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National Healthcare Quality & National Healthcare Disparities Reports: Data Sources Appendix, 2013

Data Sources Used for 2013 Reports—Centers for Disease Control and Prevention

Behavioral Risk Factor Surveillance System (BRFSS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Office of Surveillance, Epidemiology, and Laboratory Services.

Description

BRFSS is administered as a telephone interview. Computer-assisted telephone interviewing has been used since 2004. State data may be collected directly by the State health department or through a contractor. In 2011, 11 State health departments collected their data in-house; 43 contracted data collection to university survey research centers or commercial firms.

Survey Sample Design

BRFSS is a State-based system of telephone health surveys of adults age 18 and over who reside in households. BRFSS is conducted by landline and cell phone. Random-digit-dialed (RDD) probability design was used initially. Disproportionate stratified sample (DSS) design has been implemented for landline portions of the sample since 2003 and the number of States using DSS is increasing.

In the DSS design most commonly used in BRFSS, telephone numbers are divided into two strata, high density and medium density. Strata are sampled separately. Telephone numbers in the high-density stratum are sampled at the highest rate. In 2011, 50 States and the District of Columbia used DSS design. Guam, Puerto Rico, and the U.S. Virgin Islands used RDD design.

Primary Survey Content

The objective of BRFSS is to collect uniform, State-specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases in the adult population.

The survey consists of core questions asked in all States, standardized optional questions on selected topics that are administered at the State's discretion, a rotating set of core questions asked every other year in all States, and State-added questions developed to address State-specific needs. Questions cover behavioral risk factors (e.g., alcohol and tobacco use), preventive health measures, HIV/AIDS, health status, activity limitations, and health care access and utilization.

Population Targeted

U.S. civilian noninstitutionalized population age 18 and over who reside in households with telephones.

Demographic Data

Gender, age, educational attainment, race/ethnicity, household income, employment status, and marital status.

Years Collected

Since 1984. The number of States participating in the survey has increased from 15 in 1984 to 50 States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands since 2001.

Schedule

Annual. Data are collected monthly.

Geographic Estimates

National; State; smaller area estimates possible in some States.

Contact Information

Agency home page: http://www.cdc.gov.

Data system home page: http://www.cdc.gov/brfss.

References

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System operational and user's guide. Version 3.0. Atlanta, GA: U.S. Department of Health and Human Services; December 12, 2006.

Go to http://www.cdc.gov/brfss/data_documentation/index.htm for a collection of documents and survey data providing technical and statistical information regarding BRFSS, such as comparability and sampling information.

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National Ambulatory Medical Care Survey (NAMCS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NAMCS is an annual survey that collects visit, practice, and provider-level data from office-based physicians and community health center (CHC) providers in the United States. Field personnel meet with participating office-based physicians and instruct them in survey data collection methods. Physicians are asked to complete a 2-page questionnaire (Patient Record Form) on a sample of their office visits during their assigned reporting period. However, more than half of NAMCS Patient Record forms submitted in 2010 (54.6%) were abstracted by field personnel from the U.S. Census Bureau rather than by the physician or medical office personnel.

Survey Sample Design

NAMCS has been fielded since 1989. The sampling frame for office-based physicians in NAMCS is derived from the American Medical Association and the American Osteopathic Association master files. Physicians are excluded if they are federally-employed, do not provide direct patient care, or specialize in anesthesiology, radiology, or pathology. A special stratum of CHC providers was first added in 2006.

The sampling frame for CHC providers in NAMCS is developed using data from the Health Resources and Services Administration's Bureau of Primary Health Care Uniform Data System and the Indian Health Service. Each participating CHC provides a list of physicians and midlevel providers who would be available during the predetermined 1-week reporting period. This list becomes the frame for selection of up to three physicians and midlevel providers in each CHC.

To maintain consistency with measures included before 2006, visits to CHC midlevel providers are excluded from this report. In 2009 and 2010, data from a total of 63,510 visits were obtained from 2,585 office-based physicians. Unweighted and weighted response rates in these years ranged from 57% to 62%, respectively.

Primary Survey Content

Data are collected from medical records and include type of provider seen; reason for visit; diagnoses; drugs ordered, provided, or continued; and selected procedures and tests ordered or performed during the visit. Patient data include age, sex, race, and expected source of payment. Data are also collected on selected characteristics of physician practices.

Population Targeted

Sample data are weighted to produce national estimates of office visits. The basic sampling unit is the patient visit. The specialties of anesthesiology, pathology, and radiology are not included. Also not included are contacts by telephone, visits made outside the physician's office, visits in hospitals or institutional settings, and visits made for administrative purposes only.

Demographic Data

Patient age, gender, race, and ethnicity.

Years Collected

Annually from 1973-1981; 1985; annually since 1989.

Schedule

Annual.

Geographic Estimates

National; U.S. Census Bureau regions.

Notes

NAMCS is a visit-based survey rather than a population-based survey. Therefore, estimates of incidence and prevalence of disease cannot be computed. The survey is cross-sectional in nature. Multiple visits may be made by the same person within the sample.

