information on the demographic

characteristics of patients, expected source of payment, patients’ complaints, physicians’ diagnoses, diagnostic and/or screening services, procedures, medication

therapy, disposition, types of health care professionals

seen, and causes of injury where applicable.

Data collection began in 1992 and has continued

annually. Data are abstracted from 70,000 medical

records of visits to 440 hospitals.

National Home and Hospice Care Survey—The

National Home and Hospice Care Survey provides

data on home health agencies and hospices and their

current patients and discharges. Conducted annually

from 1992–94 and in 1996, the survey was established

in response to the rapid growth in the number of home

health agencies and hospices throughout the United

States and the need to assess the availability and

utilization of these services.

Personal interviews with administrators and staff

provide information from approximately 1,500 sample

agencies. Data are collected on referral and length of

service, diagnoses, number of visits, patient charges,

health status, reason for discharge, and types of services provided.

National Nursing Home Survey—The National

Nursing Home Survey provides information on nursing homes from two perspectives—that of the provider

of services and that of the recipient. Data about the

facilities include characteristics such as size, ownership, Medicare and/or Medicaid certification, occupancy rate, services provided, and expenses. For

recipients, data are obtained on demographic characteristics, health status, and services received.

Conducted periodically since 1963 and most recently

in 1995, the survey is based on data collected in

interviews with administrators and staff in a sample

of about 1,500 facilities.

National Health Provider Inventory—The National

Health Provider Inventory provides the sampling frame

for the National Nursing Home Survey and the National

Home and Hospice Care Survey. This inventory is a

comprehensive national listing of nursing homes, residential care facilities, hospices, and home health agencies. It is an important source of national statistics on

the number, type, and geographical distribution of

health providers in the United States. It has been

updated periodically since 1963 under different titles—

the National Master Facility Inventory (1967–82) and

the Inventory of Long-Term Care Places (1986). Most

recently it was updated in 1991.

Based on data collected on self-administered questionnaires sent directly to agencies and facilities, the

inventory provides names and addresses of almost

56,000 facilities, including more than 15,500 nursing

homes, over 31,000 board and care homes and more

than 7,800 home health agencies and hospices. Information such as type of facility, ownership, size, location, and resident characteristics is available as well

as information on number of clients, services, and

locations.

National Employer Health

Insurance Survey

The National Employer Health Insurance Survey

is a national survey of establishments in the private

and public sectors conducted to examine characteristics of employer-sponsored health insurance. The data

collected provide information on private health insurance coverage. The study was sponsored by the Department of Health and Human Services and managed by

the National Center for Health Statistics.

Data were collected from 39,000 businesses and

organizations, primarily using computer-assisted interviews, between April and December 1994.

National Immunization Survey

The National Immunization Survey was established in 1994 to provide high quality, timely data on

immunization coverage of children 19–35 months of

age. The data are used to monitor immunization coverage in the preschool population in 50 States and 28

large urban areas. The survey is a collaborative effort

between NCHS and the Centers for Disease Control

and Prevention’s National Immunization Program.

State and Local Area Integrated

Telephone Survey

In response to the need for the development of a

national capacity to generate high quality State level

data for tracking and monitoring current and emerging health and welfare policy-related issues, the State

and Local Area Integrated Telephone Survey (SLAITS)

was initiated. SLAITS was designed to provide quick

turnaround data on a variety of broad health and

welfare related issues and includes questions on health

insurance coverage, access to care, health status, utilization of services and basic demographic and socioeconomic information taken from the National Health

Interview Survey. It uses the same telephone design

approach as used in the National Immunization Survey. The study will provide a mechanism for State and

national comparisons of data and also allow for customization for State specific needs. Data collection for

a number of pilot States were conducted in 1997.

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Research and Methods

NCHS maintains an active program in statistical

research and methodology. The major components of

that program are briefly described below.

Cognition and Survey Measurement

The National Laboratory for Collaborative Research

in Cognition and Survey Measurement applies cognitive methods in questionnaire design research, and

was a pioneering effort when established in 1985. In

collaboration with other Center programs, the Laboratory develops and tests NCHS data collection instruments. It also supports a questionnaire design research

program in collaboration with university scientists by

means of research contracts.

Statistical Methods

Research is undertaken at the Center on analytic

methods applicable to the NCHS registration systems

and sample surveys. Current projects include the development of computer software for the analysis of survey

data, methods for model and design-based State estimates, and random effect models for analyzing longitudinal data.

