Secondary Database Analysis II

Sources and Uses of Extant Databases

Last Time – Uses

Secondary Data: Can provide new information on health care delivery (quality;

geographic variation; post-marketing adverse events; cost), on natural the history of disease, and on regulatory matters.

Can save data-collection resources: time, money, personnel, participant burden

Can save researcher resources: your time, your money May permit you to build your CV without anyone’s help or

funds – just your time (but co-authors are a good thing) Can provide preliminary data for a grant proposal May enable research on rare events or difficult populations

Last Time – Precautions Take note of the study design; is it suitable? What are inclusion & exclusion criteria? Why? How does that

affect the sample and generalizability? What bias may be inherent in the database – perhaps from the

population or from the method of measurement? Selection bias: who got included; migration: who was lost/gained and why; other sources of systematic error (bias)

Control for bias – restrict (lose generalizability); match (limited # factors); stratify; adjust with covariates; then discuss potential impact of uncorrected bias on your results; could conduct sensitivity analyses on multivariable models

Risk adjustment – outcome-specific; an index incorporates many predictors – do you need to study some separately?; comorbidity index for case-mix adjustment (e.g., Charlson); other predictors based on your reading of the literature; propensity scores (for treatment choice; good for small datasets, for non-randomized studies of treatment effect)

Data Sources

Financial or Claims Files Electronic Medical Records Survey Data Trial Data

NHLBI Clinical Trialshttp://www.nhlbi.nih.gov/resources/deca/default.htm - National Heart Lung & Blood Institute

Study Name    Prepared/Updated  ↓

Asymptomatic Cardiac Ischemia Pilot (ACIP) 01/2000

Lung Health Study (LHS) 08/2001

Thrombolysis in Myocardial Infarction Study (TIMI II) 08/2001

Intermittent Positive Pressure Breathing (IPPB) 05/2001

Post Coronary Artery Bypass Graft Study (CABG) 05/2001

Antiarrhythmics Versus Implantable Defibrillators(AVID) 02/2002

Asthma Clinical Research Network: Beta Agonist in Mild Asthma (ACRN: BAGS) 02/2002

Digitalis Investigation Group (DIG) 02/2002

Asthma Clinical Research Network: Colchicine in Moderate Asthma (ACRN: CIMA) 02/2002

Psychophysiological Investigation of Myocardial Ischemia (PIMI) 07/2002

Coronary Artery Surgery Study (CASS) 07/2003

High Frequency Ventilation in Premature Infants Study (HIFI) 07/2003

Multiple Risk Factor Intervention Trial (MRFIT) 07/2003

Raynaud's Treatment Study (RTS) 05/2003

Acute Respiratory Distress Syndrome Clinical Network (ARDSNet 01/03): Lower versus higher tidal volume, lisofylline treatment and ketoconazole treatment (3 study factorial)

07/2003

… etc.

NHLBI Clinical Trials - most recent

Study Name    Prepared/Updated  ↓

Public Access Defibrillation (PAD) Community Trial 08/2007

Bypass Angioplasty Revascularization Investigation (BARI) 11/2007

Women's Health Initiative: Clinical Trials (WHI-CT) 02/2008

Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial

03/2008

Acute Respiratory Distress Syndrome Clinical Network (ARDSNet02): Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (

LaSRS)

05/2008

Acute Respiratory Distress Syndrome Clinical Network (ARDSNet05): Fluid and Catheter Treatment Trial (FACTT)

05/2008

Viral Activation Transfusion Study (VATS) 05/2008

National Emphysema Treatment Trial (NETT) 08/2008

NHLBI Epidemiology Studies (selected)http://www.nhlbi.nih.gov/resources/deca/directry.htm

Study Name    Prepared/Updated   

A Case-Control Etiologic Study of Sarcoidosis (ACCESS) 04/2004

Atherosclerosis Risk in Communities Study (ARIC) 01/2008

Bogalusa Heart Study (BHS) 12/2006

Cardiovascular Health Study (CHS) 07/2008

Coronary Artery Risk Development in Young Adults (CARDIA) 11/2007

Cord Blood Transplant Study (COBLT) 01/2007

Framingham Heart Study-Cohort 03/2007

Framingham Heart Study-Offspring 05/2007

Honolulu Heart Program (HHP) 01/2004

Lipid Research Clinics- Prevalence Study (LRCPS) 02/2005

NHLBI Growth and Health Study (NGHS) 09/2005

National Longitudinal Mortality Study (NLMS) 01/2000

Puerto Rico Heart Health Program (PRHHP) 12/2002

Cooperative Study of Sickle Cell Disease (CSSCD) 07/2008

National Center for Health Statistics (NCHS)

http://www.cdc.gov/nchs/

NCHS Public-use Data Files & Documentation

About Public-use data files - http://www.cdc.gov/nchs/datawh/ftpserv/ftpdata/aboutpud.htm Data Release Policy - http://www.cdc.gov/nchs/about/policy/reldata.htm Data Use Restrictions - http://www.cdc.gov/nchs/datawh/dur.htm NHANES III Errata