Contact Information

Agency home page: http://www.cdc.gov/nchs/.

Data system home page: http://www.cdc.gov/nchs/ahcd.htm.

References

National Ambulatory Medical Care Survey: 2010 summary tables. Available at: http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf (PDF File, 403.5 KB). Accessed April 4, 2014.

2009 NAMCS micro-data file documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc09.pdf (PDF File, 1.38 MB). Accessed April 4, 2014.

2010 NAMCS micro-data file documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2010.pdf (PDF File, 1.61 MB). Accessed April 4, 2014.

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National Health and Nutrition Examination Survey (NHANES)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NHANES is a nationally representative survey of the resident civilian noninstitutionalized U.S. population. It consists of questionnaires administered in the home followed by a standardized physical examination in specially equipped mobile examination centers. The examination includes physical measurements, such as blood pressure and dental examinations, and the collection of blood and urine specimens for laboratory testing.

Survey Sample Design

A complex, multistage, probability sampling design is used to select a sample representative of the civilian noninstitutionalized household population of the United States. The four stages of sampling are:

  1. Primary sampling units (mostly counties).
  2. Segments within counties.
  3. Dwelling units/households.
  4. Individuals within a household.

Since 1999, the annual sample size is approximately 5,000 individuals from 15 different county locations selected from a sampling frame that includes all 50 States and the District of Columbia. Oversampled subgroups from 1999 to 2006 included non-Hispanic Blacks, Mexican Americans, low-income Whites, adolescents ages 12-19 years, and people age 70 years and over. During 1999-2006, a supplemental sample of pregnant women was also included.

Oversampled subgroups from 2007 to 2010 included all Hispanics, non-Hispanic Blacks, low-income Whites, and people age 80 years and over. From 1999 to 2010, the household interview response rates ranged from 79% to 84%, and the examination response rates ranged from 75% to 80%.

Primary Survey Content

Data collected include information on chronic diseases (including undiagnosed conditions) and health status, dietary intake and nutritional status, infectious disease and immunization status, environmental health and exposures, and related risk factors. Specific survey content may vary by survey cycle.

Population Targeted

NHANES samples the civilian noninstitutionalized resident population of the United States. NHANES excludes all people in supervised care or custody in institutional settings, all active duty military personnel, active duty family members living overseas, and anyone else residing outside the 50 States and the District of Columbia. Beginning in 1999, NHANES has included people of all ages.

Demographic Data

Gender, age, education, race/ethnicity, place of birth, income, and occupation.

Years Collected

From 1960-1962 (National Health Examination Survey [NHES] I), 1963-1965 (NHES II), 1966-1970 (NHES III), 1971-1974 (NHANES I), 1976-1980 (NHANES II), 1982-1984 (Hispanic Health and Nutrition Examination Survey), 1988-1994 (NHANES III), 1999-2010 (NHANES).

Schedule

Fielded periodically (1960-1994); annually beginning in 1999, with data releases occurring in 2-year cycles.

Geographic Estimates

National; four U.S. Census Bureau regions (from 1988).

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhanes.htm.

References

Ezzati TM, Massey JT, Waksberg J, et al. Sample design: third National Health and Nutrition Examination Survey. Vital Health Stat 1992;2(113).

National Center for Health Statistics. Plan and operation of the third National Health and Nutrition Examination Survey, 1988-94. Vital Health Stat 1994;1(32).

Analytic and reporting guidelines: the National Health and Nutrition Examination Survey (NHANES). Hyattsville, MD: National Center for Health Statistics; September 2006. Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/nhanes_analytic_guidelines_ dec_2005.pdf (PDF File, 47.5 KB). Accessed July 11, 2014.

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National Health Interview Survey (NHIS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NHIS is a cross-sectional household interview survey that gathers information on demographic characteristics, illnesses, injuries, impairments, chronic conditions, use of health resources, health insurance, and other health topics. Data are collected through computer-assisted personal interviewing (CAPI), with limited telephone followup allowed. U.S. Census Bureau interviewers administer the survey in English or Spanish (the CAPI Spanish version was initiated in mid-1998). A new NHIS instrument, which utilizes Blaise® computer-assisted interviewing software, was implemented for the 2004 survey year.

Survey Sample Design

Sampling and interviewing are continuous throughout each year. The sampling plan follows a multistage area probability design that allows representative sampling of households. The sampling plan is redesigned after every decennial census. The current sampling plan was implemented in 2006. It has many similarities to the previous sampling plan, which was in place from 1995 to 2005.

The first stage of the current sampling plan consists of a sample of 428 primary sampling units (PSUs) drawn from approximately 1,900 geographically defined PSUs that cover the 50 States and the District of Columbia. A PSU consists of a county, a small group of contiguous counties, or a metropolitan statistical area. Within a PSU, two types of second-stage units are used: area segments and permit segments. Area segments are defined geographically and contain an expected 8, 12, or 16 addresses. Permit segments cover housing units built after the 2000 census. The permit segments are defined based on updated lists of building permits issued in the PSU since 2000 and contain an expected four addresses.

