Rosemarie Hirsch M.D., M.P.H.

Measuring Health Care Measuring Health Care Quality Quality from thefrom the

National Health and Nutrition National Health and Nutrition Examination Survey (NHANES)Examination Survey (NHANES)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

Presentation Topics

• NHANES overview

• Health condition components and health care quality measures collected

• Examples of healthcare quality analyses

• Public data files and access

NHANESNHANES

• NHES I: 1960-62, ages 18-79

• NHES II: 1963-65, ages 6-11

• NHES III: 1966-70, ages 12-17

• NHANES I: 1971-75, ages 1-74

• NHANES II: 1976-80, ages 6 mos.-74

• HHANES: 1982-84, ages 6 mos.-74

• NHANES III: 1988-94, ages 2 mos. and older

• NHANES: 1999 and beyond, all ages

Current NHANESCurrent NHANES

Sample Design•Continuous data collection beginning in

1999•Annual national sample of 5,000

persons

Eligible population•Civilian, non-institutionalized population•Residents of all states and D.C.•All ages

NHANES – NHANES – OversamplingOversampling•African Americans

•Mexican Americans

•Adolescents aged 12-19

•Persons aged 60+

•Pregnant women

•Low-income families

• Traditional CAPI Traditional CAPI interviewing with interviewing with portable keyboardportable keyboard.

• Traditional CAPI Traditional CAPI interviewing with interviewing with portable keyboardportable keyboard.

NHANES Household NHANES Household InterviewInterview

NHANES Household InterviewNHANES Household Interview

• Broad range of health conditions

• Environmental and occupational exposures

• Health behaviors

• Nutrition and dietary supplements

• Prescribed medications

NHANES Mobile Exam NHANES Mobile Exam CenterCenter

• Standardized physical exam

• Conducted at mobile exam center• Medical & dental exams

• Physiological measurements

• Laboratory test

• Administered by trained medical personnel

NHANES ExaminationNHANES Examination

NHANES Mobile Exam NHANES Mobile Exam CenterCenter

NHANES TOPICSNHANES TOPICS

• Cardiovascular disease

• Diabetes, lower extremity disease

• Bone status, osteoporosis

• Fitness, strength and functional limitation

• Vision, hearing and balance

• Oral health

NHANES TOPICS, NHANES TOPICS, ContinuedContinued

• Nutrition

• Anthropometry

• Mental health

• Risk behaviors

• Reproductive health

• Environmental exposures

• Infectious diseases and immunization status

NHANES LaboratoryNHANES Laboratory

• CBC and WBC differential

• Pregnancy test

• Blood, urine and vaginal swab processing

76 different vials of samples

26 laboratories

300 laboratory assays

Landmark findings and Landmark findings and public health resultspublic health results

• High blood lead levelsLead out of gasoline

• Low folate levelsMandatory food fortification

• Rising levels of obesityPublic health action plan

• Racial and ethnic disparities in Hepatitis BUniversal vaccination of all infants & children

Health Care Quality Data Analysis Examples

Ever Had Blood Cholesterol Checked:Percent of U.S. Adults Age 40+ years

72.5

84.7

69.1

8078.1

92.2

0

20

40

60

80

100

1988-1994 1999-2000

All (Age adjusted)

40-59 years

60+ years

Source: 2004 National Healthcare Quality Report

Ever Told by Doctor Had High Blood Cholesterol:

Percent of U.S. Adults Age 40+ years

28.9 27.4 31.336.4

30.5

45.8

0

20

40

60

80

100

All (Ageadjusted)

40-59 years 60+ years

1988-1994

1999-2000

Source: 2004 National Healthcare Quality Report

Taking Cholesterol-lowering Medications:Percent of U.S. Adults Age 40+ years Ever

Told by Doctor they had High Blood Cholesterol

17.9

37.7

13.3

31.625.2

47.6

0

20

40

60

80

100

1988-1994 1999-2000

All (Age adjusted)

40-59 years

60+ years

Source: 2004 National Healthcare Quality Report

Cholesterol and HgA1c Control:Percent of U.S. Adults Age 18+ years with

Diagnosed Diabetes

39.9 43.2

28.3

49.2

38.328.6

0

20

40

60

80

100

Cholesterol< 200 mg/dl

HgA1c < 7.0

HgA1c > 9.0

1988-1994

1999-2000 Age-adjusted

Source: 2004 National Healthcare Quality Report

Percent of U.S. Adults age 20-74 years with Hypertension

38.1 39.8 40.4

23.9 28.7

0

20

40

60

80

100

1960

-62

1971

-74

1976

-80

1988

-94

1999

-200

0

Age-adjusted

Source: Health United States, 2003

Awareness, Treatment and Control:Percent of U.S. Adults Age 18-74 years with

Hypertension

10

2734

51

31

68

54

70

59

0

20

40

60

80

100

Awareness Treatment Control

1976-1980

1991-1994

1999-2000

Source: JNC 7 Report, 2003

Health Care Quality Data for Cholesterol and Hypertension

• NHES• NHANES I• NHANES II• NHANES III• NHANES 1999-2000• NHANES 2000-2001

Directly download from Directly download from our websiteour websitehttp://www.cdc.gov/nchs/nhanes.htm

NHANES DataNHANES Data

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