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The NHANES is conducted by the NCHS, to provide national statistics on the health and nutritional status of the non-institutionalized civilian population through household interviews, standardized physical examinations, and collection of blood samples in special mobile examination centers. The present NHANES, started in March 1999, will be a continuous survey of 5,000 persons per year from 15 randomly selected locations throughout the US. The survey includes 18 components that measure the general health of the civilian non-institutionalized population and 74 laboratory analyses in addition to the HIV assay. Additional information and reports may be obtained from the NCHS web page at: www.cdc.gov/nchs.
Selected Citations:
McQuillan GM, Khare M, Karon JM, Schable CA, et al. Update on the human immunodeficiency virus in the United States household population: NHANES III, 1988-1994. Journal of AIDS and Human Retrovirology. 14(4): 355-360, 1997.
McQuillan GM, Khare M, Ezzati-Rice, Karon JM, et al. The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991. Journal of AIDS and Human Retrovirology. 7(11): 1195-1201, 1994.
McQuillan GM, Khare M, Ezzati TM, Schable CA, et al. The seroepidemiology of human immunodeficiency virus in the United States household populations: NHAMES III, 1988-1991. National Conference on Human Retroviruses and Related Infections. 59, 1993.
As part of the State and Local Area Integrated Telephone Survey (SLAITS), NCHS is conducting a two-phase effort to evaluate HIV-related behavior questions developed by the Behavioral Surveillance Working Group. In Phase 1, questions deemed most sensitive were assessed by four focus groups. A report was prepared and sent to the Working Group and modifications were made to the questionnaire. In Phase 2, a 200 case pilot study will be conducted as a test of the questionnaire administered by telephone with the most sensitive behavioral questions answered using a touch-tone collection methodology. Based on the findings of this pilot, recommendations will be made regarding future implementation of HIV-related behavior questions on random digit dialing telephone surveys of the general population.
The National Survey of Family Growth, or NSFG, was conducted in 1973, 1976, 1982, 1988, and 1995. During that time, it has been a survey of women 15 to 44 years of age, designed to produce estimates of sexual activity, marriage and divorce, infertility, contraceptive use, and use of health services that will shed light on birth and pregnancy rates in the US. The survey has been designed to produce estimates for subgroups by age, region, race, education, income and other variables. In the 2001 NSFG (also known as Cycle 6), the NSFG will include a national sample of men 15 to 49 years of age in addition to a national sample of women. HIV funding is being used specifically for the sample of males and for the operations necessary to obtain large samples of black, Hispanic, and 15 to 24-year-old men and women. In addition, the content of the survey is being upgraded to include more HIV-related data, including anal intercourse as well as vaginal intercourse, same-gender sexual activity, condom use for disease prevention, risk behaviors including substance use, exchanging money or drugs for sex, non-voluntary sex, and sexually transmitted disease history. Because most of this HIV-related content is very sensitive for the general population, much of it is administered with Audio Computer-Assisted Self-Interviewing (Audio CASI).
The survey schedule is also being accelerated. Cycle 6 is scheduled for 2001, Cycle 7, for 2004, and Cycle 8, for 2007.
Additional information and reports may be obtained from the NCHS web page at: http://www.cdc.gov/nchs.
The NHIS is an annual population based survey designed to collect information on the health status and health care utilization of the non-institutionalized, civilian population of the U.S. through personal interviews in about 40,000 households per year. The NHIS has been fielded continuously since the late 1950's. The sample is designed to be representative of the U.S. and of the four main regions of the country. The current design includes an oversample of both the Black and Hispanic populations to improve the ability of NCHS to make reliable health estimates for these two groups. The NHIS includes sets of questions which are asked every year to allow monitoring of trends in basic health measures such as insurance status, prevalence of chronic conditions, injuries, and smoking. In addition, the survey includes supplemental questionnaires to gather information on other important health topics. In 1997, the NHIS underwent a major redesign in both the content and the mode of data collection. The redesigned NHIS continues to cover most aspects of health but focuses on describing the health and health care utilization of individuals. Data are now collected using computer-assisted methodology; this will greatly improve the timeliness of NHIS data.