The current NHIS sample design continues oversampling Blacks and Hispanics, which was a new feature of the previous sample design. A new feature of the current design is that Asians are oversampled as well. In addition, the adult selection process has been revised so that Black, Hispanic, and Asian people age 65 and over have an increased probability of being selected.

The new sample design is anticipated to result in approximately 87,500 people residing in 35,000 households with completed interviews each year. For 2006-2010, the households and noninstitutional group quarters selected for interview each week in NHIS are a probability sample representative of the target population. Beginning in 2011, the minimum time for a probability sample changed from a week to a month.

Primary Survey Content

After household composition is established, the core family interview asks about everyone in each family within the household. Additional questions are asked of one sample adult and one sample child (under 18 years) per family in the household. The sample adult questionnaire includes chronic health conditions and activity limitations, health behaviors, health care access, health care provider contacts, and immunizations. The sample child questionnaire includes questions about chronic health conditions, activity limitations, health status, behavior problems, health care access and use, and immunizations.

Child data are proxy reported by a parent or other knowledgeable adult respondent. Adult sample person data are self-reported, except in limited instances where a physical or mental impairment prevents the adult from answering for himself/herself. Supplemental modules are fielded periodically and cover areas such as cancer, prevention, disability, and use of complementary and alternative medicine.

Population Targeted

Civilian noninstitutionalized population residing in the United States.

Demographic Data

Gender, age, race/ethnicity, education, income, marital status, place of birth, industry, and occupation.

Years Collected

Continuously, since 1957. Current sample design began in 2006; current questionnaire design began in 1997.

Schedule

Annually.

Geographic Estimates

National; U.S. Census Bureau regions; some of the 10 Health and Human Services regions; some States; metropolitan and nonmetropolitan areas.

Notes

The annual NHIS response rate is close to 90% of the eligible households in the sample.

Metropolitan statistical areas are based on the 2000 Office of Management and Budget (OMB) standards for defining metropolitan and micropolitan areas and on the 2000 census:

  • Metropolitan categories:
    • Large central—Central counties in metro areas of 1 million or more population.
    • Large fringe—Outlying counties in metro areas of 1 million or more population.
    • Medium—Counties in metro areas of 250,000-999,999 population.
    • Small—Counties in metro areas of 50,000-249,999 population.
  • Nonmetropolitan categories:
    • Micropolitan—Counties in areas with an urban cluster of 10,000-49,999 population.
    • Noncore—Nonmicropolitan.

For details, the 2006 NCHS Urban-Rural Classification Scheme for Counties is available at http://www.cdc.gov/nchs/data_access/urban_rural.htm.

Adults with a disability are defined to be those with physical, sensory, and/or mental health conditions that can be associated with a decrease in functioning in such day-to-day activities as bathing, walking, doing everyday chores, and/or engaging in work or social activities. 

Limitations in basic activities represent problems with mobility and other basic functioning at the person level. Basic activities include problems with mobility; self-care (activities of daily living, or ADLs); domestic life (instrumental ADLs); and activities dependent on sensory functioning (limited to persons who are blind or deaf).

Limitations in complex activities represent limitations encountered when the person, in interaction with his or her environment, attempts to participate in community life. Complex activities include limitations experienced in work; and in community, social, and civic life.

These two categories are not mutually exclusive since persons may have limitations both in basic activities and in complex activities.

The residual category Neither includes adults with neither basic nor complex activity limitations.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhis.htm.

References

For more details, refer to the NHIS description documents available from the datasets and documentation section at http://www.cdc.gov/nchs/nhis.htm.

National Center for Health Statistics. Data file documentation, National Health Interview Survey, 2006 (machine-readable data file and documentation). Hyattsville, MD: Centers for Disease Control and Prevention; 2007.

National Center for Health Statistics. Data file documentation, National Health Interview Survey, 2005 (machine-readable data file and documentation). Hyattsville, MD: Centers for Disease Control and Prevention; 2006.

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National HIV/AIDS Surveillance System

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention.

Description

The HIV/AIDS Surveillance System is the Nation's source of timely information on HIV/AIDS. CDC funds and assists State and local health departments to collect the information. Health departments report their data to CDC.

Since the epidemic was first identified in the United States in 1981, population-based AIDS surveillance has been used to track the progression of the HIV epidemic. Since 1985, many States have implemented a standardized confidential name-based approach for HIV surveillance. By April 2008, all 50 States, the District of Columbia, and 6 U.S. dependent areas had fully integrated HIV and AIDS surveillance and had laws or regulations requiring confidential reporting by name for adults, adolescents, and children with confirmed HIV infection.

All 50 States, the District of Columbia, and U.S. dependent areas report cases of HIV infection to CDC by using a uniform surveillance case definition and case report form. The original definition has been modified several times. The most recent modification was in 2008 when the surveillance case definition for HIV infection among adults and adolescents was revised to incorporate an HIV infection staging system that categorizes AIDS as HIV infection, stage 3.