Statistical Technology

The Center conducts a program of contract and

intramural research on automated statistical and

graphical technology. Current applications include automated mapping, statistical computing methods, geographic information systems, statistical graphics, and

statistical atlases.

Survey Design

The Survey Design program involves the design

and evaluation of the sample plans for many of NCHS

s surveys to improve their efficiency and analytical

capability. Current research focuses on linked survey

designs, designs for State telephone surveys, nonresponse adjustments, and estimation of sampling errors

for rare events. In addition, the Center maintains an

active program in monitoring data quality.

Automation Activities

A continuing initiative of NCHS is automation of

data collection, analysis, and dissemination. Computerassisted personal and telephone interviews are being

conducted to improve the quality and timeliness of

data collection. Automation of data collection has also

been successfully achieved with NCHS s medical examination centers, where data are collected for the National

Health and Nutrition Examination Surveys. The development and field testing of automated medical coding

systems is another automation effort in data collection. These systems provide the potential for more

timely processing of vital statistics at the local, State,

and Federal levels and are essential to the goal of

automating the collection of vital statistics at the

source.

In recent years NCHS has expanded electronic

access to information. National public-use data files

including all documentation are now available on

CD-ROM. These data are presented using the Center’s

Statistical Export and Tabulation System (SETS). The

SETS software is also available as a toolkit for developers to prepare large read-only databases for distribution on CD-ROM. A Windows 95TM version of SETS

is now available. The new software, which incorporates all the advantages of multitasking found in

Window 95TM, supports all the powerful aspects of the

earlier DOS version and adds a unique charting capability to the spreadsheet functions.

6
Analytical Products and Dissemination

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. NCHS

data are presented in a variety of electronic products

and publications, including journal articles and

chartbooks.

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.

Electronic Products

NCHS has an extensive program of data release

through electronic media including the World Wide

Web, CD-ROMS with statistical software, CD-ROMs

with text-retrieval software, and public-use data tapes.

Home Page

The NCHS home page provides instantaneous

access to a wide range of statistical information about

health status and use of health care in the United

States. The NCHS Web site includes links to the latest

social statistics from Federal agencies; a link to FEDSTATS with over 70 links to other Federal statistical

agencies; a data warehouse with detailed statistical

tables, links to CDC’s WONDER data retrieval system, and other data sites; news releases and fact

sheets, frequently asked questions, and sections on

what’s new, coming events, and NCHS products. Fulltext files of catalogs and publications may be viewed,

searched, printed, and downloaded. The Web page also

features a query section where users have an opportunity to direct statistical questions to NCHS technical

information specialists and to provide comments on

the home page and other Center activities.

CD-ROMs

Statistical CD-ROMs containing micro-data are now

available from many of the Center’s data collection programs. These CD-ROMs contain detailed data files; the

associated documentation; and Statistical Export and

Tabulation System (SETS) software to retrieve, access,

and search data and documentation. Text CD-ROMs

containing NCHS publications are also available. These

publications can be viewed, searched, printed, and downloaded using the Adobe Acrobat software on the

CD-ROMs. Refer to the most recent Catalog of Electronic

Products for additional information.

Data Tapes

Over 600 public-use data tapes have been produced by the Center. Data tapes available through

NCHS parallel the various data systems and represent

the full range of data collected by NCHS. The majority

of NCHS data tapes are microdata rather than summary analyses; individual identifiers have been

removed. NCHS data files are sold through the National

Technical Information Service. Purchase price for the

file includes complete documentation. Data tapes are

described in the Catalog of Electronic Products and in

periodic updates.

Major Publications

NCHS publications are indexed in catalogs of publications of the National Center for Health Statistics.

Major publications are as follows:

n Health, United States

A comprehensive annual report from the Secretary

of Health and Human Services to the President and

the Congress on the health of the Nation. Health,

United States presents current and trend data on

health status and determinants, utilization of health

resources, health care resources, and health care

expenditures.

n Vital and Health Statistics Series

Background, methodology, and analytical studies

and presentations of findings from NCHS data collection programs.

n Advance Data From Vital and Health Statistics

Summary reports that provide the first release of

data from NCHS health and demographic surveys.

n Vital Statistics of the United States

Historical marriage and divorce data through 1988

and on-going annual compilations of mortality and

natality data, with extensive demographic and geographic detail.

n Monthly Vital Statistics Report

Monthly and cumulative data on vital events, with

brief analyses.