Information on AIDS knowledge, HIV testing, and general perceptions of risk were collected from adult NHIS respondents with supplements to the NHIS from 1987 to 1995. The NHIS is unique in its ability to provide estimates of all individuals tested for HIV including those who are tested because of blood donation or who seek testing from their private health care provider. In 1997, questions on HIV testing and risk were added to the annual component of the redesigned NHIS. For 2000, the AIDS component will be expanded to collect information on knowledge and risk for tuberculosis, prevalence of sexually transmitted diseases, and additional questions on HIV testing. Thus the NHIS AIDS component provides annual data to monitor the use of HIV testing, general risk behaviors, and basic information on tuberculosis awareness and STD prevalence. This data can also be examined by the other demographic and health information collected in the NHIS. The large annual sample size of the NHIS makes it possible to examine small population subgroups; data from several years can also be combined to further increase analytic possibilities.
Selected Citations:
Tao G, Branson BM, Kassler WJ, Cohen RA. Rates of receiving HIV test results: data from the US National Health Interview Survey for 1994 and 1995. JAIDS. 22(4): 395-400, 1999.
Anderson JE, Hardy AM, Cahill K, Aral S. HIV antibody testing and posttest counseling in the US: data from the 1989 National Health Interview Survey. AJPH. 82(11): 1533-1535, 1992.
Hardy AM, Dawson DA. HIV antibody testing among adults in the US: data from 1988 NHIS. AJPH. 80(5): 586-589, 1990.
The National Vital Statistics System, conducted by NCHS in partnership with 54 States and vital registration offices, provides complete coverage of all births and deaths in the United States. This program is used to track HIV infection mortality by age, race, Hispanic origin, and sex for the United States, each State, county, and cities of 10,000 or more population from 1987 to the present (currently 1997 data year). This program also includes information on decedents by educational attainment, marital status, place of death (hospital, residence, nursing home, and other places), occupation and industry (for selected States), and State or country of birth.
HIV infection mortality data are available on public use data tapes, CD-ROMS (1991-1996), and in National Vital Statistics Reports (formerly Monthly Vital Statistics Reports), and Vital Statistics of the United States, Volume II, Mortality (annually through 1992 data year). Additional information and reports can be obtained from the NCHS web page at: http://www.cdc.gov/nchswww/products.
Selected Citations:
National Center for Health Statistics. Births and Deaths: Preliminary Data For 1997. 47(4), (PHS) 99-1120, 1998.
Buehler JW, Hanson DL, Chu SY. The reporting of HIV/AIDS deaths in women. AJPH. 82(11): 1500-1505, 1992.
The NDI is a central, computerized index of death record information compiled under contract to the NCHS by the State vital statistics programs. Magnetic tapes (beginning with deaths occurring in 1979) contain a standard set of identifying data for each decedent. The data are used to search the NDI to identify and locate death records filed in the State offices. NDI assists researchers to determine if persons in their studies may have died. If so, the NDI provides the names of the States where the deaths occurred, the corresponding death certificate numbers, and the death dates. The NDI user can them arrange with the appropriate State vital statistics office to obtain copies of death certificates or specific statistical information such as cause of death.
Selected Citations:
Dannenberg A, McNeil J, Brundage J. Mortality among 2419 HIV-positive military service applicants: an update. International Conference on AIDS. 7(1): 46 (Abstract No. M.C.94), 1991.
Dannenberg A, McNeil J, Brundage J. Mortality among 1862 HIV positive persons in a geographically dispersed US population: preliminary results. International Conference on AIDS. 125 (Abstract No. WAP31), 1989.
The NHCS is an integrated program of health care provider and establishment surveys and inventories conducted by the National Center for Health Statistics to provide national data on the provision and utilization of health care resources for the major sectors of the health care delivery system. These data are used to monitor health care use, the impact of medical technology, and the quality of care provided to the US population. Currently active NHCS components include the following national probability surveys: the National Hospital Discharge Survey (NHDS), the National Survey of Ambulatory Surgery (NSAS), the National Ambulatory Medical Care Survey (NAMCS), the National Home and Hospice Care Survey (NHHCS), and the National Nursing Home Survey (NNHS).