Primary Content

Mode of exposure to HIV, case definition category, and other clinical and demographic information.

Population Targeted

Entire population of all 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and other U.S. territories. HIV infection and AIDS data are nationally representative.

Demographic Data

Age, gender, race, ethnicity, State and county of residence, country of birth, and whether alive.

Years Collected

Since 1981.

Schedule

The HIV/AIDS Surveillance Report is published annually. Supplemental reports are published on an ad hoc basis and are available online at http://www.cdc.gov/hiv/default.htm.

Geographic Estimates

National, State, region, and metropolitan statistical area.

Contact Information

Agency home page: http://www.cdc.gov.

Data system home page: http://www.cdc.gov/hiv/topics/surveillance/index.htm.

References

Diagnoses of HIV infection in the United States and dependent areas, 2011. HIV Surveillance Report Vol. 23. Atlanta: Centers for Disease Control and Prevention; 2013. Available at: http://www.cdc.gov/hiv/library/reports/surveillance/2011/surveillance_Report_vol_23.html.

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National Hospital Ambulatory Medical Care Survey (NHAMCS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NHAMCS collects data on the utilization and provision of medical care services in hospital emergency departments (EDs) and outpatient departments (OPDs). Hospital staff are asked to complete 2-page questionnaires (Patient Record forms) on a sample of their patient visits during an assigned reporting period. However, about two-thirds of NHAMCS Patient Record forms submitted in 2010 (68% percent) were abstracted by field personnel from the U.S. Census Bureau rather than by hospital staff.

Survey Sample Design

NHAMCS is designed as a national probability sample of visits to EDs and OPDs of non-Federal, short-stay, and general hospitals in the United States. NHAMCS uses a 4-stage probability design that involves samples of primary sampling units (PSUs), hospitals within PSUs, clinics within hospitals, and patient visits within clinics and/or emergency service areas. Hospital staff are asked to complete PRFs for a systematic random sample of patient visits occurring during a randomly assigned 4-week reporting period during the survey year.

About 490 hospitals participate in NHAMCS each year. About 390 hospitals have eligible EDs and more than 200 have eligible OPDs. In 2010, 34,936 PRFs were completed for ED visits and 34,718 PRFs were completed for OPD visits. Response rates in 2010 ranged from 74% for OPDs to 88% for EDs.

Primary Survey Content

Information is obtained on various aspects of ED and OPD patient visits, including patient, hospital, and visit characteristics. The survey instrument is redesigned every 2 to 4 years to address changing health data needs. Among the items collected are patient's age, gender, race, and ethnicity; patient's expressed reason for visit; intentionality of injury, if any; physician's diagnoses; diagnostic services ordered or provided; procedures provided; medications; providers seen; visit disposition; immediacy with which patient should be seen; and expected source of payment. Items collected that are specific to the ED include mode of arrival, waiting time, duration of time in the ED, initial vital signs, and cause of injury.

Population Targeted

The survey is a representative sample of visits to EDs and OPDs of non-Federal, short-stay, or general hospitals, exclusive of Federal, military, and Veterans Affairs hospitals, located in the 50 States and the District of Columbia. Telephone contacts and visits for administrative purposes are excluded. NHAMCS is weighted to give national estimates of ED and hospital OPD visits.

Demographic Data

Patient age, gender, race, and ethnicity.

Years Collected

Since 1992.

Schedule

Annual.

Geographic Estimates

National; U.S. Census Bureau regions.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/ahcd.htm.

References

National Hospital Ambulatory Medical Care Survey: 2009 emergency department summary tables. Available at: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2009_ed_web_tables.pdf (PDF File, 480 KB). Accessed April 4, 2014.

National Hospital Ambulatory Medical Care Survey: 2010 emergency department summary tables. Available at: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf (PDF File, 524.6KB). Accessed April 4, 2014.

National Hospital Ambulatory Medical Care Survey: 2009 outpatient department summary tables. http://www.cdc.gov/nchs/data/ahcd/nhamcs_outpatient/2009_opd_web_tables.pdf (PDF File, 329.9 KB). Accessed April 4, 2014.

National Hospital Ambulatory Medical Care Survey: 2010 outpatient department summary tables. http://www.cdc.gov/nchs/data/ahcd/nhamcs_outpatient/2010_opd_web_tables.pdf (PDF File, 374.9 KB). Accessed April 4, 2014.

2009 NHAMCS micro-data file documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc09.pdf (PDF File, 1.47 MB). Accessed April 4, 2014.

2010 NHAMCS micro-data file documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc2010.pdf (PDF File, 1.51 MB). Accessed April 4, 2014.

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National Hospital Discharge Survey (NHDS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NHDS collects and produces national estimates on characteristics of inpatient stays in non-Federal short-stay hospitals in the United States. Data in the NHDS mode are abstracted from inpatient medical records, by U.S. Census Bureau field personnel. In addition, electronic files are purchased from commercial sources, States, or hospitals.

