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Economics Juniors (2020) Health Data (David Silver)

Economics Juniors Session for David Silver

Comparative Data from the CDC

The following table includes major USA health surveys. All report age, gender, education, income, marital status, occupation, race, diagnosis, and procedures. 

Survey Title Dates Variable Locator Lowest level of geography revealed Constituents Payment Source Duration of visit or waiting time

NHIS (ICPSR)

NHIS (CDC)

1963+ ICPSR 4 geographic regions; Urban vs. Rural Sample of the civilian, noninstutionalized population. Asks if you have insurance, Social Security, etc. Estimated
MEPS 1977, 1980, 1987, 1996+ Agency for Healthcare Research & Quality 4 geographic regions; Some state level summary tables; Urban vs. Rural Subsample of households that participated in the prior year's National Health Interview Survey. Yes Yes

NHANES (ICPSR)

NHANES (CDC)

1959+  
ICPSR and CDC 4 geographic regions; Urban vs. Rural Samples of the civilian noninstitutionalized population Questions regarding if you have insurance, Social Security, etc. Not applicable

USA Summary Statistics and Overview

Secondary Data Sources for Public Health. Cambridge University Press, 2007. Excellent overview of major datasets related to health.
Health United States. U.S. Dept. of Health and Human Services, 1975- Presents national trends in United States health status.  Also see Women's Health USA and Child Health USA.

Health Behavior and Risk

Behavioral Risk Factor Surveillance System (BRFSS)
CDC/BRFSS (@BRFSS) | Twitter
Recording about content and using  BRFSS
Producer:  Centers for Disease Control and Prevention
Scope: Health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District of Columbia and three U.S. territories.
Sample size:  Currently more than 400,000 adult interviews each year.  See the coverage chart over time.
2006-2018 have been converted into a cumulative Stata file. [The cumulative STATA file requires authentication via either Global Protect or SRA Aventail/SonicWall.] For junior high and high school, see YRBSS.

USA Data about individuals - Cross Sectional

American Community Survey (ACS) (1996+) 
Is the American Community Survey Legit? - Rutherford Source
Producer:United States Department of Commerce. Bureau of the Census.
Scope: Nationwide survey designed to provide communities with a fresh look at how they are changing. 2005 is the first full year. Prior years were small test runs. Replaces the decennial long form. Tells us what the population looks like and how it lives. Includes demographics, socioeconomics status, education, occupancy status, homeownership data, and housing cost data. IPUMS (which requires free registration) also contains the data in an easier to use format. More recent data may be found directly on the Census website. For summary statistics, use Social Explorer. The health insurance coverage question was added to the ACS in 2008. In 2019, questions about health insurance premiums and subsidies were added to the ACS. Research about these questions and copies of previous questionnaires are available on the ACS website.
Recordings: ACS Methodology; ACS through Social Explorer; ACS through IPUMS

 

Medical Expenditure Panel Survey (MEPS) 1996+
MEPS summary tables
Recording about content and using MEPS
Producer:  Agency for Healthcare Quality and Research (AHRQ)
Scope: provides information on health expenditures by or on behalf of families and individuals, the financing of these expenditures, and each person's use of services.
Sample Size and Makeup: (1) Households: national probability sample of the noninstitutionalized USA civilian population (2) Institutional Population: sample of nursing and personal care homes and facilities for the mentally retarded and residents admitted to those facilities. (3) American Indians and Alaskan Natives living on or near federal reservations.
How segmented: Age, Marital status, student status, veteran status, race, ethnicity
History: MEPS is the third (and most recent) in a series of national probability surveys conducted by AHRQ on the financing and utilization of medical care in the United States. MEPS is the most recent in a series of medical expenditure surveys that began in 1977 as the National Medical Care Expenditure Survey and later became the National Medical Expenditure Survey (NMES). (1970, 1980, 1987)1977: National Medical Care Expenditure Survey, 1980: National Medical Care and Utilization Survey, 1987: National Medical Expenditure Survey
Where do I get the data? AHRQ;  for historical series see ICPSR Direct
Questions: What is the average length of wait to see a doctor in a given specialty? Do physicians follow their own advice about smoking? Does a person's income determine how often they get a mammogram? How often do doctors only recommend necessary surgery? What is the cost of X procedure?
Prescription Drugs:  Survey participants are asked about their prescription drugs and then asked for permission to collect more detailed information from their pharmacies. At the pharmacies, data are collected on the type, dosage, and payment for each filled prescription. No information is collected for over-the-counter medications or for prescription drugs obtained during hospital visits.  