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Interaction with Users and Collaborators

A primary mission of NCHS is to meet the health

data needs of other agencies of the Department of

Health and Human Services and other data users. The

Center accomplishes this through several programs

that promote interaction with users and collaborators.

National Committee on Vital and

Health Statistics

The National Center for Health Statistics provides

staff support for the National Committee on Vital and

Health Statistics (NCVHS) and its subcommittees.

The NCVHS is the official external advisory committee

on health statistics to the Secretary of Health and

Human Services.

The Committee consists of 16 individuals distinguished in the fields of health statistics, epidemiology,

and health care services. The Committee fulfills important review and advisory functions relative to health

statistical problems of national or international interest, stimulates or conducts studies of such problems,

and makes proposals for improvement of the Nation’s

health statistics and information systems.

The NCVHS serves as a national forum for the

collaboration of interested parties with the long-term

goal of improving the comparability of private sector,

State, and Federal health information systems while

assuring the confidentiality of the information collected. The committee’s new charter enables the

NCVHS to foster collaboration on a voluntary means

to facilitate and accelerate the development of consensus across the public and private sectors around these

key data standards.

NCVHS has become increasingly active over the

past several years, addressing issues relating to uniform health data sets, medical classification systems,

the need for improved mental health statistics, data

needs for minority health and the medically indigent,

and State and community health data needs.

DHHS Data Council

The Director of NCHS serves as the Senior Advisor

on Health Statistics to the Secretary of Health and

Human Services (HHS) In this role he serves as a

member of the DHHS Data Council. Other members

include the HHS Privacy Advocate and Assistant Secretary and Agency Administrator-level HHS officials

who have a direct reporting relationship to the Secretary of Health and Human Services.

Established in 1995, the Data Council meets

monthly to coordinate all health and nonhealth data

collection and analysis activities of the Department of

Health and Human Services through an integrated

health data collection strategy, coordination of health

data standards, and health information and privacy

activities.

The majority of the Data Council’s work is performed by issue-specific, inter-agency standing and ad

hoc staff committees and working groups. Agenda

items include: develop a Department-wide data collection strategy, including coordination and integration of

surveys and oversight of surveys and general statistical analysis; coordinate HHS and Inter-Department

health data standards activities; serve as HHS liaison

for the NCVHS; serve as focus for HHS issues relating

to privacy of health and social services information;

provide a forum for coordination of health and human

services issues raised by the expanding National Information Infrastructure activities; and provide a forum

for coordination of HHS responses to external requests

for HHS action on issues related to health and social

services data.

Nutrition Monitoring

NCHS plays a major role in monitoring the nutritional and health status of the American population.

Working with members of the Interagency Board for

Nutrition Monitoring and Related Research (IBNMRR), NCHS provides information about dietary and

nutritional status, conditions that affect dietary and

nutritional status, and the relationship between diet

and health.

The IBNMRR oversees implementation of the

10-Year Comprehensive Plan for the National Nutrition Monitoring and Related Research Program. The

Plan was formally sent to Congress in January 1993.

The goals of the plan are to:

+ collect quality data that are continuous, coordinated, timely, and reliable

+ use comparable methods for collecting data and

reporting the results

+ conduct related research and

+ efficiently and effectively disseminate and exchange

information with data users

This information is used to set nutrition policy,

evaluate programs, and develop and plan nutrition

and health education and intervention programs.

The IBNMRR coordinates the preparation of directories and Federal and State nutrition monitoring

activities, reports of findings from the National Nutrition Monitoring and Related Research Program, and

periodic scientific reports to Congress, Federal and

State organizations, researchers, and the media. The

most recent report, Third Report on Nutrition Monitoring in the United States, was published in 1995.

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NCHS Data Users Conference and

Public Health Conference on

Records and Statistics

NCHS holds a Data Users Conference for current

and potential users of NCHS data. The Conference

provides an opportunity to meet with and ask questions of NCHS staff and to learn about present and

future plans for NCHS data collection, analysis, and

dissemination activities. The Conference program consists of plenary sessions featuring key NCHS staff,

workshops on all of the NCHS data files, and sessions

on cross-cutting topical and analytical issues of public

health concern. The Public Health Conference on

Records and Statistics (PHCRS) has been sponsored

by the National Center for Health Statistics as a

periodic meeting since 1958. PHCRS provides a forum

for representatives from Federal, State, and local governments, as well as from universities and professional associations, to share their knowledge and

experience. This diverse gathering lends the Conference a rich variety of perspectives on current issues

concerning health information in the United States.