Survey Sample Design

From 1965 to 1987, NHDS was a two-stage stratified systematic random sample. Under the 1988 redesign, hospitals were selected using a modified three-stage stratified design. Units selected at the first stage consisted of either hospitals or geographic areas. The geographic areas were primary sampling units (PSUs) used for the 1985-1994 National Health Interview Survey, which are geographic areas such as counties or townships.

Hospitals within PSUs were selected at the second stage. Strata at this stage were defined by geographic region, PSU size, abstracting service status, and hospital specialty-size groups. Within these strata, hospitals were selected with probabilities proportional to their annual number of discharges. At the third stage, a sample of discharges was selected by a systematic random sampling technique.

In 2010, 239 hospitals were selected and 203 participated. The unweighted response rate was 86% and the weighted response rate was 79%. Data were collected from medical records for approximately 150,000 discharges.

Primary Survey Content

Patient information collected includes demographics, length of stay, diagnoses, and procedures. Hospital characteristics collected include region, ownership, and bed size.

Population Targeted

NHDS contains a sample of discharges from non-Federal hospitals located in the 50 States and the District of Columbia. Only hospitals with an average length of stay for all patients of less than 30 days or with a general (medical/surgical) or children's specialty are included in the survey. NHDS data are weighted to give national and regional estimates of hospital discharges.

Demographic Data

Patient age, gender, and payment source.

Years Collected

1965 to 2010.

Schedule

Annual.

Geographic Estimates

National, four U.S. Census Bureau regions.

Notes

Data on race are not available from some hospitals because the hospitals provide data from billing forms that do not include race as a required item. In 2010, data for RACE were missing for 16% of the discharges. Data for ethnicity are not available due to a high percentage of missing responses for this data element.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/nhds.htm.

References

Dennison CF, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 2000;1(39).

Kozak LJ. Underreporting of race in the National Hospital Discharge Survey. Adv Data Vital Health Stat 265. Hyattsville, MD: National Center for Health Statistics; 1995.

National Hospital Discharge Survey, 2010. Public use data file documentation. Hyattsville, MD: National Center for Health Statistics; March 2012. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHDS/NHDS_2010_Documentation.pdf (PDF File, 1.51 MB). Accessed April 22, 2014.

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National Immunization Survey (NIS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases and National Center for Health Statistics.

Description

NIS is a continuing nationwide telephone sample survey to monitor vaccination coverage rates among children ages 19 to 35 months. Starting in 2006, NIS-Teen was established to collect similar information for adolescents ages 13-17 years. NIS-Teen was conducted for a national sample in the 4th quarters of 2006 and 2007, and expanded to an annual sample in each of 56 or more State and local geographic areas starting in 2008.

The first stage of survey administration is conducted using telephone interviews with households having age-eligible children. In the second stage provider reports of vaccination information from the child's medical record are obtained.

Survey Sample Design

In each of 56 or more State and local geographic areas (which together make up the United States), NIS draws independent quarterly samples of telephone numbers and then uses random-digit dialing to identify households that have one or more children ages 19-35 months or 13-17 years. Until 2011, NIS surveyed only homes with landline telephones. A cellular telephone sample was added in 2011.

In the telephone interview, the interviewer collects vaccination information for each child that meets the age criterion and obtains permission to contact the providers of the child's vaccinations. In a second phase, a mail survey, NIS asks providers to report vaccination information from the child's medical record. This information is generally more accurate and complete than the household information.

Primary Survey Content

Data collected for children ages 19-35 months include vaccination status and timing for diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTP/DT/DTAP); polio vaccine; measles, mumps, and rubella vaccine (MMR); Haemophilus influenzae type B vaccine (Hib); hepatitis B vaccine (Hep B); varicella zoster vaccine; pneumococcal conjugate vaccine (PCV); hepatitis A (Hep A); influenza; and rotavirus vaccine. Data collected for children ages 13-17 years include vaccination status and timing for tetanus, diphtheria, and acellular pertussis vaccine (Tdap), varicella vaccine, meningococcal conjugate vaccine, and human papillomavirus (HPV) vaccine. The data are collected by race and ethnicity, income, location of residence, geographic division, State, and selected urban areas.

Population Targeted

Children ages 19-35 months or 13-17 years living in the United States at the time of the interview.

Demographic Data

Gender, race/ethnicity, income, location of residence, four U.S. Census Bureau regions.

Years Collected

Since 1994. Data collection for varicella began in July 1996; data collection for PCV began in July 2001.

Schedule

Quarterly samples, reported annually.

Geographic Estimates

National, State, and local areas.

Contact Information

Agency home page: http://www.cdc.gov/vaccines/.

NIS estimates home page: http://www.cdc.gov/vaccines/imz-managers/coverage/index.html.

Data system and information for survey respondents home page: http://www.cdc.gov/nis.

References

CDC. National Immunization Survey: A user's guide to the 2011 public use data file. Available at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NIS/NISPUF11_DUG.PDF (PDF File, 1.64 MB). Accessed April 4, 2014.