National Health Interview Survey Series (NHIS)
NHIS January-June 2019 Early Release
Recording about content and using  NHIS
Producer:  National Center for Health Statistics
Years covered: 1975- . For 1963-1975, see Health Interview Surveys.
Scope: basic purpose is to obtain information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive. Information on the utilization of medical care facilities is also available in the form of data on medical and dental care, hospitalization, preventive care, nursing care, prosthetic appliances, and self-care. The Core variables are contained in the files for household, person, condition, doctor visit, and hospital data. Each year additional batteries of questions are asked which focus on specific topics.
Sample Size and Makeup: representative sample of the civilian, noninstitutionalized population of the USA.  Family core answers questions on health insurance and basic demographics.  A randomly selected adult from the household is asked more questions along with a randomly selected child under the age of 18 (if present).
How segmented: type of living quarters, size of family, geographic region, age, sex, race, marital status, veteran status, education, income, industry, occupation codes, and limits on activity.
Where do I get the data?   NHIS (CDC) for latest data. See ICPSR Direct for historical.. Also see the Integrated Health Interview Series which integrates 1969+.
Questions: Does income status impact health service received? Does the patient have Medicare, Medicaid, private health insurance? Does race impact prevalence of certain illnesses? Do certain areas of the country have higher incidences of certain diseases? What variables (age, race, sex, education, etc) impact one's health? Does your occupation impact your health?

 

National Health and Nutrition Examination Survey (NHANES) and Followup Series (1971+)
NHANES Coming to Your Community - YouTube
Recording about content and using NHANES
Producer:  National Center for Health Statistics
The National Health and Nutrition Examination Surveys (NHANES I, II, III, Hispanic HANES, and NHANES I Epidemiologic Followup Survey [NHEFS]) were designed to obtain information on the health and nutritional status of the United States population. The NHANES I and NHANES II datasets were formerly titled Health and Nutrition Examination Surveys. This series succeeds the National Health Examination Survey, which was collected from 1959 to 1970. All of the NHANES datasets use complex, multistage, stratified, clustered samples of civilian noninstitutionalized populations. All of the files within each study are linkable to each other. NHANES I (1971-1975) interviewed persons aged 1-74 years. The sample was selected so that certain population groups thought to be at high risk of malnutrition (persons with low incomes, preschool children, women of childbearing age, and the elderly) were over sampled at preset rates. On completion of the survey, 23,808 of the interviewed sample were given a medical examination, and this information is also part of the NHANES I data collections. The NHANES I Epidemiologic Followup Study (NHEFS) is a longitudinal study designed to investigate the relationships between clinical, nutritional, and behavioral factors assessed in NHANES I and subsequent morbidity, mortality, and hospital utilization, as well as changes in risk factors, functional limitation, and institutionalization. The NHEFS cohort includes all persons aged 25-74 who completed a medical examination for NHANES I (N = 14,407). NHANES II (1976-1980), was designed to continue the measurement and monitoring of the nutritional status and health of the United States population. From the sample of 27,801 persons aged 6 months to 74 years, 25,286 people were interviewed and 20,322 were both interviewed and examined. Because children and persons classified as living at or below the poverty level were assumed to be at special risk of having nutritional problems, they were sampled at rates substantially higher than their proportions in the general population. NHANES III (1988-1994) contains information on a sample of 33,994 persons aged 2 months and older. A home examination was employed for the first time in order to obtain examination data for very young children and for the elderly. The Hispanic HANES (HHANES) was conducted to obtain sufficient numbers to produce estimates of the health and nutritional status of Hispanics in general, as well as specific data for Puerto Ricans, Mexican Americans, and Cuban Americans. The latest data can be found on the CDC website

Hospitals

 Annual Survey of Hospitals
Producer: American Hospital Association


Recording on content and using AHA
Years covered: 1975-2018
Scope: surveys for-profit and not-for-profit hospitals on utilization and cost related matters
Sample Size and Makeup: profit and not-for-profit hospitals
How segmented: by state, type of authority, type of service, bed size, metropolitan statistical area size
Where is the documentation? (DSS) RA981.A2.A32
Authentication: Requires authentication via either Global Protect or SRA Aventail.
Sample Questions:
How many doctors, nurses, etc. does each hospital have? Which hospitals provide hospice care? Cardiac facilities? Does your hospital provide an HMO? PPO? Indemnity Plan? What were the total Medicare and Medicaid discharges? What were the employee benefits?
Related Surveys:  Princeton also has the AHA Annual Survey IT Database for 2007-2018 (covers data for 2008-2018), the AHA Survey of Care Systems and Payment for 2013, 2015, 2016 and the AHA System Survey (2016).