Data from the National Health and Nutrition Examination Survey (NHANES) What’s New http://www.cdc.gov/nchs/about/major/nhanes/whatsnew.htm Third National Health and Nutrition Examination

http://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm Reference Manuals and Reports/Plan and Operations http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/main.pdfAnalytic Guidelines http://www.cdc.gov/nchs/data/nhanes/nhanes3/nh3gui.pdfNHANES I Epidemiologic Followup Study (NHEFS)

http://www.cdc.gov/nchs/products/elec_prods/subject/nhefs.htm

Longitudinal Studies of Aging (LSOA ) http://www.cdc.gov/nchs/lsoa.htm - available on CD

National Health Interview Survey (NHIS)http://www.cdc.gov/nchs/nhis.htm

National Center for Health Statistics (NCHS)

National Ambulatory Medical Care Survey (NAMCS), 1993-2000http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm

National Ambulatory Medical Care Survey (NAMCS), 1973-1992http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm

National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992-2000 http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm

National Hospital Discharge Survey (NHDS), 1996-2000& National Survey of Ambulatory Surgery (NSAS), 1994-1996

http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm

National Home and Hospice Care Survey (NHHCS), 1996http://www.cdc.gov/nchs/nhhcs.htm

National Nursing Home Survey (NNHS), 1995 and 1997http://www.cdc.gov/nchs/nnhs.htm

NCHS

Behavioral Risk Factor Surveillance System (BRFSS)

http://www.cdc.gov/brfss/ Datasets are large – ASCII version may be

15Mb for a single year Documentation is online with data 24 years of data available at

http://www.cdc.gov/brfss/technical_infodata/surveydata.htm

Don’t forget the citation! http://www.cdc.gov/brfss/suggestedcitation.htm

VA Data

Data descriptions and access details are documented (http://www.virec.research.va.gov) No public use files; must be VA employee/WOC Data: administrative, hospital/facility level data, medical record information, patient-level medical care data including procedures, surgeries, radiography, laboratory (some), pharmacy, and diagnoses, all in SAS datafiles 5.5 million patients with incentive to stay in the system

Healthcare Cost and Utilization Project (HCUP)

Largest collection of all-payer longitudinal hospital data in US available for release to researchers

Family of administrative databases and tools maintained by AHRQ

As of 2002 data, 35 state-level data organizations contribute data on hospital stays including Texas

http://www.hcup-us.ahrq.gov/home.jsp What's New – right-hand insetWhat is HCUPHCUP Products (data are not free)HCUP Services

FACT SHEET – very informativeNote the Clinical Classifications Software (CCS) & Comorbidity Software (this is free)

HCUP DatabasesState Inpatient Databases (SID)State Ambulatory Surgery Databases (SASD)State Emergency Department Databases (SEDD)Nationwide Inpatient Sample (NIS)Kids' Inpatient Database (KID)

Healthcare Cost & Utilization Project (HCUP)

Another AHRQ product - http://www.meps.ahrq.gov/

Overview: MEPS Web SiteThe Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States.

MEPS Web SiteSurveys used, data available, canned reports, data FAQ’s, MEPSnet query tools, etc.

http://www.meps.ahrq.gov/mepsweb/data_stats/data_overview.jsp

Medical Expenditure Panel Survey (MEPS)

DATA from Substance Abuse and Mental Health Data Archives (SAMHDA)

http://www.icpsr.umich.edu/SAMHDA/ "A national resource providing public data

access and online analysis"SAMHDA Helpline: 1-888-741-7242

Local: (734) 615-9524Fax: (734) 647-8200e-mail: samhda-support@icpsr.umich.edu

CTS Surveys: from HSC, funded by RWJF, stored at ICPSR

- Household Survey, Employer Survey, Physician SurveyTo provide an in-depth look at the issues and challenges physicians face in the rapidly changing health care system, HSC's Community Tracking Study includes a Physician Survey.

http://www.hschange.org/index.cgi?data=04 Get data from ICPSR http://www.icpsr.umich.edu/HMCA/

Health Medical & Care Archive (HMCA) - Health System Change (HSC) – The Robert Wood Johnson Foundation – ICPSR Archives

SEER: Surveillance Epidemiology & End Results

http://seer.cancer.gov/registries/ SEER*Stat software:

http://seer.cancer.gov/seerstat/

Websites with Database Lists

AHRQ http://www.ahrq.gov/ NLM http://www.nlm.nih.gov/ CDC http://www.cdc.gov/ VIREC http://www.virec.research.va.gov/ HERC http://www.herc.research.va.gov/ ICPSR http://www.icpsr.umich.edu/ Census & CDC: http://dataferrett.census.gov/

Who Will Fund Your Analyses?

Your institution has a listserv: FUNDINGINFO2@LISTS.UTHSCSA.EDU NIH has career development awards : http://grants1.nih.gov/training/ -- and RFAsAnd there are Program Announcements that are pertinent, e.g., these from NIAAA:

Secondary Analysis of Existing Alcohol Epidemiology Data (R21): PA-08-168 http://grants.nih.gov/grants/guide/pa-files/PA-08-168.html

Secondary Analysis of Existing Alcohol Epidemiology Data (R03): PA-08-169 http://grants.nih.gov/grants/guide/pa-files/PA-08-169.html

VA HSR&D has grants (PI must be or become 5/8+ VA) http://www.hsrd.research.va.gov/for_researchers/ Foundations have grants (ADA, AHRQ, Hogg, NARSAD, etc.) Local pots of money