Zell ER, Ezzati-Rice TM, Battaglia MP, et al. National Immunization Survey: the methodology of a vaccination surveillance system. Public Health Rep 2000;115(1):65-77.

National Program of Cancer Registries (NPCR)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion.

Description

NPCR provides funds and guidance to States and U.S. territories to implement and enhance their cancer registries. As of 2013, NPCR supports central registries and promotes the use of registry data in 45 States, the District of Columbia, Puerto Rico, and the Pacific Island jurisdictions. Cancer registry data collected through NPCR are used to identify and monitor trends in cancer incidence and mortality; guide planning and evaluation of cancer control programs; help allocate health resources; contribute to clinical, epidemiologic, and health services research; and respond to concerns from citizens over the presence of cancer in their communities.

Population Targeted

NPCR registries collect data about cancer cases occurring in approximately 96% of the U.S. population.

Demographic Data

Gender, age, race.

Years Collected

Since 1994.

Schedule

Data collection is ongoing. Reports are published periodically. Since 2001, State registries have been reporting data annually.

Geographic Estimates

National, participating States.

Contact Information

Agency homepage: http://www.cdc.gov/.

Data system homepage: http://www.cdc.gov/cancer/npcr/index.htm.

References

U.S. Cancer Statistics Working Group. United States cancer statistics: 1999-2009 incidence and mortality Web-based report version. Atlanta: Centers for Disease Control and Prevention and National Cancer Institute; 2013. Available at: http://www.cdc.gov/cancer/npcr/uscs. Accessed April 4, 2014.

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National Tuberculosis Surveillance System (NTBSS)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination (DTBE).

Description

Reports of verified cases of tuberculosis (RVCT) are submitted to DTBE by 60 reporting areas (the 50 States, the District of Columbia, New York City, Puerto Rico, and seven other jurisdictions in the Pacific and Caribbean). In January 1993, an expanded system was developed to collect additional information for each reported TB case to better monitor trends in TB and TB control. A software package (SURVS-TB) for data entry, analysis, and transmission of case reports to CDC was designed and implemented as part of the expanded TB surveillance system.

In 1998, the Tuberculosis Information Management System (TIMS) replaced SURVS-TB. Beginning in 2009, case reports no longer had a specific software requirement. Two CDC-sponsored software options—the NEDSS base system and the electronic Report of Verified Case of Tuberculosis were introduced as two options for reporting TB cases to CDC. In addition, commercial- and State-developed software came into use. TIMS was allowed to be used for reporting 2009 results in instances where other software was not yet available. TIMS was officially retired for case completion in December 2010 for cases occurring in 2008 and prior.

In total, 10,528 TB cases were reported in the United States in 2011.

Primary Content

Number of new TB cases, patient management, and program evaluation.

In the expanded system started in January 1993, the RVCT form for reporting TB cases was revised to collect information on occupation, initial drug regimen, HIV test results, history of substance abuse and homelessness, and residence in correctional or long-term care facilities at the time of diagnosis. RVCT Follow Up Report-1 was added to collect drug susceptibility results for the initial M. tuberculosis isolate from patients with culture-positive disease. To evaluate the outcomes of TB therapy, RVCT Follow Up Report-2 was added to collect information on the reason and date therapy was stopped, type of health care provider, sputum culture conversion, use of directly observed therapy, and results of drug susceptibility testing for the final M. tuberculosis isolate from patients with culture-positive disease.

In 2009, the RVCT form was further expanded to collect variables to reflect the changing field of TB epidemiology and to collect more accurate data on TB cases. New variables include count status to address TB burden, pediatric TB to collect information on guardians and travel outside the United States, nucleic acid amplification test, initial chest CT scan or other chest imaging study, interferon gamma release assay blood test, primary reason evaluated for TB disease, additional TB risk factors, immigrant status, genotyping accession number, whether or not a patient moved during treatment and where, and reason therapy was extended for more than 12 months. Other variables were modified to include the addition of dates that specimens for diagnostic tests were collected and reported.

Population Targeted

Civilian population residing in the United States with a diagnosis of TB.

Demographic Data

Age, gender, race, and country of origin.

Years Collected

In aggregate form, since 1953; in individual case forms since 1985.

Schedule

Annual.

Geographic Estimates

National and States.

Contact Information

Agency home page: http://www.cdc.gov.

Data source home page: http://www.cdc.gov/tb.

References

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination. Reported tuberculosis in the United States, 2010. Atlanta, GA: Centers for Disease Control and Prevention; October 2011. Available at: http://www.cdc.gov/tb/statistics/reports/2010/pdf/report2010.pdf (PDF File, 3.08 MB)

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National Vital Statistics System: Linked Birth and Infant Death Data (NVSS-I)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NCHS's Division of Vital Statistics obtains information on births and deaths from the registration offices of each of the 50 States, New York City, the District of Columbia, Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Mariana Islands. Before 1972, NCHS received from all registration areas and processed microfilm copies of all death certificates and a 50% sample of birth certificates.