Technical and philosophical issues are brought to light

during each Conference session. The proceedings are

published and serve as a valuable reference tool in

addressing issues raised at the Conference. In 1997,

the two meetings were combined into one Conference.

Reimbursable Work Program

Many NCHS data systems are designed to allow

flexibility in content in targeting special populations.

This flexibility allows NCHS to add questions or examination procedures to existing data collection mechanisms and to target population subgroups (for example,

older persons, Hispanics, and blacks) in its surveys.

Agencies with data requirements frequently are

able to work with NCHS to meet their needs through

modifications or additions to NCHS data systems,

eliminating the need to mount new data collection

efforts that may be costly or may duplicate existing

efforts. NCHS is reimbursed by these agencies for

costs incurred in providing such services.

Technical Assistance

NCHS offers technical assistance to interested parties in the areas of health statistics development and

in access to or use of existing health-related data. Staff

members from the major survey divisions of NCHS are

frequently called upon to assist in developing sample

survey questionnaires, methods, and procedures. Other

research or analytical staff provide assistance in the

areas of survey design, estimation, and analytical

methods. Where design-based estimates for small areas

are impossible from existing survey vehicles, NCHS

provides guidance in the development of and use of

model-based estimates.

NCHS uses a variety of opportunities to share

plans, developments, and analyses. These include university lectures and seminars; data system seminars;

special topic seminars; presentation of research findings at annual association meetings; conferences, workshops, symposiums, and ad hoc site visits for unique

problem solutions.

Minority Statistics and Grants

For several decades, NCHS has held a leadership

role in highlighting the health of racial and ethnic

populations in the United States, and in calling attention to the significant differences that exist between

various population groups.

NCHS data programs provide the statistics to

profile the health of minority populations in the United

States. Vital statistics provide information on life

expectancy, infant mortality, and patterns of birth by

prenatal care and birthweight. Other data to determine the prevalence of major chronic conditions—such

as heart disease, hypertension, and diabetes—and the

use of hospital and physician services are provided

through health surveys. In general, all NCHS data

systems make special efforts to make estimates for the

black and Hispanic populations, but are limited in

their ability to provide data for Asian or Pacific Islanders, and for American Indians or Alaskan Natives.

NCHS is continuing its efforts to improve the availability of data for minority populations. These efforts

include oversampling of minority populations in NCHS

surveys to improve the precision of the estimates made

based on the collected data, modification of coding

methodologies to provide data for subpopulations of

the broader racial and ethnic groups, and increased

publication of data for racial and ethnic minority

populations. NCHS has conducted the Hispanic Health

and Nutrition Examination Survey that includes a

range of data on chronic conditions, disability, growth,

and physical development.

As a result of legislation passed in 1990, an extramural grants program to improve minority statistics was

established by NCHS. Grants were authorized for the

support of studies to fill in gaps where national surveys

cannot provide sufficient data; analysis of existing data;

and research to improve methods for obtaining information on racial and ethnic subpopulations.

International Collaboration

The National Center for Health Statistics (NCHS)

maintains international health statistics programs with

developed and developing countries all around the

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world. These programs consist of cooperative ventures

and collaborative research on analytical and methodological issues, technical assistance and consultation,

training and information exchange, and joint activities

with multinational agencies. In addition, NCHS sponsors international meetings and symposiums, and contributes to other international forums through scientific

articles and presentations. Through these efforts, NCHS

seeks to improve the availability and quality of health

data in the United States and other countries.

The international research program is carried out

in collaboration with other countries and with other

agencies of the HHS. An important part of this research

is carried out through International Collaborative

Efforts (ICE’s), which bring together domestic and

foreign experts to focus on specific health issues of

mutual interest to the participating countries. Research

findings from these analytic research projects are used

to provide guidance to specific HHS programs and to

improve the health statistical activities of NCHS. Current topics included in these collaborative research

projects are perinatal and infant mortality, health and

health care of the elderly, and injuries. Under development is a new ICE on the automated classification of

causes of death.

The Center 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, housed

at NCHS. NCHS also serves as 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.

For additional information about the National Center

for Health Statistics, contact:

Data Dissemination Branch

National Center for Health Statistics

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782-2003

Telephone (301) 436–8500

E-mail: nchsquery@cdc.gov

Internet: http://www.cdc.gov/nchswww/nchshome.htm

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