HIV data needs are addressed through each of the NHCS components through the collection and provision of diagnostic and other information related to HIV. These data describe the utilization of the major sectors in the health care delivery system and the impact of treating HIV on the health system. Specifically, NHDS reports have been published addressing trends in hospital use for HIV. The NAMCS and the NHAMCS provide data on visits to physicians’ offices, and hospital emergency and outpatient departments, respectively, and also collect data on visits at which HIV serology tests were ordered or provided. The NHHCS provides data on the patients receiving care and services received from home health agencies and hospices.
The National Hospital Discharge Survey (NHDS) is the principal source of information on inpatient utilization of hospitals and is based on a sample of discharges from non-federal, short-stay and general hospitals. The NHDS provides data on the characteristics of inpatients, diagnoses, surgical procedures, expected source of payment, length of stay and on the size, location, and ownership of hospitals. Data from the NHDS are used for tracking specific diseases, the introduction of new technologies, and the impact of changes in financing systems. The NHDS has been conducted annually since 1965.
The National Survey of Ambulatory Surgery (NSAS) complements the NHDS by providing data on the increasing variety of surgical and diagnostic treatments performed outside the inpatient setting. The NSAS provides data on visits to freestanding and hospital-based ambulatory surgery centers. Data include patient demographic characteristics, diagnoses, surgical operations, and diagnostic procedures performed, patient disposition, and expected sources of payment. The NSAS was conducted from 1994 to 1996.
The National Ambulatory Medical Care Survey (NAMCS) is based on a sample of visits to non-federal, office-based physicians who are primarily engaged in direct patient care. Physicians in the specialties of anesthesiology, pathology, and radiology are excluded. Data are obtained on the patient’s demographic characteristics, symptoms, physicians' diagnoses, and medications ordered or provided, and services provided, including information on diagnostic procedures, patient management, and planned future treatment. The NAMCS was conducted annually from 1974 to 1981, in 1985, and annually since 1989.
The National Hospital Ambulatory Medical Care Survey (NHAMCS) is based on a sample of visits to the emergency departments and outpatient departments of non-federal, short-stay and general hospitals. Data are obtained on the demographic characteristics of patients, expected source(s) of payment, patients' complaints, physician’s diagnoses, diagnostic/screening services, procedures, medication therapy, disposition, types of health care professionals seen, causes of injury where applicable, and certain characteristics of the hospital, such as type of ownership. The NHAMCS has been conducted annually since 1992.
The National Home and Hospice Care Survey (NHHCS) is a continuing series of surveys of home health and hospice care agencies, regardless of whether they are Medicare certified or licensed. Data are collected about agencies that provide home and hospice care and about their current patients and discharges. Home health care is provided to individuals and families in their place of residence for the purpose of promoting, maintaining, or restoring health or for maximizing the level of independence while minimizing the effects of disability and illness, including terminal illness. Hospice care is defined as a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones. Hospice services are available in both home and inpatient settings. Data are collected on demographic characteristics, referral and length of service, diagnoses, number of visits, patient charges, health status, reason for discharge, and types of services provided. The NHHCS has been conducted in 1992-1994, 1996, and 1998.
The National Nursing Home Survey (NNHS) is a continuing series of surveys of nursing homes, their residents, and their staff. Recent surveys have included nursing homes that were freestanding or were nursing care units of hospitals, retirement centers, or similar institutions where the unit maintained financial and resident records separate from those of the larger institutions. Board and care homes and homes with fewer than three beds were excluded. The NNHS provides information 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/Medicaid certification, occupancy rate, days of the care provided, and expenses. For recipients, data are obtained on demographic characteristics, health status, and services received. The NNHS was conducted in 1973 to 1974, 1977, 1985, 1995, and 1997, and will be conducted in 1999.
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