In 1972, some States began sending their data to NCHS through the Cooperative Health Statistics System (CHSS). States that participated in the CHSS program processed 100% of their death and birth records and sent the entire data file to NCHS on computer tapes.

Currently, data are sent to NCHS through the Vital Statistics Cooperative Program (VSCP), following the same procedures as CHSS. The number of participating States grew from 6 in 1972 to 46 in 1984. Starting in 1985, all 50 States and the District of Columbia participated in VSCP.

In the linked birth and infant death dataset, the information from the death certificate is linked to the information from the birth certificate for each infant less than age 1 who dies in the United States, Puerto Rico, Virgin Islands, and Guam. Starting with data year 1995, linked file data are produced in a period data format preceding the release of the corresponding birth cohort format. The 2005 linked file contains a numerator file that consists of all infant deaths occurring in 2005 that have been linked to their corresponding birth certificates, whether the birth occurred in 2004 or 2005.

Other changes to the dataset, starting with 1995 data, include addition of record weights to correct for the 1.0% to 1.4% of records that could not be linked in 2000 to 2005 (2% in 1995 to 1999) and imputation for unstated birth weight.

Primary Survey Content

The vital statistics general mortality data are a fundamental source of geographic and cause-of-death information and some demographic information. The birth certificate is the primary source of demographic information, such as age, race, and Hispanic origin of the parents; maternal education; live birth order; and mother's marital status; and of maternal and infant health information, such as birth weight, period of gestation, plurality, prenatal care use, and maternal smoking.

Population Targeted

Infants in 50 States and the District of Columbia.

Demographic Data

Age, gender, race, and Hispanic origin of infant and parents, mother's education and marital status.

Years Collected

Linked data are available for the data years 1983-1991 and 1995-2009.

Schedule

Annual.

Geographic Estimates

National, State.

Place of death is classified by State and county. In residence classification, all deaths are allocated to the usual place of residence as reported on the death certificate and are classified by State, county, and city.

Notes

Data on mother's educational attainment, tobacco use during pregnancy, and prenatal care based on the 2003 revision are not comparable with data based on the 1989 revision of the U.S. Standard Certificate of Live Birth.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/linked.htm.

References

Mathews TJ, MacDorman MF. Infant mortality statistics from the 2009 period linked birth/infant death data set. Natl Vital Stat Rep 2013;61(8).

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National Vital Statistics System: Mortality (NVSS-M)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NVSS mortality files include data for the 50 States, the District of Columbia, and Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Mariana Islands. All deaths occurring in those areas are included (close to 2.5 million annually).

By law, registration of deaths is a funeral director's responsibility. Administrative records (death certificates) completed by funeral directors, physicians, medical examiners, and coroners are filed with State vital statistics offices. Selected statistical information is forwarded to NCHS to be merged into a national statistical file.

States are phasing in the 2003 revision of the standard certificates. Those that have not revised yet are using the 1989 version of the standard certificates. Demographic information on the death certificate is provided by the funeral director and is based on information supplied by an informant. Medical certification of cause of death is provided by a physician, medical examiner, or coroner.

Currently, data are sent to NCHS through the Vital Statistics Cooperative Program (VSCP). All 50 States and the District of Columbia have participated in VSCP since 1985.

Primary Content

Age at death, Hispanic origin, race, sex, marital status, decedent's residence, place of birth, educational attainment, underlying and multiple causes of death, injury at work, place death occurred, day of week of death, month of death, and year of death.

Population Targeted

U.S. population.

Demographic Data

Sex, race, Hispanic origin, age at death, place of decedent's residence, educational attainment, and marital status.

Race and ethnic origin are separate items on the death certificate. As of 1997, all States report Hispanic origin. The categories reported include Mexican, Puerto Rican, Cuban, Central and South American, and Other Hispanic. Beginning in 1992, California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington reported expanded Asian and Pacific Islander categories: Asian Indian, Korean, Vietnamese, Samoan, and Guamanian. The rest of the States reported a combined Other Asian and Pacific Islander category in addition to the categories of White, Black, American Indian, Chinese, Hawaiian, Japanese, and Filipino that all States report.

Beginning with data for 2003, multiple-race data are available for selected States and the previous distinction about particular Asian groups is being replaced by the categories available on the 2003 revision of the standard certificate.

Years Collected

The mortality reporting data system began in 1880, but not all States participated before 1933. Coverage for deaths has been complete since 1933.

Schedule

Annual.

Geographic Estimates

National, regional, State, and county but access below national has limitations.

Notes

Beginning with 1989 data, some changes were initiated to increase confidentiality. Identifying information, including date of death and geographic identifiers for counties of fewer than 100,000 persons, was not available for public use. Beginning with 2005 data, geographic identifiers below the national level were removed from the public use data files. Data are still accessible using tools such as WONDER (http://wonder.cdc.gov).

The item on educational attainment was changed on the 2003 revision of the standard certificate. Some States have implemented the 2003 revision, while others still use the 1989 revision of the U.S. Standard Certificate of Death. One State does not have either version of the item.

NHQR and NHDR tables report geographic location. Geographic locations are based on the 2006 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme, which is based on the 2000 Office of Management and Budget standards for defining metropolitan and micropolitan statistical areas:

  • Metropolitan Areas:
    • Large central—Central counties in metro areas of 1 million or more population.
    • Large fringe—Outlying counties in metro areas of 1 million or more population.
    • Medium—Counties in metro areas of 250,000-999,999 population.
    • Small—Counties in metro areas of 50,000-249,999 population.
  • Nonmetropolitan Areas:
    • Micropolitan—Counties in areas with an urban cluster of 10,000-49,999 population.
    • Noncore—Nonmicropolitan.

Details are in the 2006 NCHS Urban-Rural Classification Scheme for Counties, available at http://www.cdc.gov/nchs/data_access/urban_rural.htm.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/deaths.htm.

References

Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2010. Natl Vital Stat Rep 2013;61(14).

Hoyert DL, Xu JQ. Deaths: preliminary data for 2011. Natl Vital Stat Rep 2012;61(6).

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National Vital Statistics System: Natality (NVSS-N)

Sponsor

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Description

NVSS natality files include approximately 4 million birth records annually, with data for the 50 States, the District of Columbia, and Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Mariana Islands.

State laws require birth certificates to be completed for all births. The registration of births is the responsibility of the professional attendant at birth, generally a physician or midwife. Federal law mandates national collection and publication of birth and other vital statistics data.

Birth certificates completed by physicians and midwives are filed with State vital statistics offices; selected statistical information is forwarded to NCHS to be merged into a national statistical file. Standard forms for the collection of the data and model procedures for the uniform registration of events are developed and recommended for State use through cooperative activities of States and NCHS (the Vital Statistics Cooperative Program).

The most recent revision of the U.S. Standard Certificate of Live Birth was effective in 2003. Implementation of the 2003 revision is being phased in by the States. As of 2011, 36 States and the District of Columbia, representing 83% of 2011 births, had implemented the 2003 revision. Those States that have not yet implemented the 2003 revision are using the 1989 revision. Full implementation of the 2003 revision of the standard certificate is expected by January 1, 2014.

Primary Content

Demographic information includes year, date, place of birth, age, race, and Hispanic origin of mother, and live-birth order.

Maternal and infant health information includes maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birth weight, plurality, medical risk factors, maternal weight gain, obstetric procedures, characteristics of labor and delivery, and congenital anomalies.

Population Targeted

U.S. resident population.

Demographic Data

Child: Sex.

Mother and father: Race, Hispanic origin (beginning in 1978), age, place of mother's residence, and educational attainment (beginning in 1978) (education of father is currently collected on the 2003 revision of the standard certificate).

Mother: marital status.

Race and Hispanic origin are separate items on the birth certificate. As of 1993, all States report Hispanic origin. The categories reported include Mexican, Puerto Rican, Cuban, Central and South American, and Other Hispanic.

Beginning with 1992 data, California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington have reported expanded Asian and Pacific Islander (API) categories of Asian Indian, Korean, Vietnamese, Samoan, and Guamanian. The rest of the States report a combined Other Asian and Pacific Islander category in addition to the categories of White, Black, American Indian, Chinese, Hawaiian, Japanese, and Filipino that all States report.

Beginning with data for 2003, multiple-race data are available for selected States and the previous distinction about particular Asian groups is being replaced by the categories available on the 2003 revision of the standard certificate.

Years Collected

The national birth registration system was established in 1915. Not all States participated before 1933. Coverage for births has been complete since 1933.

Schedule

Annual.

Geographic Estimates

National, regional, State, county, and city, but access below national has limitations.

Beginning with 1989 data, some changes were initiated to increase confidentiality. Identifying information, including geographic identifiers for counties of fewer than 100,000 persons, is not available for public use. Beginning with 2005 data, geographic identifiers below the national level were removed from the public use data files. Data are still accessible using tools such as VitalStats (http://www.cdc.gov/nchs/VitalStats.htm) and WONDER (http://wonder.cdc.gov). In addition, restricted data files with geographic identifiers are available and may be requested (http://www.cdc.gov/nchs/nvss/dvs_data_release.htm).

Notes

Data on mother's educational attainment, tobacco use during pregnancy, and prenatal care based on the 2003 revision are not comparable with data based on the 1989 revision of the U.S. Standard Certificate of Live Birth.

Contact Information

Agency home page: http://www.cdc.gov/nchs.

Data system home page: http://www.cdc.gov/nchs/births.htm.

References

Martin JA, Hamilton BE, Ventura SJ, et al. Births: final data for 2010. Natl Vital Stat Rep 2012;61(1).

Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2011. Natl Vital Stat Rep 2012;61(5).

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Page last reviewed August 2014
Page originally created August 2014
Internet Citation: National Healthcare Quality & National Healthcare Disparities Reports: Data Sources Appendix, 2013. Content last reviewed August 2014. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/research/findings/nhqrdr/nhqrdr13/datasources/cdc.html